The President wrote an article about Obamacare this summer that was worthy of circa 2009, selected "facts," omitted truths and frightening implications wrapped up in a plea to save his law. Omitting grandiose self-congratulatory language based on opinion, such as characterizing Obamacare as "the most important health care legislation…since the creation of Medicare and Medicaid in 1965," will save you a lot of time as will ignoring the repeated lies such as the law was "designed to improve the accessibility, affordability, and quality of health care," so the article is a lot quicker to read than you might think. (http://jama.jamanetwork.com/article.aspx?articleid=2533698)
Naturally, the President plunges into enrollment, "the uninsured rate has declined by 43%," because after all, that is the last refuge he has in justifying this catastrophic administrative black hole of a mess. While he applauds himself for the reduced figures of "The Uninsured," by now consumers are savvy enough to realize that Obamacare has a four-pronged way of reducing The Uninsured, originally numbered at 47 million, that is new, but surely not "reform" in any positive sense of the word.
The Affordable Care Act's tiered approach to reducing The Uninsured has FOUR elements which can be examined in terms of government, insurance companies and consumers.
Covering children till age 26, is a win for government, a win for insurance companies and a lose for consumers, financially. Parents paying for grown children's health insurance up to age 26, which already was available to many employees who could afford to pay for their grown children's health insurance. This is a win-win-lose, insurers sell more health insurance, the government claims victory that another adult is now insured, and naturally, parents who desire their grown children to be insured are paying more.
Then there's the individual mandate, which again, is a win-win-lose. The government collects fines from working Americans who do not purchase the consumer financial product of health insurance, health insurers have a ready-made set of customers who MUST purchase their product or pay that fine, and consumers are forced to purchase a financial product of health insurance regardless of whether it meets their needs or not.
Then there's expanded Medicaid, which in terms of government, insurance companies and individuals is, financially a lose for government (though a win for enrollment, therefore worth it since the money being spent is ours), a win for insurers, and a win for consumers.
Medicaid is not Obamacare, as the President mentioned it dates from 1965. What Obamacare did was expand the parameters for eligibility, which made more people eligible for the near free health insurance and near-free health care. This is important, because rarely do you see Obamacare separating out Medicaid from the law's "reforms." Medicaid predated Obamacare, and certainly making near-free health care and near-free health insurance available to more people would mean more people would have health insurance.
What is new is that for Medicaid, the government loses, not only are more people eligible for the near-free health insurance and near-free healthcare, but the Federal government chose to pay a much greater share of the costs (which are traditionally shared by states and the federal government) in order to incentivize the states to expand the program. Medicaid costs government much more under these circumstances. Insurance companies are competing for the Medicare/Medicaid business since guaranteed payments by the government are good for them. It's also good news for individuals who are eligible for near-free health insurance and near-free health care.
Finally there's the elaborate system of premium assistance and cost-sharing via health exchanges which are not only the only "novel" idea of Obamacare, but the biggest evidence that the law is a failure. Designed for working people who under Obamacare are now forced to purchase the financial product of health insurance, the exchanges are a marketplace, an online phone book essentially of insurance companies offering insurance plans.
Getting participation from consumers and insurers to make exchanges viable has proven a bottomless pit of expense, from paying insurers to participate to paying individuals to participate--not the poorest individuals, but individuals who have INCOME which if proven to fall within certain parameters makes them eligible for the government to pay a portion of their premiums. There is no assets test so that those who can effectively fudge their numbers for income even if they're millionaires can get this entitlement money.
At its best, enrollment through exchanges, arguably the only "novel" part of Obamacare has been way below what was anticipated (this year between 9.1 and 11.1 million) which is why you'll rarely see the numbers separated out concerning how exactly Obamacare claims "the uninsured rate has declined by 43%." You don't have to be a math genius to figure out that at its high-end, 11.1 million is nowhere near 43 percent of the 47 million uninsured (which would be over 20 million, right?).
The President himself underscores the utter failure of Obamacare by touting "successes" focusing on Medicaid, the program in existence since 1965. Obama brags "an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points," nonelderly meaning the new Medicaid population and grown children on parents' health insurance plans--free health insurance and near-free care help makes healthcare "affordable," hardly a reform.
Again citing Medicaid, near-free health insurance and near-free medical care, the President brags about "an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage," uh duh.
The President's facts disappear in the next part of the article as he recommends "…increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs." In other words, Obamacare failed, people still can't afford premiums, people still can't afford drugs, and there is no effective method in the law for controlling prices charged to consumers absent a public option--The very reasons that healthcare "reform" ideas have failed for decades and other wiser leaders opted not to pass some half-baked "reform" that might, as it has, made things worse for millions upon millions of Americans in terms of costs, options, and the ability to obtain timely, competent and needed medical care and services.
As per the President, in order for people to afford even the federally financed health insurance plans, the President acknowledges the government would have to pick up more of the tab. Also, circa 2009, the President who tossed out the public option early on and along with it the hopes of controlling prices charged to consumers, now in 2016, reasserts that in fact that public option is necessary for Obamacare to work. And finally, vaguely, the President whines that prescription drugs cost too much.
Then, for the record, the President brags without justification and without any supporting facts as he included in his first paragraph that Obamacare has helped the healthcare environment--Opinion.
Then the President "reviews" historical data (where he picks up citations again).
Then the President returns to his new math. Recalling as we now know the four tiers of reducing that uninsured rate, surprisingly the President asserts that not 47 million, but now 49 million people were uninsured before the ACA. Interestingly, the government disagrees--"…the agency now says that more people than anticipated already had health insurance before the law took effect," https://www.washingtonpost.com/news/wonk/wp/2015/03/09/obamacares-cost-is-falling-as-fewer-receive-coverage-under-health-care-law-cbo-says/. So, according to the government itself, if 47 million was an overstatement, 49 million is more of an overstatement.
Then the President brags: "Early evidence indicates that expanded coverage is improving access to treatment, financial security, and health for the newly insured." NEWLY insured. For good measure the President asserts that essential health benefits and checkups, made part of the minimum requirements for health insurance plans which used those standards as a justification to charge more and cover less of needed medical services is "improved health insurance coverage" for the rest of us--that would be an opinion.
Then the President addresses what the rest of us didn't know that we now know, that Affordable was about saving government payer and insurance companies money on how much they paid out on behalf of consumers. Obama confirms, "mean annual growth in real per-enrollee Medicare spending has actually been negative," "mean real per-enrollee growth in private insurance spending has been 1.1% per year since 2010."
This also is not rocket science. Health care costs for services have gone up so how would payers be paying out less per person? Now you get it, by requiring us to pay more of the bill out of pocket or by covering fewer needed medical services. Why would any consumer celebrate this? Not even those who are deluded enough to celebrate scrimping on paying for individuals' care in order to preserve payer dollars are still silly enough to ignore the fact that we don't know how much Obamacare is costing even after scrimping on benefits payments because conveniently the government doesn't count that.
The government stopped counting how much it spends on administering Obamacare in order to ignore the black hole money pit of the law: “…[e]stimates address only the insurance coverage provisions of the ACA and do not reflect all of the act’s budgetary effects…", (“Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act,” http://www.cbo.gov/sites/default/files/cbofiles/attachments/49892-breakout-AppendixB.pdf, page 1.)
In short, Obama's defense of himself is unchanged from his original "sell," peppered with cherry-picked stats that rarely provide a full picture of what we're living with. This is nowhere more clear than the sheer hubris of his attempt to influence future "policy makers."
First, naturally, he blames Republicans for "hyperpartisanship," seemingly unhappy that he had to follow our system of government at all, which he's spent ample presidential time in finding "legal" loopholes to enhance his own power.
Obama's "second lesson is that special interests pose a continued obstacle to change," tough talk from the man who adopted the INSURANCE COMPANY plan for what health insurance coverage should look like in the US, "Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate,” produced by AHIP, the insurance lobby, 2008.
The "third lesson," introduces more untruths than are actually worth going through as the President rationalizes his actions asserting "…the importance of pragmatism in both legislation and implementation," claiming the government public employees and himself have been were "brutally honest in assessing problems," not so much.
The article's worth a read because it illustrates why Obamacare failed, it was a poorly conceived law that accommodated the insurance lobby's plans in order to sell the American people on "sexy" provisions such as covering preexisting conditions off the backs of every American in the form of forcing the purchase of a commercial financial product, health insurance, that charged more in premiums for less meaningful coverage by substituting prevention coverage for needed medical services coverage in order to save payers, insurance companies and government money.
The sheer disconnectedness of the President from the reality of what Obamacare has done is a testimony to his bullheadedness rather than his ability to formulate meaningful reform, of which the exchanges are the only true structural reform and which stand out as Exhibit A of the law's failure.
Finally, regarding the death panel, note the President's historical snickering stops as he underscores his support of this panel, "In addition, Congress should not advance legislation that undermines the Independent Payment Advisory Board, which will provide a valuable backstop if rapid cost growth returns to Medicare," that's right, the death panel. But hey, no one cares about that since Medicare now has the money to pay physicians to use financial costs of possible-life-saving treatments as part of their spiels to DISCOURAGE those facing life-threatening situations from opting into certain treatments (see end of life counseling payments to physicians).
Want to preserve the President's reputation? Dump Obamacare and let it and its President go down in history as an effort rather than as the time when US society was forced to purchase a financial product of health insurance or pay a fine, where a country's population has no choice but to pay for things like women's annual exams even though male exams aren't covered, women's sterilization even though male sterilization isn't covered, and where as the President himself pointed out health insurance remains unaffordable (after all, he wants MORE money dumped into premium assistance), failed to make prescription drugs more affordable, and failed to implement the only provision that he originally promised that would have kept CONSUMER costs under control, the public option.
