As pieces of the nation’s new healthcare law, the Affordable Care Act (ACA), continue to take effect throughout the country many continue to mount opposition to the new rules. Some of the objections raise questions of religious liberty and many of those revolve around the controversial topics of contraception and access to abortions.
However, one challenge to the ACA raises the question of whether people should carry health insurance at all if they have “sincerely held religious beliefs” that preclude them from seeking medical care. The so-called “Equitable Access to Care and Health Act” is a proposed bill in both the House and Senate. HR 1814 is widely supported by the Christian Science lobby as well as 216 members of the House of Representatives and 30 senators according to an “action alert” on the website of the Freedom from Religion Foundation.
Christian Scientists typically do not seek healthcare and therefore claim they should not be forced to buy health insurance coverage under the ACA. They are holding a “national call-in” lobbying day on Tuesday, urging supporters to call members of Congress and ask them to support the bill.
Those in opposition to the exemption argue that allowing religious exemptions would set a reckless legal precedent, raise healthcare costs for those who do purchase insurance, and endanger the children of those who refuse medical care.
Rita Swan of the organization, Children’s Healthcare Is A Legal Duty (CHILD), says she worries mainly for the children.
“Our organization has information on hundreds of American children who have died because of their family’s religious objections to medical care. Many others get to the emergency room at the last minute, and their medical care is much more expensive than it would have been if the children had a medical home and routine basic care. HR 1814 increases the risk to children in faith-healing sects and the cost to the state if the children do get medical care,” Swan is quoted as saying in the action alert.
Others argue that asking for the exemption may be valid but there is likely a better way to assure that everyone has to put money into a national healthcare system and circumvent the religious questions.
Dr. Don McCanne, writing for the Physicians for a National Health Program, says he understands the objections of Christian Scientists and others and that a universal national plan is the simplest solution.
“Do not fund it based on medical need, but fund it through equitable, progressive tax policies. Under such a system, anyone can decline medical care for whatever reason, religious or otherwise (except if the person's disorder constitutes a genuine threat to public health),” McCanne writes.
The Freedom from Religion Foundation is also urging people to call Congress members and oppose HR 1814.
Arkansas earned some distinction with its approach to the unpopularity of expanding Medicaid under the Affordable Care Act and using federal money for that purpose to help its citizens. Rather than expanding the program, Arkansans have the option to use that money to purchase private insurance. However, GOP lawmakers in the state are opposed to this measure and are working to reform the practice.
In a column in the Arkansas Times, Max Brantley highlights Rep. Josh Mille,r who opposes the measure,but has benefitted personally from the Medicaid program. In 1997, he was in an automobile accident involving alcohol that left him paralyzed. Uninsured at the time, his ultimately $1 million healthcare bill was “mostly” picked up by the government, and he was on disability for a time. Brantley uses Miller’s case as evidence that the motivation of the Arkansas GOP is only against this because it wants to undermine the Democratic president’s signature policy.
Brantley takes it a step further, saying that Miller believes “some who qualify for the private option aren’t working hard enough.” He says that someone (not him) who is “coldly rational” would look at this debate and believe “a cook in a fast-food restaurant, working long hours at low pay to feed a family, looks more deserving than an uninsured person injured on a drunken joy ride.”
In a telephone interview with Opposing Views, Miller denied that was ever his position. “I can’t speak for every other legislator in Arkansas,” he said. “I opposed it from the beginning, but not because I feel like anyone is unworthy.” Miller does not seem to be a politician caught up in partisan fervor or with any sort of larger, national ambitions. Instead, he seems genuinely concerned about the future of Arkansas and America, with respect to debt.
In his comments from the floor of the Arkansas House, Miller speaks about the danger of entering into an agreement with “a financing agent who is trillions of dollars in debt.” He reasserted that belief, saying that he doesn’t oppose expanding healthcare, but has “uncertainty about [Arizona’s] ability to pick up the tab” after three years when Arkansas would have to pay for a larger share of the program.
Denying anything involving politics, he asserted, “I am [opposing the private option] for fear of traditional Medicaid, to prevent it from taking further cuts.” Of his own experiences through his recovery and rehabilitation, he said that the current system “has been in need of improvements.” He worries that when the bill comes due, Arkansans will be forced to take one of three actions. People would have to be removed from the program that they signed up for “in good faith,” as a way to cut costs. Alternatively, the only other options are to raise taxes or cut other existing services.
In an interview Thursday on Chris Hayes’ MSNBC show, Miller said that he wasn’t pushing for the removal of people already in the program, but merely hoping to “slow down enrollment.” He suggested that during the next legislative session in 2015, they could figure out a way to pay for the Medicaid expansion for years to come.
At least, for the moment, they’ve stopped trying to repeal it.
After over 40 failed attempts to roll back the Affordable Care Act, serious GOP legislators decided that rather than try to slay a political dragon, they would try a little governance and perhaps try to fix their specific problems with the law. One such congressman was Rep. Todd Young, R-Ind., who submitted H.R. 2575, or the Save American Workers Act. For the purposes of healthcare, the law would redefine full-time work as 40 hours per week instead of 30, a way around the much-maligned employer mandate.
Yet an analysis released Wednesday by the nonpartisan Congressional Budget Office painted the picture that the bill would do more harm than good. Adding those ten weekly hours would see “about 1 million people” lose their health insurance. Consequently, somewhere between half a million to a million people would end up insured via a (likely subsidized) health exchange plan or through Medicaid. The remainder — less than half a million people — would wind up uninsured.
Employers who do not provide full-time employees with health insurance must pay a fine to the government, but this bill cut that amount considerably by making fewer companies subject to that penalty. All told, the bill would end up costing the taxpayers $73.7 billion over the next ten years.
While Young should be commended for trying to pass a bill that reforms the law rather than seeking outright to repeal it, the Los Angeles Times said that Young and his 208 cosponsors handled it “so ineptly,” and that it would ultimately make “the problem they’re addressing much worse.”
Part of the justification behind dropping the full-time threshold to 30 hours per week is that it would be much more difficult for employers to scale back hours for full-time employees than it would be if the line was drawn at 40 hours per week.
There ain’t no victory like an Obamacare victory, because an Obamacare victory…isn’t exactly a victory at all. The embattled program announced enrollment numbers recently and hit its proposed 1.1 million new enrollee-goal. This marks the first-time in the program’s history that it didn’t fall short of projected numbers. Yet, according to an anonymous insurance industry insider who spoke to Fox News, “Those numbers are inflated. The question is how much.[sic]”
Breitbart.com broke it down further, saying that the numbers offered by the Obama administration reflect those who’ve enrolled but not paid their first premium. Thus, those who may have been dropped and then reenrolled would be counted twice. It is believed that the numbers of enrollees who’ve not yet paid their bills is around 20 to 30 percent.
White House Press Secretary Jay Carney said that insurance companies were the best source for that information. According to CNN, he said, “It is a contract between an individual or - well, an individual even representing his or her family - and a private insurance provider. So insurance companies obviously have data about when those payments are made.”
The online apparatus for paying premiums was one of the things not yet ready when Healthcare.gov rolled out to disastrous results in October of 2013. However, they are developing a system that will track payments, specifically for Medicare and Medicaid. A CNN Money article from last month takes an optimistic approach, suggesting that as the site works out its problems more people will start paying.
Even with the inflated numbers—totaling 3.3 million enrollees—the program will most likely fall short of the March 31 goal of 6 million enrollees from the nonpartisan Congressional Budget Office. So far, according to Fox News, the Administration is not considering extending open enrollment past that date.
A group of almost two dozen protesters recently descended upon a hotel in San Francisco where Gilead Sciences Inc. “touted its $1,000-a-pill hepatitis C cure to investors in a hotel ballroom,” according to Bloomberg. An entire 12-week course of treatment would cost $84,000. While these types of expensive private drugs are not uncommon, there is usually a cheaper, generic option that people can choose to save some money.
However, according to a recent report from the National Journal, that may soon change.
While the conservative-minded Breitbart.com report has no problems asserting that “Obamacare” is to blame, the very first line of the Journal’s report says that it is “difficult—if not impossible” to work out why costs are going up. The National Community Pharmacists Association doesn’t know, either, and it has asked Congress to hold a hearing on the matter.
According to the Breitbart.com article, Dan Mendelson, the CEO of the consulting firm Avalere Health, said that prices of generic drugs have gone up because the demand for them has risen. Mendelson has a point, because as long as their prices stay well below the prices of their main competitors, generic drug manufacturers can charge whatever they want.
While it’s unclear what effect the Affordable Care Act has had on this market trend, it is a safe bet that it has impacted the trend in some way. All new health plans have to cover prescription drugs, so, theoretically, with more people in the market for prescriptions who previously might not have been able to afford them, an increase in demand makes sense.
Yet, one might suggest that this is evidence that the ACA is relatively impotent where cutting or controlling costs are concerned. Gilead Sciences' hepatitis-C cure would cost a patient’s insurance company $84,000 for a 12-week treatment. This and other drugs like it have led to an overall increase in health costs.
If the main battle of the Obama presidency has been over health care, the GOP’s strategy up to this point was to simply derail the law (later, repealing or crippling it) without offering any viable alternatives of their own. However new legislation proposed by Republican Senators Tom Coburn, Richard Burr, and Orrin Hatch represents the first real alternative to the President’s signature policy offered by the GOP.
Called the Patient CARE Act, this law does not contradict the Affordable Care Act, but instead steals some of the most popular parts of that law in theory if not in practice. In a sense it recognizes that the ACA is the “law of the land” and rather than trying to undo it, the law seems to be a sensible, fiscally conservative alternative. John Goodman—the founding president of the National Center for Policy Analysis, not “King Ralph”—calls the bill “an economist’s dream” mostly because it limits tax preferences for health care that wreak havoc on the insurance market by driving up demand for “Cadillac” health plans that otherwise people would not have.
There are no health exchanges and protections against premiums increasing for pre-existing conditions are lessened, as are subsidies for the middle class. This is different from Sen. Coburn’s last health proposal which included tax-relief for all. In fact, Sen. Coburn’s first proposal could have been a big step towards kind of single-payer program desired by many progressives.
Each taxpayer would receive a refundable tax credit with which he or she could purchase insurance—about $2500. Since this is about what it costs to enroll in Medicaid, if people had the option to use that credit this way, it would go a long way towards true “universal” healthcare coverage in America. Still what’s most interesting about this bill is that it signals a slight acquiescence on the part of the GOP to the fact that despite its troubled roll-out, the ACA isn’t the policy boondoggle that other GOP Senators (e.g. Ted Cruz, Rand Paul) have claimed.
Democratic Senator Ricardo Lara of California is making headlines this morning after proposing that illegal immigrants should have access to a state version of President Obama’s Affordable Care Act.
"Immigration status shouldn't bar individuals from health coverage, especially since their taxes contribute to the growth of our economy," said Lara.
Currently, the state health insurance program Covered California does not allow for illegal immigrants to be covered, but many of the 2.6 million undocumented immigrants in the state are already covered by their employers through privatized plans. Lawmakers are currently trying to sort out the details of the proposal and say one option would be to create a program separate from Covered California that would pay for health insurance through state funds instead of federal funds.
"By the end of this year, Covered California will be entirely self-sustaining anyway," said Health Access executive director Anthony Wright, who is working with Lara on the proposal. "It will not be federally funded, it will not be state funded. It's funded by a small fee on each policy sold."
Wright says that this could be a chance for California to pave the way in the fight for immigration reform and rights for undocumented immigrants.
"There is precedent for California to be a leader,” said Wright. “There is precedent for California to piggyback on federal programs but take an extra step to expand to additional folks."
There are a number of different options on the table that could expand health insurance to illegal immigrants in California, and Lara, along with a team devoted to the proposal, is currently figuring it all out.
The support is not unanimous, however. Republican Assemblyman and gubernatorial candidate Tim Donnelly says that Lara’s proposal is misguided and could do economic harm.
"California cannot afford to create another incentive to attract people to come to our state illegally in pursuit of taxpayer-subsidized benefits," said Donnelly. "It's shameful that … Lara would trade on the plight of those who are ineligible."
Still, Lara and his team are moving forward, and it should be interesting to see where the future of government-funded healthcare for illegal immigrants goes in the coming months.
President Obama’s signature healthcare initiative never had a chance. From its very inception, political opposition and special-interest lobbyists ginned up their PR machines, which led to immediate and frenetic resistance from Republicans, conservative media, and citizens themselves. Since October 1, when healthcare exchanges and other major pieces of the legislation were officially rolled out, stories of how the Affordable Care Act or Obamacare was failing the public were ubiquitous.
Remarkably, considering the dearth of criticism the Obama administration knew was out there, the rollout of the exchanges was almost hopelessly bungled. The website was full of glitches and could not handle the traffic. The networks in the exchanges are narrow, and it is more difficult to hold on to one’s preferred plan—or even their preferred doctors—because of it.
The story was covered as a political one. Individual experiences with the website and health plans were reported in the news, sometimes without even doing due diligence to determine the veracity of the claims, as simple anecdotal evidence to prove political speculation. All that seems to matter is what “side” a person is on, rather than how the system is actually affecting these people.
The latest line from the Obama administration is that 6 million people have signed up for health insurance thanks to the Affordable Care Act. However, CNN Money reports that these figures “are somewhat misleading.” According to their statistics, 2.1 million people were able to sign up for private coverage through the marketplace exchanges found on Healthcare.gov. The other 3.9 million people are those covered under Medicaid or the Children’s Health Insurance Program or CHIP. What’s uncertain is how many of those 3.9 million people were already eligible for these programs and reapplied and how many were newly eligible thanks to the new law.
In fact, the Medicaid numbers would be even higher if 24 governors hadn’t refused the federal funds to expand the program for their citizens. According to estimates from the White House in November, they expected the already-approved Medicaid expansions to provide coverage to 4.6 million people, and they fell short of that number.
One could spend days wondering if conservatives would be see the Medicaid numbers being lower than expected as a “victory” because there are fewer people on the government program than expected or because the White House guessed a number and was wrong again. Yet little concern is given to those in the states without the expansion who need coverage or how those newly on Medicaid are being serviced and its effect on the overall program efficiency, at least unless someone develops a political angle on that story too.
Also being ignored are the real problems with the new law that don’t lend themselves to good political rhetoric. For example, the public option was supposed to serve as market control by giving consumers a low-cost, (supposedly) quality choice. This would (in theory) force hospitals, insurers, and companies that profit from medicine to force ways to cut costs and stay solvent. Without this in place, a provision in the bill meant to provide relief to companies if not enough people signed up has now become (essentially) an insurance company bailout.
Whether or not the law is good or bad policy, inherently flawed or adaptable to perfection, all that seems to matter is the horse race. For President Obama to fail, the law has to fail, and Republicans have seemingly adopted a strategy that his failure is the key to their success. Rather than winning elections by saying “I’m right,” they seem instead to be relying on voters saying “He’s wrong.” The policy and the people it’s meant to help take a backseat to that story.
A New York Post article from Sunday seemed to be the latest indignity in a long line of Affordable Care Act (or Obamacare) screw-ups that have followed the program since it was implemented in the fall. The article told the story of a Long Island family—both adults self-employed—who were initially told they were unable to add their youngest child to their existing policy purchased on the New York Health Exchange until the child was two years old.
According to The Post, once they contacted the insurance company in question they insisted it was simply a mistake.
The source of the problem, of course, falls back to the embattled Healthcare.gov website. According to The Associated Press, the site “can’t handle new baby updates, along with a list of other life changes including marriage and divorce, a death in the family, a new job or a change in income, even moving to a different community.”
In the past, such changes were handled by contacting the insurance company, yet it seems as if with the addition of the government website the companies are suddenly baffled by how to handle these simple changes.
According to Capital New York, Bill Schwarz from the New York Department of Health called the story completely false. “Family plans in New York cover the whole family,” including newborns. Apparently Cornelius Kelly—who Capital says ran for Suffolk County legislature as a Conservative Party candidate—mistakenly left his fourth child off of his initial application.
The update process was supposed to be part of the Healthcare.gov site from the beginning, but “that feature [was] postponed as the government scrambled to fix technical problems that overwhelmed the health care website during its first couple of months” according to an Associated Press article published today on Business Insider. If anything this current Obamacare glitch says more about how the law and its problems are being covered, rather than the extent to which the problems are not “solvable.”
The Post and then Fox News ran with the story, approaching from the angle that the “baby problem” was fundamentally part of the law and not another in a long line of glitches that the government needs to fix. It also shows—if the Kelly’s story is true—that the insurance companies themselves opted to “trick” them into buying an additional plan rather than fixing things on their end. And all in the name of making Obamacare look bad.
It begs the question then: how can the Affordable Care Act succeed, if the news media, the insurance companies, and even the consumers themselves want it to fail?
The New Year always brings a combined feeling of excitement and impending doom, although for opponents of the Affordable Care Act, or Obamacare, January 1 is D-Day.
Putting aside political motivations for wanting the act to fail, those opposed fear that Obamacare is going to undermine the effectiveness of the U.S. healthcare system which will result in worse care for all involved. Many who believe that Obamacare is a government-takeover of healthcare—it’s not, if anything it’s a government handout to insurance companies—will immediately tell you that it will lead to the rationing of care. This idea is not that far from the truth of a real concern that has existed before the bill was even written: the forthcoming “doctor shortage.”
An article from Forbes published some weeks before President Obama was inaugurated cites the main fault of the forthcoming shortage not with Republicans or Democrats, but with the Association of American Medical Colleges or AAMC. The nonprofit organization of medical educators “foresaw an oversupply of doctors” in the 1980s. The solution was to cap medical school enrollment but the population increase outpaced those restrictions so much so that the AAMC is now saying there will be a shortage of about 91,000 practitioners and specialists by 2020.
According to The New York Times, the Obama administration anticipated this problem, but eventually the suggestions—such as increasing Medicare and Medicaid payments to family doctors over specialists—were mired in the unyielding controversy that has surrounded almost every item that was to be included in the reform. A detailed investigation by nonprofit journalism resource Stateline reveals that “the shortage of providers is worse than the numbers indicate,” because of already-in-place healthcare business practices.
Although, a post last January by The Washington Post’s “Wonkblog,” speculates that the shortage may not be as severe as some think. Citing the increased role that physician’s assistants, nurse practitioners, and technological advances (e.g. telemedicine) are playing, the 7 million newly-insured (at least that is what Obamacare needs to become financially viable) may be able to weather the storm after all, at least where general practitioners are concerned. The 46,000 specialist shortage is a far more complex problem.