[A]ll these numbers are simply guesses. Really. That’s it. California’s numbers are guesses. Maryland’s numbers are guesses. Oregon’s numbers are guesses. Vermont’s numbers are just guesses. Everyone is just guessing. … We’re covering those guesses in the press. When they come in low, we say it’s good news for Obamacare. When they come in high, we say it’s bad news for Obamacare. But we don’t really know whether the guesses are right or wrong either.
Even more interesting is what happens in year two. By then, insurers will know who signed up and how much their care actually cost. But at that point, their pricing won’t really be up to them. The law’s medical loss ratio rules require insurers in the exchanges to spend at least 80 percent of premiums on actual health care. If the care costs less than that, insurers have to send consumers a rebate — something many have already had to do.
Aaron Carroll wonders if political maneuvering based on these “guesses” will come back to haunt Republicans actively opposed to implementation:
[T]he gambit of those opposing Obamacare seems to be a full throated and all-out-effort to show that Obamacare doesn’t work. The danger, though, is that it might.
Despite the recent announcement of low premiums for Californians under Obamacare, Sarah Kliff isn’t celebrating yet:
California’s health-care marketplace isn’t like those being set up elsewhere in the country. When California created the country’s first-ever health insurance exchange, way back in November 2010, it made a very significant policy decision. The state decided that it would act as an “active purchaser” that would select a small number of health plans allowed to sell on the California exchange. Health plans would have to do more than meet a set of requirements in the Affordable Care Act. They would need to be selected by the California exchange’s board to compete in the marketplace. …
In an active purchaser exchange, health plans know that they’re competing against others for the chance to access millions of customers with tax subsidies. That could easily effect the bids that they submit, the ones they hope will get them into the new marketplace. That’s the dynamic in California, but not in most other states. That makes it a bit difficult to generalize what the state’s insurance rates say about what will happen elsewhere, where this downward pressure doesn’t exist.
Lanhee Chen, Romney’s former policy director, argues that the California’s rates aren’t as favorable as they first appear:
Yesterday California announced premium rates for its healthcare exchanges. Sarah Kliff points out that the premiums are lower than many estimates:
Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles. A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221. These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.
It’s also worth noting that, thanks to Obamacare’s subsidies for the poor, many will pay less than the already low sticker prices. In case you missed it, Jonathan Cohn weighed in this morning in a must-read. Ezra notes how California is a vital test:
The latest reader thread we want to highlight centers on your personal experiences with the ACA – mostly good, some just okay, a few terrible. Read the whole collection here. Several more of your stories are below, aired for the first time:
I’m 43 and was laid off last year from one of the major banks. I fell off a ladder about five years ago and ended up having four surgeries to get it all straight. Besides that, I’ve got ADD and generic meds, but no other major health issues. I was pretty surprised to be denied coverage by a few companies when trying to get it myself last year. When Obamacare activated, I was surprised that I got subsidies as a member of the upper-middle class and able to get affordable coverage while looking for a job. When I did get a contract job, I looked into health coverage. What the contract company was offering was over twice what I was paying on my own! The benefits weren’t even that different. I kept my plan through healthcare.gov and am very happy for it. For an income around $100k, I figured I’d make sacrifices for the greater good, but I’m actually seeing benefits.
My extended family’s Obamacare success stories come with a huge helping of Republican epistemic closure.
It’s an uplifting story that also makes you want to despair of government. Three 20-year-old programmers from San Francisco have set up a website – thehealthsherpa.com – that already does a huge amount of the work that the government website cannot effectively handle yet. No, you can’t enroll in Obamacare on it, but you can quickly see your options. What a concept! Available information! Money quote:
“They got it completely backwards in terms of what people want up front,” said Liang. He added: “They want prices and benefits, so that they could make the decision.” Liang showed CBS News how it worked. “You come to our website and you put in your zip code — in this case a California zip code. You hit ‘find plans,’ and you immediately see the exchange plans that are available for that zip code.”
It didn’t work for me, because they don’t have New York or DC plans yet in their system (California is their strong suit). But I did get instant access to both states’ exchange sites – no clogged system at all:
Using information buried in the government’s own website built by high-priced government contractors, they found a simpler way to present it to users. “That’s the great thing about having such a small team,” said Kalogeropoulos. “You sit around a table and say, ‘Okay, how does this work?’ There’s no coordination meetings, there’s no planning sessions. It’s like, ‘Well, let’s read the document and let’s implement this.'”
They’re busy updating and adding new features, like calculations for the various tax subsidies, as the video shows. So why not use this site or encourage other young geeks to set up similar ones outside the government just to convey information that is currently buried in healthcare.gov? You can then use that information to call up an insurance company or broker or navigator and buy your insurance. Then ask yourself: how did three 20 year-olds manage this in weeks while the feds had three years and fucked it up so bad it seems like an episode of computer Hell?
Mike Konczal blames Obamacare’s technical problems on the law’s design. He contrasts Obamacare’s form of social insurance, which he labels “Category A,” with previous forms of social insurance, such as Medicare and Social Security, which he labels “Category B”:
What we often refer to as Category A can be viewed as a “neoliberal” approach to social insurance, heavy on private provisioning and means-testing. This term often obscures more than it helps, but think of it as a plan for reworking the entire logic of government to simply act as an enabler to market activities, with perhaps some coordinated charity to individuals most in need.
If I had my way, we’d have a fairly simple, universal, single-payer health care system in the United States. It would work better; provide broader coverage; and probably be cheaper than what we have now. But countries like Switzerland and the Netherlands demonstrate that an Obamacare-like system can work reasonably well too.
At the end of [the book, Steven] Brill offers his own solution to the health-care crisis. He wants the big regional health-care systems that dominate many metropolitan areas to expand their reach and to assume the function of insuring patients as well. He talks to Jeffrey Romoff, the C.E.O. of the University of Pittsburgh Medical Center, who is about to try this idea in the Pittsburgh area, and becomes convinced that the same model would work throughout the country. “The [hospital’s] insurance company would not only have every incentive to control the doctors’ and hospitals’ costs, but also the means to do so,” he writes. … A system like this, Brill estimates, based on a few back-of-the-envelope calculations, could slice twenty per cent off the private-sector health-care bill.
It’s at moments like this that Brill’s book becomes problematic. The idea he is describing is called integrated managed care. It has been around for more than half a century—most notably in the form of the Kaiser Permanente Group. Almost ten million Americans are insured through Kaiser, treated by Kaiser doctors, and admitted to Kaiser hospitals. Yet Brill has almost nothing to say about Kaiser, aside from a brief, dismissive mention. It’s as if someone were to write a book about how America really needs a high-end electric-car company that sells its products online without being the least curious about Tesla Motors.
In an interview, Brill spells out his primary complaint about Obamacare:
The Commerce Department revised its estimates of first-quarter gross domestic product Wednesday to show that the economy contracted at a 2.9 percent annual rate. A combination of shrinking business inventories, terrible winter weather and a surprise contraction in health care spending drove the first-quarter decline, which is the worst since the first quarter of 2009, when the economy shrank at a 5.4 percent rate.
And that contraction is worse than expected; forecasters had predicted only negative 1.8 percent. Ben Casselman has more:
Last month, I noted that negative quarters are rare outside of recessions. Quarters this bad are even rarer. There have been only two other non-recessionary quarters since World War II when the economy shrank at a rate over 2 percent. Both times, the economy entered a recession the following quarter.
That doesn’t mean we’re about to fall back into a recession. On several other occasions, negative quarters were followed by a strong rebound. Just a few years ago, for example, U.S. GDP fell 1.3 percent in the first quarter of 2011, then bounced back to post a 3.2 percent growth rate in the second quarter.
Then again, it’s worth remembering that we’re notoriously bad at predicting recessions. In fact, we aren’t even very good at knowing when we’re in one. The semi-official arbiters at the National Bureau of Economic Research didn’t identify the most recent recession until December 2008, by which point it had been underway for a year; they didn’t pick up on the 2001 recession until it was over. If we were in a recession now, we might not know it.
Weather accounted for somewhere between 50 and 100 percent of the GDP pullback, says PNC senior economist Gus Faucher. When polar vortexes and multiple feet of snow keep people stuck at home, they just can’t get out to buy groceries or see the doctor. That’s only a temporary hit to the economy — everyone has to go to the doctor and buy food again at some point. …
Broadly speaking, the job market isn’t growing as fast as we’d like it, but it didn’t seem to pull back in the first quarter. And though healthcare helped pull GDP downward in the first quarter, even employment in that industry didn’t appear to take a hit:
Danny Vinik details the dip in healthcare spending:
[The new GDP data] may be a case of bad news that’s not so bad – and maybe even good.