[Vision2020] BULL***T ! ! !

[Nicholas Gier]

Hi Gary,

Do you know what you are talking about, or are you just repeating what you
have heard on right-wing radio/TV?  I will do some more research,
especially on whether these people are paying higher premiums, but the
following from factcheck.org will do for a start:

The Line: Millions of people have lost their health insurance and their
doctors because of the Affordable Care Act.

The Party: Republican

President Obama gave ad-makers plenty of fodder last year when his promise
— “If you like your health care plan, you can keep your health care
plan” — clearly
was proven false
<http://www.factcheck.org/2013/10/reality-confronts-obamas-false-promise/>.
We had said years earlier
<http://www.factcheck.org/2009/08/keep-your-insurance-not-everyone/> that
Obama couldn’t make that promise to everyone, but the claim made headlines
when Americans received cancellation notices for individual market plans
that no longer met the law’s requirements.

Critics of the law now say millions lost their health insurance. But that’s
misleading. Those individual market plans were discontinued, but
policyholders weren’t denied coverage. And the question is, how *many*millions
of insured Americans had plans canceled, and how does that compare with the
millions of uninsured Americans who gained coverage under the law.

There is evidence that far more have gained coverage than had their
policies canceled.

The conservative Americans for Prosperity has made the canceled policies a
theme in its advertising. In one series of ads, a soft-spoken woman says:
“Millions of people have lost their health insurance. Millions of people
can’t see their own doctors.” That ad, which aired in February and March,
targets Democratic senators in three states: Sens. Mark Udall in Colorado,
Mary Landrieu in Louisiana and Mark Pryor in Arkansas. The ad aired
<https://www.youtube.com/playlist?list=PLdSOGKMMlmmY7PeOxod80xHZxUhfsDh2H>
against
Sen. Kay Hagan in North Carolina in November, and it’s also been used to
target a few House members.


Another AFP ad targeting Landrieu — and airing in January — said that
“millions of Americans have lost their health care.”

It’s true that insurance companies discontinued health plans that had
covered millions of people who had bought them directly rather than through
an employer. That’s because those plans didn’t meet the coverage standards
of the new law.

But those policyholders didn’t lose the ability to have insurance. In most
cases, insurers offered them an alternative plan, though there were some
instances of companies exiting the individual market altogether.

Whether offered an alternative or not, individuals could shop for insurance
on the federal and state marketplaces, or through a broker or insurance
carrier directly. Many were likely eligible for federal subsidies to help
pay for insurance, resulting in better coverage and lower rates for some.
But the specific plan they had was indeed discontinued. (More than half of
those with canceled policies were likely to be eligible for federal
assistance, according to Urban Institute research
<http://healthaffairs.org/blog/2014/03/03/how-many-nongroup-policies-were-canceled-estimates-from-december-2013/>,
and about 80 percent of all those buying plans on the exchanges are
expected to qualify for subsidies, according to the Congressional Budget
Office
<http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2014-02-ACAtables.pdf>
.)

How many individual market cancellations were there?

The most commonly used figure is 4.7 million, based on reporting by the
Associated Press last December. But there’s reason to doubt the accuracy of
that figure. An analysis of a more recent poll by researchers at the Urban
Institute puts the figure at somewhere around 2.6 million.

An AP story that ran Dec. 26
<http://finance.yahoo.com/news/policy-notifications-current-status-state-204701399.html>
said
that “at least 4.7 million Americans received the cancellation notices,”
and gave state-by-state figures for the “number of policies scheduled to be
canceled.”

But the news agency didn’t say exactly how it arrived at the other figures
that went into the 4.7 million total, making the reporting impossible for
outsiders to verify. In three states, the figures appear to be inflated.
Washington state’s insurance commissioner, for example, has publicly stated
that the AP’s figure of 290,000 discontinued policies in that state is
“inaccurate.” In a news release on his official website
<http://oic.wa.gov/about-oic/news-media/news-releases/2014/2-13-2014.html>,
Insurance Commissioner Michael Kreidler said that there were only 278,000
total in the individual market at the end of September. Recent reports by
our fact-checking colleagues at Politifact.com
<http://www.miamiherald.com/2014/03/30/4022122/rick-scotts-political-committee.html>and
the *Washington Post*
<http://www.washingtonpost.com/blogs/fact-checker/wp/2014/04/07/mcconnells-stale-inflated-claim-on-health-plan-cancellations/>
show
the numbers were too high in Florida and Kentucky.

And now, new research also gives reason to think the AP estimate may be
inflated.

In a March 3 posting on the website of the journal Health Affairs, two
researchers from the Urban Institute analyzed findings from a nationwide
poll and said, “Our findings imply that roughly 2.6 million people
<http://healthaffairs.org/blog/2014/03/03/how-many-nongroup-policies-were-canceled-estimates-from-december-2013/>would
have reported that their plan would no longer be offered due to
noncompliance with the ACA.” And in this case, the methodology is made
explicit.

In December 2013, the Urban Institute’s quarterly Health Reform Monitoring
Survey <http://hrms.urban.org/index.html> of adults ages 18-64 included
this question: “Did you receive a notice in the past few months from a
health insurance company saying that your policy is cancelled or will no
longer be offered at the end of 2013?” And of the 522 people polled who
were covered by non-group policies, 18.6 percent said yes, their old plan
would no longer be offered because it didn’t meet the new coverage
standards that went into effect Jan. 1.

And if 14 million people were covered by non-group policies nationwide (as
indicated by the National Health Information Survey of the U.S. Centers for
Disease Control and Prevention), that percentage translates to 2.6 million
non-group policies discontinued, the authors stated.

To be sure, there is always a statistical margin of error in any
random-sample poll. Lead author Lisa Clemans-Cope told us in an email that
statistically, there is a 95 percent certainty that the true percentage
whose non-group policies were discontinued falls somewhere between 16.2
percent and 23.3 percent. That would put the number at anywhere between
about 2.3 million and 3.3 million.

That range could be higher or lower depending on what number is used for
the total who had non-group coverage in the first place. The Urban
Institute authors cite a study published last year
<http://healthaffairs.org/blog/2014/03/03/how-many-nongroup-policies-were-canceled-estimates-from-december-2013/>
that
found estimates of the total number of people covered by non-group policies
ranged from 9.55 million to 25.3 million. So if 18.6 percent of non-group
policyholders got notices that their policies were being dropped because of
the new law, as the poll indicates, then the actual number whose plans were
dropped could be as low as about 1.8 million or as high as 4.7 million
(coincidentally, the same as the AP’s figure), depending on how many had
such policies in the first place.

The authors, as noted, picked an estimate that fell in the middle of this
range to arrive at their figure of 2.6 million discontinued policies. Until
and unless better evidence comes along, that’s the most solidly based
figure available.

How many “millions” so far have gained coverage?

The early numbers on enrollment in the exchanges and Medicaid don’t tell us
how many of the enrollees were previously uninsured — despite some claims
from Democrats to the contrary
<http://www.factcheck.org/2014/01/reid-overstates-reduction-in-uninsured/>.
The Obama administration disclosed
<http://www.politico.com/story/2014/04/obamacare-enrollment-numbers-105572.html>
on
April 10 that 7.5 million had signed up for plans on the exchanges, but we
don’t know how many previously had insurance. The Medicaid rolls increased
by more than 3 million through the end of February, the administration also
said
<http://www.washingtonpost.com/national/health-science/medicaid-chip-enrollment-grows-by-more-than-3-million-cms-data-shows/2014/04/04/fcdca03e-bc19-11e3-9c3c-311301e2167d_story.html>,
a figure that would reflect both those newly eligible under the law and
previously eligible but now signing up.

But a survey funded by the Robert Wood Johnson Foundation and conducted by
the Urban Institute
<http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/04/new-survey-results-show-significant-decline-in-uninsurance-rate-.html?cid=xrs_rss-pr>
indicates
that many of those signing up for the exchanges and Medicaid may have been
uninsured. It found that 5.4 million of the previously uninsured had gained
coverage between September and the beginning of March. The exchanges
launched Oct. 1.

An April 8 report by the nonprofit RAND Corp.
<http://www.rand.org/blog/2014/04/survey-estimates-net-gain-of-9-3-million-american-adults.html>
put
the figure of newly insured higher. Based on a nationwide poll, Rand
estimated that there had been a net gain of 9.3 million insured “adults” as
of mid-March, when the poll was being conducted. That includes marketplace
and Medicaid enrollment, as well as an increase in employer-based
enrollment.

Neither of those figures includes an estimated 3 million young adults
<http://www.hhs.gov/news/press/2012pres/06/20120619b.html> who gained
coverage in 2010 and 2011, likely because of the law’s provision allowing
them to stay on their parents’ policies.

RAND also estimated that 700,000 who previously had individual market plans
were now uninsured. The survey didn’t ascertain whether those newly
uninsured were due to cancellations or voluntarily dropped coverage.

It will be some time before more concrete coverage numbers are available.
The RAND numbers are extrapolated from a survey, and one with sizable
margins of error. The estimate of 9.3 million newly insured has a margin of
error of 3.5 million people, meaning researchers have a high degree of
confidence that the true number would be between 5.8 million and 12.8
million. And the estimate of 700,000 uninsured who previously had
individual market plans carries a margin of error of 900,000, putting the
likely real number somewhere between zero and 1.6 million people.

Millions more are expected to gain insurance because of the law nationwide
in the coming years. The nonpartisan Congressional Budget Office estimates
<http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2014-02-ACAtables.pdf>that
there will be 25 million fewer uninsured due to the ACA as early as 2016.

Losing Doctors?

The AFP ad also makes the claim that “millions of people can’t see their
own doctors,” but there’s no evidence that all those who had individual
market policies discontinued ended up not being able to keep their own
doctors. Anecdotally, we know
<http://www.factcheck.org/2013/11/the-rest-of-the-story-on-arizona-anecdote/>
 of some folks
<http://www.washingtonpost.com/blogs/fact-checker/wp/2014/03/11/update-julia-boonstras-claim-her-obamacare-plan-is-unaffordable-gets-downgraded-to-three-pinocchios/>
who
were able to keep the same doctor on a new insurance policy. But those are
only a few individual stories. One of our guiding principles here is the
saying, “The plural of anecdote is not data.”

It is true that using a smaller network of providers is one way insurers
can reduce premium costs, and there is evidence that insurers are indeed
doing that for exchange plans
<http://www.kaiserhealthnews.org/stories/2013/september/26/narrow-insurance-network-missouri-exchange-marketplace.aspx>.
As Deborah Chollet, a senior fellow at Mathematica Policy Research, a
nonpartisan research firm, told us in December
<http://www.factcheck.org/2013/12/aca-doesnt-set-prices-on-exchanges/>:
“The narrow-network plans offered by some issuers are intended to (a)
maximize negotiating leverage with providers by narrowing their PPOs; and
(b) thereby reduce premiums to attract consumers.”

Limited networks have existed for some time, as anyone with an HMO, PPO and
the like can attest. There are no available statistics showing whether the
plans on the new exchanges have more or less narrow networks than existed
in the individual market previously. But, again, insurers certainly are
limiting their networks to price their plans competitively.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told us:
“It’s definitely the case (based on conversations with insurers and with
providers) that insurers have decided to limit networks in some instances
in order to price their health plans more competitively.” She continued:
“It’s also definitely the case that some providers have declined to
participate in some of the new health insurance networks, holding out for
higher fees from some insurers in return for a promise to participate
exclusively in their networks. This is market competition at work — not
entirely transparent, unfortunately, so it’s not yet clear what the impact
will be on patients.”

*– Lori Robertson and Brooks Jackson*

On Mon, Feb 2, 2015 at 1:34 PM, Gary Crabtree <moscowlocksmith at gmail.com>
wrote:

> When Obama care caused millions of Americans to lose the health care
> they were promised they could keep and forced then to scramble for
> more expensive health plans that were less suitable to their needs you
> thought that this was a wonderful step forward for the country. Surely
> you can't be objecting to a little health care presto change-o coming
> into your own little world?
>
> g
>
> On Mon, Feb 2, 2015 at 6:21 AM, Tom Hansen <thansen at moscow.com> wrote:
> > Is this what happens under a Republican-controlled congress?
> >
> > Privatization of health care insurance for military retirees?????
> >
> > If it works, DON'T FIX IT ! ! !
> >
> > I am a disabled retiree (with a service-connected disability rated at
> 45%).
> > I would HATE to have to pay commercial health insurance premiums . . .
> and
> > hope I am covered if I should ever have to be admitted to the hospital.
> >
> > Courtesy of the Army Times.
> >
> > --------------------------------------
> >
> > Commission Calls for Abolishing TriCare
> >
> > A congressional commission has called for an overhaul of the military
> health
> > system that does away with Tricare, changes the medical command structure
> > and seeks to improve Defense Department coordination with Veterans
> Affairs.
> >
> > The goal of the Military Compensation and Retirement Modernization
> > Commission’s plan according to its final report released Jan. 29, is to
> > preserve the quality of combat care that saved many troops’ lives in Iraq
> > and Afghanistan but also improve access to health treatment for those who
> > use the system.
> >
> > Under the recommendations, active- duty members and mobilized reservists
> > still would receive medical care from the U.S. military, with easier
> access
> > to specialty care in the civilian sector if they need it.
> >
> > But their family members, and retirees under 65 and their families,
> would be
> > covered through commercial insurers, similar to plans run under the
> Federal
> > Employee Health Benefits Program.
> >
> > Active-duty families would get an allowance to cover their insurance
> > premiums, called the Basic Allowance for Health Care.
> >
> > Retirees below Medicare-eligible age would pay their premiums out of
> pocket,
> > though at a lower cost thancivilianplansas“recognition” of their service,
> > under the plan.
> >
> > The program would be run from the Office of Personnel Management, just as
> > the FEHBP is, negating the need for the huge Tricare contract management
> and
> > oversight structure that exists in the Pentagon, according to the report.
> >
> > But this would not be FEHBP, commission members stressed, because that
> > program doesn’t offer options appropriate for military beneficiaries with
> > their unique requirements, including the availability of military
> treatment
> > facilities and readiness demands, the commission wrote.
> >
> > “By moving toward private insurance, beneficiaries of the plan would have
> > improved access to health care. ... It also solves some of the issues
> with
> > mobilization and place monthly pension checks with 401(k)-style
> investment
> > accounts. That suggested the government contributions should be at least
> > 16.5 percent of basic pay, with higher rates for deployed service
> members or
> > high-demand career f ields.
> >
> > That plan went nowhere after it was criticized by troops, disavowed by
> the
> > Pentagon leadership and landed with a thud on Capitol Hill.
> >
> > Last March, the Pentagon’s personnel and readiness office broke its long
> > silence and offered several detailed and complex alternatives to the
> current
> > system: hybrid options that included both a TSP with government
> > contributions and smaller, partial pension checks before traditional
> > retirement age.
> >
> > That plan also included some lump-sum payments for troops staying at
> least
> > 20 years, offering a “transitionpay”equaltoasmuchas three years’ basic
> pay.
> >
> > The nine-member commission is chaired by Maldon. Other members include
> > Pressler, Dov Zakheim, Edmund Giambastiani, Peter Chiarelli, Bob Kerrey,
> > Christopher Carney, Michael Higgins and Stephen Buyer. N care they now
> have,
> > under the plan.
> >
> > The commission also recommends that DoD create a four-star Joint
> Readiness
> > Command that would lead much of the portion of the Joint Staff that is
> > responsible for readiness. This structure, commissioners said, would
> improve
> > coordination across the services in treatment, transportation and care
> for
> > injured and ill troops.
> >
> > “Joint readiness today is at a high level because we’ve just been through
> > more than a decade of war. This seeks to preserve that function,” Daigle
> > said.The commission also suggests changes to programs for beneficiaries
> with
> > special needs, to more closely align them with state Medicaid programs —
> > something advocates have sought in recent years.
> >
> > The commission also called for improving coordination between DoD and VA
> > health services, to include creating a uniform drug formulary for smooth
> > transition of prescriptions, establishing standard reimbursement and
> > completing the effort to create a joint electronic health record system.
> >
> > The report estimates changes to the health programs could cut the
> Pentagon
> > budget by $26.5 billion from fiscal 2016 to fiscal 2020 and save $6.7
> > billion a year by 2033.
> >
> > Unlike the retirement portion of the report, which would apply only to
> new
> > recruits, the health care portion of the recommendations would affect all
> > family members, retirees and their families — except for those on Tricare
> > For Life — once signed into law.
> >
> > Joyce Raezer, executive director of the National Military Family
> > Association, said she polled 20 military spouses shortly after the report
> > was released and said most were “intrigued” by the recommendations,
> > particularly the prospect of greater choice.
> >
> > “Generally, the option for choice in this arrangement ... they like that.
> > The Tricare bureaucracy is cumbersome,” Raezer said.
> >
> > But spouses added they would need help understanding their options and
> > choosing plans, and they also wondered how such a system would work
> across
> > state lines and overseas.
> >
> > “The biggest concern is about education,” Raezer said. “We have been
> > educating the whole country about health care with the Affordable Care
> Act
> > right now. This means we’d need to educate retirees and family members
> >
> > --------------------------------------
> >
> > Seeya 'round town, Moscow, because . . .
> >
> > "Moscow Cares"
> > http://www.MoscowCares.com
> >
> > Tom Hansen
> > Moscow, Idaho
> >
> >
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> >           mailto:Vision2020 at moscow.com
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>
>
>
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