Propaganda silliness aside...
"Where's The Train Wreck?"
http://paxonbothhouses.blogspot.com/2014/01/wheres-train-wreck.html
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The Affordable Care Act's report card. David Nather in Politico
Heavy traffic for in-person enrollment, too. Caitlin MacNeal in Talking Points Memo.
Obamacare's invisible victory: Off-exchange enrollments. "As the final figures before the end of open enrollment are posted, a significant chunk of people who bought insurance under the law will be missing from the official tally. That's because people who bought insurance directly from insurers, and not through the law's exchanges, will not be included. And just how many people that represents is a figure that will not be available in time for the big enrollment-total reveal -- and likely not for a long time after. Off-exchange enrollment is the forgotten piece of the Affordable Care Act, but it could represent millions of people who are also getting covered as a result of the health care law -- many of whom are the young, healthy customers the administration is so aggressively pursuing." Sophie Novack inNational Journal.
The poll shows one area where Obamacare has fallen short. "This is why what it is happening now with the Affordable Care Act is so dispiriting -- even with that 6 million threshold having been crossed. Of the 11 top states in the Gallup survey, from Alabama on down, only four have opted to expand eligibility for Medicaid as the Affordable Care Act called for -- the provision that was supposed to achieve half of the law's coverage expansion, with the other half coming via subsidies for people earning above 133 percent of the poverty level to buy private plans on the exchange....So: right now, we have passed a law meant to expand coverage to all Americans, and yet it does not reach the poorest of our fellow citizens in nearly half the states in the country. That, on its face, is a major policy failure. No one really wanted to say this during the law's drafting, but its underlying goal was to get coverage to people in red states where there was no local political will to address the problem." Alec MacGillis in The New Republic.
Utah has won a big concession on Obamacare. Can it win another? "Utah Gov. Gary Herbert is looking for a way to join the Medicaid expansion, and that could have national implications....A good number of the 24 states that haven't joined the Medicaid expansion are looking at a way they could enter the program by crafting their own plans....Even if Herbert can negotiate an arrangement with the feds, there's no guarantee that his state will support it. The Legislature was reluctant to expand the Medicaid program this session, and the House speaker has been strongly opposed to the idea. Still, it will be important to see how Herbert and the Obama administration work together on Obamacare again." Jason Millman in The Washington Post.
One state's strong marketplace website will replace another state's flawed one. "Maryland officials are set to replace the state's online health-insurance exchange with technology from Connecticut's insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair....Like Maryland, Connecticut was one of the first and most enthusiastic states to embrace the idea of building its own insurance exchange rather than using a federal site to implement the law's sweeping changes in health-care coverage. But unlike Maryland, where the system crashed within moments of launching and has limped along ever since, Connecticut's exchange has worked as smoothly as any in the country." Mary Pat Flaherty and Jenna Johnson in The Washington Post.
The poll shows one area where Obamacare has fallen short. "This is why what it is happening now with the Affordable Care Act is so dispiriting -- even with that 6 million threshold having been crossed. Of the 11 top states in the Gallup survey, from Alabama on down, only four have opted to expand eligibility for Medicaid as the Affordable Care Act called for -- the provision that was supposed to achieve half of the law's coverage expansion, with the other half coming via subsidies for people earning above 133 percent of the poverty level to buy private plans on the exchange....So: right now, we have passed a law meant to expand coverage to all Americans, and yet it does not reach the poorest of our fellow citizens in nearly half the states in the country. That, on its face, is a major policy failure. No one really wanted to say this during the law's drafting, but its underlying goal was to get coverage to people in red states where there was no local political will to address the problem." Alec MacGillis in The New Republic.
Utah has won a big concession on Obamacare. Can it win another? "Utah Gov. Gary Herbert is looking for a way to join the Medicaid expansion, and that could have national implications....A good number of the 24 states that haven't joined the Medicaid expansion are looking at a way they could enter the program by crafting their own plans....Even if Herbert can negotiate an arrangement with the feds, there's no guarantee that his state will support it. The Legislature was reluctant to expand the Medicaid program this session, and the House speaker has been strongly opposed to the idea. Still, it will be important to see how Herbert and the Obama administration work together on Obamacare again." Jason Millman in The Washington Post.
One state's strong marketplace website will replace another state's flawed one. "Maryland officials are set to replace the state's online health-insurance exchange with technology from Connecticut's insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair....Like Maryland, Connecticut was one of the first and most enthusiastic states to embrace the idea of building its own insurance exchange rather than using a federal site to implement the law's sweeping changes in health-care coverage. But unlike Maryland, where the system crashed within moments of launching and has limped along ever since, Connecticut's exchange has worked as smoothly as any in the country." Mary Pat Flaherty and Jenna Johnson in The Washington Post.
Long read: How the ACA is helping bring in a new health-care era, with blessings and hurdles. Abby Goodnough in The New York Times.
What's next on the political front: Democrats, Republicans prepare for new round of battles. "The first enrollment period for the Affordable Care Act ends at midnight Monday, closing one chapter on President Obama's landmark health-care law and paving the way for a new round of confrontations that could ultimately determine the law's long-term prospects. Supporters face an array of political, financial and legal challenges in the coming months. Democrats and insurance industry officials are already seeking ways to blunt what may be the next big controversy: an expected increase in monthly insurance premiums next year for the health plans sold through the federal and state marketplaces. Republicans, meanwhile, continue to use the law to attack vulnerable Democratic incumbents in the midterm elections, which will decide whether the GOP wins control of the Senate." Juliet Eilperin, Amy Goldstein and Sandhya Somashekhar in The Washington Post.
Where are we now on Obamacare? "Despite these qualifications, though, the underlying message is a positive one. Lots of Americans who previously couldn't obtain insurance, either because they couldn't afford it or because insurers wouldn't offer it to them, now have health coverage. Despite all the negative publicity surrounding HealthCare.gov's launch, despite all the attacks by Republicans and other opponents of the law, despite all the carve-outs and delayed deadlines imposed by an anxious White House, Obamacare is up and running. Contrary to the predictions of doom, it hasn't collapsed under the weight of its own complications. As was the case with the Massachusetts reform on which it was largely based, it will take a couple of years, or even longer, before we can really judge how the new system is working. Because each state is its own insurance market, the outcomes will differ widely across the country....An objective reading of this record would be that Obamacare, after a horrible foul-up in rolling out HealthCare.gov, has made a good deal of progress, and some of its problems are the consequence of deliberate efforts to undermine it." John Cassidy in The New Yorker.
Obamacare makes progress. "The Obama Administration and its Democratic allies have made the task of promoting the A.C.A. more difficult through their own fecklessness. The law is still better known for the Web-site fiasco than for the benefits it has achieved....Support for the A.C.A. remains low in opinion polls, thanks in part to 'horror story' campaigns paid for by groups such as Americans for Prosperity. But, in a peculiar way, no politician, of any stripe, has incentives to tell the whole truth. Republicans prefer not to acknowledge any benefits at all. Some Democrats who voted for the law, particularly those up for reelection, seem unable to acknowledge how much they still support it. It's easier to focus on the parts that benefit middle-class voters -- who tend to turn out at the polls, especially in midterm elections -- and to elide the benefits to the poor, which are rarely politically advantageous. But the core of the law is the guarantee of health care to the people who need it most. As the story of Medicaid illustrates, the hardest thing about programs to aid the poor is getting them started in the first place. Obamacare has now passed that hurdle." Jeffrey Toobin in The New Yorker.
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