July 25, 2014
#watchyourstepWednesday, April 2, 2014
Glitches, delays and Republican lobby have Obamacare in a bother
For The Herald in the US
NEW YORK — Breaking Bad was at its peak when a joke about the Canadian version of the TV series went viral. High school chemistry professor Walter White is diagnosed with severe lung cancer. The doctor says: “Your treatment starts tomorrow.” The public health system covers the costs for the taxpayers. The end.
No blue-methamphetamine business, no Pollos Hermanos façade, no corpses dissolved in acid, no Heisenberg narco-corrido, no money buried in the desert, no “Better Call Saul,” no “I am the one who knocks…”
Just normal health care.
“Only in America!” — as they say — can a story like Breaking Bad can be plausible. A high school teacher with a disabled son and a pregnant wife cannot make ends meet and takes a second job at a carwash; even so, he has to say no to an ambulance because his health insurance (a cheap one, therefore very limited, like most working-class US citizens) would bill him an unsurmountable co-payment. Cancer means bankruptcy and a chain of disasters for his family after he passes away: the end of the university expectations for his son, his daughter prematurely in daycare while his wife works for US $7.50 an hour (the minimum wage in New Mexico), the futile refinancing of the mortgage until eviction and foreclosure… So Mr. White started cooking.
Obamacare, which met its deadline for enrollment last Monday, does not bring civilized public health care to the US. (That would be socialism or worse, it seems.) It merely attempts to face the combined problem of about 48 million people — according to the US Census Bureau — left without preventive care, or facing bankruptcy for a car accident or a stroke, and health costs of US$3,000 more per person per year than any other comparable country, as the consultant Howard Peterson wrote in The Field Clinic blog. Among the uninsured, 9.5 million are not citizens, therefore non-eligible ghosts. (They can, and do, pay taxes, though.) The net number who could benefit from enrolling in the new health system is of 38.4 million people up to 64 -years-old (from 65 on people are covered by Medicare, as are the disabled), mostly from the middle class to the working poor (the very poor have Medicaid).
The Affordable Care Act (ACA) voted in 2010 against the militant disapproval of the Republican Party (that also opposed, in 1965, Medicare and Medicaid) basically provides that all adults buy health insurance, without restrictions for pre-existing conditions, or receive a fine (US$95 for individuals and US$285 for families, to raise in the following years); that all employers with 50 employees or more offer coverage or receive a fine; and that the states expand Medicaid eligibility to cover low-income people.
This last point was fought by the Republicans, and the US Supreme Court ordered that each state do as it pleases. So now if you live in North Carolina and make US$12,000 a year, a customer service agent of the Marketplace kindly explains to you that, since your state did not expand the federally-funded Medicaid, you are lucky because the White House has waived your fine. No, no health care for you with tax subsidies: your taxes are risible. But you can shop around: for a young healthy single man, the offer starts at $262.00 a month, more than 25 per cent your monthly income.
Twenty-five states have decided not to expand Medicaid, among them Texas, Missouri, Alabama, Louisiana, Georgia, the Carolinas, Tennessee, and Oklahoma: the impoverished South and the hard-line Republicans. Florida and Pennsylvania have not decided yet. Other 24 — among them densely populated ones like California, New York, New Jersey, and Illinois — have expanded Medicaid and would potentially cover 8.9 million individuals. That would be more than the almost seven million who have signed up for coverage by Monday midnight, one third of whom were previously uninsured. Health and Human Services Secretary Kathleen Sebelius said that, according to industry estimates, 80 to 90 percent pay their premiums.
It is still unclear how many more will be able to enroll: so many people rushed in during the final days when the websites and the call-centers could not handle them; new subscribers only have to say they were trying to make it before the deadline and they will be accepted, says the official blog of HealthCare.gov. There are also “Special Enrollment Periods” for those who have lost their coverage.
The numbers are bigger and unclear. Democrat-friendly media like the Los Angeles Times or The New Yorker have assessed that added to those seven million are at least 4.5 million previously uninsured adults who have benefitted from the Medicaid expansion, three million young adults who were added to their parents health plans until their 26th birthday, and nine million who have bought health plans, skipping the official Marketplace, directly with the insurers (but it is very hard to establish how many of them were not re-contracting previous insurance or changing plans due to the cancellations that the new system carried). A survey by Rand Corporation estimates that the percentage of uninsured adults declined from 20.9 per cent last fall to 16.6 percent one week before the deadline.
Another poll by that ONG shows that close to Monday “there was a sharp increase in favorable opinion of the ACA,” as opposed to the decrease observed in February. But still the view of the average US citizen is adverse: 50 percent of that poll has a negative opinion and 37.8 percent a positive opinion, while 11.1 percent confess the puzzlement that has perhaps been the trademark of this process.
On the one hand, there were the glitches that made the federal enrollment website exasperating: “Sorry, there’s a problem with our system. Please log out, then try again. If you continue to get this message, call the Marketplace Call Center”; “Due to high call volume, all of our representatives are currently assisting other callers in completing Marketplace enrollment applications.” On the other hand, the Republicans conducted a deceitful campaign both disguised as news and expressed in tasteless ads like those that showed a guy with an Uncle Sam mask and costume who posed as gynecologist(for the ladies) and as a urologist (for the gentleman) and ended with the message: “Don’t let government play doctor.”
There were also the cancellation of plans, the extension of closing dates, all sort of exceptions to enrolling, the inability of companies to send paperwork on time that postponed services for a month for many people, the defections of those who prefer to pay the penalty since it is cheaper than a whole year of insurance, the government shutdown due to the Republican decision to de-fund the ACA… The confusion mounted. Now it is an important problem for the Democrats: such disorientation might lead to losing the Senate to the Republicans in November.
Already representative Paul Ryan, the head of the House Budget Committee, has proposed to repeal ACA and save US$2 trillion: “This budget stops spending money we don’t have.”Dreaming of 2016 presidential elections, he also suggested deep cuts to Medicaid and food stamps, and a rise in the military budget over the cap imposed in 2011.
Senator Mitch McConnell, the minority leader, also started campaigning as the superhero of “millions of Americans facing higher premiums, cancelled plans and the loss of doctors and hospitals they liked,” as a result of ACA.
The Republicans believe they only need to sing this one song ad nauseam until the mid-term elections: Obamacare harms the economy, takes a toll on jobs, makes healthcare more expensive and hurts the liberty of choosing doctors.
The question is what Democrats will do, when some of them, aware of the hard re-election fights around the corner, have expressed that they would modify the ACA.