Tag Archives: Affordable Care Act

A Bit More on the Cost of Health Insurance

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A Vox article cites a report from the Center for American Progress that helps explain why many employees who get health insurance at work don’t like the Affordable Care Act and believe it’s causing the cost of health insurance to go up:

In recent years, the growth in overall health care costs has slowed dramatically. But for millions of Americans with employer-sponsored insurance…, this slowdown is illusory. From 2008 through 2013, the average annual growth rate of employees’ monthly premium contributions and out-of-pocket expenses, adjusted for inflation, was more than double that of average annual growth in real per-capita national health care spending, which was less than 2 percent per year. This growth has also outpaced employers’ costs of offering these benefits by more than 40 percent.

Employees experiencing higher health care costs tend to blame the Affordable Care Act, or ACA, even though the law largely leaves the employer-based system alone….The actual reason why employee and employer costs are increasing at different rates is because employers have, over time, shifted greater responsibility for health care expenses to their employees through higher deductibles, higher copayments, and higher coinsurance—a practice that began long before the passage of the ACA. Other employers pay smaller shares of their employees’ health care premiums….

In other words, almost everyone in the health care system is realizing savings, but employees’ costs are rising.

Or as Vox puts it, in still other words:

Your company’s health insurance costs are going down. But yours are going up.

This is in addition to many companies incorrectly telling their employees that the ACA is to blame for rising costs.

A Month of Unwritten Posts Condensed Into One

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It’s not as if there’s a shortage of reading material on the Internet. Nevertheless, since I haven’t done my part lately:

You might hear of a new Quinnipiac University poll, according to which Fox News is the most trusted network news in America. The poll found that 29% of American voters trust the news on Fox more than any other network. However, the poll also found that 57% of American voters trust either CNN, ABC, CBS, NBC or MSNBC more than Fox. In other words, 29% of us trust the right-wing propaganda “news” delivered by Rupert Murdoch, and twice as many of us trust the other kind, the “mainstream media” news that Rupert doesn’t own. So it’s bad enough, but not as bad as it sounds.

Meanwhile, a Pew Research Center poll found that 53% of Americans disapprove of the Affordable Care Act, even though the ACA has resulted in more people getting health insurance than the Obama administration predicted, while contributing to slower growth in overall healthcare spending. A Bloomberg article helps explain this discrepancy. First, many people think they can do without the comprehensive health insurance the law mandates and resent paying for services they’ll never need (like maternity care) or don’t think they’ll ever need (like rehabilitation). Second, more than half of the big companies in America have told their employees that the ACA is forcing them to pay even more for health insurance.

The Bloomberg article says that the coverage mandates aren’t making health insurance more expensive. The mandates are merely “pooling the cost of that coverage across more people”, which is why fewer people are having trouble paying for healthcare. Furthermore, employers are blaming an ACA provision (the so-called “Cadillac” tax) for immediate cuts in benefits and higher insurance payments, even though it’s unlikely that these employers will ever be subject to that provision.

But does it matter what the facts are? According to a very interesting article by Heather Cox Richardson, Professor of History at Boston College, America’s right-wing doesn’t accept the importance of empirical evidence or rational argument. She traces this amazing attitude back to William F. Buckley Jr.’s 1950s book God and Man at Yale. Richardson says that:

Buckley rejected the principles that had enabled social progress for centuries and laid out a mind-boggling premise: The Enlightenment, the intellectual basis of Western Civilization, was wrong.

Rational argument supported by facts did not lead to sound societal decisions, Buckley claimed; it led people astray. Christianity and an economy based on untrammeled individualism were truths that should not be questioned. Impartial debate based in empirical facts was dangerous because it led people toward secularism and collectivism—both bad by definition, according to Buckley. Instead of engaging in rational argument, Buckley insisted, thinkers must stand firm on what he called a new “value orthodoxy” that indoctrinated people to understand that Christianity and economic individualism were absolute truths.

If we accept the premise that Christianity and economic individualism (the idolatry of the “free market”) are absolute truths, it makes sense to reject any contradictory ideas, however well-founded those ideas are given the empirical evidence.

For example, the governor of Minnesota, Mark Dayton, inherited a $6 billion deficit from his predecessor, a self-styled “fiscal conservative” who wouldn’t raise taxes. Dayton convinced the legislature to raise taxes on the rich and increase the minimum wage. Republicans predicted, as always, that businesses would leave the state and unemployment would rise. What actually happened was that the deficit turned into a surplus, unemployment went down and Minnesota now has one of the best economies of any state. Forbes Magazine (a bastion of capitalism) recently ranked Minnesota as having the 7th best “economic climate” and the 2nd best “quality of life” in the nation.

But if you believe that higher taxes on the rich and a higher minimum wage are absolutely wrong, since they conflict with your “understanding” of morality and economics, it’s understandable that you’ll reject the evidence. Nothing that conflicts with absolute truth can possibly be true.

To end on a positive note, however, consider that Larry Summers, a leading economist and Wall Street-friendly Democrat, is now arguing for a relatively progressive set of policies. According to an encouraging article by Thomas Edsall of the New York Times, Summers has concluded that “free market capitalism, as now structured, is producing major distortions”:

In order to stem the disproportionate share of income flowing to corporate managers and owners of capital, and to address the declining share going to workers, the report calls for tax and regulatory policies to encourage employee ownership, the strengthening of collective bargaining rights, regulations requiring corporations to provide fringe benefits to employees working for subcontractors, a substantial increase in the minimum wage, sharper overtime pay enforcement, and a huge increase in infrastructure appropriations – for roads, bridges, ports, schools – to spur job creation and tighten the labor market…. Summers also calls for significant increases in the progressivity of the United States tax system.

Summers has advised both President Obama and Hillary Clinton on economic matters, so it’s a positive sign that he now advocates more worker-friendly policies.

Finally, with our harsh winter finally winding down, I want to express my sincere appreciation for everyone who has to work outside or travel to their jobs during terrible winter weather. Many such people aren’t able to take a day off or “work at home”, because you can’t drive a snowplow or staff your boss’s restaurant from your living room. I also want to express my profound appreciation for whoever devised the snow shovel with a bent handle. I’ve used one for years and there’s nothing better for shoveling snow while avoiding back pain!

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Some Progress, But We Could Be Doing Much More

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Jonathan Chait of New York Magazine sums up the continuing success of the Affordable Care Act here :

The Commonwealth Fund has a new survey showing that the proportion of adults lacking health insurance has fallen by a quarter, from 20 percent of the population to 15 percent. (Most respondents, including 74 percent of newly-insured Republicans, report liking their plan.) Also, this week, the Congressional Budget Office again revised down its cost estimates for Medicare, which now spends $50 billion a year less than it was projected to before Obamacare passed. Also, the New England Journal of Medicine recently estimated that 20 million Americans gained insurance under the new law.

Just think what we’d be able to do in this country if the Republicans were reasonable or if there were fewer of them in office. We could have boosted the economy, for example, by investing in our infrastructure during this terrible recession instead of going crazy about the deficit. Below is a chart from Paul Krugman’s blog showing the “Great Disinvestment”, how public spending on construction has dropped in the past four years when it should have increased:

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A Federal Judge Tells the Supreme Court to Shut the F*** Up

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Judge Richard G. Kopf, presumably a Republican since he was appointed to the Federal bench by George H. W. Bush (the first one), reacts to the Hobby Lobby ruling:

In the Hobby Lobby cases, five male Justices of the Supreme Court, who are all members of the Catholic faith and who each were appointed by a President who hailed from the Republican party, decided that a huge corporation, with thousands of employees and gargantuan revenues, was a “person” entitled to assert a religious objection to the Affordable Care Act’s contraception mandate because that corporation was “closely held” by family members. To the average person, the result looks stupid and smells worse.

To most people, the decision looks stupid ’cause corporations are not persons, all the legal mumbo jumbo notwithstanding. The decision looks misogynist because the majority were all men. It looks partisan because all were appointed by a Republican. The decision looks religiously motivated because each member of the majority belongs to the Catholic church, and that religious organization is opposed to contraception. While “looks” don’t matter to the logic of the law (and I am not saying the Justices are actually motivated by such things), all of us know from experience that appearances matter to the public’s acceptance of the law….

Next term is the time for the Supreme Court to go quiescent – this term and several past terms has proven that the Court is now causing more harm (division) to our democracy than good by deciding hot button cases that the Court has the power to avoid. As the kids says, it is time for the Court to STFU. 

Being one of the “most people”, there is no doubt in my mind that the Hobby Lobby decision was stupid, partisan, misogynist and religiously-motivated, but it’s understandable that Judge Kopf expresses himself more judiciously.

There is a little more on the subject from the judge here:

Remembering Alexander Bickel’s passive virtues and the Hobby Lobby cases.

The Burdensome and Anti-Christian “EBSA Form 700”

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As noted in the previous post, a majority of justices on the Supreme Court granted Wheaton College a temporary reprieve from having to fill out and distribute EBSA Form 700. That’s the form that’s supposed to be used by non-profit religious organizations to say they don’t want their employees’ health insurance to cover some or any forms of contraception.

Wheaton told the Supreme Court that Form 700 constituted a significant burden on their religious beliefs. They preferred writing their own letter to the government instead. Understandably, the three women on the Supreme Court thought that was crazy (I’m guessing that the other Democrat on the Court, Justice Breyer, agreed with Justices Sotomayor, Ginsburg and Kagan, but this isn’t the kind of issue that requires the whole Court to express an opinion. Maybe he was out of town or so fed up with some of his colleagues that he’s thinking of giving up the law.)

As government forms go, Form 700 is simplicity itself. Here are its key features:

This form is to be used to certify that the health coverage established or maintained or arranged by the organization listed below qualifies for an accommodation with respect to the federal requirement to cover certain contraceptive services without cost sharing…

[Enter name of objecting organization, individual authorized to make this certification, name and address, etc.]

I certify that, on account of religious objections, the organization opposes providing coverage for some or all of any contraceptive services that would otherwise be required to be covered; the organization is organized and operates as a nonprofit entity; and the organization holds itself out as a religious organization.

[Signature and date.]

The organization or its plan must provide a copy of this certification to the plan’s health insurance issuer (for insured health plans) or a third party administrator (for self-insured health plans) in order for the plan to be accommodated with respect to the contraceptive coverage requirement.

That’s basically it. The form doesn’t even ask for the name and address of the health insurance issuer/administrator, something I certainly would have included if I were the senior bureaucrat responsible for EBSA Form 700.

I think Wheaton objected to this form because they didn’t want to send a copy to their health insurance issuer or third party administrator. Apparently, they thought that doing so would amount to being too cooperative with the government in its anti-Christian effort to make sure health insurance covers contraception. Justice Sotomayor argued in her dissent that forcing the government to identify the issuer/administrator and then send them a copy would be wasting the government’s time, especially if such religious exemptions become common.

Her main point, however, was that it’s the Court’s job to determine whether a law is too burdensome on somebody, not simply take their word for it, as the majority on the Court did here. But the activist Republican judges on the Supreme Court are clearly making this stuff up as they go along.

The burdensome (?) and anti-Christian (?) EBSA Form 700 is available here.

The Court’s brief ruling and Justice Sotomayor’s lengthy dissent is here.