Sunday, October 27, 2013

Colorado's Obamacare does well in its first week

Even with the disastrous web sign up system rollout, there are those who are beginning to realize that some of the conservative  cable talk show media  did not have it quite  right about Obamacare.   What must be puzzling to the dedicated Obamacare and Obama haters is why public approval of Obamacare (the ACA, Affordable Care Act) actually rose 8 points even as media and they  focused on the web system screw ups.  In fact,  a CNN poll released October 21 three weeks into the web rollout found “ that 53% either support Obamacare or say it's not liberal enough.   Consumers are beginning to sort out  for themselves  what is fact versus the fiction of   misspeaking and  fear mongering anti Obamacare forces.

What we hear in Colorado differs from  the federal web sign up plan.   Colorado is one of the fifteen states that  opted to develop and manage their own market place exchanges and web site. The rest of the states  decided to let Uncle Sam do it and they did a disservice to their own citizens. Even in the first month of the sign ups state run Obamacare systems have worked much better than the federal one.

In Colorado, Connect for  Health Colorado is managing the  marketplace exchanges where consumers can shop, choose,  and enroll . Their web site is Colorado has also flooded the state with “navigators”,  allowing for  in person applications, certifying insurance agents to sign their customers up, and staffing call centers   for telephone sign ups and answering questions.(1- 855-752-6749.)  
The figures provided by the Colorado system  for the first week reveal a successful operation:

  • Unique website visitors: 162,941
  • Calls and chats with Customer Service Center Representatives: 9,658
  • Accounts created: 18,174
  • Average call and chat wait time: 5 minutes 44 seconds
  • Enrollments: 226
  • Covered Lives: 305
That enrollments were  low this first week  is not surprising . Experience with the Massachusetts system after which Obamacare was patterned, was that most enrollments did not occur until the last moment. It is a little early to expect much now  anyway since  open enrollment lasts for another five months , while coverage does not begin until January 1 for early birds  who enroll by December 15.
 The most popular pages visited on the Colorado website and questions asked  indicate visitors during the first week were mostly kicking the tires,  being  curious  about whether they qualified for lowered premiums, how to sign up,  and what the sticker price for them would be.  
Also, there are a wide range of plans from which to choose that require some thought and kitchen table discussion :  One major decision is whether one  should one choose a plan with low monthly premiums and higher deductibles and co pays or more expensive monthly premiums with less  subsequent out of pocket expenses.
Making sign up for Obamacare easier, applicants  will not have to fill out pages of  health history  because  all pre-existing conditions will be covered anyway.  Questions about  income will be asked and answers verified, however, to determine if customers are eligible for reduced premiums.  
Signing up young, healthy adults is critical to Obamacare’s financial success. Young people through 29 years old can get an ultra  low cost catastrophic plan as well as staying on their parents’ plans until they turn 26. There are those wringing their hands (or anti Obamacare forces are praying)  that young people will not sign up because they will be unable to deal with   a faulty computer program. They should neither  fret or hope .  Colorado systems are not faulty.  Having raised three teenagers and observed three teenage grandchildren close at hand, my experience is that if anyone has the ability and patience to apply on line, this computer savvy generation does. However, “ last minute”  is their middle name even into young adulthood. 

Tuesday, October 15, 2013

The New American Center; like 2009, it's still the middle, stupid.

The publication of  a poll conducted by Esquire Magazine and NBC NEWS should shake up some current misconceptions.  Common wisdom has been that our nation is so politically polarized that there is no middle left.  This new poll shoots holes in that line of thought.  There is a broad sector  of American voters  that is actually fluid and who  mixes and matches and cherry picks sometimes even contradictory positions.  Even those who identify themselves with one party or another are not bound in chains to either if one asks  people how they vote by issues and how they identity  with demographics and peer groups.     About 20% on either end of the spectrum are truly bound to one wing or another. Link to a summary of the poll:  The New American Center: Why our nation isn’t as divided as we think

It brought to mind a column I wrote in the Nov. 8 2009 Sky Hi Daily News, "It's the middle, stupid".  You might for enlightenment consider it the "old American center" and contrast it with the "New American Center" identified in the poll  taken exactly four years later in 2013.   There have been some changes in issue identification as the issues changed, too, but nonetheless, if this new poll is any indication, the center is alive and well and persuadable and fluid.  Polls today also show that while independents leaned for Mitt Romney in 2012, they are now leaning heavily for Democrats in the current budget and shutdown crisis.  posting from the Hill> Click  Opinion: Independents desert GOP - The Hill - covering Congress, Politics, Political Campaigns and Capitol Hill |

Some of this 2009 column sounds quaint in 2013, and some of what I predicted would be "old hat" is still "new hat" we now begin to revisit for the nth time entitlements and health care.

It's the middle, stupid.
November 8, 2009
I have been listening to the pundits struggle to find lessons in last Tuesday's vote.

Republicans won two gubernatorial races, New Jersey and Virginia. A Democrat won an upstate New York congressional seat in a district that went Republican for the past 100 years. Local issues like property tax, corruption, and outside carpet bagging from tea party folks added to confusion in analyzing the impact of President Obama's coat tails, economic woes, and other national issues.

What struck me was that all three races did have something in common: The independents made the difference and those independents were the moderate middle.

Both winning candidates for governor positioned themselves as problem solvers and pragmatists, not as ideologues, in spite of their very conservative credentials. They focused on issues concerning jobs and the economy. In upstate New York, the radical tea party right ran a conservative candidate who succeeded in knocking out a moderate Republican. Enough moderates, who resented the carpet bagging Conservative and the hard core social and economic ideology he represented, voted Democrat and the Democrat won. In New Jersey, an independent in the race found his votes swinging Republican at the last moment, accounting for the Republican's 5 percent margin of victory.

I am sometimes inspired by Murphy's Law (“what can go wrong will go wrong”) so I have devised my own list of laws of politics based on last Tuesday's elections.

Law 1: Whatever the issues, whenever a third party enters the race, the independents determine the outcome. This was true of both the New Jersey and New York races.

Law 2: Independents are not ideologically loyal. Obama had carried the independents in New Jersey and Virginia in 2008. In New York state, given the registered voter data, some Republicans appeared to have voted Democratic.

Law 3: Independents are pragmatists. Independents vote for the candidate who will fix what hurts them. This is a switch from the independents of yore who emerged after World War II with optimism about the future. My independent minded parents used to say: We vote for the person, not for the party. Fear and pessimism have replaced optimism lately: Now we vote for the person we think will fix what hurts or scares us.

The pragmatists dominate our current political climate in spite of the shrillness of talk show radicals. The Obama win in 2008 was an expression of belief that he represented hope he would fix pain felt by a majority of voters … ranging from getting us out of an unpopular war, to the stock market crash, to health care, to job loss ( then a rust belt issue). The danger for Obama is that he may not be able to deliver on the hopes that were raised by 2012. Defeat at the polls is the price a pragmatist pays for failure.

Law 4: What independents see as the source of their pain can change at warp speed. The Wall Street crash, its unbridled greed and bailouts were not even on tongue tips before September 2008. The unemployment problem grew from a regional concern to a national one by inauguration date. Health care dominated the presidential primary and general election debates ahead of worries about the economy and getting out of Iraq was the other hot potato.

Law 5: Today's solutions may not address tomorrow's problems. You just cannot assume the same lesson will apply in two or four years from now. See Law 4. It is like building a house on a foundation of sand. It looks great today, but tomorrow, the sands may shift. To appeal to independents, proposed solutions have got to address the problem of the day that concerns them.

When the gross domestic product grows again as it did last quarter, jobs are usually created about six to nine months later. The mood of the voters could be different a year from now if the economy follows economists' predictions about the timing of recovery. So far, the economists have been generally correct. The stimulus and bailout issues will then be old hat.

If health care reform gets through Congress before the mid-term campaign season begins this January, the issue will no longer be on the front burner. Most people will see no tax increases and most will still have their employer based insurance. Medicare benefits will not have been affected. The uninsured, small business employees, and consumers will see some improvements more quickly, though.

Regarding Afghanistan, it is likely the path to reaching any goal might not be clear at all. Obama must show some hope of success here or face grief from independents who are neither dedicated doves nor hawks.

Call the independents “the middle,” or “ pragmatists,” the message to ideologues is the same: Ignore them at your peril."(end 2009 column)

Sunday, October 13, 2013

The incredible shrinking Obamacare issue and why it has no place in deficit reduction negotiations

 The Obamacare (Affordable Care Act, ACA)  controversy has been rolled into  reforming entitlements as part of the dealing with the White House on raising the debt ceiling.and deficit reduction.  However, the GOP’s rationale for  defunding, repealing, delaying or  sabotaging the ACA because it would increase  the deficit is bogus.   In fact,  the GOP proposals would  add to the deficit .
 The GOP House of Representatives has reduced  their  conditions  to ending the shutdown or raising the debt ceiling  from defunding the ACA  to delaying it a year   to  just removing  the tax on medical devices, or  removing  the penalty on individuals who fail to sign up for insurance by March 31. Rep. Paul Ryan did not even mention the ACA in an op-ed in the New York Times as he tried to move the GOP goal  to reforming all entitlements as a  debt ceiling and deficit reducing  bargaining chip.
Tea Party die hards still want to include the ACA in the entitlement discussion. .  To tie the ACA to deficit negotiations  is nonsensical.  The Congressional Budget Office  said the  ACA would decrease the deficit by $109 billion over ten years and that the ACA added 12 years to the life of Medicare.  The ACA has a “pay for” built in through a variety of mechanisms:  reducing the overpayment to insurers for coverage and holding them to no more than 20% of premiums for overhead; reducing payments to hospitals because they no longer have to absorb the costs of treating  uninsured patients who could not pay their bills.  The previously  uninsured  now have affordable access to insurance.  Competition within the marketplace exchanges are  resulting in  premiums which are even 16% lower than original predictions.  Unnecessary but expensive subsidies to Medicare Advantage private insurer administrators have ended. Some taxes and penalties  will also  produce  revenue.
 Some fear   that increasing the debt limit is a go ahead to go into debt more in the future. Lifting the  debt limit does not approve  more expenditures than Congress has already approved.  There are those that contend that if the debt limit increase is not approved, nothing will happen..  There is no one in the business community or Wall Street  or  the prime funders of the Tea Party movement, the Koch Brothers,  who  agree with that.
What  the GOP  advocates could make the deficit worse.  For example, removing the tax on medical devices could  add to   the deficit by  at least  $29 billion in lost revenue over 10 years.  Another “pay for” should be included in any deal to maintain the ACA’s contribution to deficit reduction.. Some  deal is likely since the President says it  is not a “core” part of the ACA.
Another GOP proposal, to  delay the penalties associated with the  mandate for young people to sign up is a “core” attack on the ACA. Not bringing the younger and healthy into the insurance pool would sabotage the affordability of  covering pre-existing conditions because that is what makes that part of the ACA affordable.  The  GOP argues   the President let large businesses off the hook for a year from being fined for not having health insurance for their employees. The difference is the impact on the cost of the ACA. Only a very small percent of large businesses do not already provide employee insurance.
  Using  computer glitches in the federal web site  as a reason to delay is  a weak argument since computer software  can be  fixed and administrators  have until March 31, 2014 . Fourteen states like Colorado that opted to run their own systems have better results than the  states who relied on the federal system. . Sign up by computer Is not the only method to enroll.. Marketplace exchanges  provide telephone and   in person enrollment as alternatives to on line sign ups.

Sunday, October 6, 2013

The ABC's of Minority Rule. How did the Tea Party pull off the shutdown and can they do it again? They did, can, and are.

  Is defunding or delaying the Affordable Care Act (ACA), aka Obamacare, worth shutting down the government?  Polls are showing 72% of Americans do not believe it is.   The polls were   taken before the marketplace exchanges were opened October 1  that gave  consumers a  hands on chance to separate fact  from GOP fear hyping fiction. Many consumers liked what they saw.  In the first three days of a six months enrollment period, 10,000 opened accounts  to get insurance  with the Colorado administered exchanges.
 A  minority  group of around 40 Tea Party  House members were able to engineer the shutdown. How did they pull it off and  can they do it  again?  Thanks   to the Hastert rule and gerrymandering they did,  can,  and are . They are adding to their  surrender terms by refusing to increase the debt limit. Failure to raise the debit limit  threatens  to undermine   our nation’s economy  by   leading to  default on  payments for bills already obligated and  due .
  The 250 furloughed BLM , National Park,  federal conservation, and Forest Service employees are only some of the victims in Grand County. Their families lost buying power. Businesses  had also  hoped the last days of the tourist season, fall colors and elk rut viewing, would bring in some money  but the tourist season’s end  is already upon us.
 If the entire House of Representatives had been  allowed to vote, a   resolution to reopen and fund the government without  defunding the ACA  would have  passed right away. However  a  minority group in  the GOP caucus,  the Tea Party, was   determined to use the strategy of linking the issue of  continuing to fund the  government to  defunding or delaying the ACA. This  kept any “clean” bill, one  without reference to  the ACA,  from being  voted upon  by  the entire House. How far they will go on the debt limit threat is yet to be seen.
 One culprit that allows this to happen    is a rule of  the  GOP caucus in the House of Representatives, the Hastert Rule.  Unless the majority of the House GOP caucus agrees, a bill will not come up for a vote of a whole House . This rule  keeps   a coalition of moderate Republicans and Democrats from joining together to vote  for  a bill a faction of the GOP opposes.   GOP Speaker  John Boehner  chose to   invoke the Hastert Rule, some observers charge, because if he did not , the Tea Party would keep him from   being  re- elected Speaker again.   
  Another  culprit is the recent  redistricting process   that  enabled state legislatures dominated by the GOP   to gerrymander Congressional district boundaries  to make more districts overwhelmingly Republican in a general election.  These “safe” districts mean that any  member of the GOP running for Congress  who does not follow  the Tea Party’s line  could face a challenge from them  in a primary battle.  The implied or real  threat was enough to give the Tea Party additional votes of House members  who may not have  been in 100% agreement with a shutdown,  making the Tea Party the majority in the House  GOP caucus.
Knowing in advance that the Senate Democrats and the President would stop or veto any bill that   defunded,  delayed  or sabotaged the ACA , the House GOP controlled  by the Tea Party  continued sending  bills to the Senate with those poison pills and the threat to shutdown the government. Failing to bully the President to ditch the ACA,  his signature piece of legislation,  they then tried to   divide their opposition by offering to fund   a few popular programs, including reopening national parks , while excluding   other federal agencies, including some in Grand County.   To open the government for all services and agencies,  a vote by the entire House is all that is needed.