The U.S. uninsured rate continues to drop under Obamacare

by Rob Cullen on April 16, 2015 - 5:17 PM

gallup tracking poll 1st quarter 2015

Just wanted to quickly point out that the latest Gallup survey shows that the uninsured rate has dropped again, to 11.9% in the first quarter of 2015– the lowest it’s been since Gallup began tracking it in 2008. That 1% drop over the last quarter alone represents over 3 million people who gained coverage.

We were curious how opponents would respond to such clear evidence that Obamacare has, as promised, expanded coverage to millions of Americans. After all, conservative pundits and think tanks have spent the past few years predicting that the new law would have no effect on the uninsurance rate and that the only people getting coverage already had insurance.

Unsurprisingly, given how spectacularly wrong they were, many of these top conservative wonks and pundits have been pretty quiet about the falling uninsurance rate. However, we did find some weak attempts to dismiss it from their B team.  [click to continue reading…]


US President Barack Obama gives a thumbs

Back in January of 2014, in the middle of Obamacare’s first open enrollment period, Washington Post reporter Sarah Kliff pointed out that the law has so many different goals that we needed a clearer definition of what success would like. She came up with four ways to tell whether the law is working:

  • Do more people have health insurance?
  • Do Americans have better access to healthcare (i.e. how easily can you use your insurance to see a doctor)?
  • Are Americans getting healthier?
  • Is healthcare getting more affordable?

As Obamacare approached its fifth birthday, she revisited these questions and found that, based on the information we have so far, yes, the law is working. Over 16 million more people have health insurancemost Obamacare enrollees can get an appointment within two weeks, and health cost inflation is at its lowest levels since the 1960’s (although it’s still too earlier to tell if Obamacare helped cause the spending slowdown or just coincided with it). It’s also still too early to tell if Americans are getting healthier, but as we pointed out last week, the early data is promising.

Yet opponents of the law are still claiming that it’s actually been a disaster. If you’re wondering whether they’re looking at the same facts, the answer is no. A recent piece from conservative columnist Jack Kelly illustrates how they continue to delude themselves and anyone who will listen by (1) over-emphasizing the aspects of Obamacare that didn’t go as smoothly as promised; (2) ignoring evidence that it’s working; (3) predicting future disasters based on little evidence; and (4) making stuff up.

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Kaiser Tracking Poll March 2015

On Friday, we looked at how the Affordable Care Act is doing on its fifth birthday, and if nothing else, it’s clear that Obamacare has proven it’s critics wrong. Before the exchanges launched, opponents claimed that no one would sign up, that premiums would skyrocket, that it would wreck the economy. Instead, nearly 12 million people have purchased coverage through the exchanges so far, premiums were lower than expected in 2014 and rose by just 2% in 2015 (before Obamacare, the norm was around 10%) and last year was the biggest year of job creation in more than a decade.

And yet… despite all this good news, as the chart above shows, public opinion on the ACA is still split, with slightly more people reporting an unfavorable view than a favorable one. So what gives? We have a few theories.   [click to continue reading…]

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Obamacare turns five

by Rob Cullen on March 27, 2015 - 3:46 PM

obama signature on ACA

This week marked the fifth anniversary of the passage of the Affordable Care Act. For the past five years, its opponents have said that this new law would be a disaster– that people wouldn’t buy coverage on the exchanges, that premiums would double or triple, that it would explode the deficit, that it would wreck our healthcare system.

None of these things has come true. Obamacare hasn’t fixed every problem with our healthcare system, but as the law turns five so far it’s doing exactly what it’s supporters claimed it would: expanding coverage to millions of Americans, bringing down costs, and improving the quality of care.

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Republican Rep. Tom Price, chair of the House Budget Committee.

Republican Rep. Tom Price, chair of the House Budget Committee.

Since the Republicans took over the House in 2011, every budget they’ve proposed has looked more or less the same, especially with respect to healthcare. Each year their budget calls for privatizing Medicare, massive cuts to Medicaid, and repealing Obamacare with no plan to replace it.

We thought this year might be different. After all, it’s the first time since 2011 the House Budget committee has been chaired by someone other than Paul Ryan (he’s moved on to chair the more powerful Ways and Means committee), and it’s the first time in almost a decade that Republicans in the Senate have had to produce a budget of their own.

But nope, it’s pretty much just more of the same: privatizing Medicare, massive cuts to Medicaid, and repealing Obamacare with no plan to replace it. What’s different now are the budget gimmicks. In the past, they’ve been vague on how they would cut other domestic spending, but their healthcare plans were pretty straightforward. This year, both the House and Senate plans call for trillions of dollars in healthcare savings– but where most of that savings comes from is a detail Republicans say they’ll figure out later.  [click to continue reading…]


The latest Obamacare case hinges on these two justices: John Roberts and Anthony Kennedy

The latest Obamacare case hinges on two justices: John Roberts and Anthony Kennedy

After last week’s oral arguments in the latest Obamacare Supreme Court case (over whether the government can provide subsidies on federal exchanges), we have a pretty good idea how most of the justices will rule. The court’s more liberal justices– Ginsburg, Kagan, Breyer, and Sotomayor– will almost certainly uphold the subsidies, and we’re pretty confident that three of the conservatives– Alito, Scalia, and Thomas– will rule against them.

As for Roberts and Kennedy though– the deciding votes– it’s anyone’s guess. Still, their comments during the oral arguments can at least give us a sense of what they’re thinking about. And surprisingly they seem to be considering constitutional questions that even the plaintiffs didn’t bring up– and one of these questions could be a bigger threat to the law than anyone seems to realize.

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supreme court subsidies protest

One odd thing about the Affordable Care Act– given that its passage was a top priority for Democrats, while not a single Republican voted for it– is that it’s actually set up to benefit red states much more than blue ones. As Vox’s Ezra Klein explains:

Health reform spends more in states with more uninsured residents. And red states have higher rates of uninsurance than blue ones. In 2013, of the 25 states with the highest rates of nonelderly uninsured, 18 of them had voted for Mitt Romney in the 2012 election.

So all else equal, a bill that spends its money covering the uninsured is going to spend more money in red states than blue ones. But all else isn’t equal. The way Obamacare pays for itself also favors red states.

One of Obamacare’s major pay-fors is a 3.8 percent tax on investment income earned by richer taxpayers. This hits blue states harder than red states because blue states are, well, richer. Of the 25 states with the highest median income, 19 voted for Obama in 2012.

Another way Obamacare funds itself is through its tax on “Cadillac” health-care plans, which begins in 2018. The tax is really just a levy on very generous employer-provided plans — which are more common in blue states, with their history of unionization, than red ones. That means the Cadillac tax will hit harder in blue states than red ones.

But here’s what’s even weirder: Republicans have been working really hard to reverse that setup so that they pay more to get less.

When the Supreme Court made the law’s Medicaid expansion optional in 2012, it was GOP-controlled states that opted out. This didn’t save them any money– the federal government would have paid the entire cost of expansion until 2016, and those other taxes didn’t go away–all it did was leave millions uninsured in their own states. And if the Supreme Court rules in this latest case that the only states who build their own health exchanges can get subsidies, it will again be residents of red states getting screwed.   [click to continue reading…]


What Steven Brill and 60 Minutes got wrong about Obamacare

by Rob Cullen on February 24, 2015 - 1:52 AM

steven brill and lesley stahl

If you asked us to name the best article on health care we’ve read, near the top of the list would be Steven Brill’s 2013 Time Magazine cover story, “Bitter Pill: Why Medical Bills are Killing Us.” It’s a fascinating (and at 36 pages, thorough) look at a topic that affects all of us: America’s ridiculously high medical costs.

Brill’s follow-up articles were also excellent. His “Hate Obama, Love Obamacare,” published in January of 2014, was one of the best assessments of Obamacare’s successes and shortcomings in providing access to care that we’ve seen; and “Obama’s Trauma Team” was an interesting look at how the website was fixed so quickly after its disastrous launch.

We expected his new book, America’s Bitter Pill, would be equally great since it combines that previous work with new behind-the-scenes reporting on the passage and launch of the Affordable Care Act. The result, however, is less than the sum of its parts, and one of the book’s main assertions– that there’s almost nothing in Obamacare to control healthcare costs– is wrong.

Unfortunately that was the part of the book that 60 Minutes focused on in a recent segment featuring Brill. The result is a trainwreck of misinformation.   [click to continue reading…]


wolf and corbett

There was big health care news in Pennsylvania this week: as promised, newly elected Democratic governor Tom Wolf has announced the first steps in transitioning the state away from his predecessor’s Healthy PA plan to full Medicaid expansion under Obamacare.   [click to continue reading…]


child getting vaccinated

As a website devoted to explaining complicated topics in healthcare, we haven’t really tackled the vaccination debate before, because, well… it’s not all that complicated. The science is clear: there’s no evidence that vaccines cause autism. End of story.

Or at least it should be. With so many people choosing to opt out of vaccinations, an outbreak of measles– a disease that the Centers for Disease control considers eliminated in the U.S.– recently infected at least 40 people at Disneyland who spread it to at least six states. In the midst of this, some prominent political leaders (most notably Rand Paul) have implied that vaccines actually do cause “profound mental disorders” despite zero credible evidence, while others, like New Jersey Governor Chris Christie, have said that the decision whether or not to get a vaccine is simply a matter of personal choice.

But while vaccines have gotten much more attention in recent weeks, there’s still not that much to say about the issue. According to Aaron Carroll, a professor of pediatrics at the University of Indiana who blogs at The Incidental Economist, all that really needs to be said on the subject are these points:

  1. Measles is a terribly infectious illness that is a public health issue.
  2. There’s a vaccine that is amazingly effective.
  3. The vaccine is very, very safe, and it doesn’t cause autism.
  4. Policies in the United States should try and encourage all children to get immunized, as we need almost everyone to be immune to achieve herd immunity.
  5. We should allow some people to forego vaccination if they absolutely must, but we should try to make sure it’s not for reasons that are scientifically wrong – ie violate (1), (2), or (3).
  6. Unvaccinated people can be restricted from certain public activities (ie school) during emergency situations like outbreaks.

We agree; however, we thought it might be helpful to explain the reasoning and scientific evidence behind each of them.   [click to continue reading…]