luis lang

Last week, Charlotte Observer‘s “Health Care Challenge” blog highlighted the plight of Luis Lang, a self-employed handyman who’s slowly going blind from a partially detached retina caused by his diabetes. Lang has never bought insurance and was paying his medical bills out of pocket, and as the Observer explains:

That worked while he and his wife were relatively healthy. But after 10 days of an unrelenting headache, Lang went to the emergency room on Feb. 25. He says he was told he’d suffered several ministrokes. He ran up $9,000 in bills and exhausted his savings. Meanwhile, his vision worsened, and he can’t work, he says.

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage, but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Barack Obama and congressional Democrats for passing a complex and flawed bill.

“(My husband) should be at the front of the line, because he doesn’t work and because he has medical issues,” Mary Lang said last week. “We call it the Not Fair Health Care Act.”

The story went viral, particularly on liberal-leaning blogs, since it perfectly captures how misguided some opposition to the ACA has been. Lang could have purchased an affordable insurance plan under the new law– which, as a 49-year old smoker with diabetes, would likely have been impossible before Obamacare– but he chose not to. When his eyesight got so bad that he couldn’t work, his income dropped enough that he’d qualify for Medicaid (which you can enroll in at any time) thanks to Obamacare’s expansion of the program– but he lives in a Republican-led state that rejected it. In both instances he was blocked by Republicans (first himself and then South Carolina lawmakers), yet Lang still blames President Obama and the Democrats for his predicament.

However, we’ve been watching Republicans falsely accuse Obamacare of causing one disaster or another pretty much every day for the past five years– it’s not really news at this point. For us, the interesting part is how Lang’s story illustrates a real shortcoming of the ACA that is often ignored by both parties.   [click to continue reading…]

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The health of poor neighborhoods in cities like Baltimore

by Rob Cullen on May 6, 2015 - 6:10 PM

In a video that went viral during the protests over the death of Freddie Gray, Baltimore resident Kwame Rose confronts Fox News’ Geraldo Rivera, telling Rivera:

I want you and Fox News to get out of Baltimore City, because you are not here reporting about the boarded up homes and the homeless people under MLK. You’re not reporting about the poverty levels up and down North Avenue. Two years ago, when the 300 man march, when we we marched[…], you weren’t there. But you’re here for the black riots. You’re not here for the death of Freddie Gray I want the cameras off. I want the white media out of Baltimore city until you’re here to report the real story.

Fox News has yet to report on what Rose calls the “real story,” but the riots did inspire the rest of the national media to finally take a closer look at life in poor, predominantly black West Baltimore neighborhoods. What they’ve found is a health crisis. As the pastor at one Baltimore church put it to The New York Times: “If the statistics that are present in these communities were present in any white community in Baltimore, it would be declared a state of emergency.”  [click to continue reading…]



If you ignore the politics, the decision on whether or not a state should choose to participate in Obamacare’s Medicaid expansion should be a no brainer. States pay almost nothing– the federal government is paying for the entire cost of expansion until 2017 and 90% of the cost after that. Meanwhile, hundreds of thousands of their poorest residents gain coverage; hospitals see far fewer unpaid bills (which drive up prices for everyone else); and all that federal money coming in boosts state economies, creating thousands of jobs (and not just in healthcare).

The Medicaid expansion is such a good deal for states that even Republican governors in Ohio, Arizona, Iowa, Michigan, Indiana and New Jersey have signed on. And as more and more red states sign up, the politics become less of an issue; other Republican lawmakers in Utah, Tennessee, Missouri, Alaska and Florida are considering joining as well. Conservative think tanks have realized that they now need more substantive reasons to convince red state leaders not to join the Medicaid expansion. One argument, put forward by the Foundation for Government Accountability (FGA), is that Medicaid expansion will harm state economies by causing 2.6 million “able-bodied” Americans to drop out of the workforce.

For starters, the math in the report is garbage. The FGA “scholars” cherry-picked the highest estimate from just one study showing that Medicaid decreased the employment rate among childless adults– other studies have shown no effect– then applied that rate to everyone expected to enroll in Medicaid under Obamacare. This ignores the fact that that a huge proportion of those gaining coverage are, in fact, people with children. Before Obamacare, the maximum income to qualify for Medicaid was so low in most states that over two-thirds of uninsured, low-income parents were ineligible.

But really, the report isn’t pointing out an overlooked problem so much as trying to reframe a benefit of Obamacare. The whole point of the new law was to provide Americans with a way to get affordable coverage outside of an employer– and as a result, those who were stuck in jobs solely because that’s the only way they could get health coverage may choose to work fewer hours or drop out of the labor force altogether. Most people would say this is a good thing.

The FGA report does touch on an important point though. It says that Obamacare is structured in such a way that some low income Americans who might want to get a full-time job or work more hours will choose not to, because it would mean paying more than they could afford for health coverage. And we’re as surprised as anyone to be saying this, but… they kind of have a point. However, there is an Obamacare program for states (that hardly anyone has heard about) which would help: the Basic Health Program.

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IRS building

The April 15 deadline for filing your taxes has come and gone, but if you found yourself paying the Affordable Care Act’s penalty for not having coverage, you might be able to get that money back. Also, there may still be time to get coverage so that you don’t have to pay next year’s penalty either. Here’s how.   [click to continue reading…]


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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