Meanwhile, Back At The Issues . . . .

While our easily distracted nation has been preoccupied with political horse races, insults on debate stages, and brawling at campaign rallies, some of the real issues facing the country plod on.  It’s just that no one is paying any attention to them.

Consider the Affordable Care Act, known colloquially as Obamacare.  It’s been up and operational for several years now.  So, how is it doing?

A man looks over the Affordable Care Act signup page on the HealthCare.gov website in New York in this photo illustrationIt turns out that Obamacare is facing a number of challenges and is in what a recent Washington Post editorial describes as “an awkward place.”  The problem is that although people are still enrolling, they’re not doing so at the rates that were forecast when the new law’s financial viability was evaluated.  If there are fewer enrollments than were estimated, or the mix of new enrollees doesn’t include as many young and healthy people as was originally projected, then the Affordable Care Act could produce substantial premium price increases rather than what the statute’s name promises.

Another aspect of this complicated law is whether it is offering good insurance choices for people.  The Investor’s Business Daily recently published an article that focused on how the Affordable Care Act is working in Mississippi, which is one of the underinsured places that were a focus of the statute in the first place.  The IBD article found that enrollments of uninsured people in Mississippi were disappointing — just 38% of those eligible for subsidies — that the premium costs for the cheapest “bronze” plans are spiking, and that the increased expense may cause some people to opt for paying the uninsured, individual mandate tax rather than buying insurance as they are supposed to do.  Still other articles, from the New York Times and elsewhere, have reported that many people believe that while subsidies might be holding down premium costs in some states, high deductible amounts, which require the insured person to pay cash out of pocket before the insurance kicks in, are making some plans bought on the exchanges unaffordable and unusable.

The Affordable Care Act was a huge new governmental program, hotly debated and the subject of strong opposition from Republicans.  How is it working, really?  We deserve to know, and un any rational world, candidates of both parties would be debating that very important issue.  In this crazy year, however, the news media and the public have been distracted by the Trump phenomenon and all of its embarrassing nuttiness, so even in Republican debates the Affordable Care Act gets short shrift.  And does anyone really believe that, if Donald Trump somehow becomes the Republican nominee, he’ll work to understand the workings of this complex law, and be able to say anything other than that it is a “disaster” and he’ll “repeal and replace it with something much better”?

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Should We Go To Organ Opt-Out?

There was an interesting piece on the CNN website today.  Written by a young woman whose health condition required her to receive a heart transplant, it argues that the United States should change its approach to organ donations, and go from a voluntary donation system to an opt-out system.

organ-donation-transplantationThat is, the United States would presume that all of its citizens have agreed to become organ donors unless and until they have “opted out.”  Some European countries, most recently Wales, have gone to an “opt-out” system, and the argument is that the system will allow the U.S. to avoid the many deaths — according to the writer of the CNN piece, 22 each day —  of Americans who are waiting for a life-saving organ transplant that simply doesn’t arrive in time.

I’m one of the 40 percent of Americans who have voluntarily become organ donors.  I figure that when I’m dead I won’t need my eyes, or organs, or anything else, and if somebody can get some additional use out of them, that would be great.  (Of course, I’m hoping that I’ll have gotten a lifetime’s worth of production out of them before that inescapable eventuality happens.)

Still, there’s something about an opt-out system that troubles me, ethically.  The CNN writer argues that such a program will heighten awareness of organ needs, and better match public opinion — where polls indicate that 95 percent of Americans favor organ donation — with the number of actual organ donors.  And, she contends that an opt-out approach is still voluntary, only the choice is to opt out, rather than opt in.

I disagree with that.  Unlike some, I don’t think an opt-out approach would turn doctors into ghouls who would fail to provide appropriate care in order to expedite harvesting valuable organs.  Instead, I think the issue boils down to one of very basic, essential choices.  If the United States went to an opt-out system, the government would presume to be deciding what to do with your organs, and the burden would be on you to take action to reverse the government’s decision.  I think deciding whether to contribute organs upon your death is about the most personal choice a human being can make.  The fact that the government thinks the greater good might support one choice rather than another doesn’t make the choice any less personal, or one that should be taken away from the individual, even if it is only until they state their intention to the contrary.

I hope that everyone decides to contribute their organs upon their death, so people like the young CNN contributor can live a long and healthy life — but I also think it is a decision that everyone has to make for himself.

Obamacare’s First Birthday

It’s hard to believe, but it was only a year ago on October 1 that Obamacare, through that ill-fated healthcare.gov website, was born.  Parents will tell you that a newborn’s first year passes by in a blur — and it has, hasn’t it?  It sure seems like more than a year ago that we were hearing about wait times and website crashes, but ISIS beheadings and Ebola outbreaks and other assorted disasters have a way of telescoping the passage of time.

So, how is Obamacare doing on its first birthday?  Not surprisingly, given the superheated controversy surrounding the Affordable Care Act, it kind of depends who you ask.

The New York Post has done a review and gives Obamacare an overall grade of “F,” because it has cost a lot of money, hasn’t really made a huge dent in the mass of uninsured people, has messed with a lot of people’s plans, and is affecting full-time job creation by businesses because of the costs it imposes.  The Department of Health and Human Services, on the other hand, has released a report that says Obamacare has produced a significant reduction in uncompensated costs that have to be borne by hospitals, presumably because there are fewer uninsured people who can’t pay their hospital bills.  Yahoo Finance, in a survey article, found that some people like it and some people hate it, depending on whether Obamacare has raised or reduced their costs, helped them get insurance that they couldn’t have received otherwise, or eliminated plans they liked.

And — some things never change — the healthcare.gov website is back in the news again, because it has a “critical vulnerability” in the security area.  Basically, it appears that the government entity that manages the website hasn’t been using the basic available tools to monitor security issues and test for website vulnerabilities.  It’s not clear whether any people who have used the website — and entered in lots of highly personal information in their quest for insurance — have experienced any identity theft or similar problems.

Regardless of your political affiliation or your view of Obamacare, there is one finding that pretty much everyone should be happy to celebrate on Obamacare’s birthday.   A Washington Post review of congressional floor speeches found that, this month, members of Congress mentioned “Obamacare” only 27 times.  That 1/100th of the number of mentions Obamacare received in October 2013.  Isn’t it nice to not hear politicians, Republican and Democrat alike, yammering about Obamacare, Obamacare, Obamacare?

Politically, does that mean Obamacare is no longer the hot topic it once was, or does it just mean that Obamacare has been knocked off the front pages by other problems and issues?  Beats me, but my gut instinct is that the Republicans are wise to not beat the Obamacare drum incessantly.  People who hate Obamacare or feel they were screwed by it don’t need to be reminded over and over.  Focusing on ISIS, terrorism, the border, and other non-Obamacare topics make the Republicans seem like less of a one-trick pony.

The Obamacare Deadline Arrives

Today is March 31. It’s the “Obamacare” deadline that we’ve been hearing about for months, the end of the open enrollment period on the health care exchanges — although the federal government has extended the deadline for a week, to allow people who claim to be in the midst of applying to complete the process.

How is the process going? We know for sure that a lot of money and effort has been spent in encouraging people to apply by the deadline. The federal government has spent millions on TV ads and social media banners, alerting people to the deadline and encouraging people to “get covered.” President Obama himself has led the charge. Over the past few weeks, you couldn’t go to a website or social media outlet without seeing an ad. It’s been, by far, the largest, most visible, and probably most expensive government-sponsored ad campaign in my lifetime. It’s blown the “click it or ticket” and anti-drunk driving campaigns out of the water.

Has the ad campaign worked? According to information provided by the government, enrollments surged as the deadline neared. By mid-March, the government reported that 5 million had enrolled, then 6 million a few days ago. Some people hold out hope that enrollments might hit 7 million. The 7 million figure has some significance, because the Congressional Budget Office initially forecast that 7 million enrollments were needed during the open enrollment period, although the CBO later revised that forecast to 6 million.

It’s not entirely clear what these numbers represent. There are supposed to be 48 million residents in the United States who do not have health insurance; 7 million is only a small fraction of the uninsured whole. What do we do about the remaining millions of uninsured people? Moreover, it’s not clear how many of the people who have enrolled through the exchanges were formerly uninsured, either. Many of the users of the health exchange websites apparently were people who were insured but whose policies were terminated because they lacked mandatory provisions required by the Affordable Care Act. There are also valid questions about how many of the enrollees have actually paid premiums and therefore have coverage.

There will be a lot of information coming our way over the next few days and weeks about Obamacare. The Affordable Care Act is such a hot-button issue — and the impending elections in November will keep it so — that supporters and opponents of the law are sure to massage and select the data to favor their positions. The average voter would do well to apply skepticism to the messaging from both sides of the Obamacare debate.

If you’re someone who bought a new policy through healthcare.gov, the ultimate question about your fellow enrollees is: who are these people, and how sick are they? Insurance fundamentally involves a pooling of risk, and the cost of health insurance is directly tied to who else is in your pool. If you’re in a group with lots of young, healthy people who don’t need much health care, your premiums will be lower than if you’re in a group with a preponderance of sick people who regularly need expensive medical attention. We won’t know the true actuarial makeup of the new plans until the people who are covered begin to make claims, the claims get processed and paid, and the insurance companies look at the results and decide whether the pricing of the plans needs to be adjusted — and if so by how much. If health care costs increase dramatically, few people are going to consider Obamacare a success no matter how many people have enrolled.

It will be nice to see some new ads once the March 31 deadline passes, but everyone needs to take a deep breath. This initial deadline is just one step in a very long process, and we won’t know the outcome until we are much farther down the road.

“Obamacare” And The Coming Elections

In 2014, every seat in the United States House of Representatives and 36 seats in the Senate — 21 held by Democrats and 15 by Republicans — will be up for election. Non-presidential election years are always unpredictable. In 2010, Democrats lost six seats in the Senate and 63 seats, and their majority, in the House of Representatives. Could 2014 see similarly significant swings in the makeup of Congress?

The wild card seems to be the Affordable Care Act, which everyone now seems to call “Obamacare.” In the past year, Obamacare has moved from concept to reality. The rollout of the law and its signature website have been beset by problems that have been well documented. The website hasn’t worked. Many of the deadlines have been delayed by executive orders that have angered conservatives who feel President Obama and administrators are bypassing the constitutional legislative process. Some individuals have been affected by the cancellation of their insurance policies or significantly increased premiums and other out-of-pocket costs. There is tremendous uncertainty about how, and when, and whether, other parts of the law may work.

As a result, Obamacare is not very popular with the public. According to the Real Clear Politics average of polling data, more than 50 percent of respondents oppose the law. Obviously, that’s not good news for Democrats who voted for the law. How will they respond?

According to a recent article in the National Journal, the plan for vulnerable Democrats is to distance themselves from President Obama, acknowledge difficulties with the law, but present themselves as working to fix its problems while Republicans just cross their arms and insist on a full-blown repeal. (Modern politics being what it is, I’m confident that the Democratic incumbents will be attacking their Republican challengers on a host of other issues, too, of course.) The National Journal article expresses some skepticism about whether the Democratic strategy is viable, and there is a special election for a House seat in Florida in March that may provide some clues about which way the electoral winds are blowing.

I think it’s still too early to draw hard and fast conclusions about “Obamacare” and its potential impact on the coming elections, because there are still pieces that have yet to fall into place. The deadline for individual enrollment is March 31, so we don’t know how many of the uninsured at whom the law was aimed will eventually sign up. We also don’t know how many people who have coverage under new health insurance plans purchased on the exchanges will fare as they seek health care at hospitals and with doctors, or whether a significant number of businesses might change their health care plans, or employee contribution requirements, in response to developments with the law.

I do agree with one point made by the National Journal article, however: messaging can only carry politicians so far. I think there is a broad understanding on the part of Americans of all political stripes that the rollout of the law and its website has been less than ideal — but by November 2014 the initial rollout problems will be many months old and the attention of the American electorate will likely be on more recent matters. Americans tend to be practical. If there haven’t been substantial new problems, the website crashes and error messages will seem like old news, and arguments that the President is governing by improper executive orders aren’t likely to gain much traction.

The broad awareness of “Obamacare” problems, however, has created a climate where many people are skeptical of the law and therefore receptive to more news about its problems. If the ultimate enrollment figures are well below what was forecast, if people start reporting that under their new plans they can’t get the health care they got before, and if the broad number of people who are covered by group plans through their employers start to see large increases in their premiums, deductibles, and co-payment obligations, no slick ad campaign is going to cure the sense that the law was a disastrous mistake. Carefully messaged TV commercials just won’t hold up if Americans are hearing about real Obamacare-related problems and costs from worried family members, neighbors, and friends.

Pimping The CBO

The Congressional Budget Office is supposed to be an independent analyst — one of the few nonpartisan entities still operating in our national politics. So, when the CBO comes out with a report, it possesses a certain inherent credibility . . . and the partisans who read the report as favoring their positions will tout the CBO’s nonpartisan status and try to use the report as sword and shield to further their partisan objectives.

Recently the CBO came out with a report estimating the impact of the Affordable Care Act on the job market, and both sides of the debate predictably tried to use the report to support their positions. The CBO report estimated that, by 2017, American participation in the workforce will drop by the equivalent of 2 million full-time jobs and that there will be a slower rate of growth in compensation and employment over the next decade.

Some Republicans leaped on the report to buttress their arguments that “Obamacare” is costing jobs. Democrats responded, however, that the CBO doesn’t really forecast an impact on the supply of jobs, but rather on the demand for work hours — a matter of individual choice. The CBO report predicts that the health law would cause some workers to voluntarily forgo working more hours in order to protect the subsidies that they will receive from the federal government to pay for health insurance and related costs. Of course, conservatives bemoan the CBO’s conclusion that a federal law will encourage able-bodied people to sit at home and receive subsidies rather than go out, work, and earn money on their own.

It’s hard for me to get worked up about CBO reports about the impact of the Affordable Care Act, because I just don’t believe they have any credibility. The CBO earlier forecast that the Affordable Care Act would produce a net loss of the equivalent of 800,000 full-time jobs by 2021, now it says a loss of the equivalent of 2.5 million full-time jobs by 2024. What’s changed? Who knows — but why should the CBO’s current estimate be any more valid than their earlier estimate?

Recently a member of Congress asked the CBO whether it ever goes back and checks on the eventual accuracy of its estimates. The CBO website contains a response where the CBO explained why that was impossible in many cases, looks at a few instances where a comparison could be made, and finds that the CBO estimates were reasonably accurate in some instances and not in others. Trying to predict the impact of a law like the Affordable Care Act on the job market, however, is a far more daunting assignment than, for example, trying to estimate the impact of the 2009 “stimulus” legislation on federal spending and revenues. There are simply too many moving parts — individual decisions by millions of large companies and small businesses, individual decisions by millions of workers, the impact of outsourcing and overseas job markets, and decisions by federal regulators, among countless others — to make the “Obamacare” estimates meaningful.

So, let the CBO make its future forecasts and let the partisans on each side pimp the CBO conclusions that they think support their positions. I’d rather focus on the tangible reality of how the Affordable Care Act is performing right now.

The Perils Of Overpromising

In a memorable episode of the classic TV sitcom 3rd Rock from the Sun, Sally the alien and Officer Don are discussing becoming intimate for the first time.  The straightforward Sally asks:  “Well, Don, are you ready to rock my world?’  And the nervous Officer Don gulps and responds:  “Well, perhaps jostle it a little bit.”

Officer Don clearly understood the perils of overpromising.  It’s a lesson that President Obama and his administration are learning the hard way these days.

Hundreds of thousands of Americans have been receiving cancellation notices from health insurers that are discontinuing existing coverage because it doesn’t satisfy all of the requirements of the Affordable Care Act, or “Obamacare.”   It’s not clear how many people ultimately will receive cancellation notices, but experts predict that a significant percentage of those who currently buy individual coverage — between 7 and 12 million people — will be affected.  Under the Act’s “individual mandate,” all of those people will need to find new insurance that complies with the requirements of the Act, either through the dysfunctional Healthcare.gov website or some other process.  News sites are filled with stories about people who have found that they will need to pay much more each month for coverage, often with higher deductibles.

These people are upset because they remember President Obama’s repeated promise that, under the Affordable Care Act, if you like your insurance, you can keep it.  But the statute and its regulations were written to prevent that pledge from being honored, by requiring that all insurance plans include certain forms of coverage, such as maternity care, mental health benefits, and prescription drug benefits, that were not offered by many stripped down, inexpensive plans.  The inevitable result was that those plans would end and the new options, all of which include the mandatory coverage, would be more expensive for many people.  Of course, when you hit people who are trying to live within their means with monthly insurance costs that are significantly higher than what they had budgeted, you’re bound to make those people angry and bitter.

It’s a predicament that the humble Officer Don would have avoided.  Of course, few politicians seem to truly appreciate the perils of overpromising.