Monthly Archives: October 2013

Insurers “Had a Seat at the Table” when Reformers Hammered Out the ACA, but Things Didn’t Work Out Quite As They Expected . . .

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What This Means for Health Insurance Stocks–and Your Premiums

When Congress passed the Affordable Care Act (ACA) in 2010, liberal critics feared that the Obama administration had “cut a deal” with for-profit insurers.  Single-payer advocates were particularly incensed when reformers invited the insurers’ lobbyists to the table to help hammer out the details of the legislation.  Some charged that, in return for the industry’s support, the administration agreed to a mandate that would force 30 million uninsured to buy private-sector insurance (or pay a penalty,) thus guaranteeing carriers millions of new customers, and billions in new revenues.

“It pays to be one of the few sellers of a product the government is going to force everyone to buy and provides subsidies to help them do it,” one Obamacare opponent sniped. 

Why Health Industry Insiders Were Offered Seats at the Table

At the time, I didn’t believe that the administration was selling out to the health care industry. Reform’s architects offered insurers, drug makers and device-makers seats at the negotiating table, in part because because they hoped to persuade them to help fund reform – and they succeeded.

Ultimately, the industry agreed to shell out over $100 billion in new fees and taxes to help fund the legislation. Those contributions are critical to financing subsidies for low-income and middle-income Americans.

The Obama administration also did not want to watch re-runs of the “Harry & Louise” television ads that helped torpedo “HillaryCare.” Here too, they prevailed.  In a new series of 2009 ads, the make-believe TV couple were all smiles: “A little more cooperation, a little less politics, and we can get the job done this time,” Louise declares.

Still, some feared that the administration was giving away the store. “No wonder the cost of reform keeps going up and up and up,” said  Bill Moyers.  “Could it be” he asked, “that Harry and Louise are happier because, this time, they’re in on the deal?” 

              But Didn’t the  Administration Capitulate On the “Public Option”?

Skeptics on the Left also believed that  reformers agreed to quash the “public option”—a government insurance plan that would compete with private sector carriers.
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Health Wonk Review – Rich and Varied Offerings

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Joe Paduda has hosted the newest edition of Health Wonk Review, a bi-weekly roundup of some of the best healthcare posts in the blogosphere. You will find it at Joe’s blog,  Managed Care Matters.:

Here are just a few highlights:

  • Over at HealthBusinessBlog David E Williams  responds to a relative’s question : Why are Obamacare’s opponents so vehement?The bottom line, says David, is that “some opponents have whipped themselves into a lather over their revulsion to all things Obama and are living in an echo chamber where these views seem rational. It would be better for everyone if they went back to the Birther madness.”

    I agree. This is not about healthcare, and it is not about money. The Congressional Budget Office has told us that the ACA will not add to the deficit..  As David points out many of the ideas in the Affordable Care Act were originally Republican ideas. It is not a radical plan for health care reform; it is a moderate plan. And Obama himself is a moderate. Why then do they hate him with such a passion? I’ll leave it to you to answer that question.

  • In a post titled “We’re all in this together” Louise Norris confides that under the Affordable Care Act, her family’s insurance premiums will rise sharply. (They had a high deductible plan with low premiums. The ACA outlaws such high deductibles because in too many cases, insurers sell them to low-income and lower-middle income families who then cannot afford to use them. So they put off getting healthcare until they are very, very sick.)Meanwhile, Louise and her husband earn too much to qualify for premiums. But they’re not angry. “We support [reform]” she explains, “because something like this isn’t supposed to be all about us. In the case of healthcare reform, our higher premiums will help ensure that our friends and neighbors and fellow citizens have access to affordable health insurance.”  Joe writes: “Thanks for the reminder, Louise!” I agree wholeheartedly. (btw Louise is a health insurance broker.)

 

 

Breast Cancer: Catching Up With Amy Berman, a Woman Who Chose Life Over Longevity

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HealthBeat readers may remember the two-part post that I wrote about Amy Berman back in October of 2011.

Part 1 began:  “When Amy Berman was diagnosed with Stage IV breast cancer a year ago, she made a courageous choice. Instead of fleeing death, she decided to pursue life.  Rejecting chemotherapy, radiation and surgery, she chose palliative care instead.” 

                                   Our War on Cancer

Berman knew that her stage IV cancer could not be cured. As a nurse, she also knew what women who undergo aggressive treatment endure—and that, despite that treatment, many will never escape the disease.

As Clifton Leaf points out in his new book The Truth in Small Doses, when people talk about the strides that we have has  made in our War On Cancer, they greatly exaggerate our success. When it comes to breast cancer, for example, 30 years after we launched the way, the number of women per 100,000 who die of breast cancer had actually grown from 28.4 per 100,000 in 1970 to 29.2 per 100,000 in 2000.

Over the next 10 years, the death rate fell to 26.2 per 100,000 women. But we know that this was mainly because we have gotten better at detecting breast cancer early, when the tumors are small and easily removed.  By contrast, most of the caustic drugs designed to defeat cancer have disappointed.

Of  “the myriad compounds that have set the research community abuzz, the ones that have already built up billions of sales,” Leaf observes, “there is little evidence” that “they have had more than a modest effect on long-term patient outcomes. Taken together, this multitude of drugs has been responsible for about a quarter of the reduction seen in the standardized death rate.”

Granted five-year-survival rates have improved. But this, too, is largely because we are diagnosing cancer earlier.  In the past, if the disease was detected when a woman was 65 and she died at 67, we would say she died of cancer. Today, if a tumor is detected when she is 62, and she lives a few months past 67, she has made it to the five-year mark and is counted as a “survivor.”  Thus Elizabeth Edwards’ name was added to the roll of victories–even though breast cancer killed her.

By measuring our progress in terms of five-year-survival rates we “transform nearly six hundred thousand annual deaths into a victory-in progress,” Leaf notes. This allows us to hide from what he calls “an unshakable reality: the rising toll from cancer is plain to see, but this method of counting is so firmly established and so commonly used by health care researchers and policymakers, that few remember anymore that it’s a statistical sleight of hand.”

Even If She Could Not Be Cured, Why Didn’t Berman Try to Buy More Time?

After she was diagnosed, Berman secured an appointment a pre-eminent researcher/clinician in the field of inflammatory breast cancer.

He was clear about what she should do: Chemo, radiation and a mastectomy, followed by more chemo. This he told her, is “what I recommend for all of my patients.”

In part 2 of my 2011 post, I quoted her memory of that conversation:

“I pressed him, ‘Why do the mastectomy?’ I asked, puzzled. ‘The cancer has already spread to my spine. You can’t remove it.’

“His brow furrowed: ‘Well, you don’t want to look at the cancer, do you?’

“He made it sound like cosmetic surgery,” she recalled. “Considering that a total mastectomy includes months of pain and rehabilitation, I thought that worrying about the view was secondary.”

She continued to press him.

“But what about the side effects of radiation?’ I asked. ‘I’ve heard they are terrible’.

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Take Your Time—They Are Not Going to Run Out of Policies!

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The stampede into the Exchanges only proves that the people who said that “Young Invincibles” don’t want insurance –or that older Americans won’t be able to afford the Exchange’s offerings –were wrong.

Think Progress offers snapshots of folks like Butch Matthews who have signed up for Obamacare in the past two days.

A life-long Republican, the 61-year-old Matthews was paying  over $12,000 a year for health insurance that carried a $10,000 deductible. The former small business owner had two stents placed in his heart in 2006, and the policy didn’t even cover his medication and doctors’ visits. But that was all he could find in the private sector’s individual market—until Tuesday, when he discovered that after applying his government subsidy, the silver plan sold in his Arkansas Exchange will cost him nothing. And the deductible is just $250.

“It’s a lot better plan,” said Matthews. When he goes to the doctor he will no longer have to shell out a $150 co-pay. Instead, he will owe just $8.

Until Tuesday, Matthews had been extremely skeptical about Obamacare. So what would Matthews tell other Americans who are just as skeptical today? 

“I would tell them to learn more about it before they start talking bad about it. Be more informed, get more information, take your time and study and not just go by just what you hear on one side or the other. Actually check the facts on it.. . I still am a very strong Republican, but this… I’m so happy that this came long . . .”

Why was Butch Matthews so surprised to discover how much Obamacare would help him? Because when it comes correcting the lies that conservatives have been spreading about the Affordable Care Act, the media has done a miserable job. From the beginning, rather than reporting on the content of the legislation—and the ideas and values behind reform, most pundits focused on the political debate, as if it were a sporting event. Who is  winning? Who is losing? This was far easier than delving into the details of the law.

Now, however, millions of middle-income Americans are beginning to find out for themselves what reform will mean for their families. As I have argued in the past: once they know what is actually is in the legislation, they will like it.

                            Obamacare Proves Too Popular

Never at a loss for words, the nay-sayers now are claiming that the computer glitches that we’ve seen during the first two days of enrollment serve as evidence that Obamacare is a disaster

No, the delays simply prove that modern technology is far from perfect– something I am reminded of each day. (I recently bought a new computer, complete with a new version of Windows.)  But over time, we find our way around computer glitches

Shouldn’t  the Exchanges have been prepared for the crowds? No, the polls had told Exchange planners that most people knew little about Obamacare and had no idea that they could enroll on Oct. 1. We were told that the majority were not even aware that they might receive government subsidies. (Now it appears that critics exaggerated what a bad job the government was doing when it came to publicizing the marketplaces. )

More importantly, the technical snafus say nothing about the benefits that people like Butch Matthews will receive.  In six months, if a great many Americans are complaining that the policies offered in the Exchanges are too expensive—or  just are not very good—then we might say that Obamacare is running into trouble. (Though it will probably take two years to make a judgment as to whether it is a success.)  What  matters is the quality of the product reform is delivering, not whether the process of enrolling people goes without a hitch.     

 Kentucky, the Exception that Proves It Can Be Done

Moreover, while the Federal Exchanges have been having more than their share of problems (perhaps because Washington wound up having to take responsibility for setting up the marketplaces in so many places), in  some states enrollment is proceeding smoothly.

In Kentucky, of all places, some 11,879 people already have enrolled for coverage–,and paid their first month’s premium, to boot.  (Hat-tip to Wonkblog’s Sarah Kliff.)

Governor Steve Beshear, a second-term Democrat who is also a technocrat, deserves the credit. He managed to pull this off despite furious opposition from state Republicans such as Kentucky Senator Mitch McConnell, the minority leader who is up for reelection next year  If the citizens of the Bluegrass state like Obamacare, could this wind up hurting McConnell’s chances? One can only hope.

Up until now, Alison Lundergan Grimes, the Democrat who will be challenging  McConnell, has been wisely reticent on the question of reform. When pressed by reporters, Grimes has indicated that she is troubled by some parts of the Affordable Care Act and would push to “fix” some of its mandates on businesses, but not repeal the entire law

In August she said “Let’s not throw out the baby with the bath water,” noting that the law prohibits insurance companies from cancelling coverage for people with pre-existing medical conditions and allows young adults to stay on their parents’ health insurance plans until they turn 26.

If Kentuckians embrace Obamacare,no doubt she will step forward to firmly endorse reform.

“I think it is probably smart politics,” U.S. Rep. John Yarmuth, D-Louisville told the Lexington Herald-Leader.  I think she has the opportunity to wait and see how it’s received. When she starts to say positive things about it, the climate will be better for her to do that.”

I agree. In Kentucky, the Affordable Care Act already has a strong supporter–Governor Beshear,  Grimes’ job is to drive Mitch McConnell out of Congress.

                              Why You Don’t Want to Enroll Now

In coming months, the Federal Exchanges will catch up with Kentucky, They have plenty of time. The open enrollment period lasts for six months –until the end of March, 2014.

Americans who plan to purchase their own insurance in the state marketplaces should focus on the fact that there is NO RUSH to enroll.

If you want new insurance by January 1, you don’t need to enroll until  December 15. Of course you probably don’t want to wait until the last minute. You need time to look at the plans, and ask questions.

But keep in mind that you have to pay your first premium 30 days after you enroll. If you sign up on October 15, that premium is due November 15—even though your insurance will not begin until January 1.)

My suggestion: if you don’t want to be part of the current madness, wait a few weeks.  Let the people running  the Exchanges get some of the kinks out of the system.