Levees Not War

Insurers, Too, Must Be Held Accountable

Our friend Stephen in NYC, who has contributed good ideas to this blog before, shares his experience in enrolling with an insurer. Stephen makes the very important point that the news media (including us bloggers) would serve the public interest if we would “start reporting on the incompetence of the health insurance companies and their technologically defective systems for enrollment, rather than putting all the blame for the recent mishaps of health insurance enrollment on the ACA rollout. My own experience is a case in point.”

One week after his old health-insurance policy lapsed, and three weeks after he mailed his application (with payment) to a New York health insurance company—and after speaking to eight customer service representatives and supervisors at the new insurance company over the past week—he was finally enrolled in the policy he had applied for (retroactive to Jan. 1), perhaps moved along by the threats he made earlier that day to alert the New York State attorney general, U.S. Senator Kirsten Gillibrand, and WOR-TV’s “Help Me, Howard” if his policy was not in effect within 24 hours—in addition to the letter that he had sent to The New York Times the day before, which is copied below.

To the Editors:

The NY Times and most other (all other?) news organizations have been covering the mishaps of the ACA rollout and ascribing them entirely to the incompetent programming of the new fed health-exchange website and some state health-exchange websites. I’d like to suggest, from my recent experience trying to get a 2014 health-insurance plan by enrolling directly with a NY health-insurance company (i.e., NOT through an exchange), that much of the incompetence is with the health-insurance companies themselves and has nothing to do with ACA. I’m still trying to get my new health-insurance company, Emblem Health, to actually enroll me in their 2104 health-insurance plan (as opposed to theoretically enrolling me)—and I applied directly through their own system, not through the fed or state health exchange.

As of today, Jan. 7, I still don’t have health insurance (my 2013 plan lapsed on Dec. 31), even though I sent my application for enrollment, along with a check for payment, by mail on Dec. 16—and it was received there on Dec. 19. Since then, I have called Emblem Health numerous times and have spoken to seven customer representatives and two supervisors, and was assured on Dec. 31 that my enrollment was in fact being processed, and that I would receive an e-mail affirming that I would be enrolled shortly and that my coverage would be retroactive to January 1. I have received nothing. I called Emblem Health again today and spoke to another customer representative, who searched on the Emblem Health system and found that my name was not on it yet. Tomorrow, I will be calling the supervisor to whom I spoke on Dec. 30 AND ON Dec. 31 (when I stayed on the phone continuously for 3 hours), to ask her why I have not heard from her about my enrollment nor received the e-mail confirming my imminent enrollment and retroactive coverage. (It’s a good thing I’ve had no health emergencies during this past week.)

So when I read or hear news reports of how bad ACA is, I’ve decided to be skeptical, and I’d like the NY Times to demonstrate some of that same skepticism, and to report on the effectiveness (or lack thereof) of the insurance companies and what appears to be their technologically defective systems for enrollment. I would be happy to share with a NY Times reporter more details of my frustrating experience trying to enroll for a health-insurance plan outside the exchange.

Well done, Stephen. Congratulations. But note how much time and effort he had to expend—time he had to take from his freelance work, which means a loss of some potential income. It should not have to be so difficult.

Dear readers, we encourage you to share your experiences in enrolling with health care providers under the Affordable Care Act. You can also share your stories—success stories, we hope—on Facebook at ACA Success Stories (facebook.com/acasuccessstories). Bloggers, reporters, hold the companies accountable, too, as well as the elected officials and pundits who are obstructing progress and exaggerating glitches and malfunctions for political gain.

We would also recommend that readers take a look at Rachel Maddow’s emphasis on the slow start of ‘Romneycare’ in Massachusetts (TRMS 1/2/14). This healthcare coverage expansion program, now regarded as a success for the people of Massachusetts, is roughly the template on which the Affordable Care Act was designed.

Despite Successes, 47 Million Americans Lack Health Coverage

Josh Marshall of Talking Points Memo finds that some 9 to 10 million people have gained health care coverage because of the Affordable Care Act, and that about 5 million “currently do not have coverage because individual states decided not to opt into Medicaid expansion.” By the end of 2013, more than 1.1. million Americans had signed up for healthcare coverage through Healthcare.gov. (One Charles Gaba has been compiling data on the number of people who have enrolled for healthcare coverage through the 14 states that have exchange sites.) Still, the Kaiser Family Foundation reports, some 47 million Americans are without healthcare coverage.

For political reasons, of course, Republicans want the president’s healthcare expansion initiative to fail.

While we’re “redistributing blame” for the ACA’s rocky start, let’s look also at what Steve Benen calls “the scourge of the wingnut hole” (the term “wingnut hole” was coined by Ed Kilgore). Whenever the totals of people enrolled in healthcare insurance programs under the Affordable Care Act are given, Benen says, “it’s worth remembering that the coverage totals would be far greater were it not for “red” states refusing to accept Medicaid expansion”—5 million greater, as Josh Marshall reports above.

In a related article, Ryan Cooper at the Washington Post’s Plum Line points out: 

About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America. . . . The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children. . . .

Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.

Expanding healthcare coverage has been, and will continue to be, a struggle. But it is the good fight. It’s our hope that the circle of coverage will expand steadily, eventually to include all Americans, and that the insured will be able to have their policies in good health (that is, not to need them for anything too serious).

Further Reading

Healthcare.gov

Kaiser Family Foundation

Healthcare coverage at Think Progress

Healthcare at Mother Jones

Healthcare at The Nation

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[cross-posted at Daily Kos]

Has anyone besides us found it kind of odd that there’s been so much “fire and brimstone” about the health care reform bill compared to Bush’s Iraq War?

The first thing we’ll say about the violence and threats following Congress’s passage of health care reform—officially the Patient Protection and Affordable Care Act—is that right-wing politicians and radio/TV “hate-spewers” have stoked outrage among their followers and are still fueling the flames. They thrive on conflict; it boosts ratings and fund-raising. The second observation, which we find more intriguing, is that there is a shocking disparity between the opponents of Obama’s health care reform and the anti-war protesters who opposed Bush’s drive to invade Iraq. Both presidential “initiatives” have been controversial, but the temperament and character of the public protests of each are different in the extreme. It is more than a little disconcerting that a push to expand public access to health care is more violently opposed than a determined march to a war of choice. Look at the aims, the purposes underlying the two initiatives, and think about which warrants the more passionate support, and which the stronger opposition.

Maybe the different responses are not so surprising, though, when you consider the traditional American readiness to wage war (as long as we personally don’t have to fight it, or have our taxes raised to fund it), and our reluctance to spend money on (rather, to be taxed for) public health, education, or other social programs. The Pentagon has the credit card.

“Break Their Windows. Break Them Now.”

In recent weeks millions of Americans have been alarmed by the death threats and bricks through office windows of Democratic members of Congress, the spitting and ugly slurs at the Capitol when the House of Representatives was debating the health care bill. Americans have been troubled, too, by the silence of the Republican leadership, who have opened their mouths only to say that “the American people have a right to be angry”—then to claim the Democrats are to blame for the threats and violence against Democrats. (This is akin to Iowa Rep. Steve King’s combining a near-justification of Joseph Stack’s flying his plane into a Texas federal building in Austin in February with self-promotion of his own calls to abolish the IRS. If only we’d listened!)

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Just when we were trying to get our attention back on flood-protection infrastructure and coastal restoration . . .

We try to get along nice with everyone, but still we were surprised to receive a “Dear Friend” e-mail from Louisiana’s Republican senator David Vitter (as distinct from the other Louisiana senator who just votes like a Republican half the time). It was dated April 1, but we don’t think it was an April Fool’s joke. Was Mr. Vitter writing to say “sorry I took up so much time trying to stall passage of the health reform bill in the Senate last week with frivolous, unworkable legislation”? No, silly, he was writing to assure us that he has already filed a bill to repeal “Obamacare” because “In the face of tremendous public outrage and bipartisan opposition, the president and liberal politicians in Congress violated the Constitution and ignored the will of American people.” [full text below] Wow, are there really that many liberals in Congress?

The second paragraph reads in full:

This newly-signed law is packed full of policies the American people overwhelmingly and loudly rejected. We know it will add to our already enormous national deficit, increase the burden on American families by enacting job-killing taxes and put the government between patients and their doctors. This bill’s mandates are unconstitutional, and the process by which it was passed disrespects not only the will of the public, but also our legislative process. Worst of all, this bill insults and disregards the traditions that have made our country great—limited government, personal responsibility and individual freedom.

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“. . . what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.” —Senator Edward M. Kennedy to President Obama

“We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn’t work, we will parachute in. But we are going to get health care reform passed.” —House Speaker Nancy Pelosi, press conference, Jan. 28

We’re almost there. Last night the House of Representatives voted 219–212 for the health care reform legislation that was passed by the Senate on Christmas Eve, along with a separate, amending bill of “fixes” to fine-tune the Senate bill. President Obama will sign the House-approved Senate bill tomorrow, and the Senate, we hope, will soon pass the “fixes” without a single word changed, via budget reconciliation, which requires only a simple majority (at least 51 votes). (Reconciliation process explained here.) Even without the fixes, however, with the president’s signature the Senate+House bill becomes the law of the land. (Click here to see 11 hours of debate distilled into 10 minutes of hi-lites and lo-lites.)

The House’s amendments would cover 32 million of the uninsured by 2019 (the Senate’s would cover 31 million), and would cut deficits by $138 billion over the first 10 years ($118 billion under the Senate bill) and by over $1 trillion in the following decade, according to the Congressional Budget Office. The House bill would also increase the subsidies to help low- and middle-income people afford health insurance and would do more to close the so-called donut hole, the gap in Medicare coverage for prescription drugs. For an additional fee, parents will be able to be able to keep adult dependent children on their health insurance plans up to the age of 26—great news for young people having trouble finding a job.

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Did you miss us? We apologize for a longer-than-usual absence, but there was a family medical emergency involving coronary intensive care that showed us all too dramatically (as though we didn’t already appreciate it) the life-or-death urgency of access to good health care. (Mom is recovering now, thank God.)

We’ve also been busy again with Organizing for America health care phone banks. On Thursday night some two or three dozen volunteers gathered in an apartment in Manhattan’s Gramercy Park to phone voters and urge them to call Congressman Scott Murphy in New York’s 20th congressional district to urge him to reverse his November “Nay” and vote for the health reform bill on Sunday. Our group made 1,446 phone calls, spoke to 417 people,  and got 232 to commit to calling Congressman Murphy. Rep. Murphy has now announced that he will vote for the health bill. (See our previous post “Scenes from a Health Reform Phone Bank.”) One woman we spoke to said she had already called the congressman once; was it okay to call again?

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We’ll soon have more to say about Thursday’s health care reform summit, but first wanted to share some good observations written by Ezra Klein of the Washington Post (a sharp, gifted young blogger-reporter who knows policy like a wonk but explains it in plain English). In a blog post titled “Sen. Lamar Alexander Explains Why There’ll Be No Compromise,” Klein observes:

At best, what you can say today is demonstrating is that there’s a sharp contrast in the philosophies on display: Democrats believe the federal government is capable of writing and implementing legislation that will take a big step forward on a hard problem. Republicans believe government doesn’t have that capability, and shouldn’t try. There’s no real compromise available between those two position, but they’re philosophies that the American people can choose between.

(This, by the way, is a good, clear way of saying from another angle what we’ve observed before about the parties’ different philosophies of governance, and shows why, if, say, you want public, government-directed investment in flood defense infrastructure or environmental protection, if you want public officials who just might believe in a social contract and a social safety net, you want to vote in as many Democrats—preferably progressive Democrats—as possible.)

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Scare Tactics Unlimited: From “Death Panels” to “Nuclear Option”

On the eve of the health care reform summit convened today by President Obama, Republican senators, echoed by their chorus of Beck, Limbaugh, Drudge, et al., are smearing as a “nuclear option” the Senate Democrats’ potential strategy of passing health reform via budget reconciliation, a not uncommon procedure. Senators Kyl, Cornyn, and Hatch are lying, and they know it. Republicans are trying to alarm the public and intimidate the Democrats from using reconciliation because they know the Dems are going to push reform through with or without them. Reporters, news organizations should not let them get away with this mendacious blurring of two distinct phenomena.

As explained in a comment to a reader yesterday, the “nuclear option” denounced by Senators Biden and Obama in 2005 was not voting by budget reconciliation, but a Republican threat to totally obliterate the filibuster. Budget reconciliation, a perfectly rule-abiding process for passing legislation that reduces the deficit (that’s its original intent, since 1974), has been used 22 times since 1980, sixteen of which were led by Republicans, as with the 2001 and 2003 Bush tax cuts. Reconciliation has also been used by Democrats to pass health reform legislation such as COBRA and S-CHIP. Reconciliation is explained further in this previous post, written at a less optimistic stage of the long process.

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