Cheerleading for ObamaCare
The Kaiser Family Foundation (KFF) does some very good and objective work on health issues, but sometimes it just can’t help itself and turns into a bubble headed cheerleader for ObamaCare.
The latest example is an essay by KFF president Drew Altman on “Small Area Variations and the ACA’s Coverage expansion.” The point of the essay is that some areas of the country will be much more affected by ObamaCare than others. It’s a fairly obvious point. Even on a state-by-state basis, places like California and Texas with 20% or more uninsured will be more profoundly affected than Massachusetts with 5% or fewer uninsured. Altman takes it further and finds that the level of uninsured within a state varies considerably as well. This is drawn from a study KFF sponsored.
All of this is interesting and worthwhile information. The problem is that in Altman’s telling, the “effect” is an unmitigated “benefit.” He uses the term “benefit” as a verb fifteen times in this very short essay, including five times in a single paragraph:
In fact, there is wide variation in how many people will benefit from the ACA’s coverage expansions…really wide! It ranges from 2-4% of the non-elderly population who could benefit from coverage expansions in parts of states with broad coverage, such as Massachusetts and New York, to as much as 36-40% in parts of Florida, New Mexico, Texas, Louisiana, and California. PUMAs (Public Use Microdata Area) in the country benefiting the most are parts of the Miami area, areas northwest of Albuquerque, and Fort Worth. And the PUMAs benefiting the least are all in the Massachusetts suburbs. Of course, Massachusetts already has its own nearly universal coverage plan. On average across the country, 17% of the non-elderly population could benefit from the coverage expansions. (Emphasis added)
Really? Are we quite so sure that the effect will be beneficial? Assuming ObamaCare goes into effect as scheduled, people in those areas cited with 36% to 40% uninsured will be required to spend money on health insurance they are currently spending on food, housing, transportation, and the like. How will they pay for those other necessities once they are required to pay for Mr. Obama’s dream?
Further, if the numbers of insured people rise from 60% to 100% in a small area, and there is no increase in the number of providers, how accessible will services be? In fact, these folks may be required to pay insurance premiums yet have even worse access than they did before. Is that really a “benefit?” It sounds like an unmitigated disaster to me.
Now, Mr. Altman does make a small concession on this point. He writes –
But, there is a flip side to this picture. The more uninsured people there are in a PUMA, the greater their (sic) number that will be subject to the insurance mandate, which is the least popular provision of the ACA and the subject of the Supreme Court case to be heard this spring.
But this doesn’t cut it. It acknowledges only that the mandate isn’t very popular, not that it may not be a good idea or that it may have severely negative consequences in the lives of working people.
The idea that all of the people cited will be “affected” by ObamaCare is beyond dispute, whether they will “benefit” from it is very much in doubt.
This report sounds like much of the same hype that all the so-called advocates are touting as benefits. Let me discuss a few:
1) Mandated benefits. A specific mandated benefit may be something a small number of people want and benefit from. But it costs all the other members in the pool accordingly. When all added together, these numerous mandated benefits are costly.
2) Employer mandates. For the most part, employers do not provide free health coverage. Rather, employers pass on the cost in the form of lower cash wages. There is no free lunch. If you have employee health coverage, you are paying for it indirectly.
3) Exchange subsidies. People below 400% of the poverty level may get sliding-scale subsidies, but these obviously cost taxpayers something. Our grandchildren will be expected to pay the bill. Like Greece, as some point it will become painfully obvious we cannot live on borrowed money indefinitely. Sooner or later, society will have to adjust its standard of living and live within its means. This will be especially difficult once much of society depends upon deficit spending. Why not start now and cut out the excess. A good place to start is by cutting out all the mandated benefits and taxpayer subsidies found in the UnAffordable Care Act.
Great point! Short-sightedness makes most view “beneficiary” as a term of entitlement. Being entitled to lower quality care doesn’t produce benefits, even if it makes one a “benficiary” for more goods and services. Efficacy in delivering care to the consumer should be the top goal. Instead, we’ve replaced effiacy with faux equality. Everyone but the politicians spinning the issue lose.
With the exception of California and maybe a couple of others, it’s red states and swing stands that stand to “benefit” the most according to that map. Interesting.
The more I read about Obamacare, the more it seems that no one has a clue what its aggregate impacts will be. This begs the question, why was it passed in the first place?
of course Kaiser likes obamacare, the MLR is a dream come true for them. Smaller carriers wont be able ot meet the MLR, so Kaiser, Blue Cross and United will be the only 3 left standing. A great way to increase prices and eliminate your competition.
Brian, I believe that’s because red states, in general, provide fewer safety nets to the poor than blue states. This causes them to undersubscribe to health insurance, and according to the author’s analysis, it is those states with the most uninsured population that stand to benefit from a federal program.
You sort of ask if “people in those areas cited with 36% to 40% uninsured will be required to spend money on health insurance (how will they afford) food, housing, transportation, and the like.”
That is not an issue in Massachusetts, said by many to be the test bed for PPACA. Almost all the newly insured — and all the net new insured — receive the insurance for free or so highly subsidized that it is effectively free. Granted, unless every other state gets the same deal from CMS that we in Massachusetts got in a 1115 waiver plus the Nantucket Cottage windfall in PPACA plus stimulus money, it will be hard for those states to give away insurance the way Massachusetts has.
Great points! Furthermore, the currently uninsured are disproportionately low-income and many will not be getting insurance, but will be required to enroll in Medicaid. For many types of outpatient care, Medicaid-covered patients have less access than the uninsured!
Dennis: lets not forget that the nearly 200,000 newly-insured in Massachusetts who receive free or heavily-subsidized insurance get it courtesy of a 50% subsidy from the Feds. This is on top of the existing Federal subsidy of the Uncomspensated Care Pool (which was diverted to cover the insurance). The problem with ObamaCare is that there is no Federal backstop to pay the 50% (except us taxpayers).
Yes, free money is a BENEFIT but at what cost to the rest of us?
@ian
yes, that’s the 1115 Medicaid waiver I mentioned.
Re the Uncompensated Care Pool that was supposed to pay for RomneyCare — for the other 200,000 just above the Medicaid line — there’s a little problem there. No one told the folks that liked Boston City and the community health center in Codman Square, because those facilities were close, that they now had to go over to Mass General or to Brookline to see a doctor. So the Uncompenstated Care Pool costs — part of the state budget paid for with a tax on insurance premiums — are almost back where they started and so is the tax. The basic Mitt Romney concept failed.
> This begs the question, why was it passed in the first place?
Um, so we could find out what’s in it?
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