Fox News Turns More Health Care Options Into Fewer Health Care Options

JUSTIN BERRIER/Media Matters For America:

Fox News dishonestly claimed that consumers in the health care law's exchanges would have limited options, ignoring reports that the exchanges will offer significantly more choice than is currently available in the individual market.

On Fox News' Fox & Friends, co-host Brian Kilmeade said, "You cannot force a private company to get into these exchanges. And if they all bail out like Aetna's done in a lot of states, like United's done in a lot of states, next thing you know, they're only going to have one option and it's going to be a federal option, a nationalized health care system because none of the private sector wants to get involved." Co-host Steve Doocy agreed, claiming "That's kind of subterfuge is - a lot of people are saying that's the ultimate end game for President Obama and the Democrats, is the single-payer where the government pays for everything":

But Fox's characterization of choices in the health care exchanges is misleading. Despite some insurers not initially providing plans in the exchanges, consumers in the majority of markets will have several health care options to choose from. The New York Times reported that, as of May, 2013, "More than 120 insurance companies have filed applications with the federal government":

More than 120 insurance companies have filed applications with the federal government, and it appears that most consumers will be able to choose from health plans offered by five or more insurers, the administration said.

One-fourth of insurance companies proposing to offer coverage in these federal exchanges have recently entered the individual market, the administration said.

Experts on health policy said the filing of applications was only the beginning of a race to the market for insurers. After scrutinizing applications, federal and state officials could demand changes in benefits and rates, and insist that insurers expand their proposed networks of doctors and hospitals.

A recent report by the Department of Health and Human Services of exchanges in 36 states found that consumers "will be able to choose from an average of 53 different plans when the new health insurance marketplaces, also called exchanges, open on Oct. 1."  

For many consumers purchasing insurance through the individual market, options for purchasing insurance are already extremely limited. The Center for American Progress pointed out that individual insurance markets often only offer a few options and many markets are dominated by one insurer:

[I]n many states insurance markets are dominated by only one or two insurance carriers. In at least 21 states, one carrier controls more than half the market. More than half of the market is controlled by two carriers in at least 39 states. In 2007, a survey conducted by the American Medical Association found that in more than 95 percent of insurance markets, a single commercial carrier controlled at least 30 percent of the insurance market.

In addition, exchange plan choices for initial enrollment will only affect a small portion of the market. In theWashington Post's Wonkblog, Ezra Klein pointed out that "we're talking about a small fraction of the American health-care system":

Here's the first thing to know: We're talking about a small fraction of the American health-care system. This isn't about people on Medicare or Medicaid or employer-based insurance. It's about people joining Obamacare's insurance exchanges. That's people who buy insurance on their own now, as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the population, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million people, or 8 percent. 

So we're talking about a small portion of the market.

Romney’s Advice To The Uninsured: Go To The ER

By Sy Mukherjee/Think Progress

During a 60 Minutes interview with Scott Pelley on Sunday evening, Mitt Romney suggested that there are already adequate measures in place to protect Americans who lack health insurance. According to Romney, Americans should just go to the hospital to seek care, regardless of the crippling expenses they may incur without adequate health coverage:

PELLEY: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

ROMNEY: Well, we do provide care for people who don’t have insurance, people — we– if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.And different states have different ways of providing for that care.

PELLEY: That’s the most expensive way to do it…In an emergency room.

ROMNEY: Different, again, different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms. In my state, we found a solution that worked for my state. But I wouldn’t take what we did in Massachusetts and say to Texas, “You’ve got to take the Massachusetts model.”

However, as Pelley points out, ambulatory care is extraordinarily expensive and shifts costs from often-uninsured emergency room patients into the overall health care market, effectively driving up everyone’s cost of care.

All Americans are entitled to care though the Emergency Medical Treatment and Active Labor Act or (EMTALA), a law Ronald Reagan signed. It requires hospitals that accept Medicare or Medicaid funding to treat patients for emergency medical conditions regardless of legal status or ability to pay. But EMTALA only applies to medical emergencies. “So, yes, if you’re actively giving birth, you can expect to receive care at an emergency room,” Austin Frakt and Aaron Carroll explain. “If you’re actively having a heart attack, you can also get emergency room care. If you’ve been seriously harmed in a car accident, you can go to the emergency room.” Patients with chronic conditions that don’t require emergency interference — the millions of Americans with diabetes who need “regular access to medication to stay alive,” asthma patients, or women diagnosed with breast cancer — would not be able to access needed treatments.

Although Obamacare and Romney’s own health reform law in Massachusetts both overcome this hurdle by mandating and subsidizing health insurance for all residents, irrespective of pre-existing conditions, Romney no longer seems to believe that his own program — which has improved the lives of millions in Massachusetts while nearly eliminating the children’s uninsured rate in the state — is effective enough to be implemented in other states.

UPDATE

Romney has not always believed that emergency rooms are the best route for the uninsured. Back in 2008, Romney decried uninsured emergency room visits as “free riding,” declaring, “If somebody could afford insurance, they should either buy the insurance or pay their own way. They don’t have to buy insurance if they don’t want to, but pay their own way. But they shouldn’t be allowed to just show up at the hospital and say, somebody else should pay for me.” According to Jonathan Gruber, a close adviser and architect for Romney’s Massachusetts health care law, overcoming this “free-rider” dilemma was at the heart of Romneycare. “The guy has come completely full circle,” Gruber said.

CNN's Erin Burnett Cherry-Picks Numbers To Attack Health Care Law

by Todd Gregory & Jeremy Holden/Media Matters


CNN's Erin Burnett cherry-picked numbers to claim that the health care reform law was "a massive fail" because medical costs are expected to grow more in 2014 than they did in 2010. 

But the massive fail here is on Burnett: health care costs in 2010 grew at historically low rates as the country emerged from a deep recession, making it an inappropriate point of comparison.

Discussing the Supreme Court's decision to uphold the Affordable Care Act on Thursday, Burnett claimed that "we're all losers" under the health care reform law because it will not reduce health care spending. Burnett explained:

According to the Centers for Medicare and Medicaid Services, health spending in 2010 grew about 3.9 percent from the year before. But in 2014, when the president's health care law takes full effect, spending will jump 7.4 percent.

But the very research that Burnett cited, a June report from the Centers for Medicare and Medicaid Services, explains that unusually slow cost increases in 2010 was a historic anomaly explained by the recession:

[T]he continuing impact of losses in employment and health insurance coverage associated with the recession helped to limit growth in private spending. Private health insurance spending growth is estimated to have been just 2.6 percent in 2010 as the number of people enrolled in private plans fell by roughly 5 million. Moreover, out-of-pocket spending climbed just 1.8 percent (after 0.4 percent growth in 2009) as many people continued to restrain their use of health care goods and services.

A June 12 Wall Street Journal article reporting on the CMS estimates explained that the 2010 figures were "a short-term trend" tied to the recession:

Consumers have been cutting back on doctors' visits and employers have trimmed insurance since the U.S. first fell into a recession. National health-care spending growth was 3.8% in 2009, the smallest increase on record, and was followed by a similar 3.9% in 2010.

Burnett's massive failure only begins with her cherry picking 2010 for her point of comparison. Her second point of comparison is 2014, which is when CMS researchers said the "largest impact on the growth of health spending is expected to occur."

So Burnett took one of the lowest rates of health spending growth on record and compared it to the year that will bring the largest impact on growth, and declared that everybody loses.

CNN's viewers most certainly did. 

Romney: Uninsured with preexisting conditions should be denied coverage

From the Stephanie Miller Facebook page

By David Edwards/Raw Story

Republican presidential candidate Mitt Romney on Tuesday insisted that President Barack Obama’s health care reform law should be overturned and that people with preexisting conditions should be denied coverage if they had never had insurance before.

During an appearance on NBC’s Tonight Show, host Jay Leno told Romney that he knew people that had never been able to get insurance before “Obamacare” was passed.

“It seems to me like children and people with preexisting conditions should be covered,” Leno noted.

“People with preexisting conditions — as long as they’ve been insured before, they’re going to continue to have insurance,” Romney explained.

“Suppose they were never insured?” Leno asked.

“Well, if they’re 45 years old, and they show up, and they say, I want insurance, because I’ve got a heart disease, it’s like, `Hey guys, we can’t play the game like that. You’ve got to get insurance when you’re well, and if you get ill, then you’re going to be covered,’” Romney replied.

“I know guys that work in the auto industry and they’re just not covered because they work in brake dust,” Leno pressed. “And then they get to be 30, 35, and were never able to get insurance before. Now they have it. That seems like a good thing.”

“But people who have had the chance to be insured — if you’re working in an auto business for instance, the companies carry insurance, they insure all their employees — you look at the circumstances that exist,” the candidate explained. “But you don’t want everyone saying, `I’m going to sit back until I get sick and then go buy insurance.’ That doesn’t make sense. But you have to find rules that get people in that are playing by the rules.”

The Washington Post‘s Greg Sargent pointed out that by passing health insurance mandates in Massachusetts, Romney had acknowledged that people should get coverage when they are well, but he had since moved further to the right in an effort to win the GOP presidential primary.

“So he’s forced to give a nonsensical answer to the core policy and moral question that’s left behind if we do away with Obamacare: What should the federal government do about those who can’t get insurance covarge, thanks to preexisting conditions?” Sargent wrote.

“Until Romney details otherwise, his answer, for all practical purposes, is: Nothing.”

Watch this video from NBC’s Tonight Show, broadcast March 27, 2012.

Rick Santorum Tries To Explain Why He Does Not Agree With The Catholic Church On Health Care Reform

By Amanda Peterson Beadle/Think Progresss

Rick Santorum has been outspoken about his Catholic faith on the campaign trail, explaining how his faith and personal values have influenced his political positions. But at a campaign event at Oral Roberts University in Tulsa, Oklahoma today, Santorum had trouble rationalizing how he reconciled his opposition to health care reform with the Catholic Church’s support of the plan. A questioner asked Santorum, “With you lining up with the Catholic faith on so many issues, why not the Catholic Church on health care since it is a value and a human right?”

Santorum offered a rambling answer, first saying that church’s teachings had shaped his life and then insisting that he also has to consider reason as a politician. “I always say if your faith is true and your reason is right, then you’ll end up in the right place,” he said. “And of course why would God create something where reason would bring you one place and your faith would bring you another if your faith is true?” And as a public official, he said, he had an obligation to talk to people who share his faith and those who don’t:

My conscience was formed as a result of my life experiences and primarily through faith and through the moral values I was taught through the teachings within the Bible and the church. Yes, I bring that to the table. That’s who I am. [...]

I look at the Affordable Care Act and say, both from the standpoint of faith, do I believe that people should have the opportunity to purchase health care? Yes. Do I believe that it is the right that the government should impose and control? No. It’s one thing to say that people have a right to access of care. It’s another to say that the government should be the implementer of that. And something tells me that government is the least effective tool to make that the best possible care.

Watch it:

Of course, Pope Benedict XVI has called health care an “inalienable right,” and added that it is the “moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.” The Catholic Health Associationsupported the Affordable Care Act, and during the debate about health care reform, Catholicnuns broke with the U.S. Conference of Catholic Bishops to support it. But Santorum will continue to twist the logic to fit the position he wants to support.

GOP Presidential Candidates Would Have A Hard Time Finding Coverage Under Their Health Reform Plans

By Igor Volsky/Think Progress

The National Journal’s Margot Sanger-Katz and Meghan McCarthy have an interesting pieceexamining how the GOP presidential candidates obtain health insurance coverage, given their support for repealing the Affordable Care Act and pushing individuals and families into the individual market:

– MITT ROMNEY: The Romney campaign refused to say where he gets his health care coverage. But because of the health care reform law he signed as governor of Massachusetts, he is lucky to live in one of the few states with good insurance options for a 64-year-old unemployed man with a wife who has a preexisting health condition: multiple sclerosis.

– RICK SANTORUM: The 53-year-old former senator from Pennsylvania is enrolled in insurance that “is totally private, and not related to his time in Congress,” his spokesman, John Brabender, said in a phone interview. And if Republicans succeed in their stated goal of repealing “Obamacare,” Santorum likely won’t be firing his insurer any time soon, since his daughter suffers from a pre-existing condition.

– NEWT GINGRICH: Gingrich, 68, is enrolled in Medicare and buys his own supplemental insurance from Blue Cross Blue Shield, according to his campaign.

– RON PAUL: Paul, 76, as a member of Congress, gets his insurance coverage from the federal-employee benefit program, his campaign says.

– RICK PERRY: Perry, 61, gets his insurance from the state of Texas, a benefit he can continue to receive for the rest of his life. (According to the Texas Tribune, Perry is already collecting a state pension, even while he earns his salary as governor.)

These men are insured in large-group policies that don’t discriminate against pre-existing conditions and spread the risks and costs of insurance among a pool of healthy and sick applicants who can use the advantages of their size to negotiate better rates with medical providers. (It’s unclear if Santorum actually has an individual policy or a group plan through his campaign or think tank affiliation.)

Their campaign proposals, however, would encourage individual Americans to face down health insurance companies on their own and seek out affordable rates in an unregulated national market where companies can sell policies that don’t comply with state consumer protections and offer little reliability. Insurers have an incentive to enroll the healthiest beneficiaries and avoid or price out older applicants, so that the GOP candidates and many millions of Americans who suffer from pre-existing conditions, would have a hard time finding affordable insurance if they don’t have an alternative offer of employer coverage. In that case, they could (under the Republican proposals) end up uninsured or in a state-based high-risk insurance pool, where the enrollees’ older and sicker risk profile leads to higher premiums and out-of-pocket spending. Those are costs that this particular set of wealthy candidates could surely afford, but many other Americans will struggle with.

Obama admin smacks down Michigan GOP effort to thwart Affordable Care Act

by Eclectablog/The People's View

In a rather stunning rebuke this week, the Obama adminstration, through the Center for Consumer Information and Insurance Oversight (CCIIO) at the U.S. Department of Health and Human Services denied an effort by the Republican Snyder administration in Michigan to thwart part of the Patient Protection and Affordable Care Act (PPACA).

The federal government has denied a request by the Michigan Office of Insurance Regulation to delay a regulation under health care reform that requires insurers to return $89 million to people who have purchased health insurance.

The decision means that eight health insurers in Michigan will return the $89 million to their subscribers, said Gary Cohen, acting director of oversight with the Center for Consumer Information and Insurance Oversight at the U.S. Department of Health and Human Services.

"After careful consideration, the evidence does not establish reasonable likelihood (that the regulation would) destabilize the market," Cohen said in a conference call this afternoon.

"Most issuers are profitable or would be profitable once they adjust their business model" to spend 80 cents of each health care dollar on health care or related costs, Cohen said.

In a letter to Snyder administration (PDF), the CCIIO told them they found no reason to grant the Michigan Office of Insurance Regulation's (MIOR) request to delay and phase in the requirement that insurers use at least 80% of their revenues on actual health care and that the rebates should continue as scheduled if the insurers don't get in line.

As described at the outset of this letter, section 2718 of the PHS Act permits the Secretary to adjust the 80 percent standard in the individual market if it is determined that applying this standard “may destabilize the individual market in [the] . . . State.” The regulation implementing section 2718, 45 CFR Part 158, provides that an adjustment should be granted “only if there is a reasonable likelihood” that application of the 80 percent MLR standard will destabilize the particular State’s individual health insurance market (45 CFR 158.301).

After applying the standards and criteria set out in section 2718 and 45 CFR Part 158 to the information submitted by OFIR, we conclude that the evidence presented does not establish a reasonable likelihood that implementation of an 80 percent MLR standard may destabilize the Michigan individual market. We reach this conclusion for the reasons outlined in the analysis under the criteria set out above, and based on the specific characteristics of the Michigan individual market addressed in that analysis.

Further:

“What we found: some insurance companies, based on their estimates to the Michigan insurance department, might be paying rebates in 2011, but they would still be profitable after paying rebates,” Gary Cohen, acting director of oversight for CMS' Center for Consumer Information and Insurance Oversight, said during a call with reporters. “Others said they were adjusting business practices so they would be able to meet the 80-20 rule without having to pay rebates,” he continued. “So we reached conclusion that no adjustment was needed.”

In other words, they found that the handful of companies that are complaining are doing just fine, thank you very much, and the rebates will still allow them to be profitable. The MIOR was asking that they be allowed to phase in the requirement, requesting "an adjustment of the MLR standard to 65 percent, 70 percent, and 75 percent for the reporting years 2011, 2012, and 2013, respectively." No, the Feds told them. They will meet the 80% requirement in 2011 or pay the rebates. According the Crane piece, "[b]ased on 2010 data, estimated rebates paid by Golden Rule would total $10 million, Time would pay $5.3 million, Aetna $1.7 million, Humana $1.3 million, Priority Health $200,000, and MEGA at $2.6 million."

The upshot of this is that the Affordable Care Act is, in fact, working. It's forcing insurance companies to actually deliver services and not embiggen their bank accounts at the expense of sick and injured Michiganders. The CCIIO found that companies are adjusting their business models to be more efficient at delivering services and, surprise, surprise, still making a buck or two along the way anyway.

Put this one in the "win" column for the Obama administration's health insurance reform and the Affordable Care Act.

Health care reality changes mind of Obama skeptic

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Bachmann: A Seven-Foot Doctor Told Me Obamacare Requires The IRS To Pre-Approve Medical Treatments

By Igor Volsky/Think Progress

Michele Bachmann prides herself for pressing Republicans to repeal the Affordable Care Act, but during an appearance at Webster City, Iowa Wednesday night, the Minnesota congresswoman proved that she’s also leading the charge in developing outrageous new attacks against the legislation. At the town hall, Bachmann complained that undocumented immigrants are exempt from paying for the law, claimed that a seven-foot doctor told her the IRS had to approve medical procedures, and reiterated her long-standing view that doctors and hospitals would provide free care to the uninsured if they were shielded from malpractice claims:

– “Under Obamacare illegal aliens don’t have to pay for Obamacare. Only American citizens pay for Obamacare. [...] Illegal aliens have the possibility of getting the care, but they have no requirement to pay for the care. Only the citizens do.”

– “One man stood up, he was over 7-feet tall. He was a physician in the community. And he said, ‘I had a little lady in my office and because of Obamacare, I had to call the IRS and I had to get a number to put on a form before I could see her.’”

– “When I was a little girl…There were people who could not pay [for health care]. I mean they just did not have any money at all. And so the doctor would just write it off. [...] It’s very different today. Now, doctors don’t feel like they can do that…they worry about liability.”

Watch it:

It’s hard to make sense of any of Bachmann’s claims. Republicans successfully fought to keep undocumented immigrants from receiving tax credits through the exchanges and the ACA does nothing to change the existing Reagan-era law that requires hospitals to provide health care to everyone in need of emergency services. Undocumented immigrants also paid $11.2 billion in taxes in 2010, including $8.4 billion in sales taxes, $1.6 billion in property taxes, and $1.2 billion in personal income taxes.

The seven-foot doctor’s claims are similarly dubious, since the IRS does not begin enforcing the individual requirement to purchase health insurance until 2014 — and even then, the penalty is processed through personal income tax returns and would not require a medical provider to call the agency. Finally, Bachmann’s oft-repeated solution to reducing the number of uninsured — shield doctors from lawsuits and they’ll provide free health care to anyone who needs it — is a poor idea, to put it charitably, and hasn’t actually increased access to providers in states with existing “liability shield” regulations.

MICHELE BACHMANN: OBAMACARE WILL ‘ENDANGER THE NATIONAL SECURITY OF OUR NATION’

By Igor Volsky Think Progress

In a sure sign that she’s gearing up to talk about her number one priority — “repealing Obamacare” — during Saturday’s national security debate, Michele Bachmann argued that the Affordable Care Act would undermine American’s “strong national defense” during a foreign policy address in Mt. Pleasant, South Carolina this afternoon. “Admiral Mike Mullen warned us, the greatest enemy of our national security was not a foreign one, but it was our own national debt,” she said. “And Obamacare only threatens to exacerbate this problem. Because President Obama’s plan for socialized medicine will threaten the very heart of the U.S. economy and endanger the national security of our nation as it drains valuable resources away from a strong national defense.” Someone should tell her the law is fully paid for and actually reduces the national deficit. Watch it:

Leading Conservative Federal Appeals Judge Says Case Against Health Reform Has No Basis In ‘The Text of the Constitution’

By Ian Millhiser/Think Progress




When the United States Court of Appeals for the D.C. Circuit announced two of the three judges who would hear a challenge to the Affordable Care Act — conservative icons Laurence Silberman and Brett Kavanaugh — the law’s supporters turned white. Silberman is a close ally of Justice Clarence Thomas, a former official in the Nixon, Ford and Reagan Administrations and the author of the lower court decision overturning the District of Columbia’s handgun ban. Kavanaugh is a former Associate Counsel under Clinton inquisitor Ken Starr and a leading attorney in the George W. Bush White House. If anyone would be sympathetic to the case against health reform, these two men were first on the list.

And yet, both judges wrote opinions today rejecting an utterly meritless challenge to the Affordable Care Act — Judge Kavanaugh on the grounds that the court lacks jurisdiction to even hear the case, and Judge Silberman in a tour de force opinion that absolutely obliterates any suggestion that the ACA is not constitutional:

Since appellants cannot find real support for their proposed rule in either the text of the Constitution or Supreme Court precedent, they emphasize both the novelty of the mandate and the lack of a limiting principle. The novelty–assuming Wickard doesn’t encroach into that claim–is not irrelevant. The Supreme Court occasionally has treated a particular legislative device’s lack of historical pedigree as evidence that the device may exceed Congress’s constitutional bounds. But appellants’ proposed constitutional limitation is equally novel–one that only the Eleventh Circuit has recently–and only partially–endorsed. [...]

That a direct requirement for most Americans to purchase any product or service seems an intrusive exercise of legislative power surely explains why Congress has not used this authority before–but that seems to us a political judgment rather than a recognition of constitutional limitations. It certainly is an encroachment on individual liberty, but it is no more so than a command that restaurants or hotels are obliged to serve all customers regardless of race, that gravely ill individuals cannot use a substance their doctors described as the only effective palliative for excruciating pain, or that a farmer cannot grow enough wheat to support his own family. The right to be free from federal regulation is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems, no matter how local–or seemingly passive–their individual origins.

When a federal judge tells you that your argument has no basis in the text of the Constitution, it is a good sign you don’t belong in court. When he compares your argument to claims that the federal ban on whites-only lunch counters are unconstitutional, it’s an even better sign of how deeply radical your argument has become. When that judge is Judge Laurence Silberman, a man who has stood at the pinnacle of conservative judicial thinking for decades, it is about as good a sign as you can hope for that the Supreme Court is not going to like your argument either.