Tag Archives: obamacare

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.


Young Adults and Obamacare

We've all heard our fill about Obamacare, but because it is so complex most of us don't have a clue what's going to happen as its implementation kicks into gear next year. That's beginning to change as all kinds of research is being done and reports on the results of that research starts to hit the news.

Earlier this week we saw plenty of coverage of the Rand Corporation's analysis of the 14 states that have opted not to implement the Medicaid expansions called for in Obamacare, and the projections aren't good for those states which include North Carolina. Now comes this fascinating interview with the executive director of Young Invincibles, a group that studies young adults' role in health reform. The interview is about how young adults view health insurance and the likelihood that they will opt in to Obamacare, which everyone seems to agree is a critical factor in the success of the program. Here are the most interesting tidbits:

About 19 million young adults 18 to 34 lack health insurance. Our polling shows that less than 5 percent of young people choose not to have it. The number one reason they don’t have it is the cost. Most young people don’t qualify for Medicaid right now even if they have very low incomes because most states just don’t give childless adults Medicaid. That’s one of the biggest changes under Obamacare. If every state expanded Medicaid, about 8 million would qualify for Medicaid. Another 9 million would qualify for subsidies because they make less than 400 percent of poverty.

So then 17 of the 19 million uninsured young people are, in theory, eligible for either subsidies or Medicaid under Obamacare?

That’s right. It’s a pretty phenomenal percentage. So if we do our jobs right, young people will be one of the biggest winners in the health-care law…

 But the cost does matter. So is Obamacare actually going to make insurance affordable for this group? Or will it make insurance more expensive for young, healthy people by making it easier for sicker, older people to buy insurance without getting discriminated against? 

The first important point is the huge percentage of unemployed young people who get access to either subsidies or Medicaid. So you saw in California that many young people will end up having insurance options that cost them less than $100 or less than $50 simply because their income is low enough to qualify for subsidies. For someone making $20,000 a year, they’re going to have to pay $40 a month for health insurance. That’s a very good deal. And in a state like California, there are also millions of young people who qualify for Medicaid.

Now we’ve identified a population between 300 percent and 400 percent of the federal poverty level that’s going to have more problems. The subsidies aren’t that rich for them, and so whether to buy is a tougher question. They’ll have financial strain. They have financial strain now. That’s why they’re uninsured. If you’re just getting by, then $200 a month can be a lot. That’s where education can be key. It can still make good financial sense to be covered because there are real risks. But I think, in general, it will be a good enough deal to sign up. We saw that in Massachusetts where youth uninsurance dropped in half in the first year…

So given all the issues of implementation and the political opposition to the law and the difficulties in various states and the early information about premiums, where do you think this will end up in 2014 and 2015? Do you think young people will sign up or stay away?

I’m pretty hopeful, in part because the experience in Massachusetts showed this model can work. But it will play out differently in different states. A state like California is following the playbook. They’ll do a big promotional campaign. They’re investing in on-the-ground outreach and education. They’re expanding Medicaid so really low-income folks will qualify for health insurance. So I could see it being a huge success in a state like that. But not every state will do that. An important point for young people is that some of the states with the highest rates of youth uninsurance are in the south and some of those states aren’t expanding Medicaid or building their own exchanges. My fear is what happens in those states. So I could see some states coming out and looking much better than other states.

As a father of three children a couple of years away from entering the working world and as a resident of North Carolina, one of those southern states not "following the playbook", that last paragraph truly worries me.

The Unfortunate 14

North Carolina is one of 14 states that has opted out of the new Medicaid funds linked to Obamacare. What does that mean? According to a new Rand Corporation study it means those states are sailing into a stiff healthcare wind:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

It’s a truism of health-care politics that the uninsured are impossible to organize. But Obamacare creates an extraordinarily unusual situation. The Affordable Care Act will implemented in states that reject Medicaid. There will be huge mobilization efforts in those states, too, as well as lots of press coverage of the new law. The campaign to tell people making between 133 and 400 percent of poverty that they can get some help buying insurance will catch quite a few people making less than that in its net. And then those people will be told that they would get health insurance entirely for free but for an act of their governor and/or state legislature.

North Carolina is already seeing political activism spearheaded by the state's NAACP chapter against policies of the Republican legislature. Just yesterday the NAACP's ongoing "Moral Monday" campaign led to more than 150 arrests at the state capitol. Quite frankly that action is easy for a lot of people to dismiss as just more of the same from a group trying to justify its existence (when doesn't the NAACP protest?), but if people who normally sit on the sidelines are suddenly spurred to action because their government denied them the opportunity for cheaper (or free!) health coverage then things could get very interesting for the next election cycle here in the Tarheel state.

(h/t to Fec for the link to the story).

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?


Unintended Consequences

Most of us are familiar with the law of unintended consequences (for those of you who aren't, prohibition would be a good place to start your research) and this post at Tax.com has me wondering if all those folks fighting Obamacare in the courts might have considered the unintended consequences if they win:

The only difference between the mandate and your common tax incentive is that Congress framed the incentive as a tax penalty instead of a tax break. I recognize there might be a legal difference between the two approaches that is beyond my comprehension. But the Court, Congress, and the public should understand that economically the two approaches are exactly the same…

A tax penalty and a tax incentive have the same economic impact on affected and unaffected individuals. They have the same effect on the goals the government is trying to achieve. They have the same effect on government revenues. It is possible, then, that they have the same effect on freedom and constitutional principles.

So armchair constitutional scholars should enjoy the show. But please excuse us economists if we tune out. Perhaps too blithely, we assume the mandate will be affirmed because the nation's leading legal gurus won't want to open up a can of worms that makes all tax incentives subject to constitutional challenge. If by chance the court does strike down the mandate, by all means give us a call. It could be the beginning of the end for all those complex and inefficient tax incentives we have been complaining about all these years.

So a question for you legal scholars out there: if the Supreme Court strikes down Obamacare is my wonderful deduction for mortgage interest soon to follow?