People are Signing up in Droves for Obamacare, but not for Private Insurance

[eridani]

Is it this fact on the ground that will tip us toward single payer? I hope so!

http://www.philly.com/philly/blogs/fieldclinic/People-are-Signing-up-in-Droves-for-Obamacare-but-not-for-Private-Insurance.html#ux8Y4MfDsmeJ9tim.99

Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.) But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.

Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”

This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.

[KelleyD]

1. I unfortunately live in Indiana with a Repub Gov...Pence the Putz!

[Scootaloo]

2. Becuase when it comes down to it...

The people of the United States trust their govenrment, over the "self-interest" of a private corporation. It's by no means a perfect government, but it's ours.

[stopbush]

28. Americans trust their government? Not according to 95% of the JFK CT threads

at DU over the past two weeks.

[Scootaloo]

35. When the alternative is a for-profit corporation, they do

Qualifying statements, my friend

[doc03]

3. How will they be paid for? Wasn't the idea to get younger more healthy

people to actually buy insurance not just poor people that can't afford insurance?

[doc03]

4. I think the Obamacare mess is going to lose the Senate

for us next year.

[bigdarryl]

17. OH PLEASE stop listening to the corporate news media

We don't know what the issues will be a year from now.

[Paulie]

24. LoL

10's of millions finally get health coverage and you think they are going to vote the republics in so it can be taken away?

[YarnAddict]

32. No

but they probably are not as likely to vote as those who have lost coverage, or whose premiums and deductibles have gone through the roof because of this law. And I personally know people in both circumstances.

[Paulie]

34. That too can't be fixed without replacing the republics

All states need to expand Medicaid and the new incarnation of the donut hole needs the munchkin put back.

[Orrex]

5. NPR ran back-to-back stories today about the websitr "debacle"

Just like every day for the past two months...

[stillwaiting]

18. Do they ever state clearly that the botched job was done by a private company?

I don't know because I don't watch corporate media, but I do appreciate those who do when they document their atrocities in reporting.

The government and the Obama team have had a very hard time getting this situation under control because it was outsourced to private industry. It's a great opportunity for the barons of industry (and their media) to bash government as the problem when the government didn't do all that much leading up to the rollout except hand our tax dollars over to private industry.

The website may say "healthcare.gov", but a private company created the monstrosity.

I imagine that the rollout would have been much, much better had the government ACTUALLY constructed the website portal. Any problems would have been much easier for the government to solve if they created and developed the site. It probably would have been tested appropriately, and I have to think that many of the shortcomings that private industry clearly did not foresee (or did they? ) would have been addressed had the government had taken on this project.

Isn't it funny how the corporate media never seems to successfully educate our citizens on the extent to which government services have been outsourced to private corporations? Failures get to be blamed on the government, while private corporations suck up our tax dollars. What a fantastic win for fascists.

The people of this country should be able to see through the charade though. Although I guess it's hard for some because way too many political actors that permeate both parties are active participants in creating the illusion. They protect corporate interests and profits over the interests of average Americans, and they allow government to take the blame over corporate interests whenever possible.

[magical thyme]

27. it will be old news eventually...

something will replace it. Last week, it was the Iran deal that Obama (and a bunch of other countries) cut for the express purpose of changing the subject ( ). Next week it will be something else.

The website will be functioning, people will be enrolling, and states will be freaking out because suddenly people that qualified for Medicaid and didn't know it will be on it.

[pangaia]

29. I've given up listening to anything concerning politics on NPR.

[sendero]

36. They are little better than..

... Fox news at this point, except that they have the reputation of being "liberal", which they are certainly not. They are just more MSM propaganda with a patina of respectability that the foolish believe in.

[WCGreen]

39. They are corporate. just like the Main Stream Media...

Because they both rely on the kindness of strangers.

[glowing]

6. This is more telling of the economic condition many Americas are facing.

The fact that soooo many are qualifying for the Medicaid expansion and the many more who would if more states opted in just goes to show everyone what is truly happening... And it may lead to single payer faster to deal with the costs.

And the way for Dems to run is to say they need both houses to get jobs going and make the fixes to the ACA... The R's shutdown the govt over repealing. There is no way anyone can repeal this now! The Dems have to go on a forward message and quit playing defense or being mealy mouthed to the people they rep. Perhaps they really have been in DC for too long and believe the DC clap trap that most of us in the real world look in at with just a wonderment at how out of touch they truly are.

[Wilms]

9. I'd like to rec your reply. n/t

[flamingdem]

14. I hope it does

but wow we're in deep do do with this in many ways.

I've spend about 30 hours on trying to figure out what to do and I've learned that as of now, in LA where I live anyway, Medicaid - Medical here is flooded and the program offers very limited care. Let's hope it improves but they've added a half million people so there you go, it was fast and the resources aren't there.

Very few doctors are holding up their hands to take Medical patients of course that's understood due to lower payments and the sheer numbers but the other problem is that the ACA plans are also not offering good access and instead are offering very limited care. So sorry to say that usually means inferior care. Personally I like to chose my doctors and that won't work now due to the narrow networks of care being offered. That might not be that bad outside of urban areas. In my case I know exactly what is being taken away from me since I called my doctors to ask.

They can chose not to accept ACA and many will not.
Money and flood of people being the issue.

So for me it's mostly okay. For a savings of a couple hundred a month I get insurance but I still have to be anxious that I won't be able to see the doctor I need and that I cannot, in the case of Blue Cross EPO, access and out of network provider. What if that one is the one who knows how to cure you..

You might see the problem. But I see it applying to Single Payer as well. Too much demand, government rates too low. We're still going to see a stratified situation. I still have to be grateful to get anything since I'm not rich. I'm disappointed so far.

[glowing]

16. That is Medicaid. The ACA plans for people who are buying insurance will be accepted readily.

The sheer volume of extra patients with Medicaid expansion will increase the availability of Drs into accepting patients with it because so many more will have it. It will take time; I know for many it's time that they don't have. It's all a bunch of baby steps when we really needed a single payer option back when the Clinton's first tried to make reforms. We got HMO's which stemmed the costs for a little bit. But we all knew it wouldn't be the cure. And now PPP plans seem to be the only type of insurance offered anymore for our employer based insurance because of the nature of the law and what it makes insurance companies cover.

Our family plan is now $7,500 for cost out of my husband's paycheck. This doesn't include the extra for dental. This doesn't include the extra for co-pays, prescription co-pays, deductibles, and % of shared costs if someone becomes ill with a severe medical condition or is hospitalized for a health problem. And we make around $50,000 a yr.

I know that if we had a single-payer plan and rates were based upon a tiered progressive income level, overhead costs were the 3-5% it takes to run the govt programs (instead of 20% the insurance co's are allowed to siphon off as profit), and with single-payer, organizing efficiency and costs for care could be controlled by the govt, then we would have a better system of delivering actual health care to everyone from beginning until end. Plus having everyone in one system, like Medicare for all, would help offset the costs by having younger, healthier persons paying into the system for the older, more costlier elderly people. It would also free up quite a bit of economic burden for individual people and families so that they had a real safety net that wouldn't bankrupt them. Even with the ACA and more access to medical insurance, many are still extremely vulnerable financially if they or a family member does become sick with cancer for instance.

And creating a single-payer pool thru the govt (because that's basically what a Medicare for All program would help do), would help to bring back jobs, innovation, and small start up companies in this country. The biggest issue for many when they are deciding their work place status, is the insurance and dental benefits. My employer doesn't offer them. My husband has remained at his company for years now because changing employement may mean going without insurance for 3-6 mos or not at all possibly depending on the security of the job. Smaller start up companies don't have the ability to compete with the very large companies because they are small and cannot offer the benefits to an employee that a large corporation could. Many people who are unhappy at their work or would try to go off and do their own thing, feel stuck in place. And these days, even the very large corporations are feeling squeezed by having to cover insurance costs. Part of people's potential raise earnings are automatically going toward the increase in health insurance premiums.

If I was a Democrat running in an election, I would be pushing the idea of trying to shore up the ACA and creating a Public Option plan that employers and individuals could "buy" into. Or removing "Medicaid" and making one Federal "Medicare" option with insurance companies available to buy into to pick up the 20% extra that the govt doesn't pay for if one is above a certain economic threshold... Along with this the option for dental that actually covers dental procedures, vision, better mental health options, and prescription plans to cut down the costs. Essentially, put everyone at a basic level of Medicare for All with part D available.

One of the reasons that we didn't just jump straight into a smart single-payer plan is do to the fact that insurance co's are extremely wealthy and can buy off political votes. And for as crappy as they are, they also employ quite a few people in the real world. They have sort of set themselves up like the MIC has. Companies and contracts in every state. People who are employed with, for the most part, decent pay and economic ties to communities. (Just one of the reasons that Dems did not want insurance co's to be able to sell insurance across state lines; the insurance co's wouldn't be able to pull up stakes and move their business and headquarters into a state with lax insurance regulations and giidelines. We all know that if they could, they would already have moved their companies).

It's just another vulture, capitalistic predatory nightmare for Americans to wade thru. And now, the govt has made it mandatory to buy into these abusive bustards who care more about quarterly earnings than they do actual people. Just look at the stock prices and CEO's take home pay. They aren't much better than Wamart or McD's, and they have the added bonus of having a mandated system thru their products. We can't even boycott them like we can choose to do with other companies we disagree with. Boycotting means potentially putting our lives or our family's lives on the line, along with having to pay a penalty to opt out (more than the states that opt out are having to deal with).

This issue is one that will need serious people with hearts and brains to fix for us. I do hope that it is sooner, rather than later that we will be able to get rid of these health care predators. I'm hoping with the states who plan on creating a single-payer system, will take hold in the minds of the people. Having a couple of states who aren't affraid to try out a system such as this. It's only too bad they couldn't get a waiver to create the systems in 2014 and still have to wait to 2017 for full implementation. Hope that we have a saner system on the horizon and that my kid will have surety in his young adulthood and grandkids would only know not having health care as a history lesson.

[flamingdem]

21. Good analysis on many aspects, thanks

They really are predatory. When I've called some of the people in sales are vile and tried to mislead me. Plus, they're rude, intimidating and they vulch my private info (I gave different names but they caught it since they can see my phone number even though it's private!). So I'd like to see them disappear but see what you mean about how they offer employment, etc.

i like your Medicare for all with optional D idea. Too bad Lieberman was born, we almost had that.

[Barack_America]

25. Or evidence of private insurers purposefully sabotaging enrollments.

People are applying for the private insurance, they just aren't being enrolled.

[glowing]

26. I believe they have to accept a plan and make a payment.

The fact that insurance isn't available until Jan 1st and Xmas presents come first, many first time purchasers will be awaiting their tax refunds to make the initial payment into a plan. I know I would if I had until March as a deadline. Why would anyone purchase the plan now? It's not good until January.

[libodem]

7. What if it evolved

Into single payer by magic. Just a creative speculation. A wish and a prayer. A hope and a dream.


Big Insurance has been the death panel for forever dictating whether you were dropped or nor or if they would pay. It is a racket. Predatory racketeering.

[Doctor_J]

8. Predatory government-sanctioned racketeering

our government is part of the crime syndicate

[Lifelong Dem]

10. This has to hurt in states not expanding

The non-expanding states will get more Medicaid enrollees but without any additional federal expansion money.

The money will need to come from somewhere.

[glowing]

11. I thought opting out meant that states would keep their current Medicaid qualifications.

That means quite a few stuck in the gap that is too poor to buy health care and be subsidized, but too "wealthy" by current state standards to qualify for Medicaid. In the end though, the states not opting in will be paying toward the states who have. And sadly, these are the states that have been Red for a while and are poorer states.

It's not a wonder that the GOP doesn't want this to opt in and a reason why the Supreme Court changed the nature of the law. Many now won't see the benefits of what ObamaCare/ ACA was supposed to help do for them... And the lies are overwhelming.

[Lifelong Dem]

12. They could keep their current Medicaid qualifications.

People are still signing up for Medicaid in states that are not expanding. They were already eligible for Medicaid and didn't know it until ACA. Now those states will need to pay for this increase on their own.

[stopbush]

30. In CA, MediCal is dropping the "assets test" as of 1/1/14.

I'm out of work, so we only have my wife's part-time income these days. To qualify for MediCal, you can't have over $3300 in assets. That all changes with the Medicaid expansion in January. No more assets test.

I've done the paperwork and talked with my case worker - we will probably qualify for MediCal. It may not be the best insurance, but it's better than nothing...and it's cheaper than the $400+ we were spending each month on our Cobra which just expired.

Were it not for Obamacare, we would be looking for private insurance for a family of 4 in CA. We're already dipping into our retirement funds to make ends meet. Oh, yeah, and my wife had cancer back in 2004. It's been in remission ever since, but who knows if it would have been called a pre-existing condition without ACA.

[TheKentuckian]

13. It isn't a choice really. I'm sure most would choose it but what you are seeing isn't demonstrated.

This is in no small part about access, there are folks who previously had met guidelines but the biggest jump is pure access. The Medicaid eligible population isn't eligible for subsidized plans on the exchanges so Medicaid is what is essentially available.

[duffyduff]

15. Medicaid has strings attached, not least your estate can be pilfered upon your death. n/t

[pnwmom]

40. That has only happened in cases where people's nursing home costs

were covered by Medicaid, as far as I'm aware of.

Some people were giving their houses and other property to their children so they'd qualify for Medicaid coverage of nursing home care. Putting in the 3 year window that allowed Medicaid to "claw back" gifts that were made shortly before death was designed to prevent that.

[SoCalDem]

19. Of course they would be the first to sign up.

I am a bit sad that the whole ACA has been portrayed as more than it ever really was.

ACA is NOT actual healthcare
ACA is not insurance
ACA is not "the website".

ACA is LAW that sets minimum standards that all insurers have to follow

ACA expands Medicaid (or tried to), for the very poor who could never afford insurance on their own, and whose chintzy bosses offer them none

ACA eliminates yearly/lifetime caps/pre-existing condition exclusions

ACA sets in place certain tests/prescriptions that must be covered for FREE

ACA was intended to capture a small sector who were NOT being served (or who were being served poorly)

ACA allows parents to "carry" older "children" on their policies (this is now a problem, because a lot of 18-26ers do not "need" to buy their own)

ACA is the "rulebook"

ACA had to make a deal with the devil .. The Obama admin had to convince insurers that the millions of new customers (some subsidized by the government) would give them enough of a benefit that they needed, to go along with the new restrictions for the way they do business in the future. Insurers were poised to lose MILLIONS of customers, as we Boomers "graduated" into SS, so they should have gotten on their knees in thanks...but we all know how they operate.

ACA is the conduit.. the fact-checker (eligibility for subsidies etc)

It's just too damned bad we were unable to just roll every one who wanted to..into SS on a sliding scale for payments (based on age/income...for those under 65)

[Demeter]

20. I rec your post

and urge you put this up as a new topic!

[flamingdem]

22. Yes this is very important to remember

There were very good reasons to put these basic protections in place.

[YOHABLO]

23. It really is a horrible mess. But we know if the Senate and the House both go GOP majority>

we can kiss much of these programs goodbye. That's not to say, that there are a substantial amount of Democrats who also think cutting back on ''entitlement'' programs is the way to go. Very scary for sure. I am on Medicare Disability .. and I have doc bills I cannot pay. Medicare won't cover anything 100% .. and the difference things like cardio testing etc .. can be substantial. I am planning on applying for Medicaid .. well just to see if I will qualify. I live in the State of Georgia, where our illustrious Governor, Nathan Deal, .. a typical GOP good'ole boy, won't go for the Medicaid expansion. There's a lot of us falling through the cracks for sure. This is not even getting into the dental problems I need attended to. Isn't dental health just as crucial to wellness? I think most progressives know where the fix needs to come from .. but the 1% refuse to pay more taxes. Okay, rant over.

[pnwmom]

41. If Obama is still President, he'll wield the veto pen. nt

[BlueStreak]

31. What would one expect? The mandate doesn't take effect until April.

The people signing up for coverage January 1 and those who need the coverage or have a sense of personal responsibility.

The rest of the uninsured probably fall mainly into 3 groups:

1) Those falling into the Red State Medicaid hole

2) Those who are in places (mainly red states) where the exchanges prices really are not affordable for them.

3) People who don't have any sense of personal responsibility and are comfortable with the idea of just going to the ER if they are sick.

This third group will be somewhat motivated as the individual mandate draws closer. However, most of them probably will not act in 2014. The mandate becomes sharply higher in 2015 and beyond, so it will take several years to get these people into the system, just as it did in Massachusetts.

Regarding the finances of the program at large, I am damned sick of these news reports that say "Oh the system will collapse if we don't get lots of young healthy people into the system.

That is bullshit. This gradual transition was already factored into the CBO cost projections. It is covered. And the thing that was NOT in the CBO projections is that there would be 24 idiot Republican Governors who wouldn't lift a finger to help the neediest people in their states. That is saving "Obamacare" billions of dollars.

[Niceguy1]

33. I think #2

Without the brackets is going to be the big one. The plans are better than the individual market but still aren't cheap once you use them.

[BlueStreak]

44. I agree. And these vary WILDLY by locale. This is a big problem.

In my market, the policies cost 200-250% the cost of the pre-ACA policies that are roughly equivalent. I realize there are a lot of benefits to the ACA standards, but this does not justify a 2X increase. If a person qualifies for a subsidy (and many people who are not rich do not qualify for subsidies) that policy might be affordable.

In other markets, ACA policies seem to be the same or cheaper than the similar pre-ACA policies, even without a subsidy. This is the real crime of not having a public option. There is clearly collusion in my market where Humana, Wellpoint, and United Healthcare decided not to compete, and leave the whole space for Anthem. And I bet if a person looked closely, they would find other places where Anthem "just happened to decide" to not be in those markets, allowing one of the other companies to gouge the public. A public option would have prevented that price-fixing.

[pnwmom]

42. There are plenty of others who can look at the calendar and,

knowing that there are still problems with the websites, realize they have plenty of time till February.

[BlueStreak]

45. I supppose the terminology is debatable. Some people would argue that Medicaid

is not private insurance, as it is totally funded by government. It is usually administered by private companies, but I don't think they take any risk, in the sense of an insurance company having to predict their costs. I'm not certain, but I think the Medicaid programs don't require the administration companies to take any risk.

[Spitfire of ATJ]

37. These rich corporations don't want to provide health care or a living wage....

Fine. Medicare for all and raise taxes on Corporate America to pay for it.

[obxhead]

38. Everyone signing up for "Obamacare" is signing up for private insurance.

[pnwmom]

43. This won't tip us toward single payer. If it were true it could do the opposite.

It would reinforce the Rethugs arguments that few people wanted the ACA -- all they wanted was free stuff.

But what the actual article says is that the number came from the first month, when many of the websites were barely working, and that it was much easier to enroll Medicaid people because the states already had systems in place to go to them directly. Also, the numbers, including the 9 out of 10 number, only came from some specific locations. One of them, Oregon, had a nonworking web site and that is why they didn't have a single enrollee.

If all the ACA does is expand Medicaid, the Rethugs -- who have prevented Medicaid expansion in all the states they control -- will continue to treat it as a miserable failure. And the media will fully support them.

As it is, I think that article was VERY selective in the numbers it chose to report. In New York state for the first two months, there are very different results. 35,000 for Medicaid, 41,000 for private insurance.

http://www.democratandchronicle.com/story/VoteUp/2013/11/27/nys-health-exchange-hits-76000-enrollees/3769175/