Morning Jolt
. . . with Jim Geraghty November 1, 2013 The New Spin: Hey, 9 Million Eggs Have to Break to Make This Omelet! The new spin from Obamacare defenders: Sure, some people are worse off, but they're only a small minority. Ryan Lizza reports: [Jonathan Gruber, an M.I.T. economist and an architect of both Mitt Romney's health-care plan in Massachusetts and Obama's Affordable Care Act] broke down the A.C.A. "winners" and "losers" for me. About eighty per cent of Americans are more or less left alone by the health-care act—largely people who have health insurance through their employers. About fourteen per cent of Americans are clear winners: they are currently uninsured and will have access to an affordable insurance policy under the A.C.A. I would note that so far, the vast majority of those 14 percent are being added to Medicaid. We can argue about whether that's a good thing or a bad thing; I think the simplest assessment is that it's good for them but bad, or at least ominous, news for the deficit and financial stability of states. Medicaid is important for protecting the most vulnerable, but it's also expensive: As Medicaid's actuarial report lays out: Following the expiration of temporary increases in the Federal matching rate, the States' share of Medicaid expenditures have grown rapidly over the last 2 years — nearly 40 percent — and the States have acted to reduce provider payment rates and/or optional benefits. Their actions had a substantial impact in 2012 and emphasize the difficulty in balancing Medicaid against other government programs in the context of States' budgets. . . . Aggregate Medicaid costs will increase significantly as a result of these changes to eligibility criteria, due to the very large number of additional enrollees starting in 2014. It's worth noting that the Medicaid expansion was a relative afterthought in the debate about Obamacare, compared to the individual mandate and some other provisions. And yet, it may be one of the most consequential parts. Back to Lizza: But much of the current controversy involves the six per cent of Americans who buy their own health care on the individual market, which the A.C.A. has dramatically reformed. Gruber argued that half of these people (three per cent of all Americans) will have little change to their polices. "They have to buy new plans, but they will be pretty similar to what they had before," he said. "It will essentially be relabeling." If the new plans are the same as the old with a different label, why do they have to change them? Obamacare fans shouldn't count on these folks being cheerful and bursting with gratitude, because nobody enjoys having their insurance canceled and being forced to sign up again, only to end up with something "pretty similar to what they had before." It feels like a lot of needless stress and unnecessary aggravation. The other half, however, also three per cent of the population, will have to buy a new product that complies with the A.C.A.'s more stringent requirements for individual plans. A significant portion of these roughly nine million Americans will be forced to buy a new insurance policy with higher premiums than they currently pay. I suspect those nine million will be pretty loud. The primary reason for the increased cost is that the A.C.A. bans any plan that would require people who get sick to pay medical fees greater than six thousand dollars per year. In other words, this was a deliberate policy decision that the White House and Congress made to raise the quality—and thus the premiums—of insurance policies at the bottom end of the individual market. "We've decided as a society that we don't want people to have insurance plans that expose them to more than six thousand dollars in out-of-pocket expenses," Gruber said. Obama obviously should have known that his blanket statement about "keeping what you have" could not apply to this class of policyholders. That's a very gentle way of saying, "the president lied." And here's a fantastic video of Ezra Klein -- who's been alternatingly brutal and gentle in his assessment of the administration's rollout of Obamacare -- in his pre-Washington Post days, back in 2008, laying out why Obama had to be dishonest about people keeping their plans. The short version is that people's attachment to their current plan, and wariness of sweeping changes, meant that they resisted past Democratic efforts to give greater government control over to the health-care system. So any Democratic program had to assure people that they could keep their plan, even if the ultimate aim was, as he prefers, "sign the insurance companies out of existence with my pen. It would be sweet. " "At some point, you have to win," he summarizes. 
Allahpundit: Imagine a president trying to pass the highest-priority item on the Democratic policy wishlist by telling Americans "only" nine million of them will be sure losers, with some as yet undetermined number of further losers to come once the law's unintended consequences start flowing. Gruber can get away with the omelettes-and-broken-eggs approach because he doesn't have to face the voters like Obama and Frank Pallone do. Which brings us to the second form of spin: Lie, lie, lie your ass off and claim that the insurance plans that have been canceled to comply with ObamaCare's new regulations were uniformly lousy, crappy "scams." To watch Pallone in this clip, you would think that nine million people were essentially being loan-sharked by their insurance companies and now, thanks to a benevolent Democratic administration, the thieves and fraudsters have all been put out of business. Back in reality, many of the plans that have now been non-grandfathered out of existence under the regs were being offered by the same insurers whom the White House has partnered with all along in implementing ObamaCare. That is to say, the very people who conspired with him to pass this gigantic boondoggle are now being demagogued by the White House as "bad apples" because it's a convenient way for O to pass the buck on who's really to blame for all the cancellations. Courtesy Campaign Spot reader Morgen, here's the Anthem Blue Cross message to customers in plans that are grandfathered: Three reasons to stay grandfathered
1. Your current medical policy or plan doesn't include some of the benefits that health care laws require for new policies and plans. This could help you save money and control costs over time. However, this is not a guarantee that your premium rates will be lower in the future. 2. Some changes taking place in 2014 may be limiting. Your current policy or plan may offer you greater options with provider choices, prescription benefits and more. 3. Because many health care reform provisions do not apply, you won't be affected by changes that could increase your deductible or your share of the costs. For these reasons, your current grandfathered policy or plan may offer more choices for you in the future. If you choose to stay in this policy or plan, you're not "opting out" of health care reform. Oh, Hey, the Insurer Selection on the Exchanges Stinks in Certain States You recall President Obama's message to those being notified that they're losing their insurance: "If you're getting one of these letters, just shop around in the new marketplace. That what it's for." He's so out of touch, the light from touch takes several years to reach him. CNN: A CNN analysis found that consumer options vary significantly from state to state, and many Americans are discovering that they have very few options. In West Virginia and New Hampshire, for example, residents shopping on the exchanges can only purchase plans from a single company. Contrast that with the state-operated exchange in New York which has 16 participating companies, an average of five per county. Wisconsin, which is on the federal exchange, has 13 participating insurers, although some counties in the state have only one. A Department of Health and Human Services report released in late September asserted that an average of eight insurance companies would be participating in states on the federal exchange; try telling that to a resident of New Hampshire or West Virginia with their single choice. In general, urban and suburban counties with higher populations tend to have more insurers, while it's common for rural counties to be limited to one or two options. The number of insurance companies operating on the exchange is often a fraction of the number that actively sells insurance in the private market. In Wyoming, for instance, there are six companies that actively sell insurance but only two advertise plans on the exchange. In North Carolina, nine companies sell plans, but only two of those are on the exchange and only one of those sells statewide. Some companies are choosing not to participate in certain areas because they are waiting to see how the implementation of Obamacare plays out in the first year. It remains to be seen how many will ultimately sign on despite the problems the exchange has faced so far. A Thin Glimmer of Hope in Virginia? I don't want to lead you wrong about Ken Cuccinelli's odds in Virginia. The outlook is grim. But Quinnipiac had Cuccinelli trailing Democrat Terry McAuliffe by four, and a new McAuliffe e-mail to supporters warns against complacency: "No matter what pollsters are reporting, newspapers are writing, and your friends might be telling you — we're facing two hard truths," said McAuliffe's email. "In off-year elections like this one, Tea Party voters turn out more reliably than Democrats. For 45 years, the political party that controls the White House has lost our governor's race the next year. In 2009, fewer than 40 percent of Virginia voters cast a ballot for governor, despite the fact that nearly 70 percent voted in the presidential election the year before," he explained. "That's why we absolutely CANNOT afford to fall short of our $250,000 Get Out the Vote Fund Goal at tonight's midnight deadline — right now we're $48,345 away," he said in his latest push for more money. For what it's worth, in 2009 Republican Bob McDonnell won by a margin of 17.5 points, and the final RealClearPolitics average was a 13.4 margin. So a GOP over-performance of four points wouldn't be unthinkable . . . ADDENDUM: Thank goodness Louisiana Democrat Senator Mary Landrieu said in August of this year, "If I had to vote for the bill again, I'd vote for it tomorrow." That will come in handy in a lot of television commercials next year.
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