Well, that’s my headline: “Obamacare is Killing Americans,” in order to illustrate the illogical assertions made by Michael Cohen in his 2/13/15, opinion article in the BOSTON GLOBE, “Killing Obamacare would kill Americans,” (http://www.bostonglobe.com/opinion/2015/02/13/killing-obamacare-would-kill-americans/YvqScToxKEjol4kOb2m2zM/story.html).
In his article Michael Cohen resorts to the obstructionist and misleading reasoning that Obamacare is a marvel of beneficent intent while criticism of Obamacare, and a desire for changes in our healthcare system including the possibility of the repeal of the law are automatically a reflection of nefarious intent and inevitable disastrous outcome.
This kind of dogged loyalty to some misconceived notion of the law in both its structure and implementation is obstructionist aiming to prevent reasonable improvement and modification of the significant challenges that PRICES for healthcare services create as a barrier to obtaining health care services.
But back to KILLING OBAMACARE IS KILLING AMERICANS, the title and idea put forth by Mr. Cohen. Michael Cohen’s article seems to rely on the 2012 research, “Mortality and Access to Care Among Adults After State Medicaid Expansions,” by Benjamin D. Sommers, Katherine Baicker, Arnold M. Epstein, New England Journal of Medicine, online July 25, print September 13, 2012, that found that “…expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, and—most importantly—improved health and reduced mortality.”
I don’t quite understand why we needed a study to argue that providing free health insurance that also provides virtually free health care to individuals improves their health and longevity because it improves their access to care through gains in coverage. That is essentially a no-brainer.
But in his opinion, Mr. Cohen is arguing that anything that reduces participation in HEALTH INSURANCE reduces access to care and is “monstrous” and is KILLING AMERICANS. Of course, this is NOT what the study suggests and is not true, it is not health insurance but the COVERAGE PROVIDED BY HEALTH INSURANCE that is the key to overcoming the PRICE barrier to healthcare services.
In America, cost is a BARRIER to CARE and the answer has always been the same when it comes to payers, “We’re not denying care, we’re just saying we won’t pay for it (coverage).”
Aside from this error, two questions remain for Mr. Cohen: FIRST, Does Mr. Cohen mistakenly equate non-Medicaid Obamacare as establishing a situation where individuals have “access to care” through widespread gains in coverage (that is also virtually free)? The answer to that is, “No.”
SECOND, Does Mr. Cohen mistakenly interpret that health insurance coverage, REGARDLESS of what it covers and what it demands in out-of-pocket payments by individuals seeking medical care improves ACCESS TO CARE THROUGH COVERAGE? The answer is also, “NO.”
If the answer to either one of these questions was, “Yes,” then Mr. Cohen would not have included the case of Medicaid expansion as an example of the “Monstrous” Republican opposition to Obamacare that is KILLING AMERICANS as a means of considering the issue in the upcoming case of King v. Burwell which is NOT About Medicaid.
King v. Burwell is actually not even about Obamacare, but is about the IRS paying premium assistance and cost-sharing subsidy payments to individuals under the authorization of the text of the Affordable Care Act which in 36B requires individual enrollment “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act.”
Back to Mr. Cohen’s misleading headline: “KILLING OBAMACARE WOULD KILL AMERICANS.” The research upon which Mr. Cohen relies identifies expanded Medicaid as a financial tool, a new “program” that increases access to health care by covering the expense to individuals of such health care and therefore increases their access the health services for which price is no longer a barrier which in turn improves their health and longevity. It’s not having health insurance that helps Medicaid enrollees, it’s having health insurance COVERAGE that makes their healthcare services near-free.
According to Mr. Cohen’s reasoning and reliance on the Harvard School of Public Health study, therefore, anything that reduces access by making healthcare services more unaffordable KILLS people who face the barrier of PRICE to medical services.
We begin to see the problem with Mr. Cohen’s reasoning that makes my opinion article that asserts that OBMACARE IS KILLING AMERICANS just as accurate or inaccurate as his opinion claiming KILLING OBAMACARE IS KILLING AMERICANS.
There is ample evidence that Obamacare health insurance has reduced people’s ability to pay for needed healthcare services through its provisions allowing for higher out-of-pocket expenses in the form of deductibles, coinsurance and copayments that have increased the barriers to obtaining needed health services. Therefore using Mr. Cohen’s logic, Obamacare is killing Americans.
There has apparently been a shift in who’s NOT getting medical care. As USA TODAY reported Obamacare cost-shifted and left Americans with employer-sponsored health insurance struggling with increased premiums, deductibles, copayments and coinsurance that have gotten everyone’s attention (besides apparently Mr. Cohen’s).
Articles such as the January 2, 2015 article in USA TODAY, address this issue and describe in detail how people are not getting the care they need because of out-of-pocket costs, “Dilemma over deductibles: Costs crippling middle class,” 1/1/15, Laura Ungar and Jayne O'Donnell , “USA TODAY,” http://www.usatoday.com/story/news/nation/2015/01/01/middle-class-workers-struggle-to-pay-for-care-despite-insurance/19841235/.
In the above article, “Dilemma over deductibles: Costs crippling middle class,” Dr. Praveen Arla is quoted noting that Medicaid patients are getting care “but middle-class workers are increasingly staying away,” because, “…health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills.” Middle-class workers are increasingly staying away…Obamacare is killing Americans.
A 2/28/2014 Gallup Poll, “Cost Still a Barrier Between Americans and Medical Care,” by Rebecca Riffkin, http://www.gallup.com/poll/179774/cost-barrier-americans-medical-care.aspx, mirrors the findings when she reports: “One in three Americans say they have put off getting medical treatment that they or their family members need because of cost… it is among the highest readings in the 14-year history of Gallup asking the question.” In the lingo of Mr. Cohen, Obamacare is Killing Americans.
In contrast to the above research, Mr. Cohen asserts that “fewer Americans are having problems paying their medical bills,” Michael Cohen, BOSTON GLOBE, 2/13/15, “Killing Obamacare would kill Americans.” While the latest figures from December 2014 show that 43 million people have medical debt, and there is an assertion that this number represents a reduction of about 9 million people who have such debt, not one honest consideration of this drop-off fails to include that contributing to the drop might be that more people are putting off medical care and therefore, are not incurring medical debt in addition to the individuals who are newly covered by Medicaid, which obviously is different—free health insurance AND virtually free health care services for enrollees.
Finally Mr. Cohen gets around to premium assistance payments under Obamacare and worries about the 8 million people who won’t be able to afford health insurance without such payments. TWO PROBLEMS: FIRST, there is an issue as to whether they were supposed to ever be eligible for such payments to begin with, and SECOND, health insurance isn’t what saves lives, only health insurance that provides COVERAGE to remove the PRICE barrier to medical services.
Mr. Cohen asserts that the argument challenging the premium assistance payments based on the language of the PPACA is “evidence-free.” Yet, we know that two cases brought the attention to the Supreme Court one deciding for the government and one deciding for the challengers.
In the case that ruled against the challengers and for the government, King v. Burwell, even the 4th Circuit Court of Appeals Judge who ruled in favor of the government wrote, “…the court is of the opinion that the defendants have a stronger position, although only slightly,” (page 20)…Not quite the evidence-free standard Mr. Cohen describes. That same court notes: “…while we think the defendants make the better of the two cases…Both parties offer reasonable arguments and counterarguments that make discerning Congress’s intent difficult,” King v. Burwell page 23.
Mr. Cohen continues, “By the end of open enrollment this weekend, sign-ups for an Obamacare health care plan will likely top 10 million people. Millions more are receiving coverage through expanded Medicaid or have been able to stay on their parents’ health plans.”
Again, Mr. Cohen twists the health-insurance-saves-lives-by-providing-coverage-for-the-expenses-of-healthcare-services argument into an untrue assumption that HEALTH INSURANCE SAVES LIVES. It is only true that health insurance saves lives when it reduces price barriers to healthcare services through coverage.
Further, in citing the “successes,” of more people having health insurance based on his original mistaken understanding that health insurance saves lives rather than health insurance saves lives to the extent that it reduces the PRICE barrier to healthcare services through coverage, Mr. Cohen misleads about the “successes” he cites. Mostly he omits the overwhelming evidence that PRICE continues to be barrier to healthcare services under Obamacare.
Mr. Cohen, omits that although many parents are able to carry their grown children on their health insurance through the age of 26 that the Obamacare FAMILY GLITCH has made health insurance for dependents unaffordable for almost two million Americans, (approximately 1.93 million, according to a 9/8/2014 article Brittany La Couture and Conor Ryan, “The Family Glitch,” Americanactionforum.org.) Almost 2 million “killed” by Obamacare according to Mr. Cohen’s standard.
According to the government, premium assistance payments by the government have been and are predicted to remain lower than expected because “Lower estimated enrollment obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (page 11, CBO, 1/15/15, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act.”) LOWER ENROLLMENT THAN EXPECTED.
Further, in predicting lower government outlays for cost-sharing subsidies, the CBO notes that more people than they anticipated have enrolled in bronze plans which don’t provide such cost-sharing subsidies and that this trend is going to continue as people try to save money on premiums, (CBO, page 13). The government reports that worse coverage, which we know COSTS LIVES as a barrier to obtaining needed medical services is the kind of coverage that more people than they anticipated are buying and will continue to buy in an effort to SAVE MONEY ON PREMIUMS. MORE PEOPLE CHOOSING WORSE COVERAGE.
Medicaid expansion as noted saves lives because it expands health insurance and coverage that makes healthcare costs virtually free for its enrollees. But we also know that CUTS to program occur when they become more expensive than anticipated and according to the government, the costs of Medicaid are predicted to remain higher than expected: “CBO and JCT now project that the federal cost of the additional enrollment in Medicaid and CHIP under the ACA over the 2015–2024 period will be $851 billion, $59 billion (7 percent) more than the April 2014 projection,” (page 13, CBO, 1/15/15, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act.”) MEDICAID COSTING THE GOVERNMENT MORE THAN PROJECTED.
Finally, Mr. Cohen, assumes that 8 million people getting less premium assistance will NOT have health insurance, which as we know has nothing to do with a PRICE barrier to healthcare services except in terms of the COVERAGE that is provided by such health insurance.
The only thing King v. Burwell will do is increase the number of people exempt from the individual mandate because without including the wrongfully paid amounts they received for premium assistance they would not meet the income threshold for having to buy insurance under Obamacare.
The individual mandate, buy health insurance or get taxed still applies. Premium assistance was NEVER intended for everyone, it already has criteria of who is entitled to it, including the apparent requirements of 36B. Even today although it’s estimated as much as 85 percent of the individuals are receiving premium assistance, obviously at least 15 percent of enrollees are NOT. Finally, we don’t know who would be affected in terms of overall wealth because eligibility for premium assistance, unlike Medicaid which has an assets test, has no assets test. Very rich people whose INCOMES are within the criteria established by the ACA are eligible for premium assistance.
In short, my assertion that Obamacare is KILLING AMERICANS for which I cite the increased numbers of people putting off needed medical care because of higher deductibles, copayments, coinsurance costs, and because of the FAMILY GLITCH that created a new class of Americans unable to afford dependent coverage for their families, AND because of the greater than anticipated number looking to comply with the law but purchasing plans that provide less coverage is as accurate as Mr. Cohen’s assertion that KILLING OBAMACARE WILL KILL AMERICANS. There is no moral high ground, just trade-offs.
