Morning Read: Obamacare debate comes home to the North Country

I don’t often use the morning read to point In Boxers back toward NCPR’s own stuff, but this morning we have a pair of stories that give new context to the Obamacare debate as it shapes our lives locally.

Julie Grant talks with one of the architects of the new healthcare insurance exchanges being created in New York as part of Obamacare, with $88 million in funding from the Feds.

Politics aside, work on creating a health insurance exchange in New York is moving forward. The state department of health has already gotten $88-million-dollars from the federal government, to provide a model of how states can create these new health insurance markets. Much of that money is being used to improve New York’s information technology, to make it simple, and convenient for people to choose and enroll in health plans.

We also have a fascinating piece from Chris Morris, who contrasts the approaches to health insurance of incumbent Democrat Bill Owens (who voted for the Affordable Care Act) and Republican Matt Dohney, who would like to repeal it.

(Check out the print version of Chris’s story for the Adirondack Daily Enterprise.)

Doheny is laying out a range of ideas for how to make insurance more affordable, without Federal intervention, including a plan to allow purchase of coverage across state lines.

“I’ve said this many times: You can go online and buy something through Amazon, Google or any other e-commerce around the world or the country and that’s not allowed for health care,” he said. “(It) makes no sense.”

Also adding food for thought this week was the independent Congressional Budget Office, which concluded that Obamacare as written will “in the aggregate reduce budget deficits.”

The CBO also concluded that repealing the reform law would add “$109 billion to federal budget deficits” between now and 2022.

Before commenting, I urge you to check out the details.  Read over the CBO’s estimates, check out the details of Chris Morris and Julie Grant’s reporting.  Dig into Matt Doheny’s ideas about what better approaches might look like.

Then have at it — your views always welcome.

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59 Comments on “Morning Read: Obamacare debate comes home to the North Country”

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  1. Peter Hahn says:

    Doheny’s plan is pretty much straight-up republican. Buying insurance across state lines. (He also adds some stuff, that Owens claims is already on the books). I suppose if there were federal insurance standards, buying insurance out of state might work although most insurance companies drive down costs by negotiating fees with the doctors. I dont know how out-of-state companies would do that.

  2. knuckleheadedliberal says:

    Putting a new Band Aid onto the already broken health insurance plan is simply not the answer, it is just another stalling tactic to keep people from getting a better health care system.

    Buying insurance across state lines may work out slightly better for a relatively small percentage of people – probably only those in very small states – but it is an idea that ignores the realities of the market and the complexities of dealing with various state laws.

    Let me take back the Band Aid analogy. The current health care system is more like a Jenga game, you know the tower built with little wooden blocks where you take a block out of the bottom and try to put it on top and make the tower grow in height? Moving blocks around does not make it more stable, just as opening up insurance across sate lines will not address the core problems of the current system.

  3. JDM says:

    The CBO constraints its estimate to “as written”. As written, there are still two extra years of revenue with no expenses, so that can skew an 11-year estimate by 2/11 or 18%.

    That said, Obamacare doesn’t have to be judged by smoke-and-mirror budget numbers. It is flawed fundamentally in that the enforcement of payment falls to the IRS.

    Any plan that empowers the IRS to enforce health decisions has to go.

    Any plan that doesn’t involve the IRS in enforcement is better. Therefore, whatever the GOP offers will be better, simply for this reason.

  4. knuckleheadedliberal says:

    Let’s address the “tax” issue. It is my understanding that the fee that Justice Roberts calls a tax will only be paid by people who do not have health insurance through their employer, through the government (Medicare, or VA), are covered through their parents plan, or who choose to voluntarily buy insurance on their own.

    For the small percentage who choose not to be covered there will be a fee, or a tax -whatever you want to call it. My understanding is that this is panned to be a Flat Tax of $95 per year.

    Can someone confirm that my information is correct?

  5. If Clapton is God, Warren Haynes is Jesus says:

    I think you summarized it nicely, Knuck. Although, I believe that $95 per year number increases over the following consecutive years depending upon ones taxable income.

  6. Larry says:

    $88 million spent to create an information technology structure for the new program! That is exactly the problem with Obamacare. Billions will be spent increasing the size of the bureaucracy but not a dime will be spent addressing the root cause of the health care crisis, runaway costs. Any attempts at health care reform are doomed to failure unless costs are brought under control.

  7. mervel says:

    I think the $88 million went to a subcontractor, one of many that will greatly benefit from this act.

    One of the reason’s that this bill will not hurt the deficit is that medicaid is going to likely be reduced for poor people.

    It looks like a complex mess that is right now, hurting our economy due to the uncertainty. However the status quo is totally unacceptable so Doheney’s plans are no better.

  8. Walker says:

    Is it just me, or is this a really strange inversion of usual Democratic/Republican politics? Republicans, ever the supporters of states’ rights, are pushing for a system that would basically invalidate each state’s insurance regulations. Meanwhile, Owens has attacked Doheny’s proposal as “creating a whole new layer of government”.

    In any case, I find the idea of a nationwide insurance market pretty horrifying. Ever try to make sense of your health insurance policy? Can you tell, by reading it, what it will cover, and what a procedure will cost you? Ever get a straight answer from your company (after the obligatory 20 minutes on hold) when you ask them whether a procedure is covered? I didn’t think so.

    A market works when the buyer has all of the information that they need about a product before they buy it. Works beautifully for simple products, and less well for more complicated ones. When a product reaches a level of complexity where it is essentially impossible to understand it, a market works pretty badly for the consumer. It works a lot better for the company that can afford to spend a bunch on slick marketing. Going national on health insurance guarantees the ascendancy of slick marketing, and ever more complicated and incomprehensible policies.

  9. Larry says:

    Subcontractors are likely to be the only ones who benefit from this “complex mess.” The insurance exchanges will soon understand what private insurance companies have known for a long time: you can’t provide quality insurance at a reasonable price unless there is some restraint on costs.

  10. knuckleheadedliberal says:

    Why shouldn’t subcontractors make money on this too? They are already the main beneficiaries of military and foreign aid spending. Might as well give it all to them.

  11. Larry says:

    Don’t worry about it, Knuck. Democrats always find plenty to pass around. Trouble is, they keep finding it in our pockets.

  12. Walker says:

    Larry, private insurance companies have been raking in record profits: “Quarterly earnings per share from continuing operations between the third quarters of 2008 and 2011 jumped 29 percent, and the results have on average beaten analyst estimates since the first quarter of 2009.” Insurance profits soar after health care overhaul

  13. Peter Hahn says:

    Larry’s point is key for reducing costs. “You cant provide quality insurance at a reasonable price unless there is some restraint on cost”. Thats what all the socialized medicine systems do and what ours doesnt do.

    Unfortunately buying insurance across state lines cant restrain cost. If there are no federal standards, it would mean that huckster companies could sell cheap insurance that doesnt cover anything. If there are federal standards (as in Obamacare) then the national companies cant simply offer less coverage for less money. But they can probably drive out the smaller companies and then raise prices. Under Obamacare they are limited to 20% overhead, so they are stuck.

    It seems to me that the only way that buying across state lines is helpful is if there is a version of Obamacare in place.

  14. Larry says:

    Old news, Walker. Profit margins are down across the board for health care companies in the 2nd quarter 2012. If you understood how insurance companies work (actuarially, financially, etc.) you would know that they are not the problem. Privately held companies should not be criticized for making a profit.

  15. Pete Klein says:

    Don’t know much about any of this. Do know Medicare sucks and the value of the health insurance that is currently offered is pretty much dependent upon who you work for that provides it. Also, its value is dependent upon how much the company or organization pays and how much you need to contribute. In other words, it’s a craps game.
    If you have to pay the whole cost for a health insurance policy, you had better be rich or you won’t be able to afford anything that offers decent coverage. This and everything above is the problem.
    The Affordable Health Care Act seems to make things a bit better. I say, give it a try and tweak as needed as time goes on.

  16. Larry says:

    The problem isn’t at the insurance company, it’s at the doctor’s office, at the hospital and at the pharmaceutical company. The problem is the unregulated cost of health care, especially forced delivery of unwanted and unneeded care. I understand why the government is reluctant to take on health care providers but that’s the problem and no insurance exchange, forced insurance participation or increased bureaucracy is going to fix it.

  17. Peter Hahn says:

    Larry – its not the forced delivery of unwanted and unneeded health care. Its patients demanding and doctors recommending wanted but unneeded health care.

  18. Walker says:

    “Profit margins are down across the board for health care companies in the 2nd quarter 2012.”

    Well, yeah. After your profits rise 29%, there’s no where to go but down. But that doesn’t mean they’re doing badly.
    WellPoint cuts 2012 forecast as health insurer’s 2nd quarter profit falls 8.3 percent

    Up 29%, down 8.3%. Not really a problem, Larry.

  19. Walker says:

    “The problem is the unregulated cost of health care, especially forced delivery of unwanted and unneeded care.”

    Guess what? Single Payer systems don’t have this problem. This is the direct result of our fee-for-service model.

  20. There are 15,000 health insurance options in NY? If that’s true how is opening up the available options to plans from the other 49 states going to help? I’ve often wondered how much could be saved on medical billing with a single payer system. Even when pondering that I never imagined that the number of plans ran into the thousands in NY alone. What we need is a standard, not a wild west of options.

    I agree with Doheny that portability should be part of the solution but the ultimate portable solution is Medicare for all. Pete thinks Medicare sucks but doesn’t say why. I’ve been on it for two years and have no problems with it. I recently moved and have spent several months, a series of emails and letters plus phone calls trying to get the various components of my secondary insurance to send mail to the new address. With Medicare it took a single visit to the SS office. The SS people have on every encounter since I retired been very helpful and professional. The secondary insurance OTOH is more inclined to tell me what they can’t do.

    IMO the only reason to repeal the ACA would be to replace it with a single payer system of basic coverage then let the private insurers sell supplementary insurance in as many different flavors as the market will bear. 15,000? It boggles my mind.

  21. Mervel says:

    Pete, Medicare will be much better than what is coming in the affordable care act. What I worry about and I think we are seeing this, they are going to cut medicare and medicaid to help pay for whatever this mess is. In the end lower middle income working people who can’t get medicaid and who can’t afford private insurance will get screwed, as usual.

  22. Mervel says:

    This is a case where compromise was actually bad, we need either universal health care totally provided and paid for by the government, or we need to let the markets really work in a competitive way. Of course letting insurance companies compete is a good thing, look at the competitive market in car insurance or any other insurance for that matter. Health insurance companies are happy keeping their state run non-competitive monopolies which is why they signed on to this bill, same goes for big drug companies.

  23. TomL says:

    Brian Mann, would it be too much to ask that you refer to the legislation by its correct name, the Affordable Care Act (ACA) rather than ‘Obamacare’? The latter is a term was coined by parties opposed to ACA, and ‘Obamacare’ discussions generally devolve into arguments about the Obama Presidency (or Barack Obama the man) instead of focusing on what is actually in the ACA. Leave use of the term ‘Obamacare’ to talk radio, where it belongs.

  24. JDM says:

    khl: “My understanding is that this is panned to be a Flat Tax of $95 per year. ”

    Yeah. In the bait-and-switch world of Obamacare. Get on board for $95, Martha! What a deal.

    Then, in five short years, it’s $2,085 per person making under $110,000.

    Flat fee: The first tier for lower income taxpayers is fixed, starting at $95 for calendar year 2014 (the first year the mandate is effective), $325 in 2015, and $695 in 2016 and beyond. The total family penalty is capped at 300% of this flat dollar tax — $2,085 in 2016 – for those earning less than about $110,000, according to the CRS.

    Small businesses start at $2,000 to $3,000 per employee.

  25. JDM says:

    correction – $2,085 per family in 2016 and beyond in households making under $110,000.

  26. Peter Hahn says:

    JDM – how much is it now, and how much will it be in 2016 if Obamacare is repealed?

  27. Larry says:

    …its not the forced delivery of unwanted and unneeded health care. Its patients demanding and doctors recommending wanted but unneeded health care.”

    Are you serious? Patients just want to feel better, they don’t demand that long-distance doctors “review” test results. They don’t demand treatments and procedures that have no chance of success. They don’t demand $3,000 ambulance rides of less than 5 miles.

  28. If Clapton is God, Warren Haynes is Jesus says:


    On the contrary, patients due demand such services. Part of the problem, as you hinted at, however, is they’re not necessarily informed of the cost of those services nor their effectiveness. On top of that, prices vary for individual patients depending upon if they have or don’t insurance, the type of insurance, etc.

    There’s simply not enough transparency of costs and it’s far too confusing a process for most to understand. I think one benefit of a single payer system is this confusion could be removed if the largest payer in the world for health care, the US gov’t, negotiated prices for services and drugs and simply passed the costs onto every citizen via their federal withholding taxes.

  29. Walker says:

    Peter, Larry’s talking about the fee (that SCOTUS has deemed a tax) for not having health insurance under the ACA, so there is no equivalent amount (unless you’re thinking of the hundreds of thousands of dollars you’re risking by not having insurance when you have a catastrophic illness or injury).

  30. Walker says:

    “There’s simply not enough transparency of costs and it’s far too confusing…”

    That’s a substantial understatement! There is no transparency. In my experience, you can not find out what something will cost you ahead of time. As for the confusion, the insurance companies’ own staff are generally unable to explain what is going on when claims are denied.

    It’s as if you went to buy a house, but you couldn’t look at it first, you couldn’t know where it was, you didn’t have any idea what it would cost you to heat it, but you had to choose between several thousand houses based on vague, breezy advertising copy descriptions.

    This is no “market solution”!

  31. If Clapton is God, Warren Haynes is Jesus says:


    That’s an excellent analogy, well said……

  32. knuckleheadedliberal says:

    Thanks for the numbers JDM. Luckily for me I buy high deductible health insurance without eye, dental or prescription coverage for several times the $695 per year so I wont have to worry about paying the tax.

  33. knuckleheadedliberal says:

    I feel like a broken record, but here goes again.

    As James Bullard points out there are so many choices in health insurance plans that nobody, not one single person alive today, can tell what the best option for an individual might be. So people are buying a product without any solid information on the best use of their money. By definition that is not a free or fair market. So if you believe in the principles of Adam Smith, or in Free Market Capitalism the current private health insurance industry should be abolished.

  34. Mervel says:

    There really is no such thing as a private health insurance industry in the US today. We have a basterdized largely government funded, half government protected state to state monopoly system. The current system is simply crony capitalism. I agree abolish it.

  35. Mervel says:

    Even as a person who thinks the ACA is a bad plan, I can’t stand saying “obamacare” it just sounds ignorant, its like HillaryCare or Reagonomics, the all sound so stupid.

  36. Paul says:

    Mervel, I agree with the name thing. The president doesn’t seem to have a problem with it.

  37. Larry says:

    There most certainly is a private health insurance industry and it is not as complicated as many of you make it out to be…that is, if you really want to understand it. Just because many don’t want to make an effort to understand does not mean it doesn’t exist. Many people (myself included) have private health insurance and are doing just fine with it.

  38. knuckleheadedliberal says:

    Obama and Care. What is not to like? Care is a good word although the Republicans who decided that Obamacare is a pejorative apparently don’t think so. Maybe they don’t care. You should definitely not vote for people who think care is a bad word.

  39. Peter Hahn says:

    The problem with market solutions to health care is that ultimately its a medical decision. I would add to Walker’s analogy that it is also as if you have a vague idea of whether you need a house in the first place or what kind of house and you have to totally go on the advise of the real estate agent. And in the current market driven situation – you only have to pay the first $20 dollars.

  40. Larry says:

    We have seen in the real estate market (to continue your analogy) what happens when people blunder around without a clue as to what they’re doing. It is, and will continue to be, the same in the health insurance market. Why can’t people take the time to educate themselves so that they can make informed, logical choices?

  41. mervel says:

    Larry what I meant was we do not have a fully functioning private market in the health care industry. It is a complex mish mash of protected monopolies that are very highly regulated.

    Right now US citizens are traveling to other countries to get medical procedures done at a 1/4 of the price and simply paying out of pocket and getting the SAME quality of service.

  42. Peter Hahn says:

    Larry – how in the world are you going to educate yourself about medical decisions so that you can make an informed decision? Your doctor says you need a heart valve replacement and you are going to go on-line to pick out the cheapest one? Or to see if there is a cheaper procedure?

    No – you might and should go for a second opinion.

  43. Peter Hahn says:

    But you aren’t going to do the same kind of research that you would if you we’re going to buy a car. (or a house)

  44. Peter Hahn says:

    And – importantly, that wouldn’t solve the problem that health insurance is too expensive for many people so they use the emergency room for free (to them) primary health care that is extremely expensive for the rest of us. (and not very good as primary health care).

  45. Larry says:

    Peter, I was speaking about the health insurance market. Mervel is wrong about it being “…a complex mish mash of protected monopolies that are very highly regulated.” There is regulation, of course, arguably too much. There are no monopolies I’m aware of and the system is not as complex as the sponsors of Obamacare would have you believe. They have fed the American people a line of nonsense to advance their own agenda which consists largely of concentrating power and money in their hands.

    As far as making informed and logical choices about our own health care, what’s wrong with that? If you don’t, you’re at the mercy of doctors and hospitals who put their own interests ahead of yours. People who blindly trust their doctors are asking for trouble.

  46. Walker says:

    Larry, if you honestly believe that our health insurance system is easy to understand, I can only assume that you have never tried to shop for a health insurance plan as an individual, and that you are lucky enough to have a very healthy family. Good luck when any of that changes!

  47. Peter Hahn says:

    Most employers, at least the large ones, can offer employees a choice between several insurance companies – maybe a fee-for service one and a couple of HMOs. Usually the fee-for service one comes with a bigger share paid by the employee. Its not that hard to pick the one that is right for the particular employee. Thats the system we have today and it results in the most expensive health care system in the world, with relatively poor results.

    If you had to go on the national market to choose between zillions of competing plans, as Walker mentions, you would be in big trouble. and you probably wouldn t really have better options that the 4 or 5 offered by the HR department.

  48. Walker says:

    Peter if you’re looking to buy insurance as an individual in NY state, there are only about a dozen options to choose from, and although there is a pretty wide range of prices, they’re all quite expensive: my wife’s policy costs more than $16,000 a year.

    When you have to choose, is not at all obvious which policy makes the most sense– we chose a relatively expensive policy for her because according to information from the state, it had the best reputation for honoring claims, and because we can afford it. We could save a good deal by using a cheaper company, but would we end up with greater costs if she had a catastrophic medical crisis? Who knows? If you read the policies, they all sound great. But they all do their best to avoid paying claims. And as I have said a few times already, good luck getting a straight answer in advance on whether a procedure will be covered and what it will cost you, or why a particular charge has been denied.

    Meanwhile, as the NCPR article linked above points out, an employer has some 15,000 policies to chose among.

  49. Larry says:

    Walker, your assumptions about me are completely wrong. I have been making informed choices about my health coverage for many years and have had to factor in potential health issues for myself and my wife as well. It’s not rocket science and I have done the best I can with it, all the while balancing coverage, care and cost. Your inability to understand your choices does not extend to the rest of us. Or, possibly, you just can’t be bothered. Either way, quit making assumptions about other people.

  50. Peter Hahn says:

    Larry – Walker said he did understand his choices and made a choice he was happy with , except that it cost 16K per year.

    Maybe you also understand your choices. Your choice also is most likely very expensive.

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