APphoto_Supreme Court Health Overhaul Subsidies

As promised, we’re back with part 2 of our coverage of the Supreme Court’s surprising decision to take on yet another Obamacare case. Last time, we pointed out that the announcement means four of the nine justices are at least considering ruling that would eliminate subsidies to help pay for insurance in states that run their own exchanges. That doesn’t mean they will, but it’s worth looking at what can be done if the Court does make coverage unaffordable for nearly five million Americans.

Luckily, not only are relatively easy fixes available at both the state and national level, but Republicans might actually be willing to join Democrats in passing them.   [click to continue reading…]



Ok, I know we said that our next post would be about how states and Congress might react if the Supreme Court does decide to kill Obamacare subsidies in 34 states. However, since the Internet has apparently decided that the most important thing in healthcare this past week was a year-old video clip of an MIT professor talking to a roomful of other health economists (aka “Grubergate”), we figured we’d take a look at that first.

For those who don’t know, Jonathan Gruber was an architect of the Massachusetts health reform effort (aka “Romneycare”), which served as the model for Obamacare, and an adviser on Obamacare itself. At the University of Pennsylvania’s Annual Health Economics Conference last year, Gruber said this:

This bill was written in a tortured way to make sure the CBO [Congressional Budget Office] did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies. So it’s written to do that.

In terms of risk-rated subsidies, in a law that said health people are gonna pay in — if it made explicit that healthy people are gonna pay in, sick people get money, it would not have passed. Okay — just like the … people — transperen— lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical to get anything to pass.

It sounds an awful lot like he’s saying that the Obama administration secretly snuck some provisions into the bill that, if the American public knew about them, Obamacare never would have passed.

But if we’ve learned anything from the resignation of Shirley Sherrod and James O’Keefe’s takedown of ACORN it’s that if a conservative website has a video clip of an Obama supporter saying something that seems outrageous, chances are it was taken out of context. So we went back and watched the full video of Gruber’s remarks, and, sure enough, that’s exactly what happened.   [click to continue reading…]



We think the Supreme Court might be trolling us. Just two days after we wrote about some silver linings for Obamacare supporters in the wake of the midterms, the justices unexpectedly announced that it would hear King v. Burwell, a case that has the potential to cripple the law.   [click to continue reading…]


2014 midterm voters

There’s really no sugar-coating it: the election yesterday was a bad one for supporters of universal health care. Margot Sanger-Katz, writing on The New York Times Upshot blog, reports:

Arkansas, Kentucky and West Virginia — states that saw substantial drops in the proportion of their residents without insurance — all elected Republican Senate candidates who oppose the Affordable Care Act. Control of the West Virginia state House of Delegates flipped from Democrats to Republicans. And Arkansas elected Republican supermajorities to both houses of its legislature along with a Republican governor, a situation that could imperil the Medicaid expansion that helped more than 200,000 of its poorest residents get health insurance.

Meanwhile, vulnerable Republican governors in Georgia, Maine, Kansas, Wisconsin, and Alaska who refused to expand Medicaid under Obamacare, and Florida governor Rick Scott who only tepidly supported expansion, all cruised to reelection. And, in what might be the night’s biggest surprise, Vermont’s Democratic governor Peter Shumlin, who had been working toward implementing a single-payer health system in his state, was nearly unseated.

However, it wasn’t all bad news for healthcare yesterday. Here are some bright spots.   [click to continue reading…]


Why the 2014 midterms are a big deal for Obamacare

by Rob Cullen on November 3, 2014 - 7:13 PM

voting machines

If you read some of this year’s election coverage, you might get the sense that the 2014 elections don’t matter all that much. The current Congress is on track to be the least productive in modern history, and even if the GOP takes control of the Senate, that’s unlikely to change much– they won’t have enough votes to overcome a Democratic filibuster or a Presidential veto.

So it seems many people have tuned out. Usually there’s more and more interest as elections get closer, but a recent WSJ/NBC News poll found that the number of people who expressed interest in this year’s midterm actually declined, from 51% to 50%, between June and October.

2014 election interest

The lack of interest is unfortunate because the 2014 elections could have big consequences for health care, especially at the state level.   [click to continue reading…]


Kaci Hickox

How NOT to treat healthcare workers who return from fighting Ebola in Africa.

Looks like our recent post, on why Americans should calm down about Ebola, worked: in a recent Washington Post/ABC News poll, 63% of respondents said they were “confident in the government’s ability to respond to an outbreak of the Ebola virus in the United States.”

That was the good news. We had hoped that the recent panic might lead more of us to support policies that would strengthen healthcare systems in west Africa, where the disease where the disease has been devastating. The bad news is that hasn’t happened:

An overwhelming 70 percent support restrictions on travel from afflicted countries (which helps explain why vulnerable Democrats have caved to Republican pressure and come out in support of one, too). And far more (61 percent) think we need to do more against Ebola in the United States than think we need to do more to stop the spread of it in Africa (46 percent).

Public health experts agree that to end the threat of Ebola in the United States, we need to stop its spread in west Africa. They also say that restrictions on travel– especially those targeting healthcare workers, like the mandatory quarantines announced by governors Mario Cuomo (D-NY), Chris Christie (R-NJ), and Pat Quinn (D-Ill.)– could actually increase the chances of future outbreaks here.   [click to continue reading…]


The Obamacare question that Republican candidates won’t answer

by Rob Cullen on October 23, 2014 - 4:32 PM

mcconnell-grimes debate

In theory, this should be an interesting election for health care issues. After all for the past few years, the debate about Obamacare has been about what might happen: would it cover millions of people as expected, or would it be a total disaster, like Republicans claimed. Now we can see what is happening: Obamacare is working.

About 7.3 million people are currently enrolled through the exchanges, 60% of whom were previously uninsured (an additional 8 million or so enrolled in Obamacare-regulated plans outside of the exchanges), and, depending how you count it, another 6 to 9 million people gained coverage thanks to the Medicaid expansion. The U.S. uninsured rate is now at its lowest point since Gallup began tracking it in 2008:

gallup uninsured poll 3rd quarter 2014

All of which naturally leads to an important question for Republican candidates: what happens to all those people if you repeal Obamacare?

Unfortunately it’s not a question they’ve had to answer.   [click to continue reading…]


Calm down, Ebola’s actually pretty difficult to catch

by Rob Cullen on October 16, 2014 - 1:29 PM

stop ebola mural

Ok, so we’ve avoided covering Ebola for months, mostly because we didn’t want to add to any unnecessary panic about the disease (although it looks like that ship has sailed). If you’re reading this site, chances are you live in a country with regular electricity and more than 50 doctors, which means Ebola really isn’t something you have to worry about. Notice that we used the present tense there– even though there are now three confirmed cases in the U.S. (the original patient and two nurses), there’s still no reason to panic.

We think that a lot of the current hysteria comes from the fact that while the President, public health officials, and the more responsible members of the media have told us not to worry, they haven’t done a great job of communicating why we shouldn’t worry.   [click to continue reading…]


alcohol consumption distribution

The graph above has been floating around social media lately, and the data it shows is surprising for a couple reasons: first, it shows that about half of all adults consume basically no alcohol. Then, on the other end of the spectrum, it shows that the top 10% of American adults– 24 million people– consume nearly 74 drinks per week on average; that’s ten drinks per day. That seems incredibly high, so over the past few weeks a bunch of really smart pundits and healthcare experts– like MSNBC’s Chris Hayes, The Incidental Economists Aaron Carroll, and Christopher Ingraham of The Washington Post’s Wonkblog– have been trying to get their heads around how it’s possible.

They may have missed a likely explanation though: that the graph is wrong.   [click to continue reading…]


This year’s insurance cancellations explained in 8 tweets

by Rob Cullen on October 6, 2014 - 3:18 PM

picking a health plan

You might remember that around this time last fall, millions of Americans were getting cancellation letters from insurance companies because their plans didn’t comply with Obamacare’s new regulations. Since the exchanges were still a mess, and since President Obama had previously promised that if you liked your plan you’d be able to keep it, the administration said that it would let states allow insurers to renew noncompliant plans for up to three years. Not every state did this– but a couple dozen did allow insurers to renew their plans.

Now another round of cancellation letters is going out, a fact that’s sure to get a lot of attention from Republicans with it being an election year and all. However there are some pretty huge differences between the latest round and last year’s cancellations.   [click to continue reading…]