Tag Archives: affordable care act

Measuring Success

There are many ways to measure success and/or failure, and it’s important to keep that in mind when you assess hot-button issues. For instance, this article in the Greensboro News & Record about Obamacare’s affect on insurance coverage in North Carolina:

In North Carolina, 16.7 percent of residents are now uninsured, compared with 19.6 percent before the onset of the ACA, according to a study conducted by the social network WalletHub.


North Carolina ranked 33 among states for its number of uninsured residents.

The Tar Heel state also ranked fourth among states with the most net new private insurance enrollees per capita.

WalletHub used data from the Kaiser Family Foundation, the Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services and the Census Bureau to make its projections.

Those who supported Obamacare will likely tout this statistic as proof that Obamacare is working. On the other hand, those opposed to Obamacare can ask the question, “But at what cost?” That’s the crux of the issue: we can all probably agree that more people having health insurance is a good thing, but we’d probably have lots of heated debate over how much to pay for it, how to pay for it and how to structure the program. Does the phrase “socialized health care” ring any bells.

Quite frankly I think it’s far too early in the process to declare Obamacare a success or failure, but I’d say these numbers show a positive trend towards getting more people health insurance coverage. Long term who knows whether or not Obamacare will be a net success, but at a minimum we’ve seen thousands of North Carolinians moved off the roles of the uninsured and that’s a step in the right direction.


Health Insurance – Caveat Emptor

One of the problems with buying health insurance is that it's one of the most complicated purchase any one of us will make in any given year. With the advent of Obamacare scores of people will be buying insurance on an open market for the first time – versus opting from a limited set of options from an employer – and that means the complexity of the process will have an ever greater impact in the coming years. That's what makes this story on Planet Money so scary:

Any day now — assuming the government manages to fix HealthCare.gov — millions of people will start shopping for health insurance.

Will those shoppers know what they're doing? More to the point, if you're one of those shoppers, will you know what you're doing?

Here's a quick quiz, courtesy of economists George Loewenstein and Saurabh Bhargava, who study what people know (and what they think they know) about health insurance. The economists have used longer versions of these quizzes in their research…

While the share of people who answered each question correctly varied, the vast majority of people who took the quizzes got at least something wrong.

And this isn't just some academic artifact: Bhargava and Loewenstein are leading an ongoing study of some 50,000 real-world choices that people make when shopping for insurance — and found that 65 percent of the time, people choose plans that are more expensive than other options but don't provide more benefits.

You should go take the quiz. You might be surprises at how much you think you know that you really don't.

The Red State ACA Donut Holes

North Carolina, like many states controlled by Republicans, opted out of the Medicaid-expansion component of the Affordable Care Act. A New York Times article explores the practical effect it's having on those states' citizens:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states…

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”

We're going to be hearing a LOT about the ACA, aka Obamacare, rollout over the next few months. The program opened for enrollment on Tuesday (Oct 1) with a start date set for January and the traffic to the website was heavy enough that it slowed to a crawl.  Like any new program, especially one of this scale, there will be issues but it will be interesting to see if the overall benefits outweigh the problems enough that people will eventually say "Keep the government's hands off my ACA!"

If that does happen it will be with folks like the self-employed who couldn't get on a regular insurance plan that was anywhere near affordable, the employees working for small employers who stopped offering health insurance long ago because they couldn't afford to provide coverage and weren't legally required to, and the folks with preexisting conditions who couldn't get any coverage no matter how much they were willing to spend. Sadly it seems that a huge chunk of the working poor will fall in the "not poor enough" donut hole created by states' refusal to expand Medicaid and won't have access to a program that was most definitely intended for them.

As you can likely tell I'm one of those who is truly hoping that ACA is a step in the right direction for our country. I don't believe it's a silver bullet or that it truly fixes anything, but I'm hoping that it's a step in the direction of a comprehensive, effective reform of our health care system. It's still way too early to see what the end result of ACA is going to be, but quite frankly it would be hard to go backwards from where we've been in the recent past so I'm pretty confident it will be a net benefit for society. On the other hand I seriously doubt it's enough on its own and I hope we continue to look for ways to make sure the neediest have some form of health coverage without bankrupting the rest of us in the process.

What’s In a Name

This is easily the most unsurprising video you'll see today. Street interviews with people who are against Obamacare but for the Affordable Care Act. If you don't know why that's funny then you may now understand why we have a problem here.

Two big points to make here:

  • This highlights why the names assigned to bills/laws are so important. People like the Affordable Care Act not because they know what it is, but because it must be affordable because that's what they call it!
  • We can also see how effective the relentless hammering home of simple talking points like "Obamacare is Socialist" has been. There's a reason political hacks on both sides of the aisle come up with a couple of simple blurbs and repeat them relentlessly-in this day of 10-second sound bites it's a very effective way to frame an issue.


ACA Getting Real

Despite the noise being made from the lunatic fringe of the Republican party about shutting down the government in an effort to force the defunding of the Affordable Care Act (ACA), the reality we're all facing is that the implementation of the ACA is set to begin in earnest over the next couple of months. For those of us who aren't intimately familiar with the effects that ACA will have on our lives there are now a few resources we can access to try and understand where this law is going to take us. Those resources include:

  • The Nevada Department of Insurance's site dedicated to explaining the ACA and allowing folks to get quotes for the various plans available through the state's exchange/marketplace. Obviously the quotes won't apply to non-residents of Nevada, but the general information is useful to non-residents and the pricing should be someone relevant to other states, especially when it comes to subsidies for lower income individuals and families.
  • The Triad Business Journal has an article about Blue Cross Blue Shield of North Carolina's announcement of its rates this coming Thursday and what we North Carolinians will likely be looking at come the October 1 deadline for insurers to make their rates public.
  • The US Census' site that shows how many uninsured there are in NC by demographics, which is a good indicator of how many people will be eligible for coverage and subsidies under the ACA.

While it's nearly impossible for anyone to predict exactly what's going to happen with the implementation of the ACA, it's becoming increasingly clear that major changes in the health care marketplace are afoot. One thing I personally hope to see is that the NC market for health insurance grows more competitive. We've had what is for all intents and purposes a duopoly in this state for years and it would be great to have more viable, competitive insurers to choose from.


The Miracles and Limitations of Modern Health Care

My wife and I spent yesterday at Brenner Children's Hospital in Winston-Salem with our youngest son. Our son has been dealing with a condition called supraventricular tachycardia (SVT), which in layman's terms means his heart will sometimes beat really fast – like 200 beats-per-minute fast – for extended periods of time even if he's sitting still. He was in the hospital for a procedure called a cardiac ablation which, if successful, would prevent these episodes from happening in the future.

The way the ablation was explained to us is that the doctor would send catheters through major veins in the legs to our son's heart and, depending on where in the heart the problem was, either burn or freeze the part of the heart that was causing it to go into this abnormal rhythm. Our son would be put under general anesthesia for the procedure and it would likely take about four hours. They would provoke his heart into going "wonky" (that's our technical term for it), identify the problem area, treat it and then observe it for a period of time to make sure they got all of it. If they needed to they'd freeze or burn more spots until they had the problem area taken care of.

Here's the really amazing part: if all went as planned we'd have our son back home the same day and he'd be under orders to take it easy for four days, not lift anything heavy for about a week, and then he'd be back to normal. To us this was truly a miracle of modern medicine – our son would have a heart procedure as outpatient surgery!

Thankfully all went as planned and we had our son home last night. Truly amazing.

Unfortunately modern medicine also has its limitations. While we were in the waiting room during our son's surgery a doctor came out and met with a mother and grandmother waiting near us. It was very early in the morning and most of the folks in the waiting area were asleep, thus it was pretty quiet. We tried our best not to eavesdrop, but it was impossible not to hear pieces of what the doctor was telling the mother – that her child did indeed have some rare, malignant cancer. It was also impossible not to hear the mother's crying and her mother trying to console her. And quite frankly it was impossible not to break down ourselves once they left – I haven't cried in public since I was a child, and I'm not ashamed to say that I just couldn't hold it together. I can't imagine going through what that family is going through right now.

Right now our country is dealing with a lot of change in our health care system thanks in large part to the Affordable Care Act, aka Obamacare. There's (rightfully) a lot of discussion about how our health care system and the related health insurance industry work. The debate often focuses on cost and on whether or not we're moving towards a system of "socialized" medicine similar to Canada's or the UK's, and if we are, whether that will lead to a stall in medical advances that have led to every day "miracles" like what our family experienced.

Those are all worthy discussion points, but after yesterday all I could think was this: when it's your child in the operating room you really don't care how expensive the procedure is, you just want him to have whatever it takes to make him well. I would gladly live in a cardboard box in order not to have to hear what that poor mother next to us heard. Whatever we do I hope we continue to work towards making sure that fewer and fewer parents have to hear that their child doesn't have a miracle available to them at any price.

Will Obamacare Lead to a Part Time Nation?

Darden Restaurants, parent company of restaurants like Olive Garden and Red Lobster, is experimenting with limiting the hours worked by some of its employees to see if it can avoid provisions of the Affordable Care Act (ACA) – a.k.a. Obamacare – that go into effect in 2014:

Analysts say many other companies, including the White Castle hamburger chain, are considering employing fewer full-timers because of key features of the Affordable Care Act scheduled to go into effect in 2014. Under that law, large companies must provide affordable health insurance to employees working an average of at least 30 hours per week.

If they do not, the companies can face fines of up to $3,000 for each employee who then turns to an exchange — an online marketplace — for insurance.

"I think a lot of those employers, especially restaurants, are just going to ensure nobody gets scheduled more than 30 hours a week," said Matthew Snook, partner with human-resources consulting company Mercer.

Darden said its goal at the test restaurants is to keep employees at 28 hours a week.

Analysts said limiting hours could pose new challenges, including higher turnover and less-qualified workers.

It would seem logical that employers would limit employees to part time status whenever possible in order to avoid fines for not providing health insurance, but on the other hand employers already spend much more than $3,000 per full time employee on health insurance – $10,522, of which the employees paid $2,204, according to the Society of Human Resource Management – so it would seem even more logical for them to stop providing health insurance altogether and lower their expenses by over 50% overnight. 

Here are some other questions:

  • How many companies, in industries that have not historically had high levels of part time employees, will start turning jobs that had been done by one full time employee into multiple positions filled by part timers? 
  • Are there provisions in the ACA that would prevent that?