Public Overwhelmingly Opposes Graham-Cassidy Bill

It's starting to look like the latest version of Trumpcare (the Graham-Cassidy bill) is in deep trouble. Yesterday, Senator McCain (R-Arizona) came out against the bill. He said:

"I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will (affect) insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won't be available by the end of the month, we won't have reliable answers to any of those questions."

That means only one more Republican "no" vote will kill the bill, and Senator Collins (R-Maine) has said she is leaning toward voting against the bill. Sen. Murkowski (R-Alaska) has not said how she would vote, but she voted against the last version of Trumpcare and many expect her to vote against this bill also.

This is probably a good thing for Republicans, even though they are unlikely to admit it. As the chart above shows, the public is against the bill -- with only 24% supporting it and 50% opposing it. And every demographic group (except Republicans) has significantly more opposing the bill than supporting it.

The chart reflects the results of a new Public Policy Polling survey -- done on September  20th and 21st of a random national sample of 638 registered voters.

The ABC News / Washington Post Poll (done between September 18th and 21st of a random national sample of 1,002 adults, with a 3.5 point margin of error) asked the question in a different way -- Which do you prefer, Obamacare or Trumpcare (Graham-Cassidy)? The respondents chose Obamacare 56% to 33%.

Medicaid Directors In The 50 States Oppose Trumpcare

Doctors, Hospitals, AARP, insurance companies, and a host of medical societies have all come out against the latest version of Trumpcare (the Graham-Cassidy bill) in the Senate. Now the NAMD, representing Medicaid directors in all 50 states, has joined in that opposition. Here is part of an article by Jessie Hellmann in The Hill:

The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states.

The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare's Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants.

It would also change the federal government's funding of the traditional Medicaid program from an open-ended commitment to the states to a per capita cap on each enrollee.

"Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history," the NAMD's board of directors wrote in a statement Thursday.

The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

The GOP bill would also require states create their own health-care programs by 2020, which the directors argue is a massive undertaking.

"The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated," the directors said. 

"States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

The directors also hit Senate Republicans for not having a full Congressional Budget Office score before a possible vote on the bill, "which should be the bare minimum required for beginning consideration." 

"With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms," the directors said. 

Insurance Companies Join Those Opposing Trumpcare

The image above is no surprise. Everyone but the rich and Republicans oppose the Senate GOP's latest effort to repeal Obamacare (the Graham-Cassidy Trumpcare plan). Now even the private insurance companies are coming out against the plan. Here is a small part of an article by Robert Pear in the New York Times:

The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market.

In the face of the industry opposition, Senate Republican leaders nevertheless said they would push for a showdown vote next week on the legislation, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. . . .

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill. They joined other groups fighting the bill, such as the American Medical Association, the American Hospital Association, AARP and the lobbying arm of the American Cancer Society.

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,’’ said Scott P. Serota, the president and chief executive of the Blue Cross Blue Shield Association. “The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

America’s Health Insurance Plans was even more pointed. The legislation could hurt patients by “further destabilizing the individual market” and could potentially allow “government-controlled single payer health care to grow,” said Marilyn B. Tavenner, the president and chief executive of the association. Without controls, some states could simply eliminate private insurance, she warned.

Insurers had been reluctant to speak out against the Republicans’ previous proposals in hopes that the White House and Congress would agree to stabilize insurance markets by providing critical funding for subsidies aimed at low-income Americans. But with hopes of securing that money before they finalize their rates virtually extinguished, insurers have less to lose by coming out against the proposal.

And many within the industry are worried that the next two years will be chaotic, with little support for the current market while states scramble to come up with a new way for individuals to buy policies.

Obamacare Is Working - But More Must Be Done

The image above is from the Urban Institute's Health Reform Monitoring Survey. It shows there has definitely been a decrease in the number of uninsured Americans thanks to the Affordable Care Act (Obamacare). Here is some of what they had to say:

Fifteen million nonelderly adults gained coverage between September 2013 and March 2015 as the uninsurance rate fell from 17.6 percent to 10.1 percent. . .

The share of nonelderly adults who are uninsured continued to decline following the ACA’s second open enrollment period. As of March 2015, the number of uninsured adults was estimated to be 15.0 million lower than the number of uninsured adults in September 2013, a decrease in the uninsurance rate of 42.5 percent. Coverage gains have been especially large among adults in states that expanded Medicaid and among adults targeted by the ACA’s Medicaid expansion and Marketplace subsidies. . . 

Though providing evidence of the ACA’s significant success at expanding coverage, these new HRMS findings also highlight that roughly 1 in 10 adults remained uninsured nationwide in March 2015, indicating considerable scope for additional reductions in coverage. This is particularly true in nonexpansion states, where coverage is lagging behind coverage in expansion states. According to HRMS data from March 2015, adults in states that had not expanded Medicaid were 1.9 times as likely to be uninsured as adults in states that had expanded Medicaid (14.4 percent vs. 7.5 percent). Of the 22 states that have yet to expand Medicaid, only a handful appear to be actively debating whether to expand.¹⁰ Therefore, it is likely that the coverage gap between expansion states and nonexpansion states found here will persist, at least in the near future.

This is good. Regardless of Republican claims to the contrary, Obamacare has successfully reduced the number of uninsured Americans. But the 10.1% who remain uninsured is still too high -- and even if all states were to expand Medicaid and get that percentage down to 7.5% nationally, that would also still be too high.

Health care should be a right of all citizens, and any amount over 0% should be unacceptable. Obamacare helped, but more remains to be done.

1/3 Of The Public Still Delays Medical Care Because Of Cost

The Republicans won't admit it, but the Affordable Care Act (commonly called Obamacare) made our broken system of medical care significantly better. There is no longer a cap of the amount an insurance company will pay for medical care, they can't charge higher prices or deny coverage because of pre-existing condition, they must pay out 80% of the premiums received for medical care, they must allow children to stay on parent's insurance until age 26, working class families can get a subsidy to help them purchase insurance, and Medicaid has been expanded to help the poor get medical coverage (in a majority of states).

Those are all good things, and the number of insured Americans has been significantly reduced (and could be further reduced if Republican governors and legislators would cooperate). But while I have no desire to go back to the pre-Obamacare system, which was much worse, we have to admit that Obamacare was far from perfect. It did not cover all Americans with health insurance, and it did not reduce the cost of health care in this country. Note the charts below.

These charts are from a new Gallup Poll -- done between November 4th and 8th of a random national sample of 1,021 adults, with a margin of error of 4 points. It shows that nearly one-third of all Americans (31%) currently delay needed medical care because of the cost -- and 19%, nearly one out of every five people, are putting off medical care for a serious medical condition.

That's unacceptable. It is just a fact that the United States spends more per patient for medical care than any other developed nation in the world. It's because we don't consider medical care to be a right of all citizens. Our leaders still consider it to be a product available to those who can afford it, and thanks to that we still have a system of for-profit medical care -- and those providers act like other businesses by continually trying to maximize those profits.

A government-run single-payer system could solve both the problem of coverage for all and cost of care. Even if we wanted to continue allowing doctors, clinics, and hospitals to operate on a for-profit basis (like Canada and France do), it would allow the government to negotiate with providers for a reasonable price and bring down costs. It works in other countries, and it could work here.

It would also work for the cost of prescribed medications (which are also higher in the United States than in any other developed nation). Currently, it is against the law for the government to negotiate with pharmaceutical companies (for government programs like Medicare and Medicaid). That's ridiculous. A single-payer system would be able to negotiate drug prices (like other countries do).

Obamacare did a lot of good, but it really just put a lot of band-aids on a system that is still broken. We need a single-payer system of insurance -- and the sooner, the better.

Percentage Of Uninsured In U.S. Drops To A Record Low 9%

The chart above was made from information in a new report by the National Center for Health Statistics. It shows that the percentage of Americans with no health insurance has dropped to a record low of 9%. That shows that the Affordable Care Act (Obamacare) is working to reduce the number of uninsured Americans.

Some of that 9% is people who simply refuse to comply with the law -- either because they have bought into the Republican lies about Obamacare, or because they simply hate President Obama and don't want to see the program succeed. It is succeeding though, and if the 20 holdout states would expand Medicaid, then that 9% uninsured could be significantly reduced. That refusal (by Republican state governments) is a callous political ploy -- and condemns about 17,000 people to die each year (because they didn't have insurance that would provide them with preventative care).

That 9% uninsured is a much better percentage than we have ever had in the past -- but we must not forget that translates into about 28.7 million people without insurance. And even if every state expanded Medicaid, there would still be a few million people without health insurance. That's because Obamacare was not designed to provide every American with health insurance.

I think it would be a serious mistake to repeal Obamacare (because that would take insurance away from millions of people), but it is getting clearer all the time that Obamacare did not go far enough. Other developed nations cover all their citizens with health insurance (and at a lower per person cost) -- and there is no reason why the United States can't do the same thing.

We need to go farther. We need to institute a government-run, single-payer health insurance system. That's what Medicare is, and it's worked very well. We need to create a Medicare-like program that covers all American citizens. It is simply immoral to not do so.

Cost Of Drugs Is Now Biggest Health Care Concern

The Kaiser Family Foundation has completed it's latest survey of Americans on their health care concerns. The chart above shows that the cost of drugs is now the biggest concern of all groups. The number one concern is to make sure drugs are affordable to people with a chronic health condition  -- general public (77%), Democrats (85%), Independents (75%), and Republicans (73%). And for the general public (63%), Democrats (74%), and Independents (60%), the second greatest concern is to lower the cost of all drugs. The second greatest concern for Republicans is to repeal Obamacare.

But the most interesting part of the survey to me is shown in the charts below. It looks like the American people are getting used to Obamacare, and beginning to realize that, while it is not perfect, it is an improvement over what we had before.

When the reform was first passed, a significant majority wanted the requirement that everyone either have insurance or pay a fine to be repealed. That is not true anymore. People have started to realize that this requirement is necessary to keep insurance costs down (and that the fines would only apply to a small minority). Only 38% now want the requirement repealed.

And the same goes for Obamacare in general. While 58% of Republicans still claim to want the Affordable Care Act repealed, only 37% of Americans agree with them. The longer the law stays in effect, the more the public likes it (and doesn't want it to go away).

Minnesota Reduces Amount Of Uninsured To Under 5%

The state of Minnesota just showed the nation how well Obamacare can work when a state complies with all aspects of it. They have reduced the percentage of uninsured citizens to only 4.9%.

Only one state has a lower uninsured rate under the new law -- Massachusetts, although they ignited their health system when it was called Romneycare (which is almost a mirror-image of Obamacare).

How did Minnesota do it? First, they had a very effective campaign urging their citizens to sign up for health insurance. But perhaps the most important thing they did was to expand Medicaid after the new health care reform was passed.

Here's how it's described in the Minneapolis Star-Tribune:

Researchers have long known that as many as two-thirds of the state’s uninsured were eligible for coverage through public programs, but either didn’t know it or didn’t take advantage of the aid.

Minnesota was one of 26 states that decided to expand Medicaid to include childless adults, which accounted for a surprising gain in new applicants, said Department of Human Services Commissioner Lucinda Jesson.

“We anticipated growth in children and families because we were simplifying the process and we were doing more outreach,” Jesson said. “But we had more adults without kids than we expected, and we had pretty healthy projections. That tells me the Medicaid expansion was even more significant than we anticipated, so far. We’re only a few months in.”

This should shame other states -- states ruled by Republicans that refuse to expand Medicaid (like Texas, which still leads the nation in the number and percentage of uninsured citizens), in spite of the fact that almost all of the cost of that expansion would be borne by the federal government. These states are condemning many of their citizens to death (about 17,000 a year) simply because they refuse to expand Medicaid (and provide these people with preventative care). They are putting politics above the lives of American citizens -- and that's just shameful.

I'm happy for the citizens of Minnesota. Reducing the percentage of uninsured to 4.9% is a great achievement. But we all know the number of uninsured citizens should be 0%. Unfortunately, while Obamacare has given many millions of uninsured citizens coverage, it can never get the percentage down to zero (because it wasn't designed to do that). We still need to do better -- and the way to do that is to institute a government-run, single-payer health insurance system (like Medicare for all).

(NOTE -- the image above is from obamacarefacts.com.)

Obamacare Is Working - But We Need More

The chart above is from a recent survey by the Gallup Poll. Between July 1st and September 30th, they questioned a random national sample of 45,615 adults, and because of the huge sample the poll has a margin of error of only 1 point.

The chart shows that the Affordable Care Act (Obamacare) has been pretty successful in its primary goal -- to lower the number of uninsured Americans (thus assuring they can get the healthcare, especially preventative care, that they need). In the last seven quarters, the percentage of uninsured Americans has been reduced fro 17.1% to 11.6% (a reduction in the uninsured of about 32%).

That's good, and I applaud the law for that reduction. But we need to get that number much lower -- all the way down to 0%. Obamacare could be even more successful if the Republican state legislatures would stop playing politics, and expand Medicaid (which currently about half of the states are refusing to do). That 22.2% of uninsured making less than $36,000 could be significantly reduced by that.

But while Obamacare has significantly reduced the number of uninsured Americans, and with GOP cooperation could do even more, the truth is that Obamacare alone will never eliminate the uninsured citizens in the U.S. -- and was never designed to do that. Obamacare was a significant step forward in many ways, but it has not completely fixed the health care system in this country. More needs to be done.

While there is not the political will for it right now, if Americans are to accept that healthcare is a right (and not just a product to be sold), then we are eventually going to have to go to a better system. I believe what is necessary is a government-run, single-payer health insurance system -- like most other developed countries have done (including our neighbor to the north).

This would be something like a Medicare-for-all -- which would have the advantage of covering all citizens with health insurance, and would reduce the amount of money spent on health care in the U.S. (which is much higher than in any other developed nation). It has to come. The only question is how long it will take to finally do it.

New Census Dept. Figures Show Obamacare Is Working

Perhaps the best statistics for how the Affordable Care Act (Obamacare) is working comes from the new official Census Department figures just released. This figures show that the health care reform has had an effect on the percentage (and number) of Americans who have, or don't have, health insurance.

It shows that the percentage of Americans with no health insurance of any kind has dropped from 13.3% in 2013 to 10.4% in 2014  (and we know that 2015 figures, not included in this report, will show another slight decrease in that percentage). Is Obamacare working? Yes -- but it could be working even better.

A major reason why Obamacare is not working as well as it could is the refusal of nearly half the states (including some very big states like Texas) to expand Medicaid. This expansion would have been completely paid for by the federal government for 10 years (and paid 90% of after that), but those states (controlled by Republicans) don't care. They are willing to sentence many thousands of Americans to death (by denying them health insurance and thus, access to preventative care) to play political games (showing their disapproval of a Black president).

The number of uninsured Americans could be significantly reduced further if those states would comply with the heal care reform. But while Obamacare has fixed a number of problems with our health care system (such as eliminating pre-existing conditions) and has reduced the non-insured, the sad fact is that it was never designed to cover 100% of American's citizens. In my opinion, that is its biggest failing.

We still need to go further in fixing our system of medical care. I believe we need to institute a single-payer, government-run system of health insurance (something like Medicare for all). Doing so would cover every single American with health insurance, and it would have another benefit -- it would significantly reduce the amount of money spent on medical care in this country. We know that other countries that have this system don't pay nearly as much per capita for health care that the United States pays.

Sadly, this will probably not happen soon. The political will, among the members of Congress or the public, just does not exist for the change yet. But it will come. There is simply no alternative if we truly believe health care is a right for all citizens.

Repeal Is Just Talk - GOP Can't Undo Obamacare Now

The congressional Republicans are still talking about repealing the Affordable Care Act (Obamacare), but they have yet to come up with a viable plan to replace it. Both Walker and Rubiuo announced plans last week, but those plans are ludicrous. They would undo the parts of Obamacare that the public likes, and they would take insurance away from millions of people. They would be a disaster for health care in this country -- and if passed, would very likely be a disaster for the Republican Party also.

Here is how Paul Waldman puts it in a Washington Post column:

In the last few days, Scott Walker and Marco Rubio released health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.

But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.

I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.

The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.

The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”

We know why every Republican health care plan has to start with repealing the ACA: politics. Republicans have spent the last five years telling their constituents that they’re going to repeal it any day now, and they’ve held over 50 repeal votes in Congress. They’ve refused to admit that a word of it has any merit, even as they try to incorporate some of its more popular reforms (like protections for people with pre-existing conditions) into their own plans. So they’ve backed themselves into a corner where whatever any Republican offers has to start with repeal.

Which is why all their plans, the ones that have been released and the ones yet to come, are absurdly unrealistic. They pretend that it will be no problem to completely transform the American health care system — and there will be no losers in such a transformation, only winners — which shows that they have no intention of actually doing so. In fact, I’d go so far as to say that if a Republican gets elected next November, he’ll be relieved when his health care plan dies in Congress.

Let’s contrast that with how Democrats acted in 2008, when there was a vigorous debate in the presidential primary over health care. The three leading candidates, Barack Obama, Hillary Clinton, and John Edwards, all had very similar plans, similar because they reflected the Democratic consensus on health care reform that had evolved in the decade and a half since Bill Clinton’s reform effort failed. One major disagreement was over whether there had to be an individual mandate — Clinton’s plan had one, and Obama’s didn’t — but when he took office, Obama accepted that the mandate was necessary to make the entire plan work. It wasn’t a fantasy plan that just pandered to liberal hopes, it was something that could actually pass and be implemented.

Whenever liberals told Obama that a single-payer health plan would be far superior to what he was proposing, he would respond that if we were starting from scratch, that would probably be true. But, he’d say, we aren’t starting from scratch, so the ACA has to accommodate itself to the health care system that already exists. The result was a gigantic kludge, new complexity layered on top of an already complex system in an attempt to solve its varied shortcomings. Like all kludges, it seemed like the realistic option given the situation we confronted, but it left us with something that was far from perfect.

A Republican who actually wanted to pass real health care reform would have to approach the problem the same way: by saying that for better or worse, the Affordable Care Act has already affected the system in profound ways, so any realistic plan has to understand what those changes are, and find the most efficient way to keep the ones that are working and change the ones that aren’t. That doesn’t mean that repeal is impossible, just that it would be a spectacular upheaval, one that I promise you Republicans have no genuine appetite for. Remember all the screaming and shouting they did over the people on the individual market whose previous plans didn’t qualify under the new regulations, and who had to shop for new plans? Multiply that by ten or twenty times, because that’s how many people would likely lose their existing coverage if you repealed the ACA in one fell swoop.

And that would be only the beginning. So when any Republican candidate says he or she has a plan to reform health care, take a close look. If it starts with repealing the ACA — and it will — then you’ll know it isn’t serious and it’s never going to happen.

Obamacare Is Still Reducing Number Of Uninsured

With every passing quarter, we see Obamacare working better to bring down the percentage of people without health insurance in this country. In the first quarter of this year, the percentage of uninsured was 11.9% -- but in the second quarter, that dropped to 11.4% (a half a percentage point drop). The Republicans are still trying to claim that the Affordable Care Act (Obamacare) is not working, but the significant reduction in those without insurance proves that to be a lie.

The number without insurance is still too high, and that 11.4% needs to be cut even further -- but most of the reason it hasn't been is not due to Obamacare, but to the Republicans refusal to expand Medicaid in nearly half of the states. Note that in the under $36,000 group, the percentage of uninsured is 20.8% -- more than 1 out of every 5 people. Many of these people would qualify for Medicaid, if they lived in a state that had expanded Medicaid.

But while the refusal of red states to get on board with Obamacare has been ridiculous, and prevents many millions from being insured, let me point out the percentage in another group -- those 65 & over. That percentage is only 2%. Why? Because this group is covered by another program -- Medicare. Why don't we just cover all Americans with Medicare? By doing that we could get the uninsured percentage down to 2% for the entire country (and maybe even lower).

The chart was made from a Gallup Poll -- done between April 1st and June 30th of a random national sample of 43,575 adults, with a margin of error of only 1 point.

Krugman: GOP Nightmare Comes True (Obamacare Works)

Last week, the Affordable Care Act (Obamacare) dodged a big bullet in the Supreme Court. Many had thought the court would declare subsidies could not be given through the federal exchange, but only through state insurance exchanges. That could have been disastrous, since nearly half the states did not create a health insurance exchange of their own.

If that had happened, somewhere between 6 and 8.5 million people would have lost their insurance. That's because they would no longer be able to afford it without a subsidy. It would have required Congress to "fix" the law -- and the Republicans, who control both houses of Congress, have shown no ability or desire to do that.

Fortunately, the Supreme Court backed Obamacare and kept the subsidies in place. So, with Obamacare in place for the long-haul now, the question arises -- how is the program working?

Nobel Prize-winning economist Paul Krugman (caricatured above by DonkeyHotey) answers that question in his column in the New York Times. Here's what he had to say:

 The Affordable Care Act is now in its second year of full operation; how’s it doing?

The answer is, better than even many supporters realize.

Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.

But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.

Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!

But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.

What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.

And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.

What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.

Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusionthat repealing Obamacare would increase, not reduce, the deficit.

Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.

Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.

That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.

Obamacare Wins And Republicans Dodge A Bullet

I don't think anyone expected Obamacare to win the Supreme Court decision by the margin it did. Most thought it would be a 5 to 4 decision regardless of which way it went, but it wasn't. The court voted 6 to 3 (with Kennedy and Roberts joining liberals Breyer, Ginsburg, Kagan, and Sotomayor) to uphold the giving of government subsidies in all states instead of just the states with a state insurance exchange. The court, in an opinion written by Roberts, said it was obvious that Congress meant to give the subsidies to people in all states.

And after the court decision, congressional Republicans and GOP presidential candidates were quick to condemn the decision as terrible and claim they would resume their effort to repeal the ACA (Obamacare). They haven't been saying much lately, because they were afraid they might actually win this court case -- and have to go into the next election after taking health insurance away from as many as 8,5 million people.

But they dodged that bullet, so they can now resume the political theater aimed at their base teabaggers -- secure in the knowledge that they can't possibly succeed (and get in the same kind of electoral trouble winning the court case would have caused). I can't believe any but the stupidest of them actually want to repeal Obamacare. Winning the court case would have taken insurance away from 8.5 million people, while repealing Obamacare would take health insurance away from around 19 million people. They say they would replace Obamacare with something of their own, a better plan -- but not a single Republican has come up with a plan so far.

This court case was a good thing, because it once again stamped the program as legal and constitutional. Now maybe we can get bust fixing Obamacare -- because while it was a big improvement over what we had before, it is far from perfect.

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A new CBS News / New York Times Poll shows the court ruled the way most Americans wanted them to rule. About 70% of poll respondents said they wanted the court to allow subsidies in all states. And for the first time since that poll has been taken, more people approve of Obamacare than disapprove. People are starting to realize that, while Obamacare is not perfect, it is better -- and most want it improved, not repealed.

What If Obamacare Was Repealed ?

It's been a little over 5 years since President Obama signed the Affordable Care Act into law (Obamacare). And the Republicans are still saying they would like to repeal it -- even though they have no alternative.

What would happen if it was repealed? The non-partisan Congressional Budget Office (CBO) answers that question in a new report. Here's how that report is reported on Political Wire:

A new CBO report finds that repealing the Affordable Care Act would cost the U.S. government $137 billion over the next decade.

“The new report is the first federal assessment since the main provisions of the law took effect in 2014. It found that repealing the health-care law would increase deficits by $353 billion over 10 years. But after taking into account economic factors, including slightly larger workforce participation that would result from repealing the law, that amount would fall to $137 billion.”

“The analysis also concluded that repealing the health-care law would increase the number of uninsured Americans by 19 million in 2016.”

Most Are Satisfied With Insurance Through Obamacare

The chart above is from the Commonwealth Fund. It shows that the people who got their insurance through an Obamacare marketplace or through Medicaid are overwhelmingly satisfied with their insurance plan. Here is what the Commonwealth Fund had to say:

The latest Commonwealth Fund Affordable Care Act Tracking Survey finds the share of uninsured working-age adults was 13 percent in March–May 2015, compared with 20 percent just before the major coverage expansions went into effect. More than half of adults who currently have coverage either through the Affordable Care Act’s (ACA’s) marketplace plans or Medicaid expansion were uninsured prior to gaining coverage. Of those, more than 60 percent lacked coverage for one year or longer. More than six of 10 adults who used their new plans to obtain care reported they could not have afforded or accessed it previously. Majorities of people with ACA coverage who have used their plans express satisfaction with the doctors covered in their networks and are able to find physicians with relative ease. Wait times to get appointments with physicians in marketplace plans and Medicaid are comparable to those reported by other working-age adults.

Now you can see why the Republicans are so worried about the Supreme Court decision that is pending on Obamacare -- a decision that could deny around 8 million people the insurance they got through the program (insurance they are very satisfied with. Heck, even 87% of the Republicans are satisfied with the insurance they got through Obamacare.

Obamacare is working. More people are covered with health insurance, and like that health insurance. And it could work even better if all the states would expand Medicaid. And the Republicans know that. They also know they would be blamed if the Supreme Court denies insurance subsidies to those millions of people -- and they have no solution for that.

The Republicans have tried to destroy Obamacare for years, and now they could be on the verge of doing that -- and it scares the hell out of them. They could well be going into the next national election with a lot of angry voters blaming them for killing their healthcare.

There's an old saying that you should be careful what you wish for, because you just might get it. The Republicans wished for the destruction of Obamacare, and now that they might get that, it could do serious damage to their party.

Supreme Court Should Protect Obamacare Subsidies

When our lawmakers wrote the bill that instituted Obamacare (the Affordable Heath Care Act), they put a provision in it to make sure that it was understood that those people going through a state health care exchange qualified for a federal government subsidy to help them purchase insurance. But they evidently didn't make it clear enough that people using either a state exchange or the federal exchange qualified for those subsidies.

The right-wing, which has been searching for a way to destroy Obamacare for several years now, has jumped on this rather poorly written provision of the law -- and they filed suit to keep those using the federal exchange from getting a subsidy. That case is now pending before the U.S. Supreme Court, and if that court decides in favor of the right-wingers who brought the case, up to 8 million people would lose their subsidy (and no longer be able to afford health care insurance).

A new poll has been done, the Washington Post / ABC News Poll, to find out what the public thinks the Supreme Court should do. That survey was done between May 28th and 31st of a random national sample of 1,001 adults, and has a margin of error of 3.5 points. And the public spoke up clearly in defense of the Obamacare subsidies.

The public wants those subsidies to remain intact. This includes 55% of all adults, 65% of Democrats, 57% of Independents, 58% of those living in a state that has a state exchange, and 53% of those living in a state without an exchange. The only group with a majority saying the subsidies should be stopped is Republicans (and 34% of them want the subsidies protected).

Republican officials are beginning to realize they may have shot themselves in the foot on this issue. They could be entering the next election cycle being responsible for something the public is against (the removal of subsidies, which could virtually kill Obamacare), and with 8 million angry voters having lost their health insurance (and looking for someone to blame).

The Supreme Court decision is expected sometime this month, and most pundits believe there is a 50-50 chance they will stop the federal subsidies. The congressional Republicans have been searching for a way out of this mess they created for themselves (with their rabid opposition to Obamacare), but right now, it looks like they are not going to be able to agree on a solution. They are too afraid of looking like they support Obamacare (which could hurt them in next year's primary).

It looks like the states will have to find their own solution -- and fortunately a simple one is available. They could follow the example of Pennsylvania and Delaware. Those two states are creating their own exchange -- sort of. It is a state exchange in name only, since their citizens will continue to use the federal website to buy insurance -- but it would be sufficient to allow their citizens to keep getting the federal subsidy to help them purchase insurance.

Will all the non-exchange states follow this example if the Court rules against the subsidies? I don't know. Some very red states, like Texas, could refuse to take action. It will be interesting to see what the court decides this month, and what Republicans do about that decision (if it kills subsidies). They have definitely put themselves between a rock and a hard place on this issue.

Public Supports Federal Subsidies Under Obamacare

The Republicans have been opposed to the Affordable Care Act since it's inception, and after it passed, they have voted more than 50 times to repeal those reforms. None of those repeal efforts ever made it out of Congress, and if they had they would have been vetoed by President Obama. None of those efforts ever had any chance of succeeding, but they kept the GOP's teabagger base happy.

But a few conservatives decided there was another chance to cripple Obamacare. They brought a case that is now being considered by the Supreme Court. They claim the law didn't allow federal subsidies to purchase insurance through the federal health care website -- but only allowed those subsidies through state insurance exchanges. This would stop the subsidies for more than 8 million Americans who got those subsidies through the federal exchange, and probably mean most of those people would lose their health insurance (since they couldn't afford it without the subsidy).

This has created a dilemma for congressional Republicans. If the court eliminates the subsidies through the federal exchange (and there's a 50-50 chance of that happening), then they would have 8 million angry people going into the next election. If they fix the law and allow those subsidies, then they will have an angry teabagger base going into the primaries. It has put them in the awkward position of hoping Obamacare wins its Supreme Court battle.

But it gets even worse for them. Not only will those 8 million (who lose their insurance) be unhappy, but a majority of all Americans (51%) will be unhappy (see above chart). That's the percentage who think the Republicans should fix the law to allow federal subsidies in all states, if the Supreme Court eliminates them.

I hope the Supreme Court upholds those subsidies -- but if it doesn't, it will be very interesting to see what the congressional Republicans do (since they control both House of Congress). Their unthinking opposition to Obamacare has now landed them between a rock and a hard place.

The charts above were made with information from a recent AP / GfK Poll -- done between April 23rd and 27th of a random national survey of 1,077 adults, with a margin of error of 3.4 points.

Texas Refuses Medicaid Expansion - & Hospitals May Close

(This image is from the website theexpertinstitute.com.)

Texas leads the nation in both the number and percentage of uninsured citizens (with more than a quarter of the state's population being uninsured) -- and about 2 million of those people are poor people, who cannot afford to buy insurance. This has always caused a problem for hospitals, since these people clog up emergency rooms when they get sick. They have to do that since they cannot afford preventative care at a doctor's office.

But the problem goes further than overcrowded emergency rooms. While hospitals have to treat these people, they do not get paid for that treatment. To cover the costs, public hospitals need more city and county tax money -- and all hospitals must raise their prices for other patients (which just increases the number of people who cannot afford care). It was a real problem that had many hospitals in financial trouble.

Right after the passage of the Affordable Care Act, the federal government came to the rescue. They agreed to give Texas about $4 billion dollars a year for five years to help defray the cost of free care being given by hospitals through their emergency rooms. The thought at the time was that Texas would expand Medicaid in that five-year period -- giving poor people insurance so they could pay for both preventative care and hospital care (and removing the need for hospitals to provide free emergency room care).

But then the Supreme Court decided that states did not have to expand Medicaid -- and Texas Republicans decided not to do it. It was a political decision, ignoring the needs of the poor in Texas, designed to please the teabagger base of the Texas GOP. But that move was not only heartless, it was also short-sighted -- since the federal money is about to end.

The federal money (about $4 billion a year) to help subsidize free emergency room care will end at the end of next year. And the federal government has notified the state of Texas that there will not be a renewal of that agreement. Washington sees no reason to keep giving Texas this free money since the state refuses to expand Medicaid -- which would give those patients both preventative and hospital care, and remove the need for hospitals to cover the cost of that care.

The federal government is right. They should stop giving the money. There is no legitimate reason for the state to refuse to expand Medicaid (since the federal government would pay all of the costs of that expansion at first, and 90% after that). Continuing the free money would just allow the state to continue playing political games with the Affordable Care Act, while denying badly needed preventative care to the poor (resulting in unnecessary deaths, since by the time these people are sick enough to go to the emergency room, it is too late to treat some of their diseases).

The Republican governor and legislature has the legal right to refuse to expand Medicaid. The Supreme Court gave them that right. But they do not have the right to keep getting federal money by refusing that expansion. It is time for the Texas Republican-dominated legislature to stop playing political games on the backs of the state's poor people, and expand Medicaid. If they don't, the hospitals will be back in the same financial trouble they were in several years ago -- and many of them will have to close their doors (hurting not only the poor, but everyone in those communities).

I think the lives of Texas citizens, and their access to a quality community hospital, is far too important to continue refusing Medicaid expansion. Unfortunately, Texas Republican legislators think getting teabagger votes is more important -- and that is shameful.

Obamacare Becoming More Accepted & Most Oppose Repeal

As millions more people get health insurance, and none of the terrible things the Republicans warned of have happened, Obamacare is becoming more popular with the general public. That's what a new survey by the prestigious Kaiser Family Foundation shows.

Note in the top chart that for the first time in over two and a half years, more people view the program as favorable than unfavorable (although the difference is within the poll's margin of error, which means the public is now split). That's a good thing, since previously most people viewed the program unfavorably.

But even though the public is now split over the program in general, only a minority want to see it repealed (or scaled back). In the Kaiser Poll, 46% want to keep the program as it is or expand it, while 41% want to repeal the program or scale it back. And a new Bloomberg Poll shows an even better percentage wanting the program. About 12% would keep it as it is, 51% want to see how it works and improve it, and only 35% want to repeal it.

What kind of modifications (or improvements) would people like to see? The most popular ones are shown in the chart below.

Figure 6: “Top Health Care Priorities” for the President and Congress	Total	Democrats	Independents	Republicans
Making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them	76	87	72	66
Government action to lower prescription drug prices	60	68	57	51
Protecting people from being charged high prices when they visit hospitals covered by their health plan but are seen by a doctor not covered by their plan	56	63	62	44
Making sure health plans have sufficient provider networks	55	64	58	43
Making information about the price of doctors’ visits, procedures, and tests, such as hip replacements and MRIs more available to patients	55	62	58	43
Making information about what doctors and hospitals are covered under different health insurance plans more available	54	60	55	46
Making information comparing the quality of health care provided by doctors and hospitals more available to patients	54	64	53	47
Changing current eligibility rules so that financial help under the health care law to purchase health insurance is available to more people	50	72	44	31
Requiring all states to expand their Medicaid program to cover more low-income, uninsured adults	50	74	43	28