Another Obamacare glitch

by on December 23, 2013 at 9:35 am in Law, Medicine, Travel | Permalink

Stella Paul reports:

Millions are losing their health insurance policies and being forced onto the ObamaCare exchanges, where most plans only provide local medical coverage. As Americans realize they must pay for all non-emergency medical care when they leave their home county.

The pointer is from Arnold Kling.

1 Michael December 23, 2013 at 9:46 am

So, pretty much the score is in, Obamacare neither expands coverage nor makes it more affordable.

Great going, guys.

2 js December 23, 2013 at 12:38 pm

The correct term is OcommieScare.

3 bon_supp December 23, 2013 at 1:36 pm

Remember when MR was a regularly thoughtful site? Now we get links to unsourced anecdotes and commenters who think their puns are clever. Sigh.

4 Edward Burke December 23, 2013 at 2:11 pm

–while the correct alternative term is ObamaFraud. (No known website linkage to boast, apologies.)

5 Mogden December 23, 2013 at 10:16 pm

Why so lenient? The score is that Obamacare makes coverage dramatically worse and less affordable.

6 JWatts December 23, 2013 at 9:46 am

Well that’s a new and rather unfortunate side effect.

7 F. Lynx Pardinus December 23, 2013 at 9:58 am

My existing individual market plan covered out-of-network care, but at a significantly higher deductible and max-out-of-pocket limit than in-network. The new plans I’m being offered have significantly cheaper premiums, but don’t seem to have any out-of-network, non-emergency coverage. So I’d be saving on premiums, but losing on doctor choice.

8 Bill December 23, 2013 at 10:34 am

My states carriers also provide for out of state coverage, with the same deductible rules as before, under the exchange and non exchange policy.

This is a good example of a contrived controversy.

Maybe one created by high cost out of state providers like Cancer Tratment Center.

9 Yancey Ward December 23, 2013 at 10:57 am

It is definitely not contrived, Bill. One of the first things I noted on shopping for plans on the exchanges was the out of network problems vs the non-exchange plans. Maybe California is different, but it definitely isn’t the rule.

10 Bill December 23, 2013 at 12:26 pm

re:”…..versus the nonexchange plans”

that’s just the point: obmamacare has nothing to do with it. You are free to purchase an indemnity nonexchange plan. ACA plans are based on community rating and prenegotiating with providers, in most cases, other than plans on the exchange with open networks

11 john personna December 23, 2013 at 12:31 pm

It is very strange right now to go to Blue Shield of California and be greeted with a question … do you want to see exchange or non-exchange plans?

I want to see the good plans?

12 john personna December 23, 2013 at 12:35 pm

(BTW, yes the California Blue Shield plans I saw paid out of state, at a reduced rate.)

13 Rich Berger December 23, 2013 at 11:11 am

I heard Rep. Luis Gutiérrez (D- Chicago) confirm this on the Geraldo Rivera show some months ago. He responded to a question about why he would not be signing up for Obamacare by saying that it wouldn’t work for him because he worked in DC and Chicago and the exchanges did not provide for coverage across state lines. So, contra Bill, this isn’t a created controversy, but was well known but downplayed.

If you think 2013 was bad for the Unaffordable Care Act, wait for 2014. Poor Mr. Obama, things have been so tough for him. It’s not working out so well for the little people either.

14 Bill December 23, 2013 at 12:28 pm

Rich, Before ACA he probably purchased an indemnity plan with an out of network rider, and after ACA he will probably purchase an indemnity plan with an out of state rider.

What changed?

15 Bill December 23, 2013 at 5:33 pm

f, if you read your policy, it does cover non-elective emergency out of network care. if you want elective out of network policy you pay more or have a different different deducts or copays. you can also by a straight indemnity policy or purchase a rider.

16 Tom December 23, 2013 at 10:08 am

Where is the evidence of the “millions” of people. This is a another FoxNews Channel type right wing hack journalism fraud piece. This type of post makes GMU economics look like a academic joke. Just keep the Koch money coming.

17 F. Lynx Pardinus December 23, 2013 at 10:10 am
18 F. Lynx Pardinus December 23, 2013 at 10:13 am

I should point out that the NYTimes article is from September, so this is definitely not a new issue or a previously undiscovered “glitch.”

19 Yancey Ward December 23, 2013 at 11:05 am

Look, when you have been reduced to linking a right wing rag like The New York Times, you have conceded the argument. Sheesh!

20 prior_approval December 23, 2013 at 12:07 pm

Anybody who has actually read left wing journalism – TAZ in Germany, Libération (much less L’Humanité) in France, or la Repubblica in Italy – has an idea just how far the war mongering (well, OK, a bit too old fashioned left wing there – let’s just remain accurate by describing the NYT as lying cheerleader for war in Iraq, among a long list of other countries) and capitalist celebrating (T Magazine? Weddings & Celebrations in Fashion & Style?) NYT is actually a right wing rag by any number of measures used by countries where there actually exists something that can be accurately called left wing media.

It is always so amusing to see the NYT described as left wing – ever noticed just how left wing a columnist like Prof. Cowen is? None of the papers mentioned above would ever employ such a capitalist tool, to use another one of those old fashioned leftest cliches. A cliche mainly because it is trivially true in just about every case where it used, but nonetheless, a cliche.

21 chuck martel December 23, 2013 at 1:12 pm

The NYT may not be left-wing enough for you personally but that’s a matter of ideological taste. Actually, it’s just poor journalism, with columnists like Charles Blow, Nick Kristof, Tom Friedmann and Paul Krugman. Their particular political leanings, predictable as they are, aren’t as disappointing as their twisted logic.

22 prior_approval December 24, 2013 at 6:20 am

‘The NYT may not be left-wing enough for you personally but that’s a matter of ideological taste’

Um no – a war mongering paper that celebrates capitalists flaunting their wealth does not become left wing merely because some people wish it to be so. At least in those countries that actually have left wing media and parties, the NYT is (at best) a moderate right wing paper. Even a paper like the FAZ (a German paper that represents much of the same banking based clientele and considers itself a leading voice for those who consider essential to the proper functioning of a caplitalist society) often feels more left wing than the NYT. Some of this having to do with the reality that pretty much the industrial world, especially the most successful parts of it (like Germany, the Netherlands, Switzerland, Canada, Australia) are considerably more ‘left wing’ than Americans seem able to understand.

The health care ‘discussion’ at places like here pretty illustrates the point – most non-Americans cannot even begin to grasp the idea of a society unable to provide routine health care, without bankrupting citizens. Or more accurately, why anyone could be against the very concept.

That’s right, the rest of the industrial world is full of health care socialists. Paying less for a level of care that most Americans seem to be unable to grasp.

A concrete example? – the very idea of ‘network’ or ‘out of county/state/country.’ I simply go to essentially any doctor I wish in Germany, they take my DAK card, and that is it. Being a non-EU citizen, it is a bit more complicated in terms of France, for example. Which is why I pay 15 euros a year for ‘foreign health care insurance,’ worldwide. Which has paid medical bills incurred both in the U.S. and the EU, so it isn’t the sort of scam so many Americans seem attached to – ‘deductible’ is not really a German Krankenkasse/health insurance concept. And even the attempt to have a 10 euro ‘praxis fee’ charged within a quarter for using the health care system has been dropped – in part, because the Krankenkassen are currently sitting on billions of euros in excess cash.

23 joe December 23, 2013 at 3:49 pm

Don’t see any reference to ‘millions’.

24 bjssp December 23, 2013 at 10:29 am

Yeah, seriously. When it comes to this subject, specificity is key. Two million people would be a lot in absolute terms, but given the number of people in the country as a whole, it’s a drop in the bucket.

25 Cliff December 23, 2013 at 10:30 am

Classic! That’s the new Obama response. “Mr. Obama, what do you think of the millions with dropped plans, increased premiums, and lost access to doctors?” Obama:”Drop in the bucket!!!”

26 bjssp December 23, 2013 at 10:53 am

Oh, please. I’m not saying it’s just a few thousand people, but it’s a big country with roughly 320 million people. We have no firm numbers on how many people are supposedly being thrown off of their former plans and forced into worse, more expensive plans. To go with my figure of 2 million, that would definitely seem like a lot, but it wouldn’t even be one percent of all people in the country. If 30 million-plus people are being affected in the way described above, it’d be a much different story.

27 Indira Gandhi December 23, 2013 at 11:05 am

Tell me about it!

28 Marie December 23, 2013 at 11:24 am

My math skills here have not been stellar, but let me give this a shot.

Of those 320, 50 million are on Medicaid and 50 million are on Medicare.

85% or so of the rest are on employer insurance.

So now you’re talking 2 million out of 33 million, not out of 320 million. Does the smaller bucket matter?

Now, if you can demonstrate that 2 million and one from that bucket benefit from ACA, you still have a case for the program.

29 bjssp December 23, 2013 at 11:42 am

Excellent points.

Allow me to counter. We don’t know how many people are supposedly losing them. Nor do know what the cost of the policies are, what the new costs might be, what the subsidies might be, whether the costs are more of a one-time thing for a more comprehensive plan or something else. We know a little bit more about how some types of policies are being affected, but not much. Based on the comments in the article above, we’ve got nothing to go on besides broad speculation.

If you want to hate the new health care law, fine, but don’t expect most people to get up in arms when it’s far from clear it’s some sort of epic nightmare for most people.

30 chuck martel December 23, 2013 at 11:52 am

The advocates of mandatory seat belt use said “If it saves one life, it’s worth it.” What do they think about millions having to pay out of pocket for health care in a few days?

31 GovCo December 23, 2013 at 12:12 pm

Does the smaller bucket matter?

Nothing matters to Organizing for America minions. OFA has erected a multitude of new bots and sent swarms of them hither and yon to harrass our people, and eat out their substantive disucssions for the sole purpose of fatiguing them into compliance with Obamacare’s measures.

32 Z December 23, 2013 at 10:47 pm

A single person losing their insurance is a tragedy; a million is a statistic.

33 prior_approval December 24, 2013 at 6:27 am

Millions of Americans being forced to recognize that what they were paying for in terms of ‘health insurance’ was delusional?


34 Cliff December 23, 2013 at 10:29 am

If there is not even a million people on the exchanges, then it’s a complete failure, right?

35 Bill December 23, 2013 at 10:36 am

Cliff, you can buy an indemnity policy outside of the exchange if you want

36 Michael December 23, 2013 at 11:09 am

Those folks could buy an indemnity policy before O-care too.

You can, but importantly, you give up the ability to get the subsidies, so outside of the folks who make north of $75k/year, who would want to, and how is this law helping them? Remember, those aren’t the people that O-care was billed as helping.

37 Bill December 23, 2013 at 12:31 pm

michael, people making more than $75k get their subsidy a different way: through the tax code and the deductibility for insurance and healthcare costs. Those low income folks do not get that deduction because they do not itemize.

38 TMC December 23, 2013 at 1:31 pm

They don’t itemize because they opt for the standard deduction, which is a better deal for them.

39 Michael December 23, 2013 at 1:31 pm

Only if insurance is provided by your employer. I though it was pretty clear that we’re talking about the individual market, hence the constant reference to “exchanges.”

40 Bill December 23, 2013 at 1:47 pm

Michael, you can itemize insurance and medical costs. It’s not just if you have an employer plan that there is a tax benefit.

41 Michael December 24, 2013 at 12:26 pm

I’m still trying to figure out how this particular rabbit hole is relevant to the argument that Ocare is helping, even if less than 1 million sign up through the exchange. I don’t understand your reasoning.

42 Vivian Darkbloom December 23, 2013 at 1:23 pm

Of course you can buy an indemnity policy outside of the exchange. You can also just buy your main policy outside the exchange, “if you want”.

But, that doesn’t strike me as the salient point. The exchange plans are being touted as a bargain. The real question is, how much does the exchange policy *plus* any additional insurance I may need to purchase going to cost? Saying that one can buy an indemnity policy (at additional non-subsidized cost) makes no more sense than the original quote that suggested you could pay out of coverage costs out-of-pocket.

43 Kevin December 23, 2013 at 10:44 am

I’d never heard of Stella Paul before, so I did some googling. Yeesh.

Obama Is a Spokesmodel for Tyranny
By Stella Paul

Barack Obama is not a real president, though he does play one on TV. So what is he? It’s my contention that the bizarre creature currently residing in the White House is an attractive spokesmodel for our destruction, sponsored by America’s mortal foes.

Read more:
Follow us: @AmericanThinker on Twitter | AmericanThinker on Facebook

44 prior_approval December 23, 2013 at 11:59 am

Stop this – there is a narrative being created, and part of it is the essential filtering that web sites like this one provide.

Who really bothers to actually read sources these days? – no reason to point out this place’s role in the scheme of things.

45 Brandon December 23, 2013 at 10:38 am

I’ll just note that the original source is “American Thinker,” not exactly a reliable, objective source. Nothing in the AT is sourced or linked, and there’s no information given on how many plans pre-ACA in the individual market had national or international coverage.

46 Brandon December 23, 2013 at 10:42 am

What is it about Obamacare that would preclude out-of-network coverage in plans?

47 Michael December 23, 2013 at 10:51 am

Nothing, per se, other than the fact that it is constructed to drive premiums significantly higher. So, it is a tradeoff between significantly higher premiums for a comparable pre-Ocare plan, or only slightly higher premiums with significantly restricted network options, such as that listed above.

48 Michael December 23, 2013 at 11:04 am

Also, it should be noted that the ACA specifies that plans sold on the exchange are sold on a per-county basis, not a statewide basis. So, moving, even in-state to a different part of the same city can result in completely different networks, not to mention different pricing and deductibles. Evidently, very few plans on the exchanges are true statewide plans.

49 joe December 23, 2013 at 4:23 pm

Which is why the ‘you should be able to buy healthcare across state lines’ was always a stupid idea. If an Iowa insurance company was going to charge Iowa rates to someone living in Manhattan going to some of the most expensive hospitals in the country, they would go bankrupt.

50 Michael December 24, 2013 at 12:47 pm

You’re confusing pre-Ocare plans with post Ocare. Before the law, those types of plans were quite common, in which circumstance, the cross state lines reform made much more sense.

Although, on its own, I don’t think that cross state reform is worth much, other than to neuter the effects of some inane local laws in just a small # of states. So much for the Repubs being pro-federalism.

51 Ben Hughes December 23, 2013 at 10:59 am

Home *county*?! As a digital nomad who travels nearly full time, this is outrageous. How incredibly regressive that we’re halting the interesting trend towards millennial location-independence by assuming people live their lives entirely within their home county.

52 Michael December 24, 2013 at 6:44 pm

It’s been a traditional Medicaid rule. I suppose the idea was that though the best local hospitals would take you, there really wasn’t going to be competition for your business, say by MD Anderson Cancer Center. So if you went out of county it might be because you found a doctor/ hospital who was ready to provide you controlled substances or otherwise would stretch the limits of appropriate treatment if your coverage would offer him that temptation; so you were restricted to treatment in county.

53 tt December 23, 2013 at 11:05 am

great, can we have single payer now ?

54 TMC December 23, 2013 at 11:36 am

When you are in a hole, Dig Faster!

55 tt December 23, 2013 at 11:42 am

yeah, things were just awesome before obamacare.

56 TMC December 23, 2013 at 1:33 pm

And that justifies making things worse?

57 tt December 24, 2013 at 10:40 am

no, so now can we have single payer ?

58 The Anti-Gnostic December 23, 2013 at 11:52 am

And make the population small, white and resource-rich while you’re at it!

59 john personna December 23, 2013 at 12:37 pm

Maybe you wish you had a smarter population, but the very people who equate that with being white are on the wrong side of the bell curve themselves. Catch-22.

60 The Anti-Gnostic December 23, 2013 at 12:54 pm

Maybe one o’ you book-learned city slicker fellers can reveal the mystery behind Moynihan’s law of the Canadian border?!

What if I had said make the population small, Ashkenazim and resource-rich? Or small, Korean and resource-rich?

Diversity, liberty or equality. Choose one.

61 john personna December 23, 2013 at 1:09 pm

If you only mean “resource rich” that’s all you need to say. On the other hand, as far as I’m concerned, any racial claim is a “kick me” sign.

62 Turkey Vulture December 23, 2013 at 12:18 pm

The best advertisements for a massive government health-care-payment program are the failings of a smaller government health insurance program.

Yeah, I don’t think that works.

63 john personna December 23, 2013 at 12:40 pm

Have you forgotten the cost comparisons across countries?

We have a horribly expensive system in good part because it is horribly complicated. A single-payer system reduces complexity and costs. But we’re blocked by emotional people who think smaller is bigger, because it has less thousands of private insurance workers?

64 Thomas December 23, 2013 at 3:44 pm

John Personna holds an interesting position. On the one hand, he likes to use studies which are inherently effected by racial compositions to push his ideology. On the other hand, anyone who mentions the racial composition of his studies is a racist.

65 joe December 23, 2013 at 4:25 pm

I think you’re reaching for straws Thomas. Please cite the study that shows that every other country in the world pays less for health care because of race.

66 RZ0 December 23, 2013 at 1:05 pm

The best advertisement for a massive government health-care-payment program is a massive government health-care-payment program. It’s called Medicare, and it’s pretty popular. If you think it’s unpopular, just try getting rid of it.

67 derek December 23, 2013 at 12:40 pm

A question. How many people does the largest single payer system in Canada serve?

68 john personna December 23, 2013 at 12:45 pm

I’m sure the largest and smallest single payer systems in the world differ in orders of magnitude. If so, why would we think any particular one is the upper limit?

69 The Anti-Gnostic December 23, 2013 at 1:01 pm

We know insurers compete for good risks, so there’s one bound right there.

70 john personna December 23, 2013 at 1:12 pm

If we had a health care system for good risks (healthy people) that would kind of leave the sick people (who actually need it) out in the cold.

Indeed that was the beauty of a system which re-tagged “pre-existing conditions” periodically. Over time it becomes insurance for problems you don’t have.

71 mike December 23, 2013 at 2:41 pm

Already sick people who can’t or don’t want to pay their own medical bills don’t need “insurance” any more than a person whose house just burned down needs “insurance”. The word you’re looking for is “charity”

72 john personna December 23, 2013 at 6:18 pm

The words I’m looking for are “health care,” and the word “charity” is indeed a poor substitute.

Again, all of us end up with “pre-exisiting” conditions, because any condition we live through becomes “pre.” The old system systematically dropped people given any opportunity, and swept them into the “pre” pile. You have to be a craven apologist to say “of course, it is only the new people in the queue who deserve ‘insurance.'”

73 The Anti-Gnostic December 24, 2013 at 8:54 am

All your plaint does is underscore that health care is for the most part uninsurable.

By the way, the system is designed to treat sick people, not deliver “health.” If you want to be healthy, you need to exercise, eat sensibly, not smoke, drink in moderation if at all, and avoid risky behaviors like promiscuous sex and driving drunk.

74 R Richard Schweitzer December 23, 2013 at 11:09 am

As posted in the comments on Kling’s site, this points up the need to separate contracts for health**care** (which provide services) from Insurance contracts which absorb the impacts of risks.

Get services in the “home” area; be protected from risks by insurance wherever you are.

75 ummm December 23, 2013 at 11:36 am

stocks surging as obama’s polls are falling

Bernanke is the real hero of the post 2008 economic & stock market boom

76 Bill December 23, 2013 at 11:51 am

This is a silly post and one which misleads.

Before the ACA, my policy provided for out of area coverage by raising the deductible and requiring me to pay a higher copay. The same policy and terms are now on my carriers policy on the state website.

Before the ACA, I could buy a nationwide indemnity policy; today I can buy a nationwide policy.

The only difference is that price sensitive consumers are attracted to the ACA website, so carriers offer area policies and narrower network; some offer broader networks at a higher price. If I want coverage that lets me go to some for profit Cancer Treatment Center (one of the leading firms objecting to the ACA for obvious reasons), then I can choose an indemnity policy that would include them. I just have to pay that price for more choice. So what. It’s a market and I can choose.

77 Turkey Vulture December 23, 2013 at 12:26 pm

The relevant question is: under Obamacare, does the same plan cost the same (or the same + typical annual premium inflation). If people are getting relatively narrower networks than they did pre-Obamacare for the same or higher price, then that would indeed seem to be a “glitch” and an indication that Obamacare is increasing costs (i.e., people are getting the same for more).

I’m not sure what the answer is, and I doubt anyone debating this on either side does. It would require careful analysis of various plans, before and after.

78 Bill December 23, 2013 at 12:37 pm

Turkey, The way you frame the question is unreasonable. Did the policy you had before automatically renew, did it exclude for preexisting conditions, did the carrier have the right not to accept you.

79 chuck martel December 23, 2013 at 1:02 pm

If the policy he had before didn’t exclude existing conditions it wasn’t insurance, it was some kind of a maintenance program. Insurance is meant to cover the financial losses of future, unpredictable events, not historical ones. It’s easy to sympathize with someone that has a debilitating pre-existing illness but the cost of its treatment can’t be covered by insurance. The administration’s approach to taking over health care through insurance regulation was a big mistake. It should have started with containing medical costs themselves, basically by releasing health care into a free market.

80 john personna December 23, 2013 at 1:15 pm

Well, health care failure pre-existed the Obama administration. Obama faced two choices, accept the then-current modes of failure, or try to find a politically acceptable improvement. He may have encountered more and different trouble than he expected, but I find “so let’s return to the previous modes of failure” not too compelling.

81 TMC December 23, 2013 at 1:38 pm

accept the then-current modes of failure, or create new, more massive modes of failure

82 john personna December 23, 2013 at 1:56 pm

I know that is the case that is being attempted here, TMC, but I’m not sure the case will be made where the rubber meets the road (the sick meet their doctor). We certainly have change and uncertainty now, and a lot of handwaving can come out of that. We don’t yet have the real kind of horror story, as in “I have X, and under Obamacare I can’t get treatment.”

83 chuck martel December 23, 2013 at 2:09 pm

“Well, health care failure pre-existed the Obama administration.”

What’s a health care failure? That patients died despite medication? Or that people died because they couldn’t become patients? Or that doctors gave up the profession because they weren’t paid for their work? Or that hospitals went out of business because people weren’t sick enough?
In very real terms people are healthier and live longer than ever before. Small pox has been eradicated and tuberculosis nearly so. Plague outbreaks are rare and isolated. Intestinal parasites are unusual in the developed world. Premature births live normal lives. So where’s the failure?

84 john personna December 23, 2013 at 6:34 pm

I think the biggest failures under the old system were like “my spouse got cancer, and I spent 10 years fighting the insurance company for coverage.”

I know of a doctor who had pancreatic cancer and was in-line for a liver transplant … he and his wife did not know until one hour before the operation whether coverage would be provided by his insurance company.

85 chuck martel December 23, 2013 at 8:56 pm

According to your anecdote you regard it as a health care failure if the insurer and the insured have a discussion over the coverage even if the insured ends up being covered. That’s a pretty significant failure, alright. In an ideal world, insurance company employees wouldn’t analyze claims for coverage, they’d just write checks to health care providers, no questions asked. They could save lots of money by simply getting rid of their claims department.

86 derek December 23, 2013 at 12:43 pm

So why did the Federal Government spend $600 million on a web site that is unnecessary, broken, intrusive, insecure and that distorts the market?

87 Michael December 23, 2013 at 1:38 pm

Because a whole bunch of narcissistic politicians were more interested in getting their own names etched into the history books than they were in actually helping poor and struggling Americans.

Seriously, the thing that stuck me the most during the debate, and immediately after it was passed, was the number of times in which defenders, Pelosi in particular, kept referring to it with some form of the word “historic” in lieu of actually explaining the benefits. It was very odd.

88 joe December 23, 2013 at 4:37 pm

1) it’s not 600 million:

2) When you have to cull together resources from 5 different federal agencies to provide health insurance for millions of people, you can probably expect it would be one of the most expensive websites ever created.

3) It is necessary for people to compare plans. It puts downward pressure on premiums. I guess the states could have done it themselves if they took up that mantel, but not really any other way to do it. Let the insurers set up comparison shopping for their competitors and hook into federal databases? Yeah, that’s a really bad idea.

4) It’s debatable to the degree of which it is ‘broken’. But they certainly didn’t pay for a ‘broken’ website. And, it will be fixed. Unless you think it’s impossible to fix?

5) ‘instrusive’ – Not sure what you mean. They are about instrusive as when you buy something from Amazon

6) Insecure. Again, you have to quantify this word. The user’s data is safe:

7) Distorts the market – Agreed. Yes it does distort the market. The market has optimized to a situation in which the healthy get all the breaks with cheap premiums and small rick pools. Anyone born with a prexisting condition, or unfairly influenced by one of the social determinants of health could easily be excluded from these small risk pools. But the market doesn’t optimize for justice. It optimizes for distribution of goods based on ability to pay. So why distort the market? Because the market has done such a godawful job (worst-in-the-world godawful) in distributing an essential good to individuals. I’m sure you don’t believe it, but it’s worth the distortion.

89 Michael December 24, 2013 at 12:35 pm

Re #1:
You are incorrect, read the update to your own link, the best number is $677m.

90 Dan Hanson December 23, 2013 at 2:09 pm

Bill, the relevant point is that the exchanges are supposed to cover people who never had insurance before, by giving them subsidies and allowing for pre-existing conditions and such. That was the whole point to Obamacare – not to provide an alternative insurance system for people who already have work-related insurance or who could afford their own private insurance.

So, if you are poor and seek out insurance on the exchange, and that insurance restricts you to a very local network of health care providers, the unintended consequence is the reduction of labor mobility in that cohort. This makes the economy more brittle and traps poor people in bad areas.

I can remember when liberals were complaining that employer-provided insurance was a bad thing because it restricted labor mobility and therefore gave employers too much bargaining power and kept employees from leaving bad jobs. But I guess that’s yesterday’s narrative. It’s so hard to keep up with the marching orders.

91 Bill December 23, 2013 at 2:49 pm

Dan, I am sorry, but I don’t buy your claim that the ACA was only intended to help the poor or those who did not have insurance. Basically, it was to correct a failing market that did not deal with pre-existing conditions, that was shoving costs onto the insureds via the uninsured receiving free quote care, and, to be technical, avoiding separating equlibria whereby healthcare insurance would skyrocket as more people became uninsured. What it did do was create community rating,which is diffeerent than individual rating with healthcare underwriters, insurance agents and medical disclosure forms, and refusals to right and not renew.

92 JimC. December 23, 2013 at 12:59 pm

I live on Maryland’s eastern shore and the rumors get more audacious by the week; the latest: “An 18mo child who had birth defects and 11 surgeries.. parents were told they were dropped by their prior carrier because of ACA. They enrolled only to find out that their new, ACA carrier would not: ‘pay for any more operations’.” The teller told me; “They (pick your target ‘they’) are going to let this BABY die.”

It’s too bad Obama let this turn into a practical and PR disaster. He had a couple if years to ask; “How’z that thing with my legacy hanging on it going?” I would have marched the top 50 people working on the ACA marched out carry personal effects in front of TV cameras and pulled contracts and clawbacks on those inept contractors on October 1st.

it’s too bad government work can continually fail to meet minimum standards and budgets without regard. My business is dependent upon the civilian economy. I could never afford to perform at such low levels without putting my family and future in jeopardy.


93 tt December 23, 2013 at 1:46 pm

i heard a rumor that JimC killed a baby in Maryland.

94 The Anti-Gnostic December 23, 2013 at 2:42 pm

Obama, like most elected officials, is not a thoughtful person. He doesn’t know how insurance works, much less the distortions and complicated interface with employment.

I am deeply sympathetic with the idea of a single-payor plan, and I hear every day from Canadian friends about the land of milk and honey to the North, where the medical care grows on trees. Of course, 1) a lot of them are down here instead of up there, and 2) the ones who aren’t spring for supplemental insurance plans in addition to their high taxes. They treat their government plan as the one that takes care of them for catastrophic events, which is really all that can be sensibly done.

Apparently the last thing anybody wants is to treat medicine as a commodity like food, water, shelter, transportation and all the other commodities which we are perfectly content to let the market provide.

Also, a HUGE omission in the debate – a tort system with open-ended general damages and “reasonable” medical expenses as opposed to “actual” medical expenses is completely inconsistent with socialized medical care.

95 john personna December 23, 2013 at 7:38 pm

“Apparently the last thing anybody wants is to treat medicine as a commodity like food, water, shelter, transportation and all the other commodities which we are perfectly content to let the market provide.”

So you are saying that if the government DID provide those things to people in need, they COULD provide health care too?

96 The Anti-Gnostic December 24, 2013 at 11:14 am

I don’t think the government can provide anything that isn’t a public good, and medicine is in most instances not a public good. Government may be a good tool for building and maintaining a public sewer and stormwater system but I don’t see any evidence it does a good job with much else. (Unless, like I pointed out, you are export-heavy and have a close-knit, homogenous population, which is the better environment for risk-spreading.)

You mention government provision of food. The government provides food to poor people, and now the poor are obese and need “health care.” I think this might be a candidate for Cowen’s doubly-stupid list.

Also, I’m really getting tired of the term “health care.” Doctors don’t care for your health; they care for your injury or illness. The proper term is “medical care.” Healthy people don’t consume medical care unless it’s to repair a torn ACL from basketball at the health club, a procedure which we should be glad to leave to the market.

97 Vivian Darkbloom December 23, 2013 at 1:42 pm

“You can buy an indemnity policy outside the exchange if you want”.

From the right wing Washington Post:

“Fact-checkers and journalists have ruled that Obama wasn’t being truthful when he claimed that people who liked their insurance could keep it. Obama during a speech in Boston sought to cast the issue Wednesday as trying to weed out “bad apple insurers” who don’t provide enough coverage.

“One of the things health reform was designed to do was to help not only the uninsured but also the under-insured,” Obama said. “And there are a number of Americans, fewer than 5 percent of Americans, who’ve got cut-rate plans that don’t offer real financial protection in the event of a serious illness or an accident.”

“Bad apple insurers who don’t provide enough coverage”?

“Don’t offer real financial protection in the event of serious illness or accident?”

I guess those folks could have always just bought supplemental insurance to those “bad apple policies”–problem solved. I wonder why the Prez didn’t think of that?

98 prior_approval December 24, 2013 at 5:54 am

So, let’s repeat this again in very abbreviated form, replacing NYT with Post where appropriate –

‘Anybody who has actually read left wing journalism – TAZ in Germany, Libération (much less L’Humanité) in France, or la Repubblica in Italy – has an idea just how far the war mongering (well, OK, a bit too old fashioned left wing there – let’s just remain accurate by describing the Post as lying cheerleader for war in Iraq, among a long list of other countries) and capitalist celebrating (Style Section) Post is actually a right wing rag by any number of measures used by countries where there actually exists something that can be accurately called left wing media.

99 Edward Burke December 23, 2013 at 1:57 pm

YET MORE ad hoc fiddling:

Why’d the Democrats even bother with the Affordable Care Tax Act legislation if the rules governing implementation all flow directly from Administration fiats?

100 mike December 23, 2013 at 2:44 pm

It was the Enabling Act, that’s why nobody needed to read it and we had to pass it to find out what’s in it

101 Bill December 23, 2013 at 5:27 pm

Most legislation delegates such authority to the executive branch.

102 Edward Burke December 23, 2013 at 5:50 pm

To the extent of spontaneously changing compliance deadlines for both insurers and citizens required now by law to procure coverage? I have to wonder whether the ACTA legislation actually permits the executive branch such latitude in implementation. (I do not cannot would not trust Nancy Pelosi to tell me.)

103 Bill December 23, 2013 at 7:45 pm

Ed, You would be surprised at the number of statutes which are passed with express authority granting the executive branch the right to define the terms of the statute or waive or modify provisions. Life is complex and the legislative process doesn’t necessarily go into the weeds.

104 Edward Burke December 23, 2013 at 8:48 pm

Bill, thanks for your patience with my argument, and I see what you say while professing to know what you mean, si oui ja da and yes.

However: Obama’s ad hoc implementation, to my estimation, only detracts further and further from both his credibility and the law’s. I mean, the law as enacted imposes a mandate: well, then when expediency knocks on the door, Obama waives the mandate (at least for select populations) or postpones or delays the requirements the law putatively imposed. This is kangaroo law on amphetamines, to my untutored eyes, my poor eyes can’t quite keep up with it, and apparently, growing numbers of Americans are becoming cross-eyed, too, trying to deal with or anticipate Obama’s next spontaneous decision.

105 mulp December 23, 2013 at 11:46 pm

Which laws detail everything in the implementation and compliance enforcement to the detail that can govern something like Medicare and Medicaid or SNAP benefits?

If the law is that detailed, then the application for benefits would be really simple with little administrative leeway.

Such things as visa and immigration and naturalization would be handled with simple forms and a person with a rubber stamp.

Military procurement would be simple administratively with no delays or cost overruns.

And, we would have zero pollution in the US causing anyone harm because the various Clean Air and Water Acts would be quickly applied and everyone would have conformed decades ago.

Why haven’t I seen outrage in this forum over the decades of delay in cleaning up the air and water of all the pollution???

106 Careless December 26, 2013 at 10:19 am

Why haven’t I seen outrage in this forum over the decades of delay in cleaning up the air and water of all the pollution???

Because only you live in Mulp’s Fantasy World.

107 Jon December 23, 2013 at 5:37 pm

Several flaws in the piece. First, state laws can affect whether plans cover out of network care or not and the size of the network. In some states, plans with nationwide networks are available; in others few or none are. Second, the trend towards narrower networks and high out of network deductibles started prior to Obamacare. Thirdly, the people who are retiring at 60 and having two homes are a relative small segment of the population.

Finally, given that they are relatively affluent and healthy (at least when they got a good non-employer plan at an affordable rate), they will have to pay for any improvements to care for poor and sick one way or another–higher taxes or higher insurance premiums. After all, people who need to consume a lot of health care are not healthy; and people who are poor can’t pay higher taxes or higher premiums.

108 Kris December 24, 2013 at 12:47 am

The writer is referencing a HMO. Don’t like HMOs, enroll in a PPO.

109 Jon December 24, 2013 at 2:50 am

In some areas you might only have HMO’s and the PPOs may have very high copays for out of network coverage. Even if you have a PPO that provides 60% coverage for out of network doctors, it is 60% of what the plan allows less a higher deductible.

110 JonFraz December 24, 2013 at 12:45 pm

This is extremely common in workplace plans: you are always covered (at least in the US), but out of network providers are covered at a much lower rate and have higher deductibles, leaving you exposed to larger bills. I don’t see anything new here that working people with benefits haven’t known for years. Though I do see this as a hassle (as it is already) for people who spend major amounts of time away from home.

111 don wallace December 24, 2013 at 6:03 pm

Nice sample size and blind quote from the “prominent” authority. So prominent we can’t see him.

112 Tom January 2, 2014 at 3:30 am

The Great and Powerful Oz.

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