Why Are So Many Americans Confused About Obamacare? How a Video Produced by CBS’ Washington Bureau Misled Millions –Part 1

For nearly four years, poll after poll has shown that the majority of Americans remain flummoxed by Obamacare.  Many are confused; some are afraid. They don’t know what the Affordable Care Act (ACA) says, and they don’t know how it will affect their lives

From the beginning, many in the media have blamed the White House.

Early in 2011, when a CBS poll showed that only 56% of Americans said the bill’s impact had not been explained well—or even “somewhat well”– CBS senior producer Ward Sloane summed up the prevailing view: “To me, that is a Monumental Failure by the Obama Administration. . . . [my emphasis]  And it opens up a big hole for the Republicans which they have driven through with, you know, several tanks.

Because Democrats had botched explaining the legislation, Sloane argued, Republicans “can say whatever they want about the healthcare bill … whether it’s true or not, and  . . . it will resonate . . .  People are afraid. People are afraid of things that they don’t understand and they don’t know. . . The Republicans are playing to this fear and they’re doing a masterful job.”

Sloane slid over the role that reporters might play in helping the public understand an enormous—and enormously important– piece of legislation.  If Republicans were spreading disinformation, shouldn’t news organizations like CBS try to separate fact from fiction?

Network and cable news shows are in our living rooms every evening. President Barack Obama and Health and Human Services Secretary Kathleen Sebelius are not. In speeches and in press conferences Obama and Sebelius can address a handful of questions, but they cannot explain the hundreds of interlocking details that will benefit millions of Americans. The public needs an independent, informed press that will dig into the major provisions of Obamacare and explain them, not once, but again and again.

There was just one problem: As Sloane suggested, the Republicans were doing “a masterful job” of misleading the public. What he didn’t take into account is that journalists are part of “the public.”

                      The Networks Spread Fear and Confusion

Fast forward two years to the fall of 2013.

Little has changed; most Americans still don’t understand the Affordable Care Act, and many are convinced that they have been betrayed by the president they elected.

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The Media’s One-Sided Coverage of Obamacare

Why does the media continue to insist on promoting the conservative meme that “Obamacare is a disaster”? Today Bloomberg ran a story headlined “Health-Care Law Support Hits New Low, Poll Shows

The piece begins: “Support for President Barack Obama’s signature health-care law has reached its nadir, according to a CNN/ORC International poll released today. The survey shows 62 percent of Americans opposing the law, the highest total since CNN began polling on the issue in March 2010. Just 35 percent favored it. The health-care law has been plagued by a faulty website, hindering efforts to log in and buy insurance, and by the revelation that millions of Americans could not keep their health insurance as Obama originally promised.”

It would be more accurate to say: “Support has been plagued by a faulty website—and a media determined to bury the good news while exaggerating the bad news.”

The very next sentence of the Bloomberg piece illustrates what I’m talking about: “Of those opposing the law, 15 percent said the legislation didn’t go far enough.” (If you actually look at the poll, you will find that pollsters were more explicit: 15% said the law was “not liberal enough.)  Bloomberg continues: ““Another 43 percent said the measure was too liberal based on Republican proposals such as the health-care measure championed by then-Gov. Mitt Romney in Massachusetts.”

Here is a more accurate, cleaerer  lead:  “50 percent of those polled either like the law (35% ) or think that it isn’t liberal enough (15%).”

It also is worth noting that the percent of people who think the ACA isn’t liberal enough is rising: in May 11% said the law wasn’t sufficiently progressive; last month 14% voiced that complaint. In other words, as more people learn about the details of Obamacare, more think that it’s too conservative.)

That’s quite different from the lead the reporter chose: “The survey shows 62 percent of Americans oppose the law.” Most readers would assume that means 62% are opposed to reform, when in fact 50% either support reform or would have liked a more progressive bill.

A balanced story would emphasize that the country remains deeply divided about the overhaul of our health care system. That should have been the headline: “Half of all Americans Support Legislation Sixteen percent thought they would be “better off” while 40% said they expected to be about the same.”Designed to Make U.S. Healthcare Better, More Equitable, and More Affordable.”

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Under Obamacare, Will Out of Pocket Spending Be Higher?

Not long ago, the Fear-Mongers were warning that under the Affordable Care Act, insurance premiums would spiral, causing “sticker shock.” Then the rates were published, and it turned out that, thanks to transparent markets in the exchanges, insurers had to compete on price, and premiums are lower than expected.  

But don’t worry, reform’s opponents haven’t run out of talking points. (I expect that long after most of the country has begun to enjoy the benefits of Obamacare, out-of-touch conservatives still will be muttering to themselves – rather like Japanese officers who held out in the jungles of the Philippines after WW II ended, unable to accept the fact that they had lost the war.)

In search of a new meme, they have latched onto the idea that, in the exchanges, customers will face “Staggering Out-of-Pocket Costs.” Sure, premiums may look low they say,, but wait until you try to use the policy and find yourself laying out $6,000. . Not long ago, Fox News summed up the argument: If the policy you bought in the individual market is cancelled because it doesn’t conform to the ACA’s rules, and you are forced to purchase coverage in an exchange, co-pays and deductibles will soon make you realize that the ACA is really “The Unaffordable Care Act.” 

Fox picked up the theme from a Bloomberg News story that went viral:“Obamacare Deductibles 26% Higher Make Cheap Rates a Risk,”  the Bloomberg headline screamed. As evidence, Bloomberg pointed to a survey of seven states, done by HealthPocket Inc., that compares the average deductible a consumer will face if he purchases a Bronze Plan in an Obamacare exchange to the average deductible in the private-sector market where 5 percent of Americans have been buying their own coverage. (These are the policies that are disappearing because they don’t meet the ACA’s standards.)

It turns out that the survey greatly exaggerates out-of-pocket spending in the Exchanges by focusing only on Bronze plan.  Meanwhile, the media ignores the most important number: what is the Maximum that an insurer can ask you to pay out of pocket?

The problem with many of the policies that are now being cancelled is not just that they were studded with holes  (some didn’t cover hospitalization; some didn’t cover chemo), but that in many states, a family could be asked to pay $30,000—or more—in co-pays and deductibles. . In a few states, there was no cap on the a patient’s liability.I This is how families lose their homes.

I’ve written about this here on healthinsurance.org. Read the entire post and, if you like, come back here to comment.

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Did You Know That 6 to 7 Million Americans Will Qualify for “Free” Health Insurance In the Exchanges? “Affordability May Not Be a Roadblock” to “Signing Up 7 Million” in 2014 –Credit Suisse

If you know someone who is uninsured, or buys her own insurance in the individual market– and lives in Texas, North Carolina, Missouri, Oklahoma, Louisiana, Mississippi, or Alabamachances are greater than 1 in 3 that under Obamacare she will qualify for health insurance that will cost her nothing. That’s right—her government tax credit will cover the entire premium.

It gets better. After shopping the state Exchanges during the first two weeks of October, McKinsey & Co, a leading global management consulting firm, discovered that people who are currently uninsured (or who buy their own insurance) in Florida, Wisconsin, Georgia, South Carolina, Tennessee, Virginia, Maine, Indiana, Kansas, Nebraska, Utah, Idaho, Montana or Alaska– stand a 1 in 4 chance of qualifying for a $0 policy.

How can that be? McKinsey explains that their income will makes them eligible for a government subsidy that will be larger than the policy’s premium.  Americans earning somewhere between $11,490 and 400% of the FPL ($48, 950 for an individual, $62,040 for a couple, $94,200 for a family) will receive subsidies. The lower your income, the larger it will be, and the more likely it is that your premium will be Zero .

This table from Credit Suisse reveals that in many states, uninsured Americans earning less than 175%  of the Federal Poverty Level (roughly $20,100 for an individual; $21,750 for a couple;  $34,170 for a family of three;  $41, 200 for a family of four) will be able to find zero-premium plans. Even if you earn somewhat more, it’s well worth the time it will take to check with your state marketplace.  You may discover that while coverage isn’t free, your subsidy will bring the cost down to as little as $20 a month.

Credit Suisse analyst Ralph Giacobbe agrees that roughly “6.5 million Americans … will be eligible for a $0 premium plan.” As a result, he believes that “affordability may not be a roadblock” to achieving the Congressional Budget Office projection that 7 million people will buy insurance in the exchanges in 2014

“Simply put, we don’t see any logical reason why anyone in this population wouldn’t take free healthcare coverage vs. remaining uninsured.”

The only question is this: How many people will hear about the free plans? Can we count on the media to inform the public? (Hat tip to the New York Times for publishing a front-page story about the McKinsey research.) Now, I would love to see the story on FOX – and in Forbes.

You can help spread the word. Do you know someone who is single, earns somewhere between $11, 490 and roughly $20,100 (175% of the FPL) and does not  have employer-sponsored insurance?  A graduate student?  Your cousin’s son?

Do you know   a family of three with income under $34,170 (175% of the FPL)  Perhaps the stay-at-home Mom down the street who just had a baby?

Good News for 20-Somethings and 30-Somethings

McKinsey reports that about half of those who will be able to purchase zero-premium insurance will be under 39 years old.

I originally published this story on  the Health Insurance Resource Center Blog. Click  there to  read the rest of the post—and find out more about the cap on the  co-pays and deductibles that someone with a $0 premium plan would pay.  

You can comment on the Health Insurance Resource Center Blog, or  you come back here to respond.

 

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The Truth About Obamacare’s Exchanges

          Paul Krugman: “There are two remarkable things about this kind of doomsaying. One is that the doomsayers haven’t rethought their premises despite being wrong again and again — perhaps because the news media continue to treat them with immense respect.”

If you Google “Obamacare,” “Exchanges,” and “Disaster,” more than 20 million articles will pop up.

One month into a six-month enrollment process, the Media Pundits have spoken.

In truth, there are two tales to be told: one that is getting widespread coverage, and one that is not.

The stories that you are Not hearing come from folks like Michael Cadigan, the president of a New Mexico law firm who enrolled his firm’s four employees the day his state’s Exchange opened. “I thought it was going to be an administrative nightmare,” he confesses. Instead, he quickly found a policy “that will cost $1,000 less a month than I’m currently paying.” 

Or, Randall Bennett: His family will be paying more for the coverage he signed up for in Utah’s Exchange, but it will be significantly better than what they had before. This year, Bennett reports he has been paying a $420 monthly premium with a $2,000 annual deductible. Next year, he’ll be paying a $720 premium, but the deductible will be only $500 and his family will be getting maternity and dental coverage — something they couldn’t  get in the individual market before Obamacare came along.

As for the application process, Bennett says: “Before, trying to get insurance was so difficult that surprisingly even with all of the bugs, I still found [the Exchange website] simpler (In the past, people attempting to buy their own coverage in the individual market had to provide carriers with detail medical information, in order to prove that they were not suffering from a pre-existing condition. Under Obamacare, that isn’t necessary. Insurers can no longer use your medical records as an excuse to jack up your premiums.

“So for us this is a huge win,” Bennett concludes, “because we’re paying what we think is fair. And yes it’s more than before, but we actually have coverage that we like now.”

As of October 24, Cadigan and Bennett were just two of some 700,000 Americans who have filed applications in the Exchanges. The truth is that Obamacare’s websites are working– though not in all states.

Make no mistake: enrolling millions of American in Obamacare represents an enormous challenge. But we know that it can be done — because it is being done, and done well– in many states.

Unfortunately this is not a story that sells newspapers, especially when a program is as controversial as Obamacare.

State vs. Federal Exchanges

The marketplaces that are working best are in states that chose to set up their own Exchanges.

Originally, conservatives in Congress argued that states should be able to construct—and control– their own online sign-up sites. The Affordable Care Act offered them that opportunity.

But after thinking it over, 26 states (24 of them led by Republicans) refused. In these 26 states, it was left to the Feds to run “Healthcare.gov.”

Health IT pioneer Fred Trotter says he is “not at all surprised” by what happened next: Computers and human navigators have been overwhelmed by the sheer size of a sprawling project. Technical glitches have created virtual gridlock.

“When you get a tremendous amount of traffic going to any site on the internet a single computer can’t handle it,” Trotert told Ezra Klein in a recent interview. “You have to have more than one computer sharing a task. At modern sites like Amazon and Ebay . . . the main innovation they’ve pioneered is using lots of computers at the same time to answer one query.”

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

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

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.

 

 

 

 

 

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Atul Gawande on Obamacare’s Opponents—How Much Damage Can They Do? Will the Exchanges Open Tomorrow?

Tomorrow, millions of Americans will find out how much healthcare will cost in their state marketplaces as the Exchanges begin enrolling new customers.  On the eve of that event, Dr. Atul Gawande writes about the forces lined up to oppose healthcare reform. The essay, which appears in the newest issue of the New Yorker, quite rightly compares those who are fighting the Affordable Care Act to those who, so many years ago, tried to block the Civil Rights Act.  In each case, conservatives refused to recognize a basic human right.

Gawande is not worried that Republicans will succeed in stopping the Affordable Care Act. Already, the reform is rolling forward on the ground, affecting peoples’ lives. Even if the extreme right wing of the Republican party manages to shut down the government tomorrow, the legislation is largely funded through mandatory appropriations that cannot be curtailed through Congressional  Nevertheless those who are blinded by rage can do great harm.

                                  Who Will Be Hurt? –Paul Sullivan’s Story  

Gawande opens his essay by reminding us of who will suffer—Americans like Paul Sullivan. “Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. ‘I should have known better,’ he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.”

Under the ACA, this would never happen. His out-of-pocket spending would be capped at $6,350–as long as he signed up for insurance. (If he earned less than $45,650, the cap would be considerably lower.) This is how the legislation helps even those who are too wealthy to qualify for a subsidy. They are protected against financial ruin.
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Reverse “Sticker Shock” Part 2 –Subsidies Mean Enormous Saving for Older Americans

In the past I have written about how government tax credits will help young adults (18-34) who must buy their own coverage because they don’t have access to “affordable, comprehensive” employer-sponsored coverage.

But older Americans forced to purchase their own insurance will save even more. Precisely because a 50-year-old’s premiums may be three times higher than a 20-year-old’s, his subsidies will be larger.

Subsidies are designed to fill the gap between the percentage of your income that you are expected to contribute toward the cost of a premium (with the government assuming that if you earn more, you can spend more on health insurance) and the actual rates that insurers in your market charge for a benchmark Silver plan..

Families USA estimates that while the majority of 18-34 year olds shopping in the Exchanges will qualify for help from the government, fully  30% of the those who receive tax credits  will be 35 to 54, and 12.5% will be 55 or older.

Note that younger Americans will not be subsidizing these tax credits  for their elders. Under the Affordable Care Act subsidies are funded by device-makers, drug-makers, hospitals—plus taxpayers earning over $200,000—and couples earning over $250,000) Very few twenty-somethings are that fortunate. A New KFF Report Offers Eye-Opening Final Numbers on Premiums and Subsidies for 40 –Year Olds and 60-Year-Olds in 17 States

In  August the Kaiser Family Foundation  (KFF) published an “Early Look at Premiums” in California, Colorado, Connecticut, DC, Indianapolis, Maryland, Maine, Montana, Nebraska, New Mexico, New York, Ohio, Oregon, Rhode Island, South Dakota, Virginia, Vermont and the state of Washington.

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