FatherGarage.com

Wednesday is the first birthday of the Patient Protection and Affordable Care Act, the law better known as health-care reform. Cake, I imagine, will not be served. As much as Democrats are trying to leverage the milestone to sell the public on the legislation’s many virtues, the reality is that it has been a tough year.

Tweet

At best, public support for the law is mixed and contradictory. A Kaiser Family Foundation survey released last week was typical: A slight plurality had an unfavorable impression of it, but a slight majority opposed efforts to repeal it or replace it with a Republican-backed alternative. It brings to mind an old Woody Allen joke about a restaurant where the food is terrible and the portions are too small. Americans don’t think they like the Affordable Care Act, but they don’t want to be without it or left with whatever Republicans want to put in its place.

For most Americans, the dominant emotion is confusion. According to the Kaiser poll, “confused” outranks “angry,” “anxious” and “enthusiastic” as a descriptor. At 53 percent, it commands an easy majority — and I’d guess that’s a low estimate.

So this is my birthday present to the legislation, and those who are befuddled by it: some clarity on what it does, and how it does it.

The health-care reform law is, without a doubt, among the most consequential pieces of social policy passed since the Great Society. But it’s also a lot more incremental than many people realize. More modest, by far, than the health-care overhauls proposed by Presidents Clinton, Nixon, Johnson and Truman.

In 2019, once the law has been fully implemented for five years, it is expected to cover about two-thirds of the uninsured, to cost about 4 percent of what the health-care system spends in any given year and to cut the federal deficit by less than 1 percent. If you obtain insurance from your employer, Medicare, Medicaid or the veterans system — and that describes most Americans — you probably won’t notice the legislation at all.

Nevertheless, the Affordable Care Act, once it kicks in fully in 2014, is expected to do four things: provide coverage; remake a small slice of the private insurance market; pay for itself; and try to control costs. Let’s take them in order.

The law has two main mechanisms for covering people: Medicaid — which is a government insurance program that focuses on the poor — and subsidies to help people afford private insurance. The split is expected to be almost even: Of the 32 million people the law is expected to cover by 2019, 16 million will be on Medicaid and the rest covered by private insurance.

The problem with subsidizing insurance is that the sick rush to sign up and the insurers refuse to cover them. The law escapes this conundrum by telling people who can afford insurance that they have to buy it or face a small fine (the dreaded individual mandate) and by telling insurers that they can’t discriminate based on preexisting conditions. That is to say, healthy people can no longer say no until they get sick and insurers can no longer say yes only when applicants are healthy.

These transactions will happen on the new “exchanges” — a place that will, in effect, be a Web site where people can compare plans and choose the one that will serve them best. But behind the pleasing exterior (you can see it at HealthCare.gov), the exchanges offer another layer of consumer protection: Just as Amazon.com would stop carrying a toaster that routinely exploded when customers plugged it in, if an insurer repeatedly misbehaves, regulators can kick it out of the exchange.

All this will cost money — and in a system that’s already overpriced. Which brings us to offsets and cost controls. It’s important to know the difference: Offsets are the policies that cover the law’s costs. They’re concrete, simple reforms — cutting this much, taxing that much — and as long as we are willing to implement them, they are likely to work. Controls are the policies that try to rein in health-care spending. They’re ambitious attempts to change the way doctors are paid, insurance is bought and Medicare is reformed. If they work, they will, in the long run, save an enormous amount of money — much more than the offsets.

The big offsets in the health-care law slow payment increases to doctors who participate in Medicare ($240 billion), cut payments to private insurers that participate in Medicare but cost more than the basic Medicare program does ($140 billion), add a new tax on high-income beneficiaries of Medicare ($210 billion) and on very expensive health-care plans ($20 billion, although much more than that between 2020 and 2029), and so on. All in all, the legislation is expected to save or raise about $100 billion more than it spends in the first 10 years.

The cost controls will occur over a longer period and are more speculative. Medicare, for instance, is going to experiment with paying hospitals a flat sum for all successful care associated with a particular condition. This will mean that doctors make more money when they do less and are successful at it, rather than making more for doing more, as is the case now. The tax on expensive health insurance plans is meant to drive people — and employers — to seek plans that better control costs.

The Independent Payment Advisory Board is a group of stakeholders and experts charged with helping Medicare control costs and empowered to make changes to the system even if Congress is too paralyzed or distracted to act. It will be fed ideas by the new Center for Medicare and Medicaid Innovation, which will test ways to improve care and cut expenses. The exchanges will make it easier to comparison-shop, and the subsidies are linked to the lowest-priced plans in the exchanges to reward cost-efficient insurers. New information about what drugs and treatments work best and for whom will come from trials, and if combined with electronic-medical records, could help doctors make more cost-effective decisions.

Is it a perfect piece of legislation? Not even close. Will everything work as expected? Almost certainly not. But for all its flaws, it’s a good law, which is why Republicans have had so much trouble coming up with state plans that could cover more people at a lower cost. And it’s worth trying.

So happy birthday, Affordable Care Act. Here’s to many more.

kleine@washpost.com

View the original article here

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

Senate Banking Committee members, from left, Sen. Michael Bennet, D-Colo., Sen. Jeff Merkley, D-Ore., Sen. Mark Warner, D-Va., Sen. Jon Tester, D-Mont., listen on Capitol Hill in Washington, Tuesday, March 1, 2011 as Federal Reserve Chairman Ben Bernanke gave the Semiannual Monetary Policy Report to Congress. (AP Photo/Alex Brandon) (Alex Brandon – AP) The letter that Sens. Michael Bennet, Mike Johanns, and 62 of their colleagues sent President Barack Obama asking him to support comprehensive deficit reduction is an odd document. It’s not the letter’s language that caught my eye. In Washington, little could be more standard than “we believe comprehensive deficit reduction measures are imperative.” What’s odd is its theory of legislative action.

”We…ask you to support a broad approach to solving the problem,” write the senators. “With a strong signal of support from you, we believe that we can achieve consensus on these important fiscal issues.” In this letter, 64 senators manage to sound like an interest group begging the White House for support rather than a supermajority of the United States Senate — which is to say, a coalition of men and women who could, on their own, draft and pass the very legislation they’re talking about. Which raises the question: Why are they writing this letter rather than the legislation this letter claims to want?

If vague statements about “a broad approach to solving the problem” could solve the problem, the problem would be solved. It would’ve been done during the president’s post-budget press conference, when he said “we can get Social Security done in the same way that Ronald Reagan and Tip O’Neill were able to get it done” and agreed that “Medicare and Medicaid are huge problems…that I’m prepared to work with Democrats and Republicans to start dealing with that in a serious way.” That sounds like a “signal of support” to me, and it should be plenty to get the Senate going on a deficit plan — if, indeed, that’s something a supermajority of senators are actually interested in doing.

I have my doubts, though. There are a lot of letters and statements about deficit reduction flying around, but precious little legislation. If the 64 senators who signed this letter wanted to write and vote for a bill, that’d be a pretty “strong signal.” But for 64 senators to instead write letters about how someone else should be making affirmative noises about deficit reduction, well, read closely, that’s a signal of a very different kind. The reality is that the White House can’t write the bill on Congress’s behalf. It can’t pass the bill through Congress. And it can’t kill the bill Congress pases if the bill has a veto-proof majority. Obama could be doing more to move public opinion, but on this issue, the empowered actor is the legislative branch, not the executive branch. And the legislative branch should begin acting like it.

Top Stories

More than 60 Senators want Obama involved in debt talks, reports Lori Montgomery: “More than 60 senators from both parties are calling on President Obama to lead them in developing a comprehensive plan to rein in record budget deficits, a powerful sign of bipartisan willingness to abandon long-held positions on entitlement spending and taxes. In a letter sent Friday to the White House, the 64 senators urge Obama ‘to support a broad approach to solving our current budget problems’ along the lines of recommendations issued last year by a presidentially appointed commission…The letter was drafted by Sens. Michael Bennet (D-Colo.) and Mike Johanns (R-Neb.), who said in a conference call Friday with reporters that it took them only a couple of days to convince a super-majority of their colleagues to sign the letter — 32 Republicans and 32 Democrats.”

Read the letter: http://1.usa.gov/hl5z1V

Senate Democrats are split on changing Social Security, reports Damian Paletta: “The idea of putting Social Security into play has triggered a firestorm of opposition from several corners of the Democratic party. Senate Majority Leader Harry Reid (D., Nev.) and Sen. Chuck Schumer (D., N.Y.), two of the Senate’s most powerful lawmakers, have said revisions to Social Security shouldn’t be attached to a deficit-reduction plan. They argue the program’s benefits are covered by giant trust funds that have no impact on the deficit…But changes to Social Security are on the table as three Democratic senators, Mark Warner of Virginia, Kent Conrad of North Dakota and Richard Durbin of Illinois, negotiate with three Republicans–together forming the so-called Gang of Six–to craft a deal to cut $4 trillion from the federal budget deficit over 10 years.”

The Congressional Budget Office was not kind to the White House’s budget proposal: “There are two major takeaways from the Congressional Budget Office’s analysis of the president’s proposed 2012 budget. The first is that the CBO doesn’t believe it will save as much money as the White House says it will. The second is that doing nothing — yes, nothing — would do more to cut the deficit than anything that the Obama White House proposed or than the GOP is likely to propose.”

Ex-Google CEO Eric Schmidt is in the running to become Secretary of Commerce: http://wapo.st/fiAsv1

The president of Brazil criticized Fed policy upon Obama’s visit, report Paulo Prada, Laura Meckler, and Tom Murphy: “At the outset of a three-country tour of Latin America, President Barack Obama heaped huge praise on Brazil’s remarkable economic rise, but received a tongue lashing in return from Brazilian President Dilma Rousseff, who criticized the U.S. loose monetary policy for contributing to ‘acute’ global imbalances by artificially weakening the U.S. dollar…The statement appeared to be a set back for U.S. officials who have sought to convince Brazil that loose U.S. monetary policy will ultimately benefit the world if it helps jumpstart U.S. growth…Ms. Rousseff also pointed out that negotiating closer trade ties with the U.S. is difficult since the U.S. restricts imports of a range of important Brazilian exports in order to protect U.S. industries – restrictions that are political unlikely to be changed.”

Late night performance interlude: The Hold Steady play “Sequestered in Memphis” on Jools Holland .

Got tips, additions, or comments? E-mail me.

Still to come: The GOP is split on including tax hike in a debt deal; Greensan vs. Krugman; Wisconsin has reversed course on implementing health care reform; a judge has blocked Wisconsin’s anti-union bill; nuclear regulators are conducting a full review of all US facilities; and a basset hound dressed up like Sherlock Holmes.

Economy

The GOP is split on backing tax hikes as part of a debt deal, reports John McKinnon: “A few prominent GOP lawmakers believe they will have to raise some tax revenue if they are to bring Democrats along on a bipartisan compromise to address the U.S.’s long-term fiscal problems. Many Democrats want higher taxes to cover at least part of future budget gaps. That has led to clashes between Republican lawmakers and a Washington advocacy group, Americans for Tax Reform, the self-appointed keeper of the party’s anti-tax flame. Grover Norquist, the group’s president, said he has ‘sent up a flare’ against placing trust in Democrats, given how bipartisan agreements, including the one struck by then-President Bush in 1990, eventually unraveled.”

Alan Greenspan argues [pdf] that the Obama administration has stood in the way of the economic recovery: “The current government activism is hampering what should be a broad- based robust economic recovery, driven in significant part by the positive wealth effect of a buoyant U.S. and global stock market.”

Krugman admires the chutzpah: “Greenspan writes in characteristic form: other people may have their models, but he’s the wise oracle who knows the deep mysteries of human behavior, who can discern patterns based on his ineffable knowledge of economic psychology and history. Sorry, but he doesn’t get to do that any more. 2011 is not 2006. Greenspan is an ex-Maestro; his reputation is pushing up the daisies, it’s gone to meet its maker, it’s joined the choir invisible. He’s no longer the Man Who Knows; he’s the man who presided over an economy careening to the worst economic crisis since the Great Depression — and who saw no evil, heard no evil, refused to do anything about subprime, insisted that derivatives made the financial system more stable, denied not only that there was a national housing bubble but that such a bubble was even possible.”

TARP’s inspector general has been uncommonly effective, writes Gretchen Morgensen: “The American taxpayer will lose a rare straight shooter when Neil M. Barofsky, the special inspector general for the Troubled Asset Relief Program, leaves his post on March 30. In his frequent testimony before Congress and in the nine quarterly reports and 13 audits his office has published, Mr. Barofsky has served taxpayers well by speaking truth to the powers at the Treasury. This has often put him at odds with the Treasury officials whose work he is charged with overseeing — a natural consequence for any watchdog with teeth. Using facts, figures and extensive interviews, Mr. Barofsky has questioned the effectiveness of the administration’s loan modification program and the Treasury’s initial refusal to require institutions that received taxpayer-financed bailouts to account for their use of TARP funds.”

Republicans are scared by Elizabeth Warren’s effectiveness, writes Paul Krugman: “Given Ms. Warren’s prescience and her role in shaping financial reform legislation — not to mention her effective performance running the Congressional panel exercising oversight over federal financial bailouts — it was only natural that she be appointed to get the new consumer protection agency up and running. And it’s hard to think of anyone better qualified to head the agency once it goes into action. The fact that she’s so well qualified is, of course, the reason she’s being attacked so fiercely. Nothing could be worse, from the point of view of bankers and the politicians who serve them, than to have consumers protected by someone who knows what she’s doing and has the personal credibility to stand up to pressure.”

Joe Nocera thinks so, too. “ Ms. Warren is the most logical person to be the agency’s initial director: if the settlement does come to pass, no one will understand its terms better, or have a better feel for how to enforce them. Let’s face it: there isn’t anybody in Washington more fearless about standing up to the big banks. No wonder they don’t like her…Senate Republicans have vowed to block her appointment if President Obama nominates her. Yet even if her nomination goes down in flames, Senate confirmation hearings would be clarifying. Americans would get to hear Ms. Warren explain why the Consumer Financial Protection Bureau has the potential to help Americans. And they would get to hear Republicans explain why the status quo — including the everyday horror of the foreclosure mess — is just fine.”

Adorable animals with deductive prowess: A basset hound dressed like Sherlock Holmes runs in slow motion.

Health Care

Wisconsin has completely reversed course on implementing health care reform, reports Amy Goldstein: “Two weeks after President Obama signed the nation’s health-care overhaul into law, then-Wisconsin Gov. Jim Doyle (D) issued an executive order creating an Office of Health Care Reform. Over the next eight months, the Badger State made more headway than virtually anywhere else in the country at preparing to carry the statute out. It designed — and presented at the White House — the country’s only prototype for how people and small businesses could navigate a new health insurance marketplace online…Then, in late January, Doyle’s Republican successor, Scott Walker, issued his own executive order, dissolving the health reform office and replacing it with the Office of Free Market Health Care.”

The health law’s frequent waivers are coming in for criticism, reports Robert Pear: “Obama administration officials say they were expecting praise from critics of the new health care law when they offered to exempt selected employers and labor unions from a requirement to provide at least $750,000 in coverage to each person in their health insurance plans this year. Instead, Republicans have seized on the waivers as just more evidence that the law is fundamentally flawed because, they say, it requires so many exceptions. To date, for example, the administration has relaxed the $750,000 standard for more than 1,000 health plans covering 2.6 million people…Steven B. Larsen, director of the federal Center for Consumer Information and Insurance Oversight, which carries out many of the health law’s provisions, said the waivers provided a ‘bridge to 2014,’ when more affordable insurance options should be available. He denied that unions had received ‘special treatment.’ Indeed, he said, the center has granted waivers to 94 percent of all applicants.

Health insurers are moving into less-regulated business areas, reports Christopher Weaver: “Here’s one change few were talking about when the health overhaul law passed: It’s sent insurers — worried the law could stunt profits and growth — looking for new types of business. Where are they investing? In less-regulated companies that could yield strong profits and make the main business — insurance — more lucrative. The purchases also could increase insurers’ control over more parts of the health system. Insurers have moved into technology, health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law. Since June 2009, seven of the nation’s largest insurers have made 25 major deals, and only six of those acquisitions run health plans.”

Americans are still evenly split on health care reform a year after its passage: http://bit.ly/e2F2Y4

Domestic Policy

Wisconsin’s anti-union bill is on hold following a judge’s ruling, report Douglas Belkin and Kris Maher: “A Wisconsin circuit court judge put on hold Friday a new law that would curtail collective-bargaining rights for public unions, delaying for now the implementation of bitterly contested legislation that drew thousands of protesters and shut down the legislature. The ruling thrilled Democratic lawmakers, who spent three weeks out of state to prevent the bill’s passage, and stunned Republicans, who vowed to appeal. ‘Dane County always seems to play by its own rules, but this morning we saw a Dane County judge try to rewrite the constitutional separation of powers,’ Republican leaders of the state Senate and Assembly said in a statement.”

Arizona is easing up on immigration enforcement, reports Richard Oppel: “Arizona established itself over the past year as the most aggressive state in cracking down on illegal immigrants, gaining so much momentum with its efforts that several other states vowed to follow suit. But now the harsh realities of economics appear to have intruded, and Arizona may be looking to shed the image of hard-line anti-immigration pioneer. In an abrupt change of course, Arizona lawmakers rejected new anti-immigration measures on Thursday, in what was widely seen as capitulation to pressure from business executives and an admission that the state’s tough stance had resulted in a chilling of the normally robust tourism and convention industry.”

It’s easy to make state pension programs solvent, writes Robert Shiller: http://nyti.ms/ftweHu

Talk of widespread municipal defaults is exaggerated, writes Iris Lav: “Municipal bond default is actually quite rare: no state has defaulted on a bond since the Depression, and only four cities or counties have defaulted on a guaranteed bond in the last 40 years. A few minor bond defaults do occur each year, usually on debt issued by quasi-governmental entities for projects that didn’t pan out, like sewers for housing developments that never were occupied…The leading rating agencies estimate the default rate on rated municipal bonds of any kind at less than one-third of 1 percent; in contrast, the default rate on corporate bonds reached nearly 14 percent during the recession and hovers around 3 percent in good times.”

Animated lecture interlude: Evgeny Morozov on how the Internet can help, not undermine, dictators.

Energy

Nuclear regulators are launching a major review of US plants, report Stephen Power and Alan Zibel: “Energy officials on Sunday said a top-to-bottom examination of procedures at U.S. nuclear-energy facilities was under way in the wake of Japan’s earthquake-triggered nuclear-plant crisis. U.S. Nuclear Regulatory Commission Chairman Greg Jaczko, in an interview, said the U.S. had already instituted procedures to reduce the risk of mishaps like those that have bedeviled Japanese authorities…U.S. Energy Department Secretary Stephen Chu, speaking on Sunday television news shows, meanwhile sought to reassure Americans about the safety of U.S. reactors, 23 of which have a similar design to the troubled Japanese facilities.”

Closing credits: Wonkbook is compiled and produced with help from Dylan Matthews and Michelle Williams.

???initialComments:true! pubdate:03/21/2011 07:27 EDT! commentPeriod:3! commentEndDate:3/24/11 7:27 EDT! currentDate:3/22/11 1:30 EDT! allowComments:true! displayComments:false!

View the original article here

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

Sens. Scott Brown (R-Mass.) and Ron Wyden (D-Ore.) introduced legislation Thursday to let states apply to opt out of certain aspects of the heath care reform law three years earlier than originally proposed. The law grants states the right to apply for waivers from some requirements in 2017, but the Brown-Wyden proposal would move the [...]

American’s for Tax Reform, the conservative group run by Grover Norquist, will host a debate for candidates seeking to head the Republican National Committee on Jan. 3, 2010 at the National Press Club. “The actual vote for RNC chairman will be made by the 168 members of the committee, but the impact will be felt [...]

Republican leaders acknowledged Sunday that an outright repeal of the health care reform law — something they told voters during the campaign they would try to do — was not within their power while President Obama is in office, but they vowed to pursue a strategy of taking it apart piece-by-piece. “If we can put [...]

Oops, poor choice of words. President Obama said he didn’t mean to refer to Republican opponents of immigration reform as “enemies” in an interview with Univision radio. “Opponents” would have been a better word. When he was asked by Eddie “Piolin” Sotelo last month how he could seek the Latino vote after not pushing hard [...]