Affordable Care Act Repeal Unlikely, Unpopular
Nobody is head over heels in love with the Affordable Care Act, but McClatchy notes that much of the discontent is from the left and the public constituency for repeal is quite small:
On the side favoring it, 16 percent of registered voters want to let it stand as is.
Another 35 percent want to change it to do more. Among groups with pluralities who want to expand it: women, minorities, people younger than 45, Democrats, liberals, Northeasterners and those making less than $ 50,000 a year.
Lining up against the law, 11 percent want to amend it to rein it in.
Another 33 percent want to repeal it. Among groups with pluralities favoring repeal: men, whites, those older than 45, those making more than $ 50,000 annually, conservatives, Republicans and tea party supporters.
Nothing surprising about the demographics here or the outcome. If you polled me on this, I’d count myself as someone who wants to expand the law. To give a more nuanced view, though, I think there’s room for both expansion and curtailment. What’s more, even though few in Congress want to hear it the reality is that we need to do more health reform. Much more. The cost/quality situation is nowhere near good enough. What’s needed, in political terms, is some kind of credible escape hatch through which conservative politicians can engage with changing health care law in some way other than demanding repeal. This is what I think is promising about the Scott Brown / Ron Wyden state waiver initiative.
Most Want to Keep or Expand Health Care Law
A new McClatchy-Marist poll finds a majority of Americans want Congress to keep the new health care law or even expand it, despite Republican claims that they have a mandate from the people to kill it.
Key findings: 51% of registered voters want to keep the law or change it to do more, while 44% want to change it to do less or repeal it altogether.
Said pollster Lee Miringoff: “On health care, there is a wide gap between public opinion and the political community.”
Taegan Goddard’s Political Wire
New Health Care Rule: You Get More Care for Your Money
Big insurers spent millions to try to gut a proposed new rule that requires they spend a certain amount of premium dollars on actual medical care. But American families and businesses are coming out on top.
The U.S. Department of Health and Human Services (HHS) today issued a new rule—known as “medical loss ratio”—that will require health insurance companies to spend 80 percent to 85 percent of your health care insurance premiums on making you healthier instead of overhead costs like advertising or executive pay.
Last month, big insurers sent more than 1,000 executives and lobbyists to the National Association of Insurance Commissioners (NAIC) meeting in Orlando to try and get the rule changed, according to the coalition, Health Care for America Now (HCAN).
AFL-CIO state federation officers actively lobbied their state insurance commissioners to listen to working families and their unions and to not give in to the big insurers’ push to stop the regulation. Their efforts played a significant role in making the rule a reality.
HCAN Executive Director Ethan Rome says the new rule will change the way health insurance companies do business and end such unconscionable abuses as denying people coverage because they are sick. He adds:
When the Republicans call for repeal (of health care reform), they’re talking about throwing out rules like this one and putting consumers at the mercy of the insurance companies again. The Republican repeal-mongers are not only on the wrong side, they’re also just plain out-of-touch with the needs of businesses to move forward and the desires of consumers to have better care.
Check out a White House video explaining what the new rule means here.
Health Reform and Accountable Care Organizations
Critics of the ACA have frequently complained that the legislation does not do enough to improve quality or to cut costs. However, the Act did create incentives for new alliances of hospitals and doctors, known as “Accountable Care Organizations.” Now provider lobbies are demanding some pretty dramatic changes to health care regulation in order to implement ACOs. In this post, I want to explain what ACOs are, and why they challenge traditional health care regulatory models.
What’s an ACO?
Elliott Fisher, director of the Center for Health Policy Research at Dartmouth Medical School, describes the “three key attributes” of ACOs: “organized care, performance measurement, and payment reform.” Fisher has argued that insurers are not well-positioned to improve the quality of health care because they “have largely focused on negotiating favorable prices within relatively open networks of providers” instead of trying to improve the health care their members received. (Private insurers have little incentive to keep current subscribers healthy over the long term, since at least half of subscribers on average churn into different plans within three years of signing up with a given plan.) He believes that a “virtual network” of physicians could do a better job, if they teamed up with hospitals. ACO refers to this legal alliance, which would be entitled to receive payments in exchange for cutting costs or improving quality.
In an ACO, an “extended hospital medical staff” (or “a hospital-associated multi-specialty group practice”) can join forces with a hospital and agree to be compensated via a lump sum payment. If the group manages to keep overall costs beneath the lump sum payment, it can share the gains among its members. Each part of the team also has an incentive to work together to keep those they care for healthy. In an ideal world, the ACO responds to the concerns about fragmentation discussed in last month’s symposium on the volume edited by Einer Elhauge recently released by Oxford University Press.
ACO Skeptics
But there are skeptics. Jeff Fisher worries about shadowy new pressures on providers that patients won’t be aware of:
Consumers would not be aware that they were being treated by ACOs. Rather, they would be “attributed” to them: virtual patients of virtual organizations. Aggregate health spending for attributed patients would be tracked, and increases in that spending would be capped using a form of “shadow capitation.” ACOs that lived within the caps would get their fees increased. Those that overspent would see their fees reduced or frozen.
Snowe Backs Challenge to Health Care Law
Sen. Olympia Snowe (R-ME) has co-signed an amicus, or friend of the court, brief to be submitted to the federal court in Florida that will hear a constitutional challenge of the individual mandate included as part of the health care reform law, the Portland Press Herald reports.
“Snowe was the only Republican to support any version of health care reform, but ultimately voted against the final bill. The version Snowe supported did include an individual mandate, but her aides said she opposed that provision and hoped to change it through the amendment process.”
Taegan Goddard’s Political Wire
Hating Israel doesn’t stop Gulf royal from seeking care there
From JPost:
A member of the royal family of a Persian Gulf state is undergoing advanced medical treatment in Israel, sources close to Deputy Minister for Negev and Galilee Development Ayoub Kara (Likud) revealed Sunday.
Kara’s office confirmed that the foreign visitor had completed a series of tests Sunday, in preparation for heart surgery on Tuesday, but would not detail the medical tourist’s country of origin, or the name of the hospital in which he is being treated.
Kara’s office became involved in the visit when Kara aided the patient in securing the necessary paperwork in order to allow him to enter Israel. Israel does not have official diplomatic relations with any of the Persian Gulf states.
Reminds me of an old All in the Family episode, where the bigoted Archie Bunker, pretending to have whiplash, insists on a Jewish lawyer:
It is amazing how tolerant people become when they need help.
And how easily they revert back once they are finished.
(h/t Zvi)
But of Course: King of Nation With Universal Health Care to Come to US for Medical Treatment
**Written by Doug Powers
The day after the Obamacare law passed, Saudi King Abdullah reportedly called President Obama to congratulate him. The bill, it seems, was one more step toward the US embracing a superior universal health care system like that which can be found in Saudia Arabia, where treatments for medical problems such as, oh, say, blood clots, are fully covered.
Now, the king of the country with that health care system that gives the US something to strive for won’t be treated in that system, but will instead come to the US for treatment. He’s lucky the law that will make US health care system more closely resemble the Saudi system — which isn’t good enough for Saudi royalty — hasn’t kicked in yet:
RIYADH, Saudi Arabia – Saudi Arabia’s aged ruler will fly to the United States for medical tests over a blood clot, according to a Saudi official, in a development that would renew questions about succession in the oil-rich kingdom.
The 86-year-old King Abdullah is set to leave on Monday, three days after he was admitted to the hospital suffering from back pain due to a blood clot, the official said late Saturday. The official didn’t say which hospital would receive the king.
To paraphrase John McCain’s question, when Obamacare is fully implemented in America, where will rich Saudis go for health care? Not to worry, Saudi royalty — the US government will be happy to grant you a waiver.
**Written by Doug Powers
Twitter @ThePowersThatBe
Don’t Ask Don’t Care (Guest Voice)
Don’t Ask, Don’t Care
by Michael Winship
Although I grew up in a small town, I live in the West Village of Manhattan, New York City, just three blocks from Christopher Street and the Stonewall Inn, where in 1969 a police raid led to angry demonstrations that marked the start of the gay rights movement. Yet in most ways my neighborhood is just like yours. We all co-exist. Kids go to school, business owners complain about the economy, everyone – straight or gay — is worried about jobs.
I also work in an industry – journalism, media and entertainment — in which men and women of diverse sexual orientation make extraordinary contributions ever day, informing, delighting and annoying audiences of every age, gender, shape and hue. No problem.
Granted, a few members of that audience are bigots and pinheads, probably unaware that their favorite show or song was created by a team of imaginative people with social and personal lives unlike their own. So let’s keep them out of this.
Because it’s about this gays in the military thing. Listen, Congress. The majority of the people have spoken – as many as 78% of them in a May CNN poll, 50% in a new Wall Street Journal/NBC News survey. And it’s not so much “Don’t Ask, Don’t Tell,” as simply, “Don’t Care.”
Don’t care if homosexual men and women openly serve in the armed forces as long as they do their job and defend their country. Don’t care what military men and women and men and men and women and women do in their spare time as long as it doesn’t involve minors, criminal activity or abuse. Don’t care because it’s none of our business.
I knew for sure that public and military opinion were changing on this issue exactly eight years ago, when I was guest lecturing at Austin Peay State University in Clarksville, Tennessee. The school is just down the road from Fort Campbell, home of the 101st Airborne Division, and many of Austin Peay’s students are active duty military personnel, veterans and family members.
Keep in mind that not so long ago, at Fort Campbell in 1999, Private First Class Barry Winchell, who had been dating a male-to-female transgender performer he met at a club, was verbally and physically harassed and eventually murdered by another soldier. But just a short time later, the young men and women with whom I spoke seemed fully comfortable with their gay and lesbian friends and comrades-in-arms, far more concerned with the safety of colleagues and loved ones in Iraq and Afghanistan than how they behaved when the lights were out. In fact, these students frequently hung out together in gay or straight or transgender bars in nearby Nashville, at ease with their own and each others’ sexuality.
But now, despite wide public acceptance, the Senate may strip the repeal of “Don’t Ask Don’t Tell” from the defense appropriations bill to prevent a filibuster, just part of the continuing spirit of legislative negativity and resistance that denies the reality of everything from nuclear arms proliferation (the START Treaty) to climate change.
It’s all so reminiscent of that old Groucho Marx song, “Whatever It Is, I’m Against It.” Because the man threatening to filibuster is the Groucho – er, Grouchy – of the United States Senate, the newly reelected John McCain.
As vividly and hilariously illustrated this week by both Jon Stewart and Rachel Maddow, the Senior Senator from the State of Cantankerous has shown that he can play a childish game of “Step over that Line” until well past bedtime, even after the bugler blows “Taps.” First, he said he’d consider backing repeal of Don’t Ask, Don’t Tell if the military’s top brass recommended it. Defense Secretary Robert Gates and Chairman of the Joint Chiefs of Staff Admiral Mike Mullen did just that (as did their commander-in-chief, Barack Obama).
Not good enough, said McCain back in February. Before he’d go along he needed to see a study thoroughly surveying the military point of view.
Questionnaires were sent this summer to 400,000 active and reserve troops and 150,000 military spouses. The results are officially due December 1 but word is out. The November 11 Washington Post reported, “More than 70 percent of respondents to a survey sent to active-duty and reserve troops over the summer said the effect of repealing the ‘don’t ask, don’t tell’ policy would be positive, mixed or nonexistent, said two sources familiar with the document. The survey results led the report’s authors to conclude that objections to openly gay colleagues would drop once troops were able to live and serve alongside them.”
Still not good enough, McCain said on Sunday’s Meet the Press. He wants hearings and another report – this one “to determine the effects of the repeal on battle effectiveness and morale” (despite the fact that the December 1 report apparently does just that).
“McCain has said he wanted to hear from rank-and-file troops,” Human Rights Campaign President Joe Solmonese said. “He just heard loud and clear from them through the study. But he doesn’t like the answer – and is stonewalling, trying to run out the clock on repeal by calling for congressional hearings.”
An old Navy man like you should know when the boat has sailed, Senator McCain. Just this once, forget John Paul Jones and give up the ship. Remember the words of your conservative mentor, the man whose seat you inherited in the Senate, Barry Goldwater. In 1994, he wrote, “The conservative movement is founded on the simple tenet that people have the right to live life as they please as long as they don’t hurt anyone else in the process.”
Or, even more succinctly and famously, in a 1993 letter Goldwater wrote to The Washington Post: “You don’t need to be ’straight’ to fight and die for your country. You just need to shoot straight.”
Michael Winship is senior writer at Public Affairs Television in New York City.
Health Care Giants Spent $86 Million in Effort to Kill Reform
We reported that Big Insurance funneled millions of dollars to the Chamber of Commerce to fight health care reform and millions more to try and water down the law once it was passed. Now Bloomberg Business News reporter Drew Armstrong has put a price tag on the effort to kill the bill. In an article earlier this week, Armstrong says tax records show big health insurers last year gave the Chamber $ 86.2 million that was used to oppose the health care overhaul law.
The Chamber is not required to disclose its donors, but unnamed sources told Bloomberg that the money came from America’s Health Insurance Plans (AHIP), an industry trade group that represents companies like Cigna and UnitedHealth Group. AHIP’s donation accounted for 40 percent of all the money the Chamber received in 2009.
The money paid for advertisements, polling and grass roots events to drum up opposition to the bill that’s projected to provide coverage to 32 million uninsured Americans, a Chamber spokesman told Armstrong.
But the spending hasn’t stopped. Opponents of the overhaul have spent $ 108 million since then to advertise against it, the New York Times recently reported—six times more than supporters have spent.
Meanwhile, the big insurers continue to make outrageous profits. Six of the nation’s biggest private health insurance companies saw their profits increase by 22 percent over last year in the quarter that ended in September, according to a new analysis by Health Care for America Now (HCAN).
HCAN says the $ 3.4 billion in 2010 third-quarter profits for WellPoint Inc., UnitedHealth Group Inc., Aetna Inc., Humana Inc., Cigna Corp. and Coventry Health Care Inc. is tied to the companies spending a “smaller share of their premiums on medical care, purging unprofitable members and burdening consumers with higher cost-sharing limits.”
Why does D.C. care so much more about Pelosi than about Reid?
For all the hubbub over the decision House Democrats made to keep Nancy Pelosi, there’s been almost nothing said on the decision Senate Democrats made to keep Harry Reid. But what’s the difference? Pelosi might be a bit more unpopular, but they’re both pretty unpopular. And Pelosi is a lot less vulnerable in her district than Reid is in his state.
Another possible answer is that Democrats lost their majority in the House, but not in the Senate. But it’s hard to give that explanation much credit, either: Senate Democrats would have lost the majority if all of them had been up for reelection. They hold the chamber because only a third of the Senate was up for election, not because Reid’s forces were more popular than Pelosi’s.
So what gives?
Photo credit: Jim Young/Reuters.
