The Selling of ObamaCare

It’s as though two completely separate conversations have been going on. From day one, the health policy community has correctly seen the Affordable Care Act as an attempt to completely change the health care system. This isn’t even controversial. It’s accepted by all as an undisputed fact.

However, no one has ever said this to the American people. In fact, the message of the Obama presidency — going all the way back to the 2008 campaign — was just the opposite. In that election, Barack Obama rejected Hillary Clinton’s call for an individual mandate (a proposal that would obviously affect everyone) in favor of his own proposal which appeared to mainly help those who couldn’t afford insurance. And how many people would that be?  You could be forgiven if you thought it was about 10% of the population.

Then, on the eve of the passage of the ACA, virtually every Democrat who appeared on TV to defend it had one and only one message to offer: people were being discriminated because of pre-existing conditions. And how many of those people are there? Well for the first three years under the law, anyone denied insurance because of a pre-existing condition was able to enter the new (ObamaCare) risk pools and pay the same premium a healthy person would pay. How many did that? About 107,000. That’s out of a U.S. population of approximately 314 million!

To allay concerns about ObamaCare’s individual mandate, the president repeatedly promised that “if you like your health insurance plan you can keep your health insurance plan” and “If you like your doctor you can keep your doctor.” Over and over again the message was the same: most people will be completely unaffected by the new health law.

Then over the past week or so, the general public woke up to some stunning revelations. It now appears that as many as 10 million people will lose their individual health insurance policies as of January 1. To put this number in perspective, the administration’s goal for next year is to sign up 7 million people. We could actually end 2014 with more people uninsured than there were at the end of 2013.

On top of that, The Washington Post has just awarded the president Four Pinocchios for his statements. Although it took them five years to do so, when they finally got around to it the write up was devastating. “Four Pinocchios” is a nice way of saying that the president has been lying all along. [Or, is it possible the president didn't know? More on that below.]

So why has it taken so long for the mainstream media and the general public to wake up to what is going on. I think there are three reasons: (a) insurance industry executives (who knew what was going on) were threatened and bullied into silence by the Obama administration, (b) the health policy community (who also knew what was going on) abandoned their role as critical analysts and assumed the role of cheerleaders for the new law instead and (c) the health care media (who should have known what was going on) didn’t do its job.

Matty told Hatty about a thing she saw.
Had two big horns and a wooly jaw.

 

Before going forward, let’s put to rest a claim now being made by President Obama and Valarie Jarrett: that the insurance cancellations are the fault of the insurance companies, not the administration. It was the administration (through its own regulations) that made it virtually impossible for most individually owned insurance to be grandfathered. As The Washington Post explains:

The law did allow “grandfathered” plans — for people who had obtained their insurance before the law was signed on March 23, 2010 — to escape this requirement and some other aspects of the law. But the regulations written by HHS while implementing the law set some tough guidelines, so that if an insurance company makes changes to a plan’s benefits or how much members pay through premiums, co-pays or deductibles, then a person’s plan likely loses that status.

If you dig into the regulations (go to page 34560), you will see that HHS wrote them extremely tight. One provision says that if co-payment increases by more than $5, plus medical cost of inflation, then the plan can no longer be grandfathered. (With last year’s inflation rate of 4 percent, that means the co-pay could not increase by more than $5.20.) Another provision says the co-insurance rate could not be increased at all above the level it was on March 23, 2010.

Even before these regulation were promulgated, no serious policy analyst ever thought that more than a handful of plans would be grandfathered for very long — not the Congressional Budget Office, not the health committees on Capitol Hill, not the specialists in the private sector, not anyone. But with Obama’s repeated assurances that no one had anything to worry about, with a compliant health care media and with a cheerleading health policy community, the general public has remained completely in the dark — until now.

As for premiums, every analyst knows that if you replace a market in which there is individual underwriting with community rating, premiums will go up for the vast majority of policy holders so that they can go down for the most expensive enrollees. As Megan McArdle explains:

It’s absolutely true that every policy wonk who was writing or speaking about the law in 2009 and 2010 understood that it would mean premiums going up for at least some people, many of whom would lose insurance that they would have preferred to keep…They had to; mathematically, it was not possible for coverage to expand and everyone’s premiums to go down — not unless you spent more in premium subsidies than the government could afford.

Everyone knew this — except ordinary folks. They received the opposite message. Going all the way back to the 2008 campaign, candidate Obama told everyone their premiums would actually go down! See this Q & A from the 2008 Obama campaign (Another HT: to Megan).

And again, why wasn’t this general impression corrected. For the three reasons I’ve already mentioned. But note: our friends at The Incidental Economist were critical of many of the president’s statements — a welcome exception to the trend.

As for the president himself, he is a complete enigma to me. I’ve never felt that I understood him. He appears to have looked directly into the TV camera and said something that was blatantly untrue (in the words of Joe Scarborough) “over and over and over and over again.” You have to go all the way back to Richard Nixon to find something comparable.

Or is it possible the president really didn’t know? He often appears very detached and he spends a lot of time on the golf course — even when critical issues are pending.

I report. You decide.

Comments (41)

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  1. Ken says:

    Excellent post.

  2. Perry says:

    This is how I analogize this law:

    I go to a car lot to be a used compact vehicle, I just need something reliable to get back and forth to work. The car dealer says, “Oh, but you don’t want that, you need this shiny Cadillac Escalade and the government won’t let you have that compact anymore anyway.” So suck it up and take this even though it’s going to cost you much more and it’s not what you want or need.

    I have also seen what is being offered with these plans, “free” (are you kidding?) colonoscopy, breast screenings, etc. Not to mention maternity care and the like. Now I ask you, how can premiums go down when offering all this extra stuff? That’s also assuming people are even going to take advantage of these things. If now, we’re all paying for it for nothing. It’s like buying car insurance and getting all your oil changes, tires, and tune-ups for no extra cost. I like the way it’s described as “free”,
    Ha!

    • Perry says:

      I also find it extremely annoying that the defenders don’t admit that they lied, they just tell us we had lousy policies to begin with.

    • JD says:

      I can’t believe that people haven’t learned this lesson.

    • Dewaine says:

      I really suspected that public cost would be where we would feel the real pain, but it is looking more and more like most individuals are paying more, too. This is a good trend if we want to get public support turned in the right direction.

  3. Greg Scandlen says:

    It is even worse than you predict. As 2014 progresses many (most) employer plans will be getting the same notices. That means they too will be dropping coverage. I expect the rate of non-insurance will nearly double to 30% by the end of 2014. Not remotely surprising. The McKinsey Company predicted this in 2011, to the scorn of the cheerleaders.

    • Chuck Bush says:

      Every individual plan and every group plan of employers with 50 or less employees, must be changed to meet the new mandates by December 2014. What percentage or how many affected individuals does that add up to? Presently, the media mantra is only 5% will be affected. Aside from this being a comfortable lie, how can the weight of the lie not come crashing down on their heads?

  4. Blake Woodard says:

    John -

    The grandfather regulations are at the heart of the lie, because they made it inevitable that all plans eventually will lose their grandfather status. All grandfathers eventually will die.

    Your editorial deals with individual policies, but group plans face the same challenges. The first draft of the regs prohibited even changing an employer’s group insurer, but the Obama Administration backed off that requirement. One of the employee benefit clients I serve lost its grandfather status merely for starting a tobacco policy that charged smokers a token amount more than non-smokers, even though such “wellness” programs are encouraged by other parts of Obamacare. So you have one part of the law encouraging people to quit smoking and the grandfather regs penalizing employers who try to encourage people to quit smoking.

  5. Steven says:

    This is why the only correct path is repeal, unwind existing system, and replace with market-based systems. How does that happen?
    Force the creators of this monstrosity to adhere to the law they made. No extension of the employer mandate, no extension of the individual mandate. Let the website and the law fall under its own weight. People will suffer in the short-run, but they will also vote out the crums who passed this abomination. Don’ let them off the hook. Let the law create the pain, then stand back and watch the electoral carnage.

  6. Vicki says:

    Good song pairing to wake us up on a Monday morning.

  7. Kent Lyon says:

    Actually, what you are saying, Dr. Goodman, is that the entirety of American institutions, both public and private, lied to the American people, either overtly or by their silence (in the old Thomas More rule of English law, silence connotes agreement and consent). The medical establisment, hospitals, insurance companies, large employers, the Chamber of Commerce, the media, top to bottom, both political parties, state administrations, excepting those who brought lawsuits to stop Obamacare, which by and large failed, and the courts, including the US Supreme Court. All of these lied to the American people. Why should anyone afford any credibility whatsoever to any American civic institutions, public or private. Civil society has been corrupted and shown to be complicit in deceit in America. America is now living a lie. Huck Finn has the last word. If slavery was America’s original sin, Obamacare has replaced it in American history as the great evil (even exceeding that other twin pillar of barbarism inveighed against in the 19th Century, Polygamy, and that great 20th Century evil, Eugenics).

    The debate on Obamacare was no debate. It was a collusion of elites to enslave the American people. The question is, will America show the will to cast off this odious oppression? Only the Tea Party has stood against it to now (forcing the House to fight it, with a little help from Ted Cruz and co). Will the rest of the nation join them, or acquiesce to the new oppression?

  8. Bob Hertz says:

    Any website that brings back Sam the Sham and Pharoahs would be worth praising, even if the blog comments were utterly inane.

    Which they are not, of course

    Greg, I am curious about your comment that group insurance plans would eventually be dropped

    Most group policies already have maternity coverage and a form of guaranteed issue and high limits and a fairly high ‘loss ratio.’

    Per the estimates I have seen, the remaining mandates of the ACA add really very little to premiums.
    Won’t most group insurers just offer a slightly more expensive product?

    Of course this assumes that they want to stay in the health insurance business. Like some of the carriers in the individual market, they may use the ACA as an excuse to exit the market.

  9. David Alexander says:

    Elected public officials have one, and only one, goal: to be reelected. Within the structure of the laws and institutions of the country the lawmakers have incredible power to bully, manipulate, buy, cheat, steal and lie to obtain their objective. J.Q. Public is continually tricked into believing some story meant to confuse and distract so the officials get reelected and the circus continues. I don’t expect much to change as long as this recipe succeeds. In order for this process to change it will require some fundamental changes in the concept and role of government and how the cost will be shared. The answer is better information, a media willing to report it and a public willing to act on it.

  10. Charlie Bond says:

    Good morning Friends:
    And so he was a politicians and he lied . . . . but I repeat myself.
    Does this “revelation” by the Post send any message to those of us dealing with health “policy”?
    Health care and health care reform does not belong in the hands of the politicians, but in the hands of the public who are the patients and people affected by how care is delivered in our country.
    Health care financing, which is the principal target of Obamacare, is big business, and the dance of Big Health with Big Government brings to mind the Waltz of the Hippopotami in Disney’s Fantasia. In the meantime, the Baby Boomers are aging and the redesign of medical, hospital and long-term care delivery becomes more and more urgent every day.
    The underlying economics of health care delivery make no sense; our system incentivizes runinous behaviors, and fragments care rather than coordinating it. If we were to set about designing a more costly and dysfunctional system we would be hard pressed to beat what we have.
    So I challenge those of us who have thought of ourselves as policy wonks–you John, Greg, Uwe, and all the readers of this blog (whom I highly respect)–to re-focus our efforts and re-define what we mean by health policy. The politicians won’t fix it. The laws and their potential amendments are hidebound by special interests. It is time to recognize that preaching to Congress and Washington bureaucracy is like preaching to the sinners’ bench full of deaf and hardened convicts (except the sinners bench may be a more respectable lot).
    If we look to government to solve this problem, the interests of greed will be the winners, while common sense and compassion will be the losers.
    So, John, your post trumpets the Post’s “revelation”. Does that not suggest the path forward? It’s the media. Rather than talking to politicians about health care “policy”, shouldn’t we be talking to the public through the media about the public’s power to insist on free market fixes and reforms? Policy should be of the people, by the people and for the people.
    For those readers who are physicians, you have a self-interested collection of colleagues who should join together and reach out to patients and the public. After all, you have a captive audience in your waiting rooms. Mobilize them, align them and begin to work with them to reform health care delivery from the grassroots up, not the top down.
    This is how health care policy can and should be implemented.
    Anyone interested?
    Cheers,
    Charlie Bond

    • Wanda J. Jones says:

      John, Charlie and Friends:

      We probably all believe that the government is simply incompetent to manage such a large project, so should get out of Obamacare. Incompetency is not, so far, an impeachable offense. But galloping ignorance should be. Some possible redirections:

      1) Have a genuine knowledge test of elected officials before they are included in a vote for a new policy move.

      2) Recognize that there is an uneven power equation between the Federal government and all other levels; there should be a buffer organization that can negotiate coverage, access and price. These should be regional healthcare systems, large enough to encompass most of the health services needed by a defined population, but small enough to actually know their markets and advocate for them. Too many of these, too small to matter, and they are still helpless against the ignorance and bad dealing of the Feds. I call it “chartering” which means that there are long term policy frameworks and economic commitments sufficient to realign resources and purposefully adopt new science.

      3. Everyone engaged in this argument about where the healthcare system is going should take a break to notice how it is being transformed despite all of us with healthcare in our professional profile by organizations with technical skills who are applying them to our customers. Look at social media, at device mft who send vital signs via RFID chips, at fitness centers that do heart disease reversal, weight loss, diet planning and joint strengthening for arthritic members. And more. Look at resorts that offer alcoholism rehab, or spiritual support for terminal cancer patients who are ready to stop aggressive treatment.

      4. Go back to the time when there were few hospitals, no medical schools and zero regulations. “Country of origin” groups got together, gave money and volunteered time to produce the “French Hospital,” the “German Hospital,” the Irish Catholic hospital and the Episcopal hospital, along with the Chinese Hospital, the Jewish hospital named Mount Zion, and more.
      Those groups have been superseded by disease-specific organizations funded by their cultural group, as with AIDS clinics. The most promising direction for the future is the Community Health Center movement–if it can only be liberated from its excessive regulation by HHS.

      If all the conservative pundits who are aghast about Obamacare, (me, too) were to accept a collaborative leadership assignment to craft a fresh set of rules/laws suitable to the 21st Century, a set that can be examined by the field and passed by legislatures (most of our current healthcare laws date back to the 1970′s). We need:

      New Mental Health framework
      New licensure laws for health and medical professionals that recognize their down side of restricting entrance to a field.
      New Health facility construction codes to permit lower cost off-site manufacturing.
      New performance oversight via automated reporting from any kind of Health IT.
      New financial incentives to encourage adoption of new science and termination of old science.
      New organization and management forms that encourage competent, aggressive and entrepreneurial leadership from professional managers, to counterweight the influence of medical and health professionals who generally opt for no change.
      New payment methods that recognize the prevalence of chronic disease and the extended relationship that the patient will have with his provider system.

      And so on.

      If anyone wants to work on health facilities construction code, you should start with the work under way under the healthcare section of the American Institute of Architects. For other encouragement, look up the Nov 1 issue of the San Francisco Business Times, which has tables showing the largest construction projects in the Bay Area; many of them are hospitals, and you will astound yourselves if you divide the number of beds into the project construction costs. Or write to me through this site.

      Wanda J. Jones, President
      New Century Healthcare Institute
      San Francisco

  11. Ron says:

    Oh, just wait until January 1 and all state high risk pools are termninated and the highest of the high risks go into the government exchanges! The Obama high risk pool may have 107,000 people but add to that the state high risk pools (and state assignment pools) of another 250-300,000.

    The other accepted expectation (even by progressives)is that the success of ObamaCare relies on previously uninsured and healthy youth signing up. Guess what? ObamaCare raises their premiums by law. Insurers can only charge them 33.3% of premiums for older folks. The actuarily correct pricing can be 20% or lower of older policyholder premiums. In industry jargon this is called “price compression.”

    This single idiocy of ObamaCare (ignoring reality of expected claims by age) raises the premiums for young and healthies at least 50% above what they used to be (before that added benefits and federal mandates).

    It is no wonder why premiums are up 100% and more, and the lie of “your premiums will be reduced by $2500″ is now so evident.

    The biggest presidential lies in history:

    1. I am not a crook – Richard Nixon
    2. I didn’t have sex with that women… – Bill Clinton
    3. If you like it, you can keep you health insurance, period!-B.H. Obama
    4. If you like your doctor, you can keep your doctor – B.H. Obama
    5. If you like your hosptial, you can keep your hospital – B.H.Obama
    6. The ACA is a bipartisan bill, because it includes republican ideas – B.H.Obama
    7. Your premiums will go down by $2500 – B.H.Obama
    8. Republican want dirty air and dirty water – B.H.Obama
    9. Republicans want Down Syndromn children to fend for themselves – B.H. Obama
    10. I will bring the world together and restore respect for the United States – B.H.Obama
    11. I didn’t know anything about Fast & Furious – B.H. Obama
    12. I didn’t know anything about targeting Tea Party groups with the IRS – B.H. Obama
    13. I didn’t know we were spying on Angela Merkle – B.H. Obama
    14. I didn’t know anything about Bengazi – B.H. Obama
    15. Mitt Romnet was responsible for the cancer death of that young women – B.H. Obama
    16. Bill Clinton is a racist – B.H.Obama
    17. Congress is responsible for closing the open air parks and national monuments – B.H.Obama
    18. The sequester means we must halt the public White House tours – B.H. Obama
    19. I have negotiated in good faith with the republicans – B.H.Obama
    20. We will provide stimulus monies for “shovel ready” jobs – B.H.Obama
    21. The summer of 2010 will be the “Summer of Recovery.” – B.H. Obama

    And many only now are realising the “political mistruths”, “disseminations”, and “misstatements”? How about calling them premeditated and purposeful LIES?

    Orwellian?? “The Patient Protection & Affordable Care Act” is neither.

    I could go on, but you get the message.

    • Perry says:

      He called Bill Clinton a racist?? That’s some cojones!

      • Ron says:

        Yes, during the 2008 Dem presidental primary. When Bill was out there campaigning against him and for Hillary.

    • Wanda J. Jones says:

      Thank you for this cogent list. Why are we not talking about impeachment? There is a book out that lists all his breaches of the Constitution, along with his list of lies.

      Wanda J.

  12. Blake Woodard says:

    Ron -

    You rock. Your comment was hilarious — and true!

    Blake

  13. Jim Morrison says:

    One of your better posts, John. Thanks for this one.

  14. L.Brody says:

    I THINK ADMINISTRATION wants sign up chaos, then employers will become frustrated, drop employees into individual mandate, and then every one of all ages goes into Medicaid like universal socialized medicine. Period. As a strategy, this could easily leave into socialized medicine with government coming to the rescue and saying “everyone is covered.” At first they will pay all claims, and then clamp down later. The Affordable Care Act could be changed hundreds of times as law and amendment, and thousands of times through regulations and still be called Obamacare.

    Before, uninsured went to emergency rooms instead of getting Medicaid. Now they would rather sign up for Medicaid, than put themselves under government scrutiny and control as an Obamacare patient even with subsidies, because they sense government control which they can avoid by going to ER.

    Hospitals bill government and private companies with higher rates for ER uninsured services and get paid enough to stay open and in business, but without direct government control. With Obamacare, government controls, but with money from taxpayers and businesses. So Obamacare just creates massive bureaucracies, and extracts money for government’s operations with no assurances the care will actually be delivered to illness care. Uninsured patients waiting in ER’s pay a price with time waiting rather than money, but there is no assurance this will change with Obamacare?

    This administrations knows excellently what it is going and where it is going.

    • Ron says:

      How right you are about them knowing what they are really doing.

      Chaos – As the Maxists say: Create confusion “bototm up & top down” to transform a nation. The populace will be so confused that they will follow anyone with a plan to help them.

      Republucans better coalease around a plan to replace ObamaCare. I tend to like Johns idea of a fixed tax credit. An alternative would be to create an “HSA Nation.”

  15. Ron says:

    https://www.youtube.com/watch?v=iGAdrQ2RpdM

    Copy the above and paste into URL and see the video of ObamaCare promises on keeping your healthcare plan….period!

  16. Wanda J. Jones says:

    John and friends:

    Notice that no member of the press is reporting the roots of the exchange comic dance. Valerie Jarrett has a relative who is an officer in a healthcare IT company in CANADA!!!! And there is another personal tie between a contractor and the project. Also note that the government contracted with over 50 firms, and did not always ask for competitive bids.

    This result was a foregone conclusion the minute HHS said they would see to it that all states had verifiable eligibility information.

    It almost does not matter whether these results come from deliberate falsehoods or incompetence. While we are worried about healthcare let us also worry about our basic government’s ethics and IAQ.

    Wanda J. Jones, President
    New Century Healthcare Institute
    SF, CA

    For those who want to understand Obama better, take a look at his signature; his capital letters are more than 10 times the height of his small letters; this is a massively inflated ego behind which his real self is hiding.

  17. Al Baun says:

    I’m starting to tire of the twist that the statement, “if you like your health insurance plan you can keep your health insurance plan” is a lie. Part of the ACA was to set a basic standard for insurance policies across the nation. If someone grandfathered their existing policy … then they could keep their policy. This is a true statement. However, if one’s insurnace company alters the policy, that existing policy no longer exists and the new one must meet muster.

    Example: If I do no remodel of my residence, i do not have to bring it up to current codes; however, if i do a remodel of any size, i must bring the entire building up to current electrical and safety codes.

    The President did not lie, your insurance companies chose to eliminate your grandfathered policies. No Lie Here. This is an example of free enterprise in action. By kicking existing customers off grandfathered policies, i (insurer) can set new pool prices at my discretion. If i set the prices higher than they should be (20% & 15% Admin), I must refund the excess back to the customers at the end of the year … but in the mean time … I bank the billions in interest on that excess.

  18. Ron Bachman says:

    Al, U gotta be kidding. I love your satire.

    I know u are smart enough to know better, so I can only assume u r satirizing what some Obamatron might try to spin.

  19. Skinny Nicky says:

    Lets say my chief goal was to extend insurance to those with pre-existing conditions. That was the main selling point of this law. And in the end, it might be the only accomplishment it can actually claim with a multitude of absolute disasters.

    If I just wanted to accomplish extending health care to those with conditions- why not just expand medicaid to these 100,000 people and be done with it? Even as a libertarian I could understand the rational behind giving these people help. Why did they have destroy my health care plan, jack up premiums, incur a huge deficit, screw up the employment market all in the name of a radical redesign of the system.

    • Al Baun says:

      Skinny Nicky,
      1) Your Health Care Plan has not been destroyed, simply altered by your insurance carrier … and as a result of their actions … the ACA updates.
      2) Your carrier is fluffing premiums this year for multiple purposes.
      3) CBO still forecasts the ACA reduces the deficit.
      4) Since the employer mandate doesn’t take effect for 14 months, your employment market ‘screw up’ has little to do with the ACA.
      5) Radical design was originally the Heritage Foundations idea, then Republicans, then Romney’s, and finally Democrat (with Republican input).

      You really shouldn’t take what you hear or read on biased sites (yes, including this one) too seriously.

      • Skinny Nicky says:

        Yea, as opposed to a ridiculous obamabot like you repeating talking points. The fact you are unwilling to accept that the strict HHS regs to the ACA created a major hobsonian choice for insurers just shows how intellectually dishonest you really are.

        ThinkProgress gave you at least 1), 3) and 5). The ACA will increase the deficit (1.8 T over 10), even by the CBO’s moronic projections that constantly and drastically underestimate the size and scope of our entitlement spending binge.

        And for 5, I would rather not hear more conspiratorial whining about a plan that was passed, implemented and funded entirely by Ds, with Ds holding a supermajority in Congress and a Democrat President. A rejected 90s Hertiage paper doesn’t get you out of that problem, lib. And it will not sell in 2014, when people like me vote these clowns out.

        • Al Baun says:

          Skinny Nicky,

          Sorry, but with respect to your “1.8T [increase] over 10″, please review the following information.

          “CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade.”

          http://www.cbo.gov/publication/44176

          I would agree with you that ‘clowns will be voted out in 2014.’ It might not be what you expect though.

  20. Paul Nelson says:

    In 2010, the average cost of health per citizen was $8,500 that year. ACA2010 proposed to eventually insure @30,000,000 citizens. Since these citizens were not already on Medicaid or Medicare, we might conservatively estimate their healtcare cost at $3,000. So, this would conceiveably represent an additional Federal cost of $100 Billion a year, an addition to our already very inefficient healthcare industry. Please that nothing in the ACA2010 solves the inefficiency of our nation’s healthcare industry: representing an excess cost in 2010 of $650 Billion.

    From the beginning, it should have been clear that we cannot afford ACA2010. I would propose that we all agree on one litmus test for healthcare reform. Will it reduce our nation’s maternal mortality ratio? In the last 20 years, it has almost doubled. And, to rank among the best 11 of the world’s 43 developed nation’s, we would need to reduce our nation’s maternal mortality ratio by 75%. By any sensible measure, the maternal mortality ratio measures the overall accessibility character of healthcare within a State. Four states already have a maternal mortality ratio comparable to the best ll nation’s of the world: Alaska, Indiana, Maine and Vermont.

    Obviously, we need a new strategy for healthcare reform. Based on the research of Elinor Ostrom, I vote for a decentralized commitment to promote equitably accessible Primary Health Care, community by community. A locally driven focus on their own needs should be augmented by a nationally sanctioned, but not nationally controlled, strategy to upgrade and expand our nation’s capacity to offer enhanced Primary Health Care to each citizen. Success over ten years would be defined by: 1) reducing the cost of healthcare as measured by a change in the percent of the GDP from 18% to 13% AND 2) reducing our nation’s maternal mortality ratio from 13 to 4 (deaths per year per 100,000 live births).

  21. Specks says:

    The bad news…my 61 year old, retired husband’s policy is being cancelled.

    The good news, and you gotta love this…..because so much of our income is either reinvested in tax deferred IRAs and SEPs, or derived from tax free municipal bonds, he is getting a subsidy!!! Thanks to all the young people who will pay it, even though we don’t need it and were perfectly content with the high deductible plan he had chosen!

    • Centrist says:

      Specks, you might want to double-check with your accountant, but I believe the ACA credits are based on ‘Total Income [line 22]‘, not ‘Adjusted Gross Income [line 37]‘. Your ACA income is based on the amount before IRA and SEP deductions, and irrespective of Federal/State taxability of municipal instruments.
      Anyone have different information?

  22. Specks says:

    Centrist…you are correct about Muni income counting in your MAGI. Mea Culpa. But adding it to line 22, he is still eligible. We no longer contribute to tax deferred instruments. My point is that this is all so skewed, with young people subsidizing us when we can afford the premiums. And my main point is that we were very happy with our plan and were told we could keep it!!!

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