Viewpoints: Parsing Obamacare numbers; experts on long-term care insurance; French cancer care

Feb 17 2014

Bloomberg: The Only Obamacare Number That Matters 
The monthly announcement of Obamacare's enrollment figures has become an exercise in confirmation bias, starting with the administration itself. Health and Human Services Secretary Kathleen Sebelius noted the "encouraging trends" in yesterday's release, while House Speaker John Boehner opted to highlight its "embarrassing failures." ... The only debate worth having is how to improve enrollment. ... enrollment numbers for Obamacare aren't some referendum on the president's popularity or lack thereof. They're the best way to tell whether the law is working as planned -- and how to adjust if it isn't (2/13).

Bloomberg: Obamacare's Missing Numbers
The number 3.3 million represents people enrolled in a policy, not the number who have paid for their premiums. Most of the reporting -- which comes from insurance industry sources -- suggests that about 80 percent of those who signed up have actually paid the first month's premium. ... The demographic mix isn't improving as hoped. ... We still have no idea how many of these people previously had insurance. If the administration knows, it is not sharing those numbers with anyone else (Megan McArdle, 2/13).

Bloomberg: Obamacare Enrollment Slowed in January. Does That Matter?
Enrollment in the Affordable Care Act's insurance exchanges grew again in January, but it grew at a much slower pace than the month before. How much of a concern that is for the law is open to interpretation. In raw numbers, total enrollment in January was indeed a win for the Barack Obama administration ... On the other hand, there are just two months left in the six-month open enrollment period ... the only game that matters right now is getting more people -- mostly young people, and young men in particular -- to sign up (Christopher Flavelle, 2/13).

The New York Times: Inequality, Dignity And Freedom
Now that the Congressional Budget Office has explicitly denied saying that Obamacare destroys jobs, some (though by no means all) Republicans have stopped lying about that issue and turned to a different argument. O.K., they concede, any reduction in working hours because of health reform will be a voluntary choice by the workers themselves -; but it's still a bad thing because, as Representative Paul Ryan puts it, they'll lose "the dignity of work." ... if you really care about the dignity and freedom of American workers, you should favor more, not fewer, entitlements, a stronger, not weaker, social safety net (Paul Krugman, 2/13).

The New York Times' Economix blog: Tax Subsidies And The Incentive To Work
It is worth reading Appendix C of the C.B.O. report to get a feel for what is really at stake here. In that appendix the agency explains, for example, that its "estimate that the A.C.A. will reduce employment reflects some of the inherent trade-offs involved in designing such legislation." Further clarification was offered in a "Frequently Asked Questions" statement by the C.B.O. The agency alludes there to the fact that any program offering means-tested public assistance to citizens will do much good but implicitly confront citizens with higher marginal tax rates that may induce these beneficiaries to work fewer hours or even retire (Uwe E. Reinhardt, 2/14).

The Washington Post: Obamacare's War On Jobs 
The honest liberal reply to the CBO report is that a disincentive to work is inherent in any means-tested government benefit. It's the unavoidable price of helping those in need because for every new dollar you earn, you lose part of your subsidy and thus keep less and less of your nominal income. ... But Obamacare's war on jobs goes beyond voluntary idleness. The administration is now conceding, inadvertently but unmistakably, Obamacare's other effect -; involuntary job loss (Charles Krauthammer, 2/13).

The Washington Post: The GOP's Health Crisis
The news that nearly 1.2 million people signed up last month for insurance through the Affordable Care Act exchanges is highly inconvenient for GOP candidates nationwide. ... Republicans may even have to take the drastic step of saying what they advocate, rather than harping on what they oppose. Is there a GOP plan to cover those with preexisting conditions? To cover the working poor? Is expanding access to health insurance really such an awful thing? Sorry, I didn't catch what you said (Eugene Robinson, 2/13).

USA Today: GOP's Unhealthy Strategy
It is hard to imagine anything they could have cooked up on their own that would have enabled Republicans to feast on for so long as Obamacare. It gave them talking points, 47 opportunities to vote to repeal the law and now a narrative for the 2014 elections. And just as the GOP was beginning to discuss immigration reform, it was erased from the menu in favor of a pig-out on the flaws of the Affordable Care Act. But putting too many eggs in the Obamacare basket could leave Republicans with insufficient nourishment for the fall campaign (Ross K. Baker, 2/13). 

The Washington Post: The Tea Party Position On Obamacare
A senior member of the Louisiana Democratic Party tells me Dems will try to get a state Constitutional amendment to expand Medicaid on the ballot on Election Day 2014. The chances of succeeding at that are very slim – more on that in a moment – but this goes to the heart of a very interesting storyline that's set to unfold in Louisiana this spring involving Americans for Prosperity, the group backed by the Koch brothers, Mary Landrieu, and the health law. This storyline also neatly captures the true nature of the Tea Party position on Obamacare (Greg Sargent, 2/13).

The Fiscal Times: Obama's Health Care Mandate: My Whim Is My Command
The latest arbitrary salvo from the Obama administration in an attempt to rescue its collapsing command health-insurance economy came from the Treasury Department earlier this week. As Barack Obama made headlines by issuing yet another delay in enforcement of the employer mandate – again ignoring the January 2014 statutory deadline for compliance in his own legislation – Treasury announced that it would keep an eagle eye on businesses that reacted to the exploding costs of compliance. The IRS would require employers to file a "self-attestation" on their tax forms "to 'certify' that they are not shedding full-time workers simply to avoid the mandate." This demand is based on … what, exactly? (Edward Morrissey, 2/13).

JAMA: Henry Waxman: Architect Of The Health Care Safety Net
As a medical student in New York and then a resident in San Francisco, I received a substantial amount of my training in safety-net hospitals. … In 2009, as a Robert Wood Johnson Health Policy Fellow, I had the opportunity to meet and work for one of the primary architects of the health care safety net, Congressman Henry A. Waxman (D, California). ... With the ACA's expansion of health insurance coverage, questions are emerging about the future of the health care safety net. ... Without Henry Waxman in Congress, finding answers to guide the health care safety net into the future is likely to become significantly more difficult. (Dr. Andrew Bindman, 2/13).

Los Angeles Times: Will Philip Seymour Hoffman's Death Be A Wake-Up Call?
After Hoffman's death, reports surfaced that the actor, a onetime heroin addict, had been abusing prescription opiates, which ultimately led him back to heroin. That's a common path ... On the street, opiate pain pills sell for $1 a milligram, according to police and addicts I've interviewed across the country. An addict can need 150 to 300 milligrams a day. A comparable high from heroin is a fifth to a tenth the price, which is part of the reason its use has almost doubled between 2010 and 2012 ... So here's hoping that Hoffman's death, which encapsulates much of this epidemic, will also rouse us to a thing that is deadlier and quieter than any drug plague we've seen before (Sam Quinones, 2/14).

Reuters: The French Way Of Cancer Treatment
When my father, the editor and writer Andre Schiffrin, was diagnosed with stage four pancreatic cancer last spring, my family assumed we would care for him in New York. ... my father announced he wanted to stick to his normal schedule -; and spend the summer in France. ... the French system is basically like an expanded Medicaid. Pretty much everyone has insurance, it explained, and the French get better primary care and more choice of doctors than we do. ... We didn't have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments. Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father (Anya Schiffrin, 2/12).

The Wall Street Journal has a panel of experts answering the question: Should healthy, younger individuals consider long-term-care insurance? The responses:

What to Consider When Considering Long-Term-Care Coverage (Sheryl Garrett, 2/13)

Get Long-Term-Care Insurance While You're Healthy (Charles Rotblut, 2/13)

You're Not Too Young For A Long-Term-Care Policy (Larry Zimpleman, 2/13)

Start Shopping For Long-Term-Care Insurance at 45  (Michelle Perry Higgins, 2/13)

Why Long-Term-Care Coverage Is Right for Me (Olivia Mitchell, 2/13)

Don't Buy Long-Term-Care Insurance. Self-Fund It. (Manisha Thakor, 2/13)