What's next for Obamacare?

7M enrolled doesn't guarantee health law's success.
Associated Press
Apr 5, 2014

Seven million people signed up, so there is an appetite for President Barack Obama's health care law, but that doesn't guarantee success for the country's newest social program

Big challenges are lurking for the next enrollment season, which starts Nov. 15. Chief among them are keeping premiums and other consumer costs in check, and overhauling an enrollment process that was advertised as customer-friendly but turned out to be an ordeal.

"They have demonstrated the law can work, but we are a ways off from being able to judge its success," said Larry Levitt, an expert on health insurance markets at the nonpartisan Kaiser Family Foundation.

Republican opponents of the law keep pushing for a repeal, but as millions of people obtain insurance, how long can the party's strategy remain a politically viable option?

"What the Republicans need to really pay attention to is what they would do different from the Affordable Care Act," said economist Gail Wilensky, who ran Medicare under President George H.W. Bush.

"Just talking about repeal is not going to make it with 7 million people getting insurance on the exchange. And it has to be something reasonably credible ... it can't just be repeal. We are beyond that."

The source of the pent-up demand that propelled health care sign-ups beyond expectations could stem from the nation's new economic reality: a shrinking middle class and many working people treading water in low-paying jobs.

Health insurance has been one of the pillars of middle-class security for decades. With fewer jobs these days that provide health benefits, there was an opening for a government program to subsidize private insurance.

Enter Obama.

When Medicare and Medicaid were created in the 1960s, policymakers took it for granted that people working steady jobs would have access to health care, said Len Nichols, director of the health policy center at George Mason University in Virginia.

That was "back in the day," Nichols said. "Our assumptions have been all along that you could buy what you needed. But you cannot. And that is why we are where we are."

It could take the rest of the year to sort out how many uninsured people have actually gotten coverage, the ultimate test of Obama's law.

Early statistics provided by the administration have not been useful, mingling uninsured people with those who previously had coverage.

But an ongoing Gallup survey has shown a steady drop in the share of Americans without insurance since Jan. 1, when the law's main coverage expansion took effect. Those numbers should improve because many people still can take advantage of extensions granted by the administration, and because those eligible for the law's Medicaid expansion can apply at any time.

Still, vindication for Obama's law isn't guaranteed. Among the top challenges:

AFFORDABILITY

Health insurance premiums tend to go up every year, so the question now is how much higher in 2015.

"How fast they go up will no doubt vary across the country," Levitt said. "Public judgment of the law will be influenced by how rapidly premiums rise."

There's a back-and-forth going on, he said. An improving economy and the law's taxes on insurers will tend to push up premiums. Mechanisms in the law to assist insurers with a disproportionately large share of high-cost patients will push down premiums.

The big unknown is what economic bets insurers made when they jumped into the markets created by the law. If they were conservative and figured a big share of costly cases among the newly insured, that would take some pressure off premiums for next year.

Another important affordability issue has to with deductibles and copayments that consumers have to pay when they use their insurance benefits. Many of the new plans have high out-of-pocket costs, a trade-off for keeping premiums low.

The advocacy group Families USA, which has supported the law from its inception, says the government should nudge insurers to cover more routine medical care outside of the annual plan deductible, the amount consumers pay before insurance kicks in. Right now it's mainly preventive services that are covered outside of the deductible.

___

OVERHAULING THE SIGN-UP PROCESS

One of the law's main goals was to take the mystery out of purchasing insurance, in the same way buying a car is less intimidating these days because prices, quality ratings and loan rates are easily available on the Internet.

But even when the websites are working, the insurance exchanges are anything but easy to navigate.

Finding out what hospitals and doctors are in particular plans requires additional work. Also, experts say it's really difficult to get to a true bottom-line estimate that includes premiums and expected cost-sharing.

"The promise has not been realized," said Robert Krughoff, president of Consumers' Checkbook, a rating service that evaluates health plans for members of Congress and federal employees. "The law says the exchanges will assist consumers in making easy plan choices, and that has not been realized. But it could be."

One common recommendation is to provide consumers with much more in-person assistance to enroll and pick a plan. A change that might help meet that goal is to align sign-up season with tax filing because that could enlist the help of tax preparers.

As it stands now, the administration has scheduled open enrollment season to end on Feb. 15, 2015, right around when most people are just starting to think about filing their taxes.

Krughoff says better online tools are needed to estimate costs and find hospitals and doctors.

"I do think there are many cases where consumers will have joined plans that will cost them a lot more than they could have," he said.

 

Comments

JACKEL

Does anyone really believe this ? Everything out his mouth for the last 6 years have been a lie. !

The Big Dog's back

Actually everything out of right wingnuts mouths have been a lie.

rbenn

Last time I checked harry reid, obama,sebilius,durban,biden were not republicans, you really need to find something else to say puppy your like a popcorn fart just hot air with no substance

abigbear

dem stands for Dementia – Signs, Symptoms, Causes, Tests, Treatment ...
what-is-dementia.symptoms, signs,treatment and care and how it relates to Alzheimer's and memory loss.

swiss cheese kat

0-bamcare has been change 37 times since it became law.

grumpy

You do know that 7.1 million includes those that were put on Medicare,around 40%, those that haven't paid their first month payment which is around 20% - 25% depending on the state. They gave the number that signed up, not the number who got health insurance not medicaid, and not those who haven't paid the first month insurance. You don't have obamacare insurance if you are on medicaid or haven't paid. I suggest you search for real numbers on how many have paid for obamacare insurance and how many have signed up for medicaid instead of obamacare health insurance, Decide for yourdself, but look at the information available, and give it time for all the numbers to come out. When the gov't says they don't know the numbers, do you really believe they don't know? Or do they not want to know? do your own looking.

They also didn't take into consideration those who lost their h=ealth insurance through companies not providing insurance due to increases in cost, and those who lost full time work and now work under 30 hours because of insurance costs.+

The Hero Zone's picture
The Hero Zone

For some, grumpy, it seems intentions are better than results. But to answer your questions toward the end, these are new statistics the government hasn't dealt with yet so they need time to create definitions and vocabulary words to use in order to measure what they claim. Similar to how our measure of unemployment (the 6.x% we hear) is considered AN unemployment number but is it THE most honest and telling that would allow us to actually work toward reducing it?

Besides using the garbage term "middle class" (and ignoring why/how health insurance became associated with work to begin with let alone why it would be considered some kind of standard into the future even back in the '60s), this is one of the more forthcoming articles I have read about the ACA. I dare say it's refreshing since we are being encouraged to talk about and explore this law.

Sadly, some would rather defend it, its implementation, and obvious statistics to the bitter end than demand better of it, the Congress/President, or their party for passing it. Perhaps there is someone who is knowledgeable or an expert in such a thing as to draw a parallel between this behavior and those of the tragic cases of the failure to report domestic abuse because if the abuser gets in trouble (and is the bread-winner) the other person thinks they will lose the house, kids, food, etc.? Some kind of Stockholm Syndrome?

"Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and sympathy and have positive feelings toward their captors, sometimes to the point of defending and identifying with them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness."

http://en.wikipedia.org/wiki/Sto...

"Stockholm syndrome is named after the Norrmalmstorg robbery of Kreditbanken at Norrmalmstorg in Stockholm, Sweden, in which several bank employees were held hostage in a bank vault from August 23 to 28, 1973, while their captors negotiated with police. During this standoff, the victims became emotionally attached to their captors, rejected assistance from government officials at one point, and even defended their captors after they were freed from their six-day ordeal."

But hey, I'm not a psychologist by trade or certification. Just someone who pays attention to people and behavioral patterns as a way of life.

Maybe it is so painfully obvious that this thing needs talked about that no amount of smoke blown from our nation's capital can cover for it? Even those who may consider the news coverage about it to be considered "praetorian" can be happy that there are stories like this at least softballing the hard facts that are to come.

I will credit the ACA with this: it may actually rustle enough jimmies that we will finally get to flush out D.C. with necessary amendments and the ruination and reformation of at least one of the two major parties.

Even if people want single-payer and I don't, I will stand shoulder to shoulder with them to demand better from our leaders because what they passed is, in the aggregate, arguably worse than what we had "before". In those savage, wild-wild-west days of pre-2009. One can only wonder how our ancestors lived in such barbarism.

grumpy

I do compliment you on your writing ability. We both have the facts and know where and how to do the research, but you can put them on paper (or online) much better than I. I have never had to write reports and my English courses in college were few. Thanks for extending and expanding what I said, you do it better than I. I can do it better face to face but writing it out is where I come up short. I do envy you this talent, as I said in another post I have the right to free speech, but not to an audience, You ability to write gives you an advantage for having the audience. No law can give me the audience, ( only access to the audience)... it can only bring down your ability access to that audience to speak to (write to), to make it equal. Free speech is NOT equal speech. As is shown by our differing writing abilities.

The Big Dog's back

Actually hz post's are all over the place. We're commenting on a particular story, not writing our own. Way, way to long for a newspaper blog. Of course if you spend all your time reading hz's posts you don't have time to read others. Hmmmm, maybe that's what he wants.

Nemesis

Dog's not ready for anything more complicated than See Spot run.

Stop It

lol...If it wasn't true I wouldn't laugh.

The Hero Zone's picture
The Hero Zone

Curses! My plot is ruined, and by some do-gooder Dog no less! I'll get you next time, mark my words! Now I shall return to the Guild of Calamitous Intent to hatch my next scheme...

anthras

Re:Actually hz post's are all over the place. We're commenting on a particular story, not writing our own. Way, way to long for a newspaper blog

Actually dog it would make more sense if your attention span was long enough to last from the beginning of the post until the end. I think that persons should be aware if you are reading the posts on any particular blog subject so then they should realize to use short words and keep their blog congruent with your attention span.

JMOP

Don't forget some state prisoners are covered. I'm guessing that's why Brown said over 1 million Ohioans have signed up. Yes, ohio is one of many states to do that.

dontknowmuch

Sadly Sherrod is a creative numbers guy. We know for a fact 7 million signed up, yet he spews a number of better than 1 million are benefiting in Ohio. That means the other 49 states had only 6 million benefit?

At the end of the day, we were sold that this would benefit 40 million and the Dems want to puff out their chest on the ability to get 7 million signed up. Dems have 33 million to go.

coasterfan

Gotta love how a Republicans believed they numbers UNTIL the signup increased in Obama's favor. They STILL won't answer the question: why are they trying so hard to keep others from having healthcare coverage? Especially as they have not presented an alternative to Obamacare...

The Hero Zone's picture
The Hero Zone

I can't and won't speak for Republicans as a broad group, but you've been presented answers to your questions here on many occasions by myself and others. Be at ease, though, the Republican Party IS dying from the old growth and the younger, stronger shoots are springing up.

Now to ask your questions back to you regarding Democrats keeping others from healthcare coverage nor presenting an alternative to "Obamacare". Perhaps you as a Democrat can answer better than I can as some kind of "default Republican"?

Stop It

Damn HZ, you went an figured a lot of these people out, didn't ya? (rhetorical)

A good portion don't believe that you can have your points about things on your own. One MUST take one side or the other on EVERYTHING...

'Your either with us or agin us...'

The Hero Zone's picture
The Hero Zone

Reckon we cain't take kindly to thems what don't take kindly. Yawp. ~spitoo~

My favorite though is a line from "O Brother Where Art Thou?"

Homer Stokes: Is you is, or is you ain't, my con-stitch-ency?

Stop It

I'd like to carry a lot of 'em out like they did Homer. Damn, that would feel good.

The Big Dog's back

hz, I must have missed yours and your fellow right wingnuts answers.

The Hero Zone's picture
The Hero Zone

No you didn't. No fibbing. You shot down one such idea from the list regarding BC/BS. Actually, two. You called me out on tort reform. It wasn't that long ago. Would you like a refresher?

Darwin's choice

Coasterfan, You're lying again. The numbers are these.... Darwin's choice
Thu, 04/03/2014 - 9:26pm
Just out today....the "real" obamacare numbers....

1.2 million new enrollees that have paid up. Not 7.1....1.2.

4.5 Million new medicaid enrollees (that were eligible anyhow)

Obama care is the colossal flop that everyone here said it would be.

Your President is a liar. (National Center of Public Policy)

Also, this doesn't count the 6,286,357 that had their policies outright cancelled.

The alternative to obamacare is repealing it entirely.

Donegan

Normal people are skeptical of a president who lies. You are just a blind follower and no one cares what you think. you want a answer to "They STILL won't answer the question: why are they trying so hard to keep others from having healthcare coverage?" Here it is. No one wants to pay for it. People are free to buy their own anytime they want, They always could. You people just want others to pay for it.

anthras

Re:"Gotta love how a Republicans believed they numbers UNTIL the signup increased in Obama's favor."

Here is some numbers for you the head of the health insurance exchange in Maryland announced that 60,000 have signed up for obamacare and 75,000 have been cancelled. The insurance companies tell us also that 15-20% of those signing up do not pay a premium

holysee

Republicon party faux news teabagging clueless crowd slowly dying off choking themselves thanks you please may I have another?

Erie County Resident

So quoting the article.
"Seven million people signed up, so there is an appetite for President Barack Obama's health care law, but that doesn't guarantee success for the country's newest social program".

First thing is this is NOT a social program it's a forced decision and not any kind of a program.
Second thing is there is NO appetite there is fear. There is a good percentage of people that signed up for it are doing it under duress. If you don't do this Obama and his IRS will fine you and/or take everything you have.

Now you liberal idiots tell me, just how does this fit into a country that is suppose to uphold freedom of choice?
This crap is nowhere to be found in the Constitution of the USA!

The Hero Zone's picture
The Hero Zone

I'd drop the "idiots" to help your point get across better.

But you are correct in your point on forcing. When something is instituted as a mandate, it's pretty lame to point to how "successful" it is as if there is some other option. This is a tactic the despots of banana republics and dictators of countries such as North Korea do in order to continue to coercion a population that has never been taught how to ask a question (or fear repercussions if they do). I can declare victory over teen pregnancy by saying the rate of it falls to 0% after age 20!

A bittersweet truth depending on one's view of the ACA is that what you said about the IRS isn't technically true. At least not after the President, without consent of the Congress, changed how the "tax" would be collected. Of course that can change too at the drop of a hat from the White House, but as of this post there is no actual "teeth" to the ACA.

So people are forced (some here have the gall to call it "responsibility" when it is imposed) to purchase something in order to help the thing forcing them, but if they don't follow the forcing there is no penalty but will still be told you must comply. Meanwhile individuals and businesses alike are jerked around whimsically by ever-changing deadlines, declarations, and shifting interpretations of the language. Yet, yes, we must comply with the law. You need to laugh to keep from crying. It's schizophrenic!

What's worse is that people such as one above will step up and bleed their own dignity by defending this as some kind of best we can do instead of stepping up to help their own party fix the mess they put us into and continue to drag us through. But non-Democrats are the ones charged by said person with coming up with ideas. When offered, they are struck down locally in the forums by the same people asking what we can do better because seemingly those who offer them don't have a (D) after their names. Or in the Senate when the majority leader kills any suggestions sent by a Republican in the House or Senate itself. Of course, our President foolishly commanded us that the argument over this is over, too. I haven't even heard a peep from any Independent elected into Congress either!

"Take your time, BUT HURRY UP!"
"The Department of Redundancy Department"
"The argument is over/is here to stay, but the law is imperfect (necessitating conversation to fix it)."

This doesn't let the Republicans go, of course. Some do have ideas but have been lacking in actually communicating them. Media bias/conspiracy? Meh. Opposition squelching? Eeeeh...a bit? Lack of an ability to articulate the points to people? I think we found the core reason. But people don't like hearing that they aren't doing a good job at something and so egos get in the way. There are probably Republicans who are content to just passive-aggressively grumble to their home constituents about the ACA but in Congress not do anything because aside from "not liking it" they don't know why or how to employ the fixes.

There are many ancient egos clinging to the ACA like the chains of Marley's Ghost. It's a bundle of good intentions perfectly packaged in poor execution making the whole thing a waste of time, money, effort, and emotion. Even Big Dog conceded (rightfully so I am not making fun of him for it) that only Democrats have done anything to pass or alter the bill. The Republicans have not a fingerprint on it as far as I can see. Seems like the Democrats better haul butt to fix it if they're going to guard it so jealously, but with vocal supporters like some on these forums who never even question them to ask or suggest better...how can they hope to get feedback?

So this is why it would mean so much more if avowed Democrats like coasterfan or Big Dog would step up and help their party from their position inside it instead of defending it embarrassingly and making sure no outside help can come to aid the law the hold so dear to their hearts for whatever reason*. I'd respect them so much more by engaging in thoughtful conversation about how to fix it and WHY it needs fixed plus they'd be bringing more thought and honor to their own parties by doing so.

In my opinion, of course.

*Giving all or portion of your identity to a party/ideal so that you achieve immortality by their actions as having supported them loyally. Instant legacy. I get it, many people do this too and it's a driving force in humanity so this isn't even a "calling out".

The Big Dog's back

The right wingnut mantra, personal responsibility, personal responsibility, personal responsibility. Making people personally RESPONSIBLE for their bills isn't personal responsibility? What's your solution?

Donegan

You have no clue what responsibility is. When others have to pay and babysit you constantly it relieves you of responsibility, Thats what you people want.

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