Saturday, June 24, 2017

The truth about the alleged "collapsing" Obamacare markets

A week ago (6/16/17) on "The Daily Intelligenser," Jonathan Chait tackled this false mantra that Republicans use to try to justify their tax-cut-for-the-rich-disguised-as-health-care-reform.

"Right-wing critics of Obamacare have been predicting for years that the law would enter an actuarial 'death spiral,' in which healthy customers flee and insurers raise rates to unsustainably high levels as only the most sick and expensive patients remain. . . .When President Trump repeatedly insists Obamacare is 'collapsing,' 'dead,' or 'gone,' he is popularizing in vulgar form an analysis that people like Paul Ryan have been spreading for years.

"The most obvious sleight of hand in this argument is that, even if it were true that the Obamacare exchanges were entering a death spiral and collapsing, it would hardly justify the Republican health-care bill. The exchanges account for a bit less than half the coverage gains in Obamacare. The rest of the newly insured come from expanded children’s health insurance and, especially, Medicaid.

"Remember, Medicaid expansion is how Obamacare provides insurance to the poorest Americans (those with incomes up to 133 percent of the poverty level). The allegedly collapsing exchanges only insure people with incomes above that level. And the spine of the GOP plan is hundreds of billions of dollars in cuts to Medicaid. There’s not even a patina of an argument that Medicaid is collapsing. The supposed 'death spiral' in the exchanges is the Republican pretext for cutting a completely different program.

"In any case, the 'death spiral' is a fiction.  [A study found]. . . that health costs of people buying insurance on the exchanges have converged with health costs of people who get insurance through their employer.

"So why are we reading all these stories about insurers pulling out of markets and premiums going way up?   Oliver Wyman, an actuarial firm, examines the markets and concludes . . . two-thirds of the higher premiums next year are due to political uncertainty created by the Trump administration and Congress. The administration is threatening to withhold payments insurers are owed under the law, and also not to enforce the individual mandate. These deliberate efforts to subvert the exchanges are having their intended effect. But the underlying expected cost of insuring patients is lowwithout a government engaged in deliberate sabotage, the firm estimates premiums would only rise 5–8 percent, a very modest level by the historic standards of health insurance costs.

"Obamacare can be improved, especially in rural markets where hospitals and doctors are spread far apart and competition has always been difficult to produce. But the threat to the exchanges is the same as the threat to Medicaid: not any inherent flaw in the operation of the programs, but a governing party that ideologically opposes the transfer of resources that is needed to make health care available to the poor and sick."

"In a separate article, reporters asked a number of Republican senators what they were trying to accomplish with their health care bill.   None really had a satisfactory answer -- except perhaps John McCain.   The old maverick just said it:  "They're trying to get to 51 votes."

And both of those were written before anyone saw the actual, awful secret bill that they've produced.   This vote is going to be a test for those senators who have any integrity or human decency left.

Yes, Sen. Schumer is right.   The Republicans were trying to keep the damned thing secret because:
 "They . . . are . . . ashamed . . . of it."


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