It’s constitutional – deal with it
Just over one million Texans had signed up on the federal health insurance exchange as of last Saturday, signaling a steady drumbeat of interest and giving local advocates a chance for some celebration.
“I will take it,” Ken Janda, president and CEO of Community Health Choice, a Houston-based non-profit health plan offering insurance plans through the Affordable Care Act’s federal marketplace, said Tuesday when he heard the numbers.
The 1,040,246 Texas enrollees included those signing up for the first time and people renewing existing coverage, according to U.S. Department of Health and Human Services statistics released Tuesday.
Nationally, 8.2 million had signed up as of last week, topping last year’s numbers for the same time period by about 2 million, she said, the agency announced.
“We have never seen this level of activity,” HHS Secretary Sylvia Burwell said during a conference call with reporters and community groups across the country. Calling the demand “unprecedented,” she added: “This is what we wanted to see.”
For comparison, the numbers were 734K in 2014, and 850K for 2015. They won’t change the mind of anyone whose mind needs to be changed, but this law has made a big difference in a lot of people’s lives. People can believe whatever BS they want to believe, but a million people who can see a doctor and who can not have to worry about being bankrupted by an illness know better. Kevin Drum, who looks at the national numbers, has more.
In order for these numbers to really mean something, we would have to know how many of those newly enrolled were formerly uninsured. If the health insurer commercials all over the airwaves are true, about 85% of those ObamaCare policies are subsidized by the taxpayer (read: welfare).
I want to know how many people were formerly uninsured, and are now at least paying something towards their healthcare, vs. how many lost their privately paid for insurance because of ObamaCare and the skyrocketing premiums it has brought, that are now being subsidized by the taxpayers, where once they stood on their own two feet and paid for their own health insurance.
Based on what I have experienced with my existing high deductible policy, what ObamaCare has done is raised my premiums so much that the money I would have normally used for normal doctor visits (fully paid for out of pocket) is now going to my insurer. What is the point of having insurance if I can’t afford to see a doctor? How has my situation improved?
Bill, you make a valid point, but I suspect they were excluding people who were covered under employer plans (and that is easy to count).
Bill you have missed the point of Obamacare. It is not to help EVERYBODY. It is make insurance more affordable for the unemployed by offering a sliding scale of subsidies. In that respect it has been an enormous success.
So far health care increases have been smaller than pre-Obamacare, but this year the increase jumped quite a bit. They expected that as the underinsured is joining the system. I’ll point out another reason for the recent increases. People like me have been sliding by not making the last payment of coverage. Usually you don’t face penalties by missing 1 point, and in Texas you have 90 days of not paying before you are officially dropped. So I paid in November but not December. Why should I? I’m still theoretically covered in case of emergency.
There are long term inflation issues with insurance, but I don’t think we’re hitting that yet. My complaint — to my amazement is that the website and the telephone agents have messed up enrollment quite a bit. I have tried 3 different times to enroll and been given success messages when in fact I did not enroll. (I will try again tomorrow).
Wow, I should have proofread my last remark: “Usually you don’t face penalties by missing 1 MONTH, and in Texas you have 90 days of not paying before you are officially dropped.
Bill, you raise some good points about the system and who is getting covered but I think a discussion of the topic would benefit from a little historical context. In 1986 Congress passed the Emergency Medical Treatment and Active Labor Act. This act requires hospitals that receive Medicare payments to provide emergency medical screenings to patients seeking emergency care. If as a result of the screening, the person is deemed to have an emergency condition, the hospital was obliged to provide emergency care without regard to legal status, citizenship or the ability to pay. (Yes, REAGAN signed this into law.) Patients couldn’t be discharged until they were stable and able to be cared for adequately at home. The law was passed to curb patient dumping of the indigent.
But despite the linkage of the requirement to Medicare, the costs for treating those who could not pay were not covered by the Medicare system in this law. In subsequent years, the federal government provided some reimbursement of charges to hospitals through another system outside Medicare. But remember some of the costs incurred by the hospitals was for screenings that determined that the person did not have an emergency medical condition, which was a lot of people who used the ER as their doctor’s office. And many hospitals fearful of lawsuits established standard that erred on the side of providing treatment. (There was a recent case of a woman in Florida who was seeking treatment for a breathing condition that was not deemed to be an emergency. She was asked to leave and when she refused the hospital called the police who was in the process of arresting her for disorderly conduct when she lost consciousness and died of a pulmonary embolism.)
Hospitals had the right to seek payment from all the patients with limited success and by the mid-2000s it was estimated that over 50% of emergency costs went unrecovered. Hospitals in turn hiked the sticker price of emergency services (and pretty much everything else) to cover the costs of the emergency room write-offs which applied to those with enough money to pay out of pocket or those with insurance. Insurance companies citing the rise in hospital costs in turn passed the cost on by raising premiums.
All that goes to explain that while we are indeed spending tax-payer money to fund insurance coverage for large portions of the low-income public under the ACA, we were spending tax-payer money to fund emergency screening and care for sizeable numbers of low-income people already. Plus consumers had ever-increasing premiums/deductibles and paid for higher service costs for out of pocket expenses at the hospital…which BTW raised Medicare costs (i.e. more taxpayer money).
The difference is that instead of focusing funding on emergency care which is more expensive and an inefficient use of resources, the ACA seeks to fund more preventative care. That’s the theory at least and it’s probably a few years before we see if that is how it actually works.
One other tidbit. I am currently on an expat assignment in the UK. In September I came down with an aggressive infection in my leg and with insurance card in hand I went to the Emergency Room at a nearby London hospital. I show the receptionist my insurance card, filled out one form and 45 minutes later was called back for a screening. My condition was so bad that I had to be held in the ER until I was stabilized enough to go upstairs to the ward where I spent 6 days of treatment.
After I checked out of the hospital, I realized that nobody had actually taken my insurance information. I called my insurance company and the HR department of my company and both advised me to just wait for a bill and if one ever came to forward it.
“If? What do you mean if a bill comes?” I asked. The woman at HR advised me that for emergency care like mine, I would likely not receive a bill. I was gobsmacked. On the other end of the line, the HR manager said with pride bursting through in her voice “Welcome to our NHS. Pretty different, huh?”
To this day, I’ve never gotten a bill. But I have had 5 follow-up appointments and 2 blood tests. No bills for those either and my out of pocket costs amounted to about $30 for prescriptions.
We in the U.S. hear that ours is the best medical system in the world. Maybe that’s true, but there are other systems that get a good bit right and maybe, just maybe we can learn some things from them.
The NHS has always been good for emergency care, and cases requiring immediate treatment. If you need treatment that’s not urgent, the statistics aren’t as good, with long wait times the standard.