52% Of Americans Want Private Insurance Eliminated And A Government Plan Instituted

 

The chart above reflects the results of the Economist / YouGov Poll -- done between June 26th and 29th of a nationwide sample of 1,606 adults (including 1,428 registered voters). The margin of error is 3.2 points for both adults and registered voters.

U.S. Wastes Billions Of Healthcare Dollars Every Year

 Americans like to think that the money they spend each year for health insurance goes to actually pay for health care. It doesn't. The truth is that the U.S. spends hundreds of billions of dollars each year that doesn't contribute to the health of any American.

The money goes to pay the overhead for private insurance companies -- profits, executive and employee compensation, stockholder compensation, et cetera. The people receiving this money provide no health care. They simply suck dollars out of the health care system.

No matter what kind of health care system a country has, some money will be spent on overhead (managing the system), but Americans spend far more on overhead than other countries do -- and that is largely why health care costs so much more in the U.S. than in most other countries. For instance, Canada spends only about $1 on this compared to $4 in U.S. for each person.

Consider this excellent article by Melissa Healy of the Los Angeles Times:

In the United States, a legion of administrative health care workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year.

Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering health care is just $551 per person — less than a quarter as much.

That spending mismatch, tallied in a study published this week in the Annals of Internal Medicine, could challenge some assumptions about the relative efficiency of public and private health care programs. It could also become a hot political talking point on the American campaign trail as presidential candidates debate the pros and cons of government-funded universal health insurance.

Progressive contenders for the Democratic nomination, including Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts, are calling for a “Medicare for All” system. More centrist candidates, including former Vice President Joe Biden and former South Bend, Ind., Mayor Pete Buttigieg, have questioned the wisdom of turning the government into the nation’s sole health insurer.

It’s been decades since Canada transitioned from a U.S.-style system of private health care insurance to a government-run single-payer system. Canadians today do not gnash their teeth about co-payments or deductibles. They do not struggle to make sense of hospital bills. And they do not fear losing their health care coverage.

To be sure, wait times for specialist care and some diagnostic imaging are often criticized as too long. But a 2007 study by Canada’s health authority and the U.S. Centers for Disease Control and Prevention found the overall health of Americans and Canadians to be roughly similar.

Some Canadians purchase private supplemental insurance, whose cost is regulated. Outpatient medications are not included in the government plan, but aside from that, coverage of “medically necessary services” is assured from cradle to grave.

The cost of administering this system amounts to 17% of Canada’s national expenditures on health.

In the United States, twice as much — 34% — goes to the salaries, marketing budgets and computers of health care administrators in hospitals, nursing homes and private practices. It goes to executive pay packages which, for five major health care insurers, reach close to $20 million or more a year. And it goes to the rising profits demanded by shareholders.

Administering the U.S. network of public and private health care programs costs $812 billion each year. And in 2018, 27.9 million Americans remained uninsured, mostly because they could not afford to enroll in the programs available to them.

“The U.S.-Canada disparity in administration is clearly large and growing,” the study authors wrote. “Discussions of health reform in the United States should consider whether $812 billion devoted annually to health administration is money well spent.”

The new figures are based on an analysis of public documents filed by U.S. insurance companies, hospitals, nursing homes, home-care and hospice agencies, and physicians’ offices. Researchers from Hunter College, Harvard Medical School and the University of Ottawa compared those to administrative costs across the Canadian health care sector, as detailed by the Canadian Institute for Health Information and a trade association that represents Canada’s private insurers.

Compared to 1999, when the researchers last compared U.S. and Canadian health care spending, the costs of administering health care insurance have grown in both countries. But the increase has been much steeper in the United States, where a growing number of public insurance programs have increased their reliance on commercial insurers to manage government programs such as Medicare and Medicaid.

As a result, overhead charges by private insurers surged more than any other category of expenditure, the researchers found.

In U.S. states that have retained full control over their Medicaid programs, the growth of administrative costs was negligible, they reported. (The same was true for Canada’s health insurance program.) But in states that shifted most of their Medicaid recipients into private managed care, administrative costs were twice as high.

America’s Health Insurance Plans, a group representing private health insurance companies, said administrative practices shouldn’t be blamed for escalating the cost of care in the United States.

“Study after study continues to demonstrate the value of innovative solutions brought by the free market,” AHIP said in a statement. “In head-to-head comparisons, the free market continues to be more efficient than government-run systems.”

AHIP cited a recent report by the Medicare Payment Advisory Commission, an independent body that advises Congress. The report showed that Medicare Advantage plans — which are privately administered — deliver benefits at 88% of the cost of traditional Medicare.

Even so, the study authors concluded that if the U.S. health care system could trim its administrative bloat to bring it in line with Canada’s, Americans could save $628 billion a year while getting the same health care.

“The United States is currently wasting at least $600 billion on health care paperwork — money that could be saved by going to a simple ‘Medicare for All’ system,” said senior author Dr. Stephanie Woolhandler, a health policy researcher at Hunter College and longtime advocate of single-payer systems.

That sum would be more than enough to extend coverage to the nation’s uninsured, she said.

This Is The Problem That Medicare-For-All Has

All of the charts in this post are from a recent Gallup Poll. That poll was done between November 1st and 14th of a national sample of 1,015 adults, with a 4 point margin of error.

The top chart shows that a clear majority of Americans (54%) think it is the government's responsibility to see that all Americans are covered with decent health insurance. That includes 80% of Democrats, 56% of Independents, and 21% of Republicans.

That might sound to some like the public is ready for a single-payer, government-run insurance system (like Medicare For All). But that is not the case.

Consider the charts below. While Americans want the government to insure all Americans have decent health coverage, they are not ready to give up on the private insurance system. A majority (54%) say they want to stick with the private insurance system (including 31% of Democrats, 49% of Independents, and 84% of Republicans), while only 42% want to move to a government-run system.

I remain convinced that a Medicare For All system would be the best -- covering all Americans, and negotiating medical and drug costs. But it is pretty clear that not enough of the public believes that.

I do think the public supports creating a public option to cover those who can't afford private insurance (and would be available for anyone to buy into). That needs to be done now. Hopefully, once people realize how well that works (just like current Medicare does), it will be easier to move then to Medicare For All.

Elizabeth Warren has it right. A public option won't solve all our problems, but it is a necessary step before we can go further. We can't go further until a significant portion of Americans agree.

Public Supports Medicare-For All (Up To A Point)

The charts in this post reflect the latest Economist / YouGov Poll -- done between July 14th and 16th of a national sample of 1,149 registered voters, with a margin of error fo three points.

One of the issues being discussed in the Democratic presidential campaign is whether this nation should go to a single-payer health insurance program (like Medicare-For-All). Sanders and some others are pushing hard for Medicare-For-All. Biden and others would beef up Obamacare and create a public option that would cover the poor and allow workers to buy into a Medicare-like program.

Personally, I believe our current system has failed us badly, and I believe we will eventually wind up with a single-payer system like Medicare-For-All. I'm just not sure the country is ready to do that yet.

Note in the chart above that 52% of registered voters say they would support a Medicare-For-All system, while only 39% would oppose it. That sounds great. But when you look further, you find that many of those people don't understand what that would entail.

Now look at the chart below. It asked those same people if they would support a Medicare-For-All program if it eliminated private insurance (which it surely would need to do to work). All of a sudden support drops to only 37%, while opposition climbs to 49%. There are a lot of people covered by private insurance (usually through their employer) that are not willing to give it up.

Obviously, more work needs to be done to convince the public that a single-payer, government-run health care insurance system would be the best option for everyone -- even those currently covered by private insurance.

I think Biden might be right. The path to a true single-payer system must start with creating a public option that provides good insurance for everyone, and allows workers to buy into it to save money over trying to get private insurance. Once people realize that the public option is good insurance and cheaper than private insurance, it will grow fast -- especially if businesses are allowed to buy into it for their employees.

Obamacare Is Not The Problem - Insurance Companies Are

The following post is by Dr. Cathleen London, and is from the Portland Press Herald. Dr. London makes a point that progressives have been trying to make for years -- that the problem with health care in this country is the private insurance companies (and not Obamacare). Dr. London writes:

With the recent news about increases in premiums for health plans sold through the Affordable Care Act marketplace, everyone wants to vilify the ACA. The ACA is but a symptom of the issue. Where are our policy dollars going?

As a primary care physician, I am on the front lines. Milbridge is remote. In good weather, we are 30 to 40 minutes from the nearest emergency room, so my office operates as an urgent care facility as well as a family medical practice.

It can take 20 minutes for an ambulance to get here (as it did one time when I had a patient in ventricular tachycardia — a fatal rhythm). I have to be stocked to stabilize and treat.

We are also about two hours from specialist care. Fortunately, I am trained to handle about 90 percent of medical problems, as my patients often do not want or do not have the resources to travel. I have to be prepared for much more than I did in Boston or New York City, where I had colleagues and other materials down the hall or nearby. No longer do I have a hospital blocks away.

One evening I was almost home after a full day’s work. Around 7:30, I got a call on the emergency line regarding an 82-year-old man who had fallen and split his head open. His wife wanted to know if I could see him, even though he was not a patient of mine.

Instead of sending them to the ER, I went back to the office. I spent 90 minutes evaluating him, suturing his wound and making sure that nothing more sinister had occurred than a loss of footing by a man who has mild dementia. When I was sure that the man would be safe, I let them go.

I billed a total of $789 for the visit, repair, after-hours and emergency care costs. Stating that the after-hours and emergency services had been billed incorrectly, Martin’s Point Health Care threw out the claims and reimbursed me $105, which does not even cover the suture and other materials I used.

I called them about their decision, said that it was not right and let them know they’d lose me if they reimbursed this as a routine patient visit. They replied, “Go ahead and send your termination letter” – which I did.

The same day, Anthem Blue Cross kept me on the phone for 45 minutes regarding a breast MRI recommended by radiologists on a woman whose mother and sister had died of breast cancer. She’d had five months of breast discharge that wasn’t traceable to anything benign (and it turns out the MRI is highly suspicious for cancer).

Anthem did not want to approve the MRI unless it was to localize a lesion for biopsy, even though the mammogram had been inconclusive! This should have been a slam-dunk fast track to approval; instead, dealing with Anthem wasted a good part of my day.

Then Aetna told me there is no way to negotiate fees in Maine. I was somewhat flabbergasted. I do more here than I did in either Brookline, Massachusetts, or New York. The rates should be higher given the level of care I am providing. I have chosen not to participate with them. This only hurts patients; however, I cannot keep losing money on visits.

I do lose money on MaineCare – their reimbursement is below what it costs me to see a patient. For now, that is a decision that I am living with.

I had thought those losses would be offset by private insurance companies, but their cost shifting to patients is obscene. I pay half of my employees’ health insurance, though I’m not required to by law – I just think it is the right thing to do.

My personal policy costs close to $900 a month for me and my sons (all healthy), and each of us has a $6,000 deductible. This means I am paying rack rate for a policy that provides only bare-bones coverage.

Something is wrong with the system. In one day, I encountered everything wrong with insurance. I am not trying to scam the system. I am literally trying to survive. I am trying to give care in an underserved area.

This is not the fault of Obamacare, which stopped the most egregious problems with insurance companies. Remember lifetime caps? Remember denials for pre-existing conditions? Remember the retroactive cancellation of insurance policies? Returning to that is not an option. . . .

Something has to change if we are to attract up-and-coming medical students to primary care and retain practicing physicians. When both patients and physicians are frustrated, we know that only greed is winning, and the blame for that lies with corporations.

ISN'T IT TIME FOR A SINGLE-PAYER INSURANCE SYSTEM (I.E., MEDICARE FOR ALL)?

Tragic Cost Of Medicare Privatization For Seniors (& Others)

During his presidential campaign, Donald Trump promised to protect Medicare. It now looks like he may be getting ready to break that promise. Speaker Paul Ryan is already writing another of his bills to privatize Medicare -- putting seniors at the mercy of heartless insurance companies. Those companies don't really want to insure seniors, because that is a group generally more in need of medical care than any other -- and you can be sure that the premiums they will charge seniors will be sky-high (meaning many poor and working class seniors will be unable to buy insurance).

Medicare is a government program that has worked exceptionally well (like Social Security) -- and has insured that seniors do not have to do without life-saving medical care (especially preventative care). It would be a tragedy to abolish it, and force seniors to buy private insurance -- a tragedy that would also extend to the families of those seniors and hospitals (who would see the misuse of their emergency rooms skyrocket).

Here is what Josh Marshall, editor and publisher of Talking Points Memo, says about this:

We are hearing more about the Trump/Ryan plan to phase out Medicare and replace it with private insurance and vouchers. But we're still hearing much, much less than about Obamacare or a lot of other issues. Obamacare is super important. Don't get me wrong. But Medicare is a much, much bigger deal. Most DC journalists don't actually understand what's being proposed. You think it's hard getting good insurance when you're 30 or 50? Try getting good private insurance when you're 70 or 80.

Providing health insurance coverage to seniors will unquestionably cost more if run through private insurance. No one who has looked at the comparative data on the cost efficiency of Medicare and private carriers can question this. There's no money savings. Quite the opposite. The only difference is that seniors will pay vastly more out of pocket because the vouchers won't come close to the costs of a policy. The upshot of the Ryan plan is significantly increasing the cost of what society pays for the medical care of seniors and then making seniors pay dramatically more out of pocket. All with none of the bedrock gaurantees Medicare provides.

That's what phasing out Medicare means. Ironically, what Trump and Ryan are proposing is something like Obamacare: you buy your insurance on an exchange and you get some premium support from the government. Obviously, not everyone loves Obamacare. But building an exchange and subsidy adjunct for non-seniors onto an existing and fairly robust private health insurance system is one thing. Creating one from scratch for people who are all pretty much by definition bad risks is close to laughable. Laughable if you're not bankrupted or dying because you couldn't get care. 

Remember the other things Medicare significantly guard against. If parents have insupportable medical bills or have no way to pay for care, they go to children. In the absence of any other options, that's how it should be. But that money comes out of other things: buying homes, putting kids through college. The social insurance model of Medicare has positive effects well beyond direct beneficiaries. 

Ryan and Trump want to pass a bill to phase out Medicare in just six months.

Majority Of Public Wants Insurance Subsidies Continued

Republicans have been pitching a hissy fit about the Affordable Care Act (Obamacare) since it was passed, and their incessant whining has convinced a lot of Americans that there must be something wrong with the health care reform. But despite their repeated attempts, the GOP has been unable to stop Obamacare. They have tried to repeal it over 50 times, but that is just political theater -- played out for the benefit of their base. Everyone knows that even if such a repeal could get through Congress (which Democratic senators would never allow), the president would just veto it.

But a few devious right-wingers came up with another plan -- use a poorly-worded section of the reform law to outlaw giving subsidies to those who bought their insurance through the federal exchange instead of a state exchange. And their case (King vs. Burwell) is now being heard in the U.S. Supreme Court -- and has about a 50-50 chance of being won, which would mean that at least 8 million people could lose their insurance (since they couldn't afford it without the subsidy).

Extremists in the GOP are celebrating this possibility, because they care more about ideology (and hating the president) than they do about citizens receiving proper health care. Smarter Republicans are beginning to worry though. They know that this one case could do more damage to their party than anything else they have done.

Eight million people, angry at the party that took their health insurance, is certainly not going to help in the next election. But a recent poll shows the damage could be even worse than that. About 71% (more than seven out of every ten Americans) want the subsidies to continue in every state -- not just the ones with a state exchange (see chart above). Many of these people may be unhappy about Obamacare in general, but they like most aspects of the law -- and one of those aspects they like (and want to see continued) is the federal subsidies to help people buy health insurance.

It the right-wingers win the court case, it's going to intensify the war within the Republican Party. They will have to decide whether to celebrate their hate, or fix the law to allow the subsidies to continue -- and that will be a huge battle, which will affect the 2016 election. I don't know how that battle would come out. I just hope the court doesn't destroy Obamacare.

The chart was made from the results of a new Hart Research Associates Poll (done for the SEIU). That survey was done between February 18th and 22nd of a random national sample of 800 likely 2016 voters,  and has a margin of error of 3.5 points.

Could Roberts Be The Swing Vote That Saves Obamacare ?

The Supreme Court will hear arguments on the constitutionality of the government subsidies that help many people buy health insurance on Wednesday (King vs. Burwell). If the subsidies (those given thru the federal insurance exchange) are ruled unconstitutional, it means as many as 8 million Americans could lose their health insurance (because without the subsidies they could no longer afford that insurance). The question now is whether the court will vote the subsidies are constitutional or not.

If we go by what party the justices belonged to when appointed, the chances are good that the subsidies would be declared unconstitutional -- because we have five Republicans and four Democrats on the court. But while that is the best predictor of how justices will vote, it does not always work out that way.

Take for instance, Chief Justice Roberts. Although a Republican, Roberts was the swing vote in the original Obamacare case, and joined the Democrats in a 5-4 vote declaring Obamacare was constitutional. Could he do the same thing again?

Think Progress thinks that could happen. At least it has a 50-50 chance of happening (see the chart above). They looked at the past votes of all the justices, and came up with odds on how each justice is likely to vote in King vs. Burwell. They believe that four justices (Ginsburg, Breyer, Sotomayor, and Kagan) have 99% odds of voting to uphold the subsidies, while four justices (Scalia, Alito, Kennedy, and Thomas) have odds ranging from 0% to 15% that they will vote against the subsidies. That leaves Roberts, who has a 50% chance of voting either way.

In other words, it's nail-biting time for the millions who would lose their health insurance.

If you would like to know more about just what this case is about, Steven Brill has written an excellent article on it for Reuters. Here is some of what he had to say:

Congressional intent will be hotly debated in the U.S. Supreme Court this Wednesday in King v. Burwell, the latest litigation vehicle being deployed by opponents of Obamacare. “Congress could not have chosen clearer language to express its intent to limit subsidies to state exchanges,” the plaintiffs, represented by the Competitive Enterprise Institute, argue in their brief.

That is fiction. Provable fiction.

Congress knew exactly what it wanted to do when it passed the Affordable Care Act in 2010, and contrary to the plaintiffs’ claim, that included wanting subsidies for buying health insurance on the Obamacare exchanges to be available to all citizens, even those residing in the 36 states that did not set up their own exchanges, instead relying on the exchange set up by the federal government.

I’m a reporter. I hate to take sides. And I certainly didn’t in what has been widely reviewed as my even-handed treatment of the merits and demerits of Obamacare in my recently published book about the broken American healthcare system and how Obamacare was conceived and implemented to fix it. But this is one of those issues where reporters err if they write an “on the one hand, on the other hand” story that creates patently false equivalency.

As I wrote in a November column for Reuters, soon after the Supreme Court’s surprising decision to take this case, disputes that end up at the court are usually about the interpretation of the Constitution and statutes, not about facts. The press is mostly left to provide the basic background of the dispute and then explain the positions of the lawyers on each side. But at its core, this case, as with any about congressional intent, is about knowable facts, not about the lawyers’ views of the law.

King v. Burwell hinges on one poorly worded sentence cited by the plaintiffs in a 961-page law that seems to negate a linchpin of that law — the availability of those subsidies to middle-class families so they can buy health insurance. The question is whether that sentence should somehow outweigh all the other provisions in the law that contradict it. And when the meaning of a federal law ends up being disputed in court because the wording is vague or internally contradictory, the dispute turns on the kinds of facts journalists are used to digging out. That’s because judges are supposed to figure out what the legislators intended the law to mean and to do.

I know what the legislators intended because in researching my book, I interviewed pretty much everyone involved in the conception and writing of the law. Moreover, I did that long before King v. Burwell had become the Obamacare opponents’ favorite new weapon, which means that those opponents had no reason to spin the fairytale that Congress did not intend for those subsidies to go to the millions of Americans signing up on the federally run exchange. At the time, no one had a dog in a fight over congressional intent, because there was no fight.

I also reviewed reams of internal emails and memos generated by congressional staffers working for both Democrats and Republicans. In no document from start to finish, in a legislative process that spanned more than two years, is there even a hint of anything but the unambiguous assumption that the law, whose first section is titled “Quality, Affordable Health Care for All Americans,” would indeed provide these insurance subsidies for all Americans who needed them.

In short, I had a catbird seat for doing exactly that kind of fact-based reporting that anyone judging a case like this — reporters, as well as judges — should do. But I didn’t appreciate it because neither I nor the people I was interviewing had any expectation that this case would become something the Supreme Court would take seriously.

Indeed, when I mentioned the case to several of those sources during the spring and summer of last year, all of them – Democrats and Republicans – did some version of an eye roll. This is why there is only scant mention of the case in my book, the draft of which was completed before the court took the case.

I’ve now gone back and looked at my notes and can report that I interviewed 21 congressional staffers and members last year in my effort to reconstruct the day-by-day narrative of how Obamacare happened. None ever mentioned the possibility that the subsidies did not apply to the states in the federal exchange.

On the contrary, everything they told me — and all of the contemporaneous emails and other internal documents I reviewed — assumed that the federal exchange would simply be a substitute for a state exchange if a state decided not to launch its own, and that the same rules would apply. That is consistent with the instructions Democratic and Republican staff members gave to the Congressional Budget Office when they asked it to “score” (estimate the cost of) various drafts of the law, including the final version.

What A Fine Mess The GOP Is Creating For Itself

When the GOP seized both houses of Congress in the last election, they were jubilant. They thought they would now be able to do whatever they wanted, and governing would not be a snap. The mess they've made by playing politics with the funding of Homeland Security shows they really weren't ready to govern. They were embarrassed before the entire nation, as it became apparent that their teabagger caucus isn't interested in doing the compromising that is necessary to govern -- but only in pursuing their own ideological purity to keep their base back home happy.

But the Homeland Security mess will look like chicken-feed up beside another mess that is brewing -- a mess that springs straight from their hatred of President Obama and his health reform plan. For years they were able to score points with their teabagger base by opposing Obamacare. That opposition didn't really hurt them much, because it was obvious that no matter how many times they voted to repeal Obamacare there was no way they could accomplish it.

But then a few Republicans got a not-so-bright idea. They would take Obamacare to court and get the Supreme Court to declare that the federal healthcare exchange could not give government subsidies to help people buy insurance (because of some poor wording in the Affordable Care Act). They reasoned that if the 34 states without a health care exchange could not receive subsidies, then Obamacare would fall -- and they are right, because those subsidies are the heart of the program.

Now it looks like they have a 50-50 chance of winning that court case (King vs. Burwell), and that is starting to scare the hell out of a lot of Republicans -- the ones smart enough to know that could seriously damage their party. It turns out that there are at least 8 million people who have gotten health insurance through the federal exchange with a government subsidy. Those people will most likely lose their health insurance if the GOP wins that court case, because they can only afford that insurance with a government subsidy.

That's a lot of angry people -- and angry people vote against the people who made them angry. And a lot of those people live in swing states -- states the GOP must win to have a chance at the White House in 2016. It would affect more than 1,000,000 people in Florida, nearly 200,000 in Ohio, over 400,000 in North Carolina, about 400,000 in Pennsylvania, nearly 300,000 in Michigan, about 400,000 in Georgia, etc.

And those numbers were just the people who had signed up through January 30th. A lot more people signed up in February, March, and April.

This gives the Republicans a tough choice. They protect the insurance those millions of people currently have by either creating state exchanges in the 34 states (or by fixing the federal law to allow the subsidies -- which would anger their teabagger base (and possibly cost them dearly in the 2016 primaries). Or they can stand firm and watch those angry people who lost their insurance vote against them in the 2016 general election.

In short, they have created a situation for themselves where they only have bad options. And it was caused by their unreasonable hatred for the president -- a hatred that had blinded them to the realities happening in the health care reform. What are they to do?

I doubt they can fix the law at the federal level. The bumbling mess they have made of Homeland Security funding shows they are incapable of governing on that level. That means it will be left up to the separate states, and that's not much better. A few states are considering creating their own exchange to allow their citizens to get the federal subsidies, but most (like Texas, which has over 900,000 who will lose their insurance) are doing nothing -- at least so far.

This reminds me of the old saying -- Be careful what you wish for, because you might get it. The Republicans wished for the downfall of Obamacare, and now they might have to deal with the consequences -- consequences that could be devastating for their party.

Obamacare Is Still A Growing Nightmare For The GOP

Last year's total sign-ups through Obamacare for private insurance purchases topped all expectations, and finished with more than 8 million people purchasing private insurance through the state and federal insurance exchanges. That would have been enough of a nightmare for the Republicans (who want to repeal the program), but it got much worse for them this year.

Sign-ups were expected to grow this year to about 10.3 million, but it went far past that -- all the way up to 11.4 million. That's 11.4 million Americans who would lose their health insurance if the Republicans were able to get the program repealed (and that doesn't even include the millions of Americans added to Medicare through the programs reforms).

Of course, there is no chance the Republicans could repeal Obamacare. Even if that repeal could get through Congress (which is extremely unlikely), the president would certainly veto it. But that doesn't mean the program is not in danger. There is currently a case pending before the Supreme Court (King vs. Burwell) that questions whether it is legal for consumers to get a government subsidy if they went through the federal government exchange instead of a state insurance exchange.

If the court decided those going through the federal insurance exchange could not legally get a subsidy, that would take insurance coverage away from about 8.6 million Americans (because almost all of them can only afford that insurance if they get a subsidy). What would the congressional Republicans do if that happened?

Would they act to legalize those subsidies for that 8.6 million Americans? Or would they celebrate the defeat of Obamacare (which would please many in their base), and risk that 8.6 million taking their anger out on them in the 2016 election (which would be the year their insurance ends)? It's a dilemma.

It turns out that the court case, which they originally celebrated, could turn out to work against them. It's one thing to take symbolic votes to repeal Obamacare, but quite another to actually take health insurance away from 8.6 million people.

Texans Flock To Buy Insurance Through Obamacare

(The image above was found at the Burnt Orange Report.)

It's no secret that Texas is a very red state, and the Republican leaders in Texas have been in the forefront of those who claim that it's citizens don't have a right to health care. For these Republican leaders, health care is a product to be sold to those who can afford to buy it -- and if you can't afford it, then you'll just have to die (because the state is not going to help you get life-saving health care).

That may sound harsh, but it's true. The Republican leaders in Texas don't want to recognize health care as a right, because if they did they might have to tax rich people and corporations to provide that health care to those who cannot afford it -- and taxing the rich and the corporations is not something Texas Republicans are willing to do. Padding the bank accounts of the rich and the corporations is far more important to Texas Republican officials than saving the lives of Texas citizens.

So it shouldn't have surprised anyone that Texas Republicans (both on the state level and those sent to Washington) fought against the Affordable Care Act (Obamacare) tooth and nail, and when it passed they filed suit in court to stop its implementation (and carried that suit all the way to the Supreme Court). And even after they lost, and Obamacare became law, they urged citizens to not buy insurance (so the law would fail). Once again, they didn't care that they were putting lives in danger -- because they had a political point to make, and for them, that was more important.

Fortunately, the citizens of Texas ignored their hard-hearted pleas to not buy insurance -- and they purchased more policies through the Obamacare federal exchange than was expected. The CBO had predicted that 629,000 private insurance policies would be sold in Texas, but the actual figure turned out to be about 733,000 (significantly more policies purchased than expected).

It turns out that Texans were not about to pass up the chance to buy affordable health insurance just to prove a point for the Republican officials. About 80% of that 733,000 qualified for subsidies under Obamacare to help them buy their insurance -- and the others were able to take advantage of the lower premium prices brought about by more healthy people purchasing insurance (and yes, 30% of those purchasing insurance were healthy young people between the ages of 18 and 34). Blue Cross added that they had sold about 150,000 additional policies in Texas outside the federal exchange, and that's only one company. It is likely that the number of new private insurance policies has exceeded a million.

That's good, but we could have done much better here in Texas. Our state government has refused to expand Medicaid -- and that leaves at least 1.5 million people that cannot get health care (because they do not qualify for Medicaid under Texas' stringent law, but don't make enough money to qualify for a federal subsidy to help them buy insurance). In other words, Texas (which has the highest percentage of uninsured people in the nation) could have reduced the number of uninsured by nearly 3 million -- the the Republican leaders chose not to allow that.

All Texans should be ashamed of their elected GOP leaders, who put politics above saving lives. How can any decent person not believe all citizens should have a right to good health care?

Obamacare Just Keeps Getting Worse For The Republicans

These's not much to say about this that I haven't already said. Republicans had hoped the Affordable Care Act (Obamacare) would be a failure. Instead it is a huge success -- and turned into an increasing nightmare for the GOP. The number of private insurance sales through Obamacare now rests at about 8.113 million (significantly above the hoped-for 7 million).

Insurance Purchases Through Obamacare Top 8 Million

When it comes to the Affordable Care Act (Obamacare), things just keep getting worse for the Republicans. They predicted that only sick people would purchase insurance under Obamacare, and that would raise the price of premiums for everyone. But that didn't happen. The ratio of sick to healthy people did not change (and in fact, 30% of new policies were sold to young & healthy people), and because the insurance companies now have a much larger pool of consumers, the premium price has actually gone down (in New York the premiums have been cut in half).

They also predicted that the number of policies sold through the Obamacare exchanges would not even reach the revised CBO estimate of 6 million new policies. They were wrong again. The number of policies sold through Obamacare has now topped 8 million policies -- a staggering figure that even Democrats could not have predicted.

And that is not all of the bad news for the Republicans. Another 5 million people purchased insurance policies without going through either the federal or state insurance exchanges. And even though they didn't go through the Obamacare exchange, they are also receiving the benefits provided by Obamacare -- lower premium prices and better quality insurance policies. That means the number of policies improved by Obamacare actually tops 13 million (and that's policy numbers, not individuals helped -- which would be much higher). And this doesn't count the millions who now are covered by their parents' insurance or the many millions who qualify for Medicaid in the states that expanded that program.

The national GOP leadership just sent out a memo telling those running for office to run against Obamacare this year, telling them that is a winning strategy. It may be a winning strategy for the primaries (where they have to keep the teabaggers happy), but I believe it may not be so good for the general election. Do they really want to tell the many millions who are now benefitting from Obamacare that they will repeal it, and go back to the old system (which means poorer quality policies that cost more) -- especially in light of several polls showing a majority now want to keep Obamacare (and improve it)?

The Republicans will continue to whine about Obamacare -- at least for a while. They must do that to keep their base happy. But even they have to know that the real fight is over now. Obamacare is here to stay (until there is enough support to go further, and establish a single-payer system).

Obamacare Insurance Sales Creeping Close To 8 Million

When the Affordable Care Act (Obamacare) was passed, the Congressional Budget Office (CBO) predicted that about 7 million private insurance policies would be purchased by the end of March of this year. But after the program got off to a weak start last October (due to computer problems), the CBO revised their estimate down to 6 million -- and the Republicans predicted that the 6 million figure would not even be reached.

Both the Republicans and the CBO were wrong -- by a significant amount. It now looks like the figure for the end of March was about 7.21 million purchases. And since the program deadline was extended for those who had trouble getting access to the exchanges, another 570,000 policies have been purchased. That brings the current total to about 7.78 million -- and it is not inconceivable that the final total will reach 8 million.

And that doesn't even count the millions who are now on their parents' policies or the millions who have qualified for Medicaid. Obamacare didn't solve all the problems facing of our health care system, but any honest person will have to admit it has been a huge success.

Obamacare Signups Are Still Growing

It seems that the failure of the Affordable Care Act (Obamacare) was nothing but a futile wish of right-wing Republicans -- a wish that has turned into a brutal nightmare for them. The number of private insurance purchases, originally predicted to be 7,000,000 by the Congressional Budget Office, has easily cruised by that figure. It currently rests at 7,588,454 and it is still growing (adding nearly 400,000 since the end of March).

And that is just a portion of the millions of new people who now have insurance coverage thanks to Obamacare. That total is well above 22.7 million people.

The Republicans are still talking about repealing Obamacare, but that is just to keep their teabagger base happy. They have to know it would be political suicide to take health insurance away from over 22.7 million people.

Over 22 Million New People Have Insurance Thru A.C.A.

The numbers of people who now have insurance coverage through the various aspects of the Affordable Care Act (Obamacare) just keeps climbing. The latest total (through Medicaid/CHIP, private insurance purchases, and those under 26 now covered by their parents' insurance) is over 22.2 million people. And the numbers continue to grow.

Last week, the Republicans in the House of Representatives voted for the 52nd time to repeal Obamacare, but that was just to keep their teabagger base happy (since most of them still face a party primary). There is no way they want to actually take insurance coverage away from more than 22 million people, which is what their repeal would do. And by 2017, the earliest a repeal could happen (since the president would veto any repeal before then), there will be a lot more than 22 million people that a repeal would hurt.

The Republicans know Obamacare is here to stay. They just don't want to admit it yet (because that would anger their teabagger base). And there is some evidence that they know it. Last week, they joined Democrats in passing some small changes to Obamacare. If they really thought it was so bad it could not succeed, or they could actually repeal it -- then why would they be voting with Democrats to improve it? Two reasons -- they know the program is  here to stay, and the business community asked for the small improvement to Obamacare.

But they made the small improvement to Obamacare without any fanfare -- holding no debate on the bill, and passing it on a voice vote (so no member would have to go on record as voting for it). Even though most of them have quietly accepted that Obamacare is here to stay, they know their teabagger base has not. The window for repeal has closed, and the Republicans are now just playing political games.

Private Insurance Sales Top 7 Million Under Obamacare

I said yesterday in a post that I thought the chances were good that private insurance purchases through the state and federal exchanges established by the Affordable Care Act (Obamacare) would top 7 million. Now it looks like that rather easy prediction to make has officially come true. President Obama announced yesterday that sales had topped 7 million -- and Charles Gaba (who has kept a running total of Obamacare signups at his website ACASignups.net) puts the total at about 7,080,180 (with some states still to report).

The Congressional Budget Office (CBO) had originally estimated that 7 million policies would be sold by March 31st, but after the slow start in October and November they revised their estimate down to 6 million. It turns out that revision wasn't necessary. Consumers flooded the market in March, buying nearly 3.8 million policies in that month alone. Now as the numbers trickle in from the state exchanges, and those who had difficulty with access getting a couple of weeks extension, the question is no longer whether Obamacare will reach its goal but by how much will they surpass that goal.

The Republicans are still saying they want to repeal Obamacare, and that they program will fail -- but the new numbers make those statements sound rather hollow. Obamacare has given more than 20 million Americans health insurance that they couldn't have gotten otherwise, and those numbers will continue to grow. In fact, the only thing keeping most Americans from being able to have quality health insurance is the Republican refusal to expand Medicaid in 25 states (where millions of the poor are still denied health insurance coverage).

Obamacare is not perfect, and I hope we can improve it soon (or go all the way to a single-payer system covering everyone). But it has been a success in getting coverage for millions of Americans, and it will not be repealed. But don't expect any Republican to admit that. They didn't think the huge number of Americans without access to health care was a problem to begin with.

Newest Numbers Verify The Huge Success Of Obamacare

The Republicans have done their best to try and make sure the Affordable Care Act (Obamacare) is a failure. They have lied about the program, pronounced it to be an unworkable failure, urged citizens not to comply with it, and voted to repeal it numerous times. But their efforts to obstruct the program and prevent it from being successful have been for naught, because the latest numbers show that Obamacare is a huge success.

When Obamacare became law, the Congressional Budget Office predicted about 7 million Americans would purchase private insurance through the program by the first cut-off date (March 31st). After the program got off to a very slow start, due to computer glitches and consumer reticence, the CBO adjusted its sales estimate down to 6 million. It now looks like that adjustment was necessary.

As of March 28th, there had been more than 6.622 million purchases of private insurance policies through the state and federal health exchanges. It is still very possible that the 7 million mark could be reached by the end of March, and if not, it will be easily achieved early in April (since the deadline has been extended for those who have had trouble accessing the exchanges). And if you add in the number of new people who have purchased insurance without going through the state or federal exchanges (but still get the same prices and benefits), the number of private insurance purchases has already topped 7 million.

And that is just a portion of the new people now covered with insurance thanks to Obamacare. When you add in the young people under 26 who have been added to their parents' policies (3.101 million) and the new Medicaid and CHIPS sign-ups (10.429 million), you'll find that the number of new people with health insurance in the United States is about 20.152 million. That's not everyone in this country that needs health insurance, but it is a significant achievement (and is expected to grow in the future as more people realize that Obamacare is a better deal than what we had before).

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But while Obamacare has been successful, the Republican efforts to stop it have been shameful -- and nothing is more shameful than the 25 states where Republicans have prevented Medicaid from being expanded. This refusal to expand Medicaid is preventing millions from getting the insurance they need to access preventative care -- and that inability to get preventative care in those 25 states is going to kill thousands of people (somewhere between 7,114 and 17,106 every year).

One of the favorite lies of the Republicans is that Obamacare created "death panels" to make end of life decisions for the elderly in this country. That is not true at all, but that doesn't mean there are death panels -- the death panels composed of Republicans in the 25 states that refuse to expand Medicaid. It is not the elderly that is victimized by these GOP death panels, but the poor. Here is a state-by-state breakdown of the number of people that will be killed each year by these GOP death panels.

Obamacare Insurance Purchases Race Past 6 Million

Everyone was wondering if the sign-ups for private insurance through the Affordable Care Act (Obamacare) would get to 6 million before the March 31st deadline. Now it has passed that goal, with at least 6.141 million sign-ups through March 26th -- five days before the deadline. That means there have been 1.9 million sign-ups so far in March, and it looks like that will easily top 2 million by the end of the month.

Although the administration said they would not extend the deadline, they are now saying there will be a "grace period" of a couple of weeks for those who experienced computer problems or extremely long waiting lines. The question now is just how close will we get to the original estimate of 7 million sign-ups. I think it's going to be pretty damn close!

Meanwhile, the Gallup Poll tried to find out what those without insurance were planning to do. Between March 1st and 26th, they questioned 1,322 nationwide adults without health insurance (and their survey had a 3 point margin of error). What they found out was that most of these people were governed by political ideology rather than any perceived need to health insurance -- with Republicans having a majority saying they would pay a fine (58%), while the vast majority of Democrats (75%) saying they would buy insurance (and Independents falling in the middle, with 52% saying they would buy insurance and 39% saying they would pay a fine).

I find that rather sad, because while it may make someone feel good right now to make a political statement by paying a fine, that fine won't pay for any medical care (and everyone sooner or later will need medical care -- and if it's serious it could wreck a families finances).

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And while we're on the subject of insurance and health care, the Gallup Poll just released their year-long study of health care in 2013 (by questioning 178,067 nationwide adults between January 2nd and December 29th of 2013). Because of the large number of respondents, most states had a margin of error between 1 & 2 points.

The chart below shows the eleven states with the highest percentage of people who say they didn't have enough money to get needed health care or medications at some point during 2013. I have also included the percentage of that state that doesn't have any kind of health insurance.

Some of these states may improve their position this year, since they have decided to expand their Medicaid program (West Virginia, Kentucky, Arizona, Arkansas). The other seven states are still refusing to expand Medicaid, and will most assuredly appear on this negative list again next year. The (Y) or (N) appearing by the state name shows whether they are expanding Medicaid or not.

Over 12 Million New People Now Have Health Insurance Thanks To The Affordable Care Act

There are more than 12 million people who certainly won't be supporting any repeal of the Affordable Care Act (Obamacare). That's because they now have health insurance -- insurance they couldn't afford before Obamacare became law. The total is actually 12.817 million, including 2.5 million under age 26 who are now covered by their parent's insurance, 5.055 million who have qualified for Medicaid/CHIPS, and 5.262 million who have purchased private insurance (many of them with help from a government subsidy).

These numbers are from the acasignups.net website, and they are conservative estimates. The actual government figures could be even higher. It also looks like the chance of reaching the CBO estimate of 6 million private insurance purchasers by the end of March is very good (since the March daily average of purchases is much higher than previous months, and will probably increase as the end of the month approaches).

Obamacare is not perfect, and won't cover every American with health insurance (especially since about 25 states still refuse to expand their Medicaid program). But Obamacare has to be judged a moderate success now, and Republican efforts to repeal or obstruct the program have to be judged as an utter failure. Obamacare is here to stay -- at least until it can be replaced with something even better (like a government-run single-payer program similar to Medicare-for-all).