Wednesday, December 11, 2013

This Is Not How It Should Be

A year ago I had lunch with a former colleague who had recently taken early retirement from an employer with good benefits, including health insurance.

My friend was enjoying his retirement, but was fretting about how to obtain health insurance for the next ten years, until he would be eligible for Medicare. For the moment he was purchasing coverage under his former employer's plan through the COBRA program, but this is a rather expensive route and is normally time limited.

Complicating the situation was the fact that my friend was essentially uninsurable in the private market because of his diabetes, a "preexisting condition" that was guaranteed to price private insurance far out of reach if it could be obtained at all. Fairly common conditions such as diabetes make insurance unattainable for anybody not in a group plan through an employer. My friend's insurance broker said "forget it." Can't be done.

Ah! I exclaimed, then you must be happy about Obamacare.

His eyes narrowed. No! he glowered. He seemed almost hostile to the notion. I was taken aback.

Why not? I wondered. My friend's situation exemplified one kind of problem Obamacare was intended to address. Didn't he know that?

All I could glean was that my friend's insurance broker insisted Obamacare wouldn't work. That was an interesting thing to say, since at that point implementation was still a year away, and none of the plans or premium schedules in the private exchanges still being constructed were close to being revealed. Anyway, his broker had no more insight than anybody else about what would happen. I sensed some other unexpressed agenda at work, perhaps ideological or political, but I didn't pursue it further.

Of course, there are millions of persons who, unlike my friend, have involuntarily lost their jobs and income, and under those circumstances can't afford COBRA. And many more never had employer provided insurance in the first place, leaving them at the mercy of a private insurance market where premiums are high, coverage is sparse, policies are canceled when the insured gets sick, and any kind of preexisting condition is ruthlessly excluded.

I've been thinking about all this as I observe how the public and political reaction to the very notion of Obamacare has been an incoherent and bewildering spectacle among a largely ignorant and sadly misinformed populace. It seems the persons least likely to understand the law are the very ones it was intended to help. The most vehemently hostile politicians represent states where the need is greatest and the populace is most likely to benefit—a bizarre and perverse dereliction of duty.

There has been a blistering campaign of misinformation and obstruction in Republican-controlled states, and outright propaganda in state and national government, and in the right wing media. This pretty much guarantees that the populace will be clueless about even the most basic aspects of the health care law. An amusing but sad example: polling consistently tells us that the public at large thinks the "Affordable Care Act" (ACA) is far better than "Obamacare." Of course, they are exactly the same thing. Polling also consistently shows overwhelming approval of the various provisions of the law, considered separately, even as the public is convinced that the law itself is a disaster.

States opting out of the Medicaid expansion, a provision of the ACA designed to assist persons too poor to be able to afford insurance, are typically the ones that need it the most: those with high rates of poverty and low rates of health insurance coverage among their populace. And they're opting out despite the fact that the federal government would pay 100% of the cost of the expansion. These states—which are naturally clustered in the south and are all under Republican control—are leaving billions of dollars in federal assistance on the table that would go to their most needy citizens.

Not only are needy states saying "no thanks" to federally funded Medicaid expansion, Republican controlled states have actively attempted to impede Obamacare implementation. One way they do so is to obstruct the efforts of so-called "navigators"—federally funded groups or individuals tasked with assisting people in obtaining coverage under the law.  In Florida, governor Rick Scott's Department of Health said it would not allow navigators to do outreach in its offices, but the push-back was swift and vehement, and the department quickly backtracked. Florida has an estimated 3.8 million uninsured persons.

Just two weeks before the October 1 roll-out of the insurance exchanges, Texas governor Rick Perry instructed his Department of Insurance to come up with new rules to regulate navigators, including requiring an additional 40 hours of training beyond the 20 hours required by the federal government. Among the states, Texas has the highest uninsured population (by percentage) in the nation. Around one in four Texans does not have health insurance. That has not stopped Governor Perry from being a vocal opponent of the ACA.

Of the 26 states not implementing their own exchanges, all but two are under Republican governors, and those two have Republican controlled legislatures.

California, with a Democrat governor and Democrat super-majority control of the legislature, has implemented its own exchange and has had considerable success enrolling its citizens. Even there, however, Republicans have attempted to impede the law's implementation with a shadow web site set up by the state assembly's Republican caucus that purports to help consumers navigate the new law. But, according to the Los Angeles Times, the site provides little helpful information and lots of propaganda. It did not even include a link to the official California site—where citizens must ultimately go to enroll—until being berated for the obviously intentional omission.

The Times says that "bogus insurance websites have sprung up all over, aiming to steer consumers away from legitimate enrollment services."

The Times also says that the Republican caucus's web site "falls into the category of exploiting your constituents' confusion for your own political ends."

Private interest groups are also working to sabotage the law. Groups like Generation Opportunity, funded by the billionaire Koch brothers, have been running ads attempting to convince young people to "opt out" of Obamacare; that is, to not buy health insurance. Good advice, kids. Live dangerously. Here are a couple of Koch-funded ads that target young people:



(It is tempting to contemplate state-mandated pre-abortion ultrasounds in Republican-controlled Virgina, Texas, Wisconsin, Kansas, and other states when considering the topic of government intrusion into health care—particularly intrusion between a woman's legs, as depicted in the ad. It would be more likely to find governors Bob McDonnell, Rick Perry, Scott Walker, and Sam Brownback poking around in unwanted places than Uncle Sam.)

A couple of conservative (including Koch)-funded web sites that experts say are spreading misinformation are operating in Alaska. On one, there's a five-question quiz about the individual's circumstances with the sham pretext of helping him decide on an appropriate course of action, but regardless of how you answer the questions, the advice is always the same: "Wait." (That is, don't buy insurance.) In general, the sites prey on consumer confusion using slick deceit, sometimes trying to masquerade as official sites. According to the Alaska Dispatch, the web sites "aim to slow or halt Alaska enrollment in Healthcare.gov."

And so it goes. Deceit. Confusion. Misinformation. All important tools in the right's anti-Obamacare toolbox.

On the national political scene, Chairman Darrell Issa's U.S. House Committee on Oversight and Government Reform has been doing a series of road trips, ostensibly conducting Obamacare hearings. The latest was held in Apache Junction, Arizona. The committee sought, in advance, witnesses who specifically experienced canceled plans, higher premiums, and so forth. Four pre-screened witnesses were allowed to testify about their Obamacare problems; nobody else was permitted to speak before the committee.

A report in azcentral.com covering the hearing noted that a group of local seniors gathered outside the hearing to support Obamacare:

Dennis Hall, an Arizona Department of Corrections retiree from Apache Junction, said he hadn’t been able to find affordable insurance for his wife, who is prediabetic and has high blood pressure, before the Affordable Care Act.

My income is less than $60,000,” he said. “Through the Affordable Care Act, we can get insurance for less than $349 a month. It is the only hope I have in the world of having health care for my wife.

As with Issa's witnesses, this is just another in a sea of annecdotes, but which anecdotes resonate with you says something about your values and priorities.  And the amount of effort you make to learn what's behind the cancelled policies (many—most?—are replaced by better policies at lower cost, and anyway there's always been huge annual churn in the private insurance marketplace) says something about whether you really want to know the truth.

Fairly early in the Obamacare saga, way back in May 2010, I reported on a mailing I received from my own U.S. Representative, Congresswoman Lynn Jenkins. I titled the piece "A Lesson In Dishonesty" for good reason. Jenkins claimed that her mailing was to answer constituents' questions about the new health care law. But instead of explaining what the law does, the mailing simply fixated on its costs—and not in a way that would provide helpful information to the average Kansan. It's hard to imagine how any  person who was not already well informed on the topic could have a positive opinion of the Affordable Care Act after reading the mailing, not least because Jenkins—while claiming to answer our questions—did not describe any of the law's numerous benefits!  You can see the brochure for yourself here.

Citizens should be able to rely on their elected representatives for honest information, but not, apparently, from Jenkins, who was operating in very bad faith. This, it seems, was an early model for what was to come. (Earlier still were Sarah Palin's "death panels" and Chuck Grassley's "pulling the plug on Grandma" demagoguery.)

It's no wonder, then, that the average uninformed American hasn't much of a clue about what Obamacare might do for him, and he's as apt as not to think he's getting screwed.  After all, that's what he's been told, over and over and over again, by the right wing media, by politicians, and right wing interest groups.

There are millions just like my Obamacare-hating friend who badly need affordable insurance, but who are convinced the ACA is their enemy, even if they can't actually say how. What an amazing accomplishment for the law's opponents! A recent NPR story is revealing, describing how things are going in Florida.  From the story:

It's not hard to find people like Elijah Mott, an itinerant heavy equipment operator who says he doesn't know much about the health care law, and that most of what he's heard is bad.

"I think it sucks," he says.

The median household income in this county is about $40,000 a year. Lots of jobs here don't come with health insurance. That means many here like Mott, who doesn't have steady work at the moment, probably qualify for subsidies to help them afford coverage.

But Mott isn't buying the idea that the health law could possibly be good for his family. "I would have to say no," Mott says, "I haven't investigated deep enough to know if there is anything."

Mott and 41-year-old Michael Dees of Mayo, who works in a paper mill, have mostly heard that Obamacare is going to increase the price of health insurance, making it more unaffordable for people like them.

Dees says he expects to be laid off soon, and worries about how he's going to buy coverage for his family.

"Who can afford $700 a month?" he asks. "It's easier to pay for the damn penalty at the end of the year the IRS is going to charge you than pay $500 a month."

Dees says it's news to him that the health law offers people making less than $45,960 a year help paying monthly premiums.

"I really hadn't heard about the subsidy," he says.

This is not how it should be. Our politicians shouldn't lie to us just because they're opposed to a particular policy. Public servants shouldn't sow confusion among the people they represent as a cynical political strategy. Same for our major media outlets. Fox News should be ashamed. You can oppose a thing and still be honest about it. And if your opposition requires dishonesty to be effective (which is what the preponderance of evidence suggests), then there's likely something wrong with your position.

The remaining question, then, is this: What will become of the lies, and the liars, once they've been exposed? This wretched Obamacare roll-out will inevitably transition to a new phase, where millions of Americans will discover, many by accident, many to their surprise, some by talking to friends—and despite the best efforts of their politicians and their media to misinform them—that affordable health insurance might just be a real option for them. At that point the jig will be up. What then?


Copyright (C) 2013 James Michael Brennan, All Rights Reserved

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