‘A complete about face’: Some Republicans change tune on Obamacare’s Medicaid expansion
Champion of Truth
“About 4.6 million people signed up for Obamacare through the fifth week of open enrollment, with roughly 923,000 people newly enrolled, according to the Centers for Medicare and Medicaid Services.
Enrollment is up 20 percent in Texas and 9 percent in Florida compared to this time last year, administration officials told reporters…crediting increased subsidies from the American Rescue Plan.”
“These two states also have some of the highest uninsured rates in the country. Texas leads the nation with 17.5 percent of its population uninsured, according to the Kaiser Family Foundation. Florida ranks fifth, with 12.3 percent of its population uninsured.”
“Overall, states that have not expanded Medicaid — which includes Florida and Texas — saw a 9 percent uptick in enrollment, officials said.”
“The Affordable Care Act’s achievements are clear. People who buy insurance in the individual and small-group markets no longer face discrimination for preexisting conditions. Preventive services for Americans with all types of insurance are free. Combine the marketplaces that provide tax subsidies for private coverage and the Medicaid expansions adopted by 38 states (along with a handful of smaller provisions), and the ACA has provided coverage to about 31 million Americans, according to a new estimate from the Biden administration.
After the rocky rollout of HealthCare.gov in 2014 and a few years of soaring premiums, the law’s private marketplaces have stabilized”
“one of the biggest gaps in the ACA itself: Medicaid. The program’s expansion to cover more low-income adults was supposed to be mandatory for all 50 states, a statutory overreach that was scaled back by the Supreme Court, where two liberal justices joined the conservatives to rule that the expansion must be optional.
As a result, 12 states still refuse to expand Medicaid. An estimated 4 million people who would have been covered by the expansion remain uninsured.”
“Some people who purchase private insurance through the law can still face high out-of-pocket costs. Some of the health plans sold on the marketplaces have deductibles as high as $6,000 for an individual or $13,000 for a family — and those are usually the cheapest plans available. Until this year, people who made too much money to qualify for the law’s subsidies had to pay the full cost for their insurance, making it unaffordable for some.”
“one core problem remains: While every other developed country in the world enjoys universal (or near-universal) health coverage, 1 in 10 people living in the United States still don’t have insurance.
That number is lower than it was before 2010, when it was about 17 percent. But it is an embarrassing outlier among our economic peers. Americans also spend more of their own money on their health care than people in almost every other country.”
“America spends more money on health care for worse outcomes than its peer countries, as researchers have noted time and again. On a global index of health care quality and access, the US trails many more socialized systems. Life expectancy has dipped in recent years, ending decades of progress and dropping the US further behind comparable countries.
There is no denying that the high quality of health care available in the United States — for those who can afford it. The US health care industry can undoubtedly be among the most innovative in the world: It was American science that cured hepatitis-C in the last decade. The success of the country’s Covid-19 vaccine development, production and distribution is undeniable.
But prioritizing innovation above all else creates its own problems, leaving US health policy captive to private interests.”
“nearly a decade after the Supreme Court ruled that states could choose whether to expand their Medicaid programs, the fight over whether to do so is far from over. So far, 38 states and Washington, DC, have expanded Medicaid, covering nearly 15 million people. In the dozen states that have not, 4 million people are uninsured who would receive Medicaid coverage if their state expanded eligibility under the ACA. More than 95 percent live in the South, they are disproportionately Black, and many are not eligible for subsidies to buy private coverage on the ACA markets.”
“We are about to witness, for the first time, the power of a fully operational Affordable Care Act (ACA).
The American Rescue Plan made 3.7 million more people eligible for the ACA’s premium subsidies. The Biden administration had already opened up enrollment after taking office, and 200,000 Americans signed up in the first two weeks. Now the administration is extending enrollment until August 15, backed by millions of dollars in advertising.
Insurers are expanding into new markets, and some who abandoned it long ago in the law’s fraught early years are now reentering. The individual mandate is gone, but, as it turns out, it may not be as important to the law’s long-term viability as originally thought. The law had been weakened since its passage by the Supreme Court and Republican opposition. So this is a new beginning of sorts.
“The ACA is right now much closer to what its advocates hoped it would be from the start,” Larry Levitt, executive vice president at the Kaiser Family Foundation (KFF), told me. “This is a true test of how effective a juiced-up ACA can be at getting us closer to universal coverage.
Taken together, come Labor Day, the country should have the clearest idea yet of how the ACA functions at full strength — and where holes in the US health system remain.”
Optimistic View: What Trump will do. Lone Candle. 11 11 2016. https://www.youtube.com/watch?v=ttw8tSXNesk&feature=youtu.be The biggest problem with Donald Trump as president Lone Candle. 7 22 2016. https://www.youtube.com/watch?v=PexQGJj3C8w&feature=youtu.be More pain than gain: How the US-China trade war hurt America Ryan Hass and Abraham Denmark.
“Supreme Court nominee Amy Coney Barrett is a critic of Roberts’s decisions upholding most of Obamacare. In a book review published in 2017, for example, Barrett denounced Roberts’s opinions in both NFIB and King, claiming the chief justice “pushed the Affordable Care Act beyond its plausible meaning to save the statute” in the first decision.
If Obamacare is struck down, roughly 20 million Americans will lose health coverage — a likely conservative estimate, as it does not count many people who have lost their employer-provided health insurance during the Covid-19 pandemic.
Questions over Obamacare have taken a starring role in Barrett’s confirmation hearing. Democratic senators have repeatedly brought up Barrett’s objections to the NFIB and King decisions and frequently referred to California v. Texas, a third case attacking Obamacare that the Supreme Court will hear in November.
Barrett didn’t deny criticizing the NFIB and King opinions, but suggested that perhaps she didn’t engage in particularly rigorous analysis when she attacked those two decisions.
After Sen. Amy Klobuchar (D-MN) asked Barrett about a 2015 NPR interview in which the future judge claimed the dissenting justices had the “better of the legal argument” in King, Barrett said she was merely a law professor when she made that statement. “A professor professes and can opine,” Barrett claimed, adding that she did not go through the “judicial decision-making process” when she determined that King was wrongly decided.”
“Barrett’s record..suggests she is a long-term threat to the viability of the ACA — even though the Court may very well still reject the unusually shaky legal arguments in Texas.”
“The US Supreme Court issued its ruling in Little Sisters v. Pennsylvania Wednesday, holding the Affordable Care Act gives the Trump administration broad authority to grant exceptions to a federal regulation requiring employers to provide birth control coverage to their employees.
On the surface, Justice Clarence Thomas’s majority opinion appears to be focused exclusively on birth control, and it also endorses a policy that could cease to exist in less than a year.
The immediate upshot of Little Sisters is to let stand Trump administration rules allowing employers opposed to birth control to refuse to provide contraceptive coverage to their employees. If presumptive Democratic nominee Joe Biden becomes president next year, however, his administration could repeal the Trump administration’s policy and implement a new policy more favorable to contraception coverage.
But dig just one inch below the surface of Justice Thomas’s opinion, and it has deeply radical implications: Little Sisters opens up a new front in the seemingly endless judicial war on Obamacare. And it gives Republicans a new weapon it can use to attack the landmark legislation President Obama signed more than a decade ago.
Thomas’s opinion does not simply allow the Trump administration to limit many individuals’ access to birth control, it could also allow courts to dismantle a key provision of Obamacare that ensures patients receive preventive care without having to pay out-of-pocket costs.”
“Millions of Americans losing their jobs may still be able to sign up for Obamacare — but Trump officials haven’t been urging people to grab onto that safety net while they can.
People who’ve lost their workplace health insurance during the coronavirus outbreak may qualify for private coverage through Obamacare, along with generous subsidies, despite President Donald Trump’s decision last week not to re-open signups for everyone. Many may also qualify for free or low-cost coverage under Medicaid, especially in the two-thirds of states that joined Obamacare’s expansion of the low-income health care program.
Some states that depend on Healthcare.gov are trying to broadcast these options to their citizens — through media campaigns, the governors’ microphones, social media and patient groups — while advocates say the federal government needs to bring in money and a marketing plan to help.”
“most of the 12 states and the District of Columbia that run their own ACA exchanges have reopened their markets.”
“For those advocacy groups or insurers who do try to spread the word, the enrollment task is made even more challenging by steep cuts the Trump administration made to the government’s Obamacare outreach. That started soon after Trump took office and intensified right through the most recent open enrollment, which ended in mid-December.”
“the usual red-tape involved in getting people who qualify for special sign-ups into ACA plans has only grown more complicated and cumbersome in the time of social distancing — when people can’t just present the documents they need to an insurance broker and fill out the necessary forms in real-time. The process is even harder if the person trying to get covered doesn’t have access to a computer. During normal signup seasons, people can call for help, go use a library computer, or get help from a broker or ACA navigator.
The Trump administration says its plan to pay Covid-19 hospital bills is better, as it promises to make direct payments for care.
But critics note that’s not health insurance. It won’t help a newly uninsured person who breaks a leg, has a heart attack, or is undergoing chemotherapy.”
“People who lose jobs can get COBRA, meaning they can extend their job-related insurance after being laid off. But that is massively expensive — particularly for anyone who has just lost their livelihood.”
“People have just 60 days after losing job-based coverage to get documentation in order and figure out a new plan.”