15
Sep
11

‘gosh, could obamacare be working?’

Jonathan Cohn (TNR): Republicans made a lot of arguments against the Affordable Care Act. But perhaps none were as effective, or as seemingly plausible, as their contention that their new law would cripple Medicare Advantage.

New evidence suggests – surprise! – that the argument was wrong.

…. The policy rationale for Medicare Advantage is two-fold: To give seniors more options and to introduce some private-sector competition. The idea is that private insurers might be able to be more innovative or offer certain combinations of services that some seniors would prefer. But, for much of its history, the program (formerly known as Medicare-plus-choice) was also a form of corporate welfare. Non-partisan studies, by the likes of the Medicare Payment Advisory Commission, suggested that the government was paying the insurers too much.

The architects of the Affordable Care Act decided, quite sensibly, to reduce those extra subsidies and use the money to offset part of the law’s cost. That’s when the Republicans, and their allies, pounced. Taking money away from the insurers, they claimed, would force insurers to charge more, limit their offerings, or pull out of the market altogether.

…. new information, just released from the administration, suggests those predictions haven’t come true.

On the contrary, the Department of Health and Human Services announced on Thursday that premiums for the plans are down and enrollment is up, well above the official projections……

More here

Thank you ‘africa’


7 Responses to “‘gosh, could obamacare be working?’”


  1. 1 utaustinliberal
    September 15, 2011 at 1:56 pm

    Great news. Definitely tweet worthy.

  2. 2 57andFemale
    September 15, 2011 at 2:31 pm

    this will be a rather long comment, because I am reasonably knowledgeable about Medicare Advantage, my husband being an enrollee. I did a lot of research on Medicare/medigap/Medicare Advantage policies before my husband signed up when he turned 65 in 2005.

    First of all, there is a lot of demonization about this program. I understand that there was a good deal of shenanigans about enrolling people in certain markets. And we certainly know that the taxpayer is footing the bill. We were both more than willing to have Advantage plans go away in order to bring affordable health care to many more Americans, me included. As self-employed people, we have struggled with insurance and health care expenses all of our lives.

    The year my husband turned 65, our business had plummeted. We were making less than half of what we had made in previous years. It was devastating. It was one of the reasons I dropped even my catastrophic insurance, because the cost had become so prohibitive and because of my pre-existing asthma, I was still paying for 99% of my health care out of pocket anyway. I never imagined I wouldn’t be able to get insurance back, but that’s another story and a problem ACA is helping me with. But I digress.

    Advantage covered everything Medicare would cover, plus everything that we could get through a Medigap policy, but for no extra cost. In that year when we made about $27,0000, Advantage was a godsend. We live in Chicago and had our choice of a wide array of hospitals and doctors. In the presentation, they told us that first and foremost, we had to be comfortable with our primary doctor as our advocate and if we weren’t happy — change your doctor. Change your hospital. It is an HMO, we didn’t get our choice of every doctor in Chicago. But we chose an office 6 blocks from our house and a hospital we were familiar with. In the 6 years years, my husband has had two primary doctors, both of them excellent. The first one left the practice, but the second and current doctor — let me just say I would pay any amount of money to have this lovely woman as our doctor, and this efficiently run office. I have never for a second thought that we weren’t getting excellent care.

    Colonscopy: $100 co-pay
    Blood work — depending on the year it’s either free or sometimes a $5.00 co-pay, and our doctor checks Jerry at least twice/year.
    Hernia surgery: $100 co-pay
    Growths removed: $35 co-pay
    Specialists: $35 co-pay
    Physical Therapy for arthritic knees and back: $25 co-pay.
    We have NEVER paid to see our doctor, even on an emergency basis. We can get in if he has the flu, cuts his finger or whatever. The office has hours 7 days/week. If they’re busy and squeeze us in, they apologize if we wait more than 15 minutes. Believe me, we get faster, better service than my husband’s stockbroker friend with Cadillac insurance.

    Wellness care and full physicals have always been included. health club membership — included.

    And many other affordable benefits.

    When my husband and the dogs were attacked, we did call their 24/7 triage center, so we did get pre-approved ER. Co-pay: $50.

    Their triage nurse practitioners are personable, caring, knowledgeable and responsive. If they need to talk to a doctor, it happens instantly.

    With ACA I was going to take another hard look at Medicare vs. Advantage for 2011. And to my surprise, our Advantage plan sweetened the plan in advance of any actual changes from ACA. Out of pocket cap of $3,750. That is a HUGE advantage.

    I will say again — if the subsidies are ended, we’ll be happy: there is no question that the insurance companies are benefiting from these subsidies and I’m sure making a profit off the taxpayer. We’ll give it up gladly. But when Thom Hartmann and even Randi Rhodes say that these programs are no better than Medicare, in our case that is just a lie. Randi said the other day that they throw in a health club membership and “everything else is the same”. That is NOT true, at least not for us. We got everything that a Medigap policy would give you, and then some.

    Advantage was cooked up to bring insurance companies into another layer of the Medicare market, there is no question about that. Bringing these policies in line with actual costs and reducing profits of insurance company CEO’s is necessary. But let’s be clear — they don’t want to lose this business. They are already offering MORE than they offered us in the past, in direct response to ACA.

    The insurance exchanges, unless Democrats sit on their butts and don’t vote in 2012, will bring all insurance into a more competitive market. Prices will go down because health care prices are inflated beyond anything reasonable. I saw it happen with Medicare Advantage, and we will see it when ACA is fully implemented. If we don’t screw it up and turn over the keys to the monsters.

    • 3 57andFemale
      September 15, 2011 at 2:41 pm

      When I say we made $27,000 that’s gross income: all our business expenses come out of that. Catastrophic health care coverage with a huge deductible that did not cover my asthma and high blood pressure, was costing us $1,000/month. And when you read the pre-existing condition rider, you could assume that if I got in a car wreck and punctured my lung, it would not be covered because anything to do with my lungs and respiratory system was not covered. That’s health care in the private market in the U.S. of A.

      I need to add one thing: We lived in fear of illness our entire married life as self-employed people. We paid for insurance up until the last year befoe my husband his Medicare age when he needed an emergency room on Christmas Day. After paying BCBS multi thousands of dollars for 25 years, they denied the claim because it wasn’t ‘life-threatening’. He had severe nerve pain in his neck, his BP was 210/110 from the pain but that wasn’t ‘life threatening’ enough for BCBS to pay the one and only claim we had ever made.

      Medicare and Medicare Advantage have given my husband health care for the first time in his life. The relief itself is a blessing although he is, thank God, remarkably healthy for his age. I will be 65 in 2015, and I am living in terror that Medicare will be taken away from me by Republicans, something I never fathomed I would face in my lifetime.

      And we hear that ‘turnout was low’ in NY 9. We hear the PL say it’s not worth voting for this President. We hear the sniping about the jobs bill when Obama by all accounts gave them everything they asked for.

      I’m terrified. Literally terrified of what is happening to this nation.

      • 4 JoJothecat
        September 15, 2011 at 3:40 pm

        Thank you 57andFemale,

        What I hear Randi talk about is the “cost” to the Government/Taxpayer. She says that Medicare Advantage (before ACA) the healthcare industry was making a ton of money off the taxpayers because they were making at least 30% in admin cost. With ACA and the putting the same services under Advantage Care back under Medicare ( admin cost 3% to the government) and paying for the additional services which you mentioned and yes, heath club (my mother joined Curves at no cost to her because medicare advantage paid for it) as well as eye examines glasses (my Mom is in California).

        • 5 57andFemale
          September 15, 2011 at 5:14 pm

          I love Randi. I really do. But she said the other day specifically that you get a health club membership and nothing else. She is of course spot on concerning the costs to the taxpayer that go directly to insurance company profits.

          The truth is just a little more nuanced and there are some advantages of these plans to actual seniors. But as I said, I’d rather see the program end, together with the subsidies, if it helps Americans get adequate and affordable health care.

      • 6 nathkatun7
        September 15, 2011 at 11:49 pm

        Thank you 57andFemale for sharing your family’s experience with Medicare and Medicare Advantage. I turned 65 last year, and I totally I agree with everything you said about Medicare and Medicare Advantage. I also know the ACA has improved, and will continue to improve, health care for seniors — especially when it comes to prescription drugs.

  3. September 15, 2011 at 2:54 pm

    I just love our President’s signature. It’s strong and confident.


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