{"id":2794,"date":"2014-11-16T08:00:02","date_gmt":"2014-11-16T13:00:02","guid":{"rendered":"http:\/\/www.dougsbriefcase.com\/blog\/?p=2794"},"modified":"2015-01-17T09:21:56","modified_gmt":"2015-01-17T14:21:56","slug":"know-dont-know-obamacare","status":"publish","type":"post","link":"https:\/\/www.dougsbriefcase.com\/blog\/know-dont-know-obamacare\/","title":{"rendered":"What We Know And Don\u2019t Know About Obamacare"},"content":{"rendered":"

<\/p>

\"The<\/a>

The White House spent bil\u00adlions last year on efforts like this to pro\u00admote Oba\u00admacare enroll\u00adment. How will they do this year? [Cred\u00adit: Wash\u00ading\u00adton Post]<\/p><\/div>If you are a law\u00adful res\u00adi\u00addent of the Unit\u00aded States and you lack health insur\u00adance today, it\u2019s almost cer\u00adtain\u00adly your fault.  You can\u2019t blame your employ\u00ader, the gov\u00adern\u00adment or the insur\u00adance com\u00adpa\u00adnies.  It\u2019s on you.\n

That is the last\u00ading achieve\u00adment of Oba\u00admacare, whose sec\u00adond open enroll\u00adment peri\u00adod began yes\u00adter\u00adday. Gone are the days when peo\u00adple with pre-exist\u00ading med\u00adical con\u00addi\u00adtions could not find afford\u00adable cov\u00ader\u00adage.   Whether the ends of this achieve\u00adment, which are unde\u00adni\u00adably good, jus\u00adti\u00adfy the means its sup\u00adport\u00aders employed to win its enact\u00adment remains a mat\u00adter of controversy.<\/p>\n

One of the law\u2019s prin\u00adci\u00adpal archi\u00adtects, MIT<\/span>\u2019s Jonathan Gru\u00adber<\/a>,<\/span> has defend\u00aded those means, say\u00ading that the \u201cstu\u00adpid\u00adi\u00adty of the Amer\u00adi\u00adcan peo\u00adple\u201d neces\u00adsi\u00adtat\u00aded the President\u2019s \u201clack of trans\u00adparen\u00adcy\u201d about the law\u2019s pro\u00advi\u00adsions.  The unwashed mass\u00ades, in Gruber\u2019s view, sim\u00adply lacked the capac\u00adi\u00adty to grasp how good the law was for them, so their rulers had to mis\u00adlead them about its hid\u00adden tax\u00ades, cross-sub\u00adsi\u00addies and the series of unpleas\u00adant sur\u00adpris\u00ades that would befall every step of its implementation.<\/p>\n

Gruber\u2019s view, no doubt qui\u00adet\u00adly shared by the com\u00admu\u00adni\u00adty of health pol\u00adi\u00adcy experts who pro\u00adduced this law, gives Amer\u00adi\u00adcans too lit\u00adtle cred\u00adit and its authors too much.  The Pres\u00adi\u00addent sure\u00adly knew that mil\u00adlions would lose the cov\u00ader\u00adage they liked and lied<\/a> about it in order to get the law adopt\u00aded and imple\u00adment\u00aded.  He sure\u00adly did not know that deba\u00adcle would accom\u00adpa\u00adny the launch of the health insur\u00adance exchanges, that his Admin\u00adis\u00adtra\u00adtion would have to waive numer\u00adous pro\u00advi\u00adsions of the law and ignore oth\u00aders because they were so shod\u00addi\u00adly writ\u00adten, that it would have to delay the employ\u00ader man\u00addate, that it would have to defy the law<\/a> in order to allow Con\u00adgres\u00adsion\u00adal employ\u00adees to keep their gov\u00adern\u00adment sub\u00adsi\u00addies, that the Supreme Court would strike down the law\u2019s require\u00adment that states expand their Med\u00adic\u00adaid pro\u00adgrams as well as a pro\u00advi\u00adsion that vio\u00adlat\u00aded the First Amend\u00adment<\/a>,<\/span> or that, five years after its enact\u00adment, that same court would be hear\u00ading oral argu\u00adments on whether one of its core pro\u00advi\u00adsions \u2013 health insur\u00adance pre\u00admi\u00adum sub\u00adsi\u00addies for peo\u00adple who enroll through the fed\u00ader\u00adal exchanges \u2013 is also unlawful.<\/p>\n

The Administration\u2019s ser\u00adi\u00adal blun\u00adders on Oba\u00admacare make Gruber\u2019s charge of stu\u00adpid\u00adi\u00adty look, shall we say, misdirected.<\/p>\n

Blun\u00adders aside, here\u2019s what we know \u2013 and still don\u2019t know \u2013 about the most con\u00adse\u00adquen\u00adtial law in a generation.<\/p>\n

What We Know<\/strong><\/p>\n

    \n
  1. Few\u00ader peo\u00adple are unin\u00adsured.<\/strong> How many few\u00ader isn\u2019t yet clear.  CDC<\/span><\/a> esti\u00admates that the ranks of the unin\u00adsured have been trimmed by near\u00adly 4 mil\u00adlion (to 41 mil\u00adlion from 44.8 mil\u00adlion).   The more author\u00adi\u00adta\u00adtive sur\u00advey by the Cen\u00adsus Bureau<\/a> sug\u00adgests that the num\u00adber of unin\u00adsured bare\u00adly budged (from 45.6 mil\u00adlion in last year\u2019s sur\u00advey to 45.2 mil\u00adlion in the one con\u00adduct\u00aded this past March), although that sur\u00advey arguably failed to cap\u00adture part of the surge in enroll\u00adments that occurred dur\u00ading March and April.   HHS<\/span><\/a>,<\/span> evi\u00addent\u00adly embar\u00adrassed by the Administration\u2019s offi\u00adcial num\u00adbers, ignored them in a recent report, instead cit\u00ading a more favor\u00adable study<\/a> based on Gallup poll results.  Shop\u00adping around for num\u00adbers miss\u00ades the larg\u00ader point: more peo\u00adple have cov\u00ader\u00adage today than if the law had not been passed and even more will gain cov\u00ader\u00adage in com\u00ading years.  That is a good thing, what\u00adev\u00ader the num\u00adber turns out to be.<\/li>\n
  2. Exchanges remain a mess.<\/strong> Here\u2019s the media nar\u00adra\u00adtive on exchanges: they were a dis\u00adas\u00adter for three or four months, but they turned the cor\u00adner and start\u00aded to work well.  Not quite.  It\u2019s true that the fed\u00ader\u00adal gov\u00adern\u00adment and that of sev\u00ader\u00adal states (includ\u00ading Mass\u00ada\u00adchu\u00adsetts<\/a>,<\/span> on which Oba\u00admacare alleged\u00adly was mod\u00adeled) botched the rel\u00ada\u00adtive\u00adly easy task of let\u00adting peo\u00adple shop online for cov\u00ader\u00adage.  Online shop\u00adping is hard\u00adly cut\u00adting edge.  Ehealth\u00adin\u00adsur\u00adance has been doing it for years. Sure\u00adly the gov\u00adern\u00adment couldn\u2019t screw that up.  Turns out that it could, and for sev\u00ader\u00adal months did, although that part of the exchanges is expect\u00aded to work rea\u00adson\u00adably well<\/a> this time around.   The prob\u00adlem is that exchanges are sup\u00adposed to do more than just let peo\u00adple select a plan.  They\u2019re required to deter\u00admine eli\u00adgi\u00adbil\u00adi\u00adty for sub\u00adsi\u00addies, ver\u00adi\u00adfy house\u00adhold income and whether the appli\u00adcant is a law\u00adful U.S. res\u00adi\u00addent, make sure that sub\u00adsidy checks go to the insur\u00adance com\u00adpa\u00adny in the right amount on a month\u00adly basis and per\u00adform oth\u00ader such admin\u00adis\u00adtra\u00adtive func\u00adtions.  This so-called \u201cback end\u201d of the exchanges still doesn\u2019t work the way it\u2019s sup\u00adposed to and prob\u00ada\u00adbly won\u2019t any\u00adtime soon.<\/li>\n
  3. The insur\u00adance prod\u00aduct is awful.<\/strong> If you were to pick the two fea\u00adtures of insur\u00adance poli\u00adcies that peo\u00adple hate most, they would be restric\u00adtive net\u00adworks (e.g., HMOs) and high deductibles.  Oba\u00admacare com\u00adbines both these fea\u00adtures into most of the prod\u00aducts sold through the exchanges.  That could prove a con\u00adtin\u00adu\u00ading irri\u00adtant to consumers.<\/li>\n
  4. Pre\u00admi\u00adums are afford\u00adable.<\/strong> Rel\u00ada\u00adtive\u00adly low pre\u00admi\u00adums are the result of this bit\u00adter brew of tight net\u00adworks and high cost-shar\u00ading.  Peo\u00adple may not be crazy about the prod\u00aduct, but fears of \u201crate shock\u201d gen\u00ader\u00adal\u00adly haven\u2019t mate\u00adri\u00adal\u00adized.  That said, the plans with the largest enroll\u00adment are the ones that have raised their 2015 pre\u00admi\u00adums<\/a> the most, so many con\u00adsumers will have to change insur\u00aders to avoid or min\u00adi\u00admize rate hikes. Those who don\u2019t switch will auto\u00admat\u00adi\u00adcal\u00adly be re-enrolled in their exist\u00ading plans. That will pro\u00adduce some unhap\u00adpy results<\/a>,<\/span> par\u00adtic\u00adu\u00adlar\u00adly for those now receiv\u00ading subsidies.<\/li>\n
  5. Worst. Law. Ever.<\/strong> I was involved in draft\u00ading health care leg\u00adis\u00adla\u00adtion for many years.  Some of the things that I had a hand in writ\u00ading (Medicare Part D and health sav\u00adings accounts) actu\u00adal\u00adly became law.  It is a com\u00adpli\u00adcat\u00aded busi\u00adness and I cer\u00adtain\u00adly have made mis\u00adtakes.  But if any\u00adthing I\u2019d helped write had been this slip\u00adshod, ama\u00adteur\u00adish and unwork\u00adable, I prob\u00ada\u00adbly wouldn\u2019t be chirp\u00ading at eco\u00adnom\u00adic sem\u00adi\u00adnars about the \u201cstu\u00adpid\u00adi\u00adty of the Amer\u00adi\u00adcan people.\u201d<\/li>\n<\/ol>\n

    What We Still Don\u2019t Know<\/strong><\/p>\n

      \n
    1. Is demand for health insur\u00adance less than had been assumed?<\/strong> When Oba\u00admacare was enact\u00aded, CBO<\/span> esti\u00admat\u00aded that it would reduce the num\u00adber of unin\u00adsured to 21 mil\u00adlion<\/a> in 2016;  now they believe that 30 mil\u00adlion<\/a> will remain unin\u00adsured in that year.  That\u2019s a big dif\u00adfer\u00adence and one that has com\u00adpli\u00adcat\u00aded caus\u00ades, but it does sug\u00adgest that there may not be a huge pent-up demand for health insur\u00adance. Reduc\u00ading the num\u00adber of unin\u00adsured even to 30 mil\u00adlion over the next two years will require a big uptick in exchange enroll\u00adments.  CBO<\/span> projects that exchange enroll\u00adments will near\u00adly dou\u00adble next year to 13 mil\u00adlion and near\u00adly dou\u00adble again in 2016 to 24 mil\u00adlion.   HHS<\/span> now believes that the num\u00adber of enrollees next year will be far less, esti\u00admat\u00ading that 9\u201310 mil\u00adlion<\/a> peo\u00adple will sign up dur\u00ading this open sea\u00adson. If this esti\u00admate proves accu\u00adrate, we may end up with more than 30 mil\u00adlion unin\u00adsured on a long-term basis, bar\u00adring oth\u00ader changes (like grant\u00adi\u00adng legal sta\u00adtus to peo\u00adple not law\u00adful\u00adly present in the U.S.).<\/li>\n
    2. Will more peo\u00adple agree to pay full price for their health insur\u00adance?<\/strong> Speak\u00ading of demand for health insur\u00adance, it appears that peo\u00adple don\u2019t want it if they have to pay the full price.  Three out of four peo\u00adple who com\u00adplet\u00aded appli\u00adca\u00adtions dur\u00ading the first open sea\u00adson and who were told that they did not qual\u00adi\u00adfy for a sub\u00adsidy didn\u2019t both\u00ader to select a plan.  Only 15 per\u00adcent of those who enrolled dur\u00ading the first open sea\u00adson are pay\u00ading an unsub\u00adsi\u00addized pre\u00admi\u00adum.  This isn\u2019t ter\u00adri\u00adbly sur\u00adpris\u00ading.  The aver\u00adage month\u00adly sub\u00adsidy for peo\u00adple enrolled through the exchanges was $264<\/a>,<\/span> or about 76 per\u00adcent of the aver\u00adage month\u00adly pre\u00admi\u00adum.  That\u2019s pret\u00adty sim\u00adi\u00adlar to the sub\u00adsi\u00addies received by those who get cov\u00ader\u00adage from oth\u00ader sources.  Employ\u00ader con\u00adtri\u00adbu\u00adtions to health pre\u00admi\u00adums aver\u00adage around 72 per\u00adcent<\/a>,<\/span> which is what the fed\u00ader\u00adal gov\u00adern\u00adment con\u00adtributes, on aver\u00adage, to the pre\u00admi\u00adums of its employ\u00adees. Pay\u00ading \u2014 or, more accu\u00adrate\u00adly, think\u00ading that you\u2019re pay\u00ading \u2014 only a por\u00adtion of the pre\u00admi\u00adum is a time-hon\u00adored Amer\u00adi\u00adcan cus\u00adtom.  Oba\u00admacare has not yet con\u00advinced peo\u00adple that pay\u00ading an unsub\u00adsi\u00addized pre\u00admi\u00adum is a good deal.<\/li>\n
    3. Can Oba\u00admacare sur\u00advive with\u00adout cor\u00adpo\u00adrate wel\u00adfare pay\u00adments to insur\u00aders?<\/strong> Every\u00adbody knows about income-based sub\u00adsi\u00addies to needy indi\u00advid\u00adu\u00adals.  Few have paid much atten\u00adtion to gov\u00adern\u00adment sub\u00adsi\u00addies to needy insur\u00adance com\u00adpa\u00adnies.   This cozy lit\u00adtle arrange\u00adment includes a $10 bil\u00adlion \u201crein\u00adsur\u00adance\u201d pay\u00adment that the gov\u00adern\u00adment is mak\u00ading to such plans this year.  On aver\u00adage, tax\u00adpay\u00aders give insur\u00adance com\u00adpa\u00adnies $1,408 for each of the 7.1 mil\u00adlion<\/a> peo\u00adple enrolled through the exchanges, or about $117 per enrollee per month.  With\u00adout this cor\u00adpo\u00adrate wel\u00adfare, the aver\u00adage month\u00adly pre\u00admi\u00adum for plans sold through the exchange would be $463 instead of $346<\/a>.  But there\u2019s more.  The gov\u00adern\u00adment also is promis\u00ading to pay these same insur\u00aders bil\u00adlions more through some\u00adthing called \u201crisk cor\u00adri\u00addors<\/a>.\u201d  Both the Gen\u00ader\u00adal Account\u00adabil\u00adi\u00adty Office<\/a> and the Con\u00adgres\u00adsion\u00adal Research Ser\u00advice<\/a> have said that it is unlaw\u00adful for the gov\u00adern\u00adment to make these pay\u00adments absent an appro\u00adpri\u00ada\u00adtion.  The Admin\u00adis\u00adtra\u00adtion will make them any\u00adway.  And my guess is that the gov\u00adern\u00adment will con\u00adtin\u00adue to make them long after these sup\u00adpos\u00aded\u00adly tem\u00adpo\u00adrary pro\u00advi\u00adsions are set to expire.  The Pres\u00adi\u00addent pro\u00adfess\u00ades to hate insur\u00adance com\u00adpa\u00adnies<\/a>,<\/span> but he just might have a secret crush on them.<\/li>\n
    4. How will vot\u00aders react next year when the tax on the unin\u00adsured is col\u00adlect\u00aded for the first time?<\/strong> There\u2019s a new tax in town and peo\u00adple will find out about it when they fill out their 1040s ear\u00adly next year.  If you lacked health insur\u00adance cov\u00ader\u00adage for any month dur\u00ading 2014, you have to pay the new tax, unless you qual\u00adi\u00adfy for a \u201chard\u00adship exemp\u00adtion.\u201d  The tax will be deduct\u00aded from your refund check.  The pub\u00adlic might just take this in its stride.  On the oth\u00ader hand, it might stir anoth\u00ader round of resent\u00adment over the law.<\/li>\n
    5. Will the Supreme Court rule against Oba\u00admacare?<\/strong> Hard to believe, but this March the court will mark the fifth anniver\u00adsary of the law\u2019s enact\u00adment by hear\u00ading oral argu\u00adments<\/a> in a chal\u00adlenge to the law\u2019s sub\u00adsi\u00addies.  Their deci\u00adsion in the case is expect\u00aded next June.  The law says that sub\u00adsi\u00addies are avail\u00adable only for pre\u00admi\u00adums pur\u00adchased through a state exchange.  Some 36 states do not oper\u00adate such exchanges, hav\u00ading turned that task over to the fed\u00ader\u00adal gov\u00adern\u00adment.  In a relat\u00aded case, a three-judge pan\u00adel from the D.C. Cir\u00adcuit Court of Appeals ruled that it is unlaw\u00adful to pay sub\u00adsi\u00addies on behalf of peo\u00adple enrolled in such fed\u00ader\u00adal exchanges.  In essence, the Court must decide whether the law is what Con\u00adgress, bless their point\u00aded lit\u00adtle heads, meant to write or what they actu\u00adal\u00adly wrote.  If the Supreme Court upholds the let\u00adter of the law and strikes down the sub\u00adsi\u00addies, then Con\u00adgress would almost cer\u00adtain\u00adly have to rewrite the law.<\/li>\n<\/ol>\n

      Which, come to think of it, might not be such a bad idea.<\/p>\n","protected":false},"excerpt":{"rendered":"

      If you are a law\u00adful res\u00adi\u00addent of the Unit\u00aded States and you lack health insur\u00adance today, it\u2019s almost cer\u00adtain\u00adly your fault.  You can\u2019t blame your employ\u00ader, the gov\u00adern\u00adment or the insur\u00adance com\u00adpa\u00adnies.  It\u2019s on you. That is the last\u00ading achieve\u00adment of \u2026 Con\u00adtin\u00adue read\u00ading \u2192<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":2803,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","wp_typography_post_enhancements_disabled":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"nfd_image_url":"","nfd_onboarding_generated":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[16,124,344],"tags":[31,511,70,648,1010,401,44,1007,623,122,1009,1008,1188,1190,1192,59],"class_list":["post-2794","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","category-obamacare","category-supreme-court","tag-cbo","tag-cdc","tag-census-bureau","tag-corporate-welfare","tag-crs","tag-exchanges","tag-gao","tag-halbig-v-burwell","tag-health-insurance-exchanges","tag-hhs","tag-jonathan-gruber","tag-king-v-burwell","tag-obamacare","tag-president-obama","tag-supreme-court","tag-uninsured"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t