When you think about it, it’s kind of an odd thing for him to do. For a number of reasons.
For instance, when you just look at the headline, it sounds like a vote of confidence (See? I believe in Obamacare enough to sign up for it even when I don’t have to!) — which isn’t going to endear him to that portion of the base he has so many problems with. That’s not what he’s doing, of course, but how many of those voters are going to dig deeper and appreciate that he’s doing it as a protest?
Anyway, here’s the release:
Graham Will Enroll in Obamacare South Carolina Exchange, Decline Taxpayer Subsidy for Members of Congress
WASHINGTON – U.S. Senator Lindsey Graham (R-South Carolina) will enroll in Obamacare’s South Carolina health care exchange and forego the special taxpayer subsidy available to Members of Congress.
“I don’t think Members of Congress should get a special deal,” said Graham. “Obamacare is being pushed on the American people and we should live under it just like everyone else.”
Graham noted that under a special exemption issued by the Office of Personnel Management (OPM), he could have enrolled in the DC Health Link exchange and the government would have continued subsidizing about 75 percent of his health care premium. This exemption only applied to Members of Congress and congressional staff.
“As a 58-year old male living in Oconee County my insurance costs are going up about $400 a month, more than 200 percent, under Obamacare,” said Graham. “In addition, my health care coverage will be a fraction of what it used to be. Sadly, I’m not the only one who will feel the negative effects of Obamacare. It’s happening all over South Carolina.
“The worst is yet to come, but I will continue my fight to repeal, replace, defund and allow Americans to opt-out of this horrible government program,” concluded Graham.
#####
Some questions and observations that occur to me as I read that:
- Will he try to do it via the website? If so, is this intended to be the first of a series documenting the difficulties that regular folks may or may not be experiencing with that interface?
- Is the angry part of the base really likely to see this as identifying with them and sharing their troubles? I mean, don’t the folks who hate Obamacare mostly folks who have insurance with their employers, and don’t they tend to generalize people who will actually be on Obamacare as the kinds of freeloaders they despise? I mean, isn’t that the shorthand for Tea Partiers? Doesn’t he, by signing up for it, become even more one of them, a manifestation of the Other?
- If he succeeds in his “fight to repeal, replace, defund,” will he then go back on the cushy congressional plan, or will he, like the people who actually depend on Obamacare, just go without medical coverage? Now that would be one for the books. If he does the first, it makes him look like a hypocrite. If he does the latter, it exposes the need, if not for Obamacare, then for something that achieves the same goals, which is not what the problematic portion of his base wants to have rubbed in their faces. It really sets up an interesting problem.
- Consider the part about “allow Americans to opt-out of this horrible government program.” Here’s the thing about that… No program that achieves or approaches the actual, legitimate goals of healthcare reform (that is to say, effective universal coverage) can allow people to “opt out.” If people can opt out, you’ve got a lousy system that accomplishes nothing and is too expensive to maintain. Everybody knows, or should know, this. Mitt Romney knew it, for instance. There is no reform without a mandate. One of the problems with Obamacare is that the mandate is too weak — you can “opt out” by paying a penalty that is less than the cost of participating, at least at first.
Perhaps other thoughts will occur to y’all. In any case, I thought this a weird way to dramatize his position.
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As a 50 year old in Richland County, my premiums are not increasing by nearly that much, which makes me wonder whether he’s comparing his previous premium, which was mostly paid by his employer, to his current payment where he’s refused the employer-paid portion.
Something just sounds off here — I wonder if he’s released the actual numbers he’s talking about.
Plenty of folks report huge savings!
“Plenty” is a lot fewer than those who had policies cancelled, those who were mistakenly told they were getting subsidies but don’t qualify, those who won’t sign up and pay a fine instead, and those who think they bought insurance but their data never made it to the insurance companies due to back end coding issues.
Just wait til January 2nd when a lot of people who thought they had insurance don’t actually have it.
This implementation has been an abysmal failure… and one that many of us knew was coming.
Gee Doug. Maybe if you quit talking about all the problems with Obamacare it won’t be so bad. Clap your hands so TinkerBelle-Obamacare will live again! Clap your hands and believe, Doug!
Some are- this year.
Be interesting to see how much they like if – after they have to fork out a few thousand for their deductible (whey the incorrectly assumed they were “covered)
or when their premium goes up by 30% next year – because too many young people aren’t interested in having insurance anyway.
It’s bizarre for those and other reasons.
1. The “subsidy”: This part is being reported in a confusing way. The ACA has a subsidy if your income is below a certain level. Initially I thought he was saying he was foregoing that subsidy, which is disingenuous because he doesn’t qualify for that subsidy. If he’s saying he’ll voluntarily foregoing his Congressional coverage (which seems more likely what he’s saying), that’s not a subsidy. It’s just like any other employer paying a part of the premium. This link explains the attempts to confuse the public about this aspect of Congressional coverage. http://www.factcheck.org/2013/08/no-special-subsidy-for-congress/
2. The premium: If as he says, an increase of $400.00 is 200%, that means his employer-assisted coverage this (pre-ACA) year results in a monthly premium for him personally of under $200.00. This is extraordinarily low and he should be grateful that he’s been so fortunate over the years. But voluntarily foregoing that in favor of ACA coverage says nothing about the effect that the ACA is having on premiums generally. How could it? He’s trading in one plan in which he gets a premium assist from his employer for one in which he doesn’t. To compare apples to apples, you need to know, among other things, how much the total premium was for his pre-ACA coverage (ie, both employer and employee portions). He hasn’t given us the data to analyze that, and no journalist seems to understand these issues well enough to insist on it. You’d also need to know more about coverages, deductibles, etc.
3. The political calculation: I agree that it makes no sense. Who does he think he’s scoring points with by choosing an ACA plan? Maybe he’s smart as a fox and the grand plan will become apparent, but like you I can’t see it now.
Hhhm. I thought Sen. Graham was in the active reserves as a JAG in the Air Force, so wouldn’t his health care be covered by the DOD?
Interesting post. I’ll bite. Addressing your questions as you’ve numbered them above.
1. How will he sign up? I think he’ll try to do it via the website first. If he has difficulties – wait, strike that. When he has difficulties going through the website, that will allow him to highlight the problems at the threshold on a personal level. It will likely be dismissed by the left as “anecdotal”, but it will be a compelling case study. I hope he does a daily update on his quest to sign up.
2. What will the “angry base” think”? Let’s just call them the Tea Party. Some of the Tea Party have likely already written Senator Graham off, so for a segment of the Tea Party, nothing he does or doesn’t do will change their mind. For others, I think this will actually be viewed in a favorable light. The people on Obamacare won’t all be freeloaders. They can’t be; that’s not how Obamacare is designed. It’s designed to charge some people (the younger, healthier ones) more than they have been paying to make healthcare more affordable for other people (the older, sicker ones). So, no. I don’t think the Tea Party will look at Senator Graham as a freeloader – especially if his premiums go up and his benefits stay the same. My guess is he’ll pay slightly more, and get services he doesn’t need, like maternity care coverage, substance abuse counseling coverage and birth control coverage. Highlighting the absurdity of his new policy terms would likely help him out with the Tea Party. That’s all IF he manages to actually be able to sign up, pay his premium, and have the information transmitted to the insurance company without errors.
3. If Obamacare is repealed, it’s going to be chaos. What do the millions of people who had their “substandard” policies cancelled do? What do the people who tried to sign up do? If I was general counsel for a health insurance company, I would be drinking heavily. Also, if Senator Graham is remotely instrumental in repealing Obamacare, then the Tea Party will be happy.
4. I agree that you need a coercive mandate under Obamacare, but if you have a coercive mandate, it becomes unconstitutional. The Roberts analysis of “it’s a tax” gets taken away. One of the central factors in Roberts calling it a “tax” as opposed to a penalty was the nature of the tax. If you came up with a “prohibitory amount” of a tax that would make it essentially a requirement that you to buy insurance, I doubt Roberts would call it a tax. A great way to get young, healthy people to sign up would be to (first, get the website working) require everyone sign up under pain of death. That would motivate people, wouldn’t it? But it wouldn’t be a tax. That would be a penalty. That’s the problem. If you come up with a big enough “stick” to motivate people to actually sign up for Obamacare, it becomes unconstitutional. The problem is the Constitution is kind of an impediment to requiring people to do things. Some people think that’s a bug; some people think that’s a feature. I like that about the Constitution, but your mileage may vary.
On a related note, it’s telling that you have to MAKE people sign up for Obamacare. It it was actually better than what they had before, you wouldn’t have to force them to do it, would you? People act in their self-interest. If the policies were better, they would sign up. The problem is that not everyone is getting a better deal. Some (by design) are getting a worse deal.
If Obama had told everyone “Hey look, some of you young people are going to have to pay more for things you don’t need to cover the old people…” this law would never have passed. If he had said “Hey, lots of people are going to have their policy cancelled because of this…” the law never would have passed.
It was a fairy tale from the beginning. All of it. Not EVERYONE was going to see their rates go down by “$2,500”. That’s impossible. But, people believed the fairy tale. Well, some of us did. Now reality is crashing down around everyone, and it’s kind of harsh.
Kathryn’s comment above of “Plenty of folks report huge savings!” makes me think a few things.
1. First, I thought of Kevin Bacon’s character at the end of Animal House saying “Remain calm, all is well.” while the Delta house destroys the parade.
2. How can people be reporting huge savings? No policy under Obamacare has gone into effect yet, right? They don’t go into effect until the new year. So what is she even talking about?
People are reporting that after they have found out what their premiums will be for next year, the premiums are much lower than what they paid this year. Not hard to figure out….
Ok. That makes sense. Point taken. There are some government selected winners.
Hope their doctors stay in the network their information was properly transmitted to the insurance company, and a couple million young folks sign up super-quick to avoid a death spiral.
When you used the word “plenty” did you mean a majority of people or just a large number compared to say 10 or 100?
The evidence appears to be that there are also plenty of people who are paying more. So is that an improvement?
There was ONE thing they had to do: prevent denial of insurance based on pre-existing conditions. ONE THING!
Not allowing deficient policies to be sold is like not allowing the sort of huge balloon mortgages to be sold, the sort that contributed to the 2008 crash.
You gotta get some talking points from somewhere other than DailyKos, HuffPost, and MSNBC.
Would it really hurt to admit that there are aspect of Obamcare that are not so great?
Bryan, thanks for the thoughtful response.
As for “require everyone sign up under pain of death,” we have that already — the problem is that too few young people understand that not having coverage can, indeed, be a death sentence…
“too few young people understand that not having coverage can, indeed, be a death sentence…”
Really? Care to elaborate? People without insurance still get treated.
Sure, here’s one scenario:
1. You have a nagging symptom.
2. You go to the doctor and he wants to do a test to rule out something life-threatening.
3. You decline the test because you have no coverage and it would be expensive. Anyway, you think you’re going to live forever.
4. A fatal condition goes undetected and untreated.
5. You die.
Or, the condition is a serious, chronic, and expensive to manage one. Or an accident leads to such a condition. Or some other unanticipated thing happens to turn your healthy life upside down.
Insurance is mitigating the risk of the unforeseen. Young, healthy people are horrible judges of the near certainty that some day, in some way, things will go horribly wrong. I have no issue with forcing them to act responsibly by acquiring health insurance which they will surely, one day, need. Nobody can project when that day will come; although we all are good at deluding ourselves into believing the day is far away.
How often does that happen? How many 20-somethings are we talking about? Is it enough of a crisis to mandate every one them buy insurance?
Or I should say, mandate rich people to be forced to subsidize the insurance of people who don’t want it or can’t pay for it. That’s what Obamacare is – a transfer of wealth.
And the part people don’t talk about is the deductibles. Many of these Obamacare policies have deductibles that are so high that the subsidized people won’t be able to afford them anyway.
You only get treated automatically if it is an emergency.
Or are an illegal immigrant… One hospital in Las Vegas was providing $ 20 million dollars a year in dialysis treatment to illegals.
Doug: the Emergency Treatment and Active Labor Act (EMTALA) requires hospital evaluate your condition and stabilize you only. They don’t have to provide comprehensive care to treat a serious condition such as metastatic testicular cancer for example or a heart or liver transplant. No treatment you die. You may die quickly with sufficient pain management but chances of being treated are decreasing.
You also won’t qualify to a transplant unless you can document you have $100,000 to deposit and/or insurance will to pay for the anti rejection medications. Don’t have either you don’t make the organ waiting list and you die. Being uninsured was estimated by the Institute of Medicine to be the 11th leading cause of death in the US.
I have said before, that, as a family, we are going to recognize significant savings. I don’t qualify for a subsidy, so I went directly through the insurance company’s website (yes, healthcare.gov was a mess). So I’m at least one example of someone who was in a bad situation without the ACA, and this will make it much better. I don’t know what “government selected winners” means, but in my case, we could not get private insurance directly. We were simply refused coverage.
Significant premium savings?
or significant savings?
Those are two different things. When you have an injury or sickness, and it comes time to pay that deductible, you’ll face that issue.
The policies that were supposed to be disallowed under ACA had the delightful features of low premiums and virtually nonexistent coverage, and/or were frequently cancelled if you actually used them.
Do you really believe that all of the millions of canceled policies had virtually nonexistent coverage? There must be some really stupid people out there.
I’m so old I remember when the goal of Obamacare was stated as “getting everyone covered”. Millions of people are now without health insurance, because the White House decided to write the regulations specifically to cancel the most plans possible. Currently, we have fewer insured people than we did in 2010. (Brad, did I use “fewer” correctly there? I can never get fewer/less straight.)
Now it’s changed to “getting rid of everyone’s plan that the White House doesn’t like and forcing them to get Government Approved™ health insurance plans.
But hey, it’s all good. If you like your plan, you can keep your plan….unless the White House doesn’t like your plan.
@KF – As opposed to the policies allowed under the ACA that have high premiums and bankruptcy-inducing deductibles?
Not having good medical insurance is bankruptcy inducing, Silence. If one is going to be bankrupted by $5,000 or $10,000; that says something.
As a taxpayer; I would rather have a few people go bankrupt that way – who likely would from something else anyway – than to have a system like now where they may either be uninsured or underinsured and we as a society get stuck with their massive medical bills – which would in all cases far exceed $5,000 or $10,000.
Nearly everyone should embrace high deductible plans. Really.
The same folks who can’t afford the premiums for the health insurance are also the ones likely to be bankrupted by the co-pays and deductibles anyhow.
I am a fan of high deductible plans, by the way, but they really are designed for people who have some level of assets to protect.
Both. I am fully aware of what my premiums and deductibles will be, and their impact on my total healthcare costs.
Actually, I find your response to be insulting. I’ve been an adult for many years — I understand healthcare plans. Many of us do.
Until Sen. Graham releases the specifics of his ACA plan coverage with a comparison of the 2014 Congressional plan he says he will forego, this has all the earmarks of a political stunt.
Some factual information on Obamcare…
http://finance.yahoo.com/news/top-tier-hospitals-excluded-obamacare-191700528.html
– Very few of the top hospitals will be available to those insured under Obamacare plans, including the top top cancer hospitals
– Many of the policies being offered on the federal and state exchanges carry annual deductibles that often top $5,000 for an individual and $10,000 for a couple, according to The New York Times. This is what is making the “savings” appear larger. (A $5K deductible is the equivalent of adding $415 a month)
“A report from the Kellogg School of Management at Northwestern University indicates that Obamacare rules intended to rein in costs and lower Medicare reimbursement could actually decrease available care. The author studied the roll-out of the State Children’s Health Insurance Program (SCHIP) in 1997and found that while the new law expanded access, it also led to shorter patient visits and to “significant numbers of physicians electing to work fewer hours,” most probably in response to lower reimbursements. The study projected that we might see fewer and less qualified medical students in the future, as the financial rewards of practicing medicine decline.
This is not rocket science; people respond to incentives. Take away the prospects of high pay, and fewer kids may agree to the rigors – and expense, and time — of becoming a doctor.
– See more at: http://www.thefiscaltimes.com/Columns/2013/11/27/Obamacare-Aftermath-Fewer-Doctors-Higher-Costs#sthash.WsC09Zaa.dpuf
A $5,000 max out of pocket deductible is not in any way the same thing as paying an extra $416.67 per month for coverage. Is that your math, Doug, or a writer’s summation of stilted research?
A large deductible is like a bit of self-insurance; it rewards judicious healthcare spending while still protecting one from catastrophic expenses.
I would take a large deductible and a smaller premium every day – because it isn’t every year that I would spend my way through that deductible. In fact, it would be the very rare year that one would. So most years that extra $416.67 per month stays in the insured’s pocket.
I know that this is a complicated financial calculation (that’s why a massive insurance industry was spawned). But we need to have more rigor here when we analyze costs and types of costs – and even more so when we try to compare apples and oranges.
And since these plans generally meet the requirements for an Health Savings Account, I put $6000/year into one and that allows me to pay all of the medical bills until I reach the deductible with pre-tax money, giving me a 20+% savings on all my medical bills (which are of course already lower than they would be if I had no insurance because the network price is lower than the individual price). And I can use that money to get the savings on things that my insurance doesn’t cover at all, like glasses. Yep, high-deductible HSA-compliant accounts are the way to go for many of us.
And one can roll the HSA over year to year.
It’s amazing the things people fear… having pre-tax money set aside to cover a large deductible, if needed. SCARY!
I thought that Obamacare changed the rules on HSA’s? This is what I see:
“The new law reduces the amount of money you can contribute to these accounts and shelter from Uncle Sam’s reach. It also creates stricter rules about how the dollars you put away can be used. These new rules and penalties are designed to generate revenue to offset the cost of the health care reform law’s health insurance tax credits and other spending.
Flexible spending accounts, or FSAs, allow employees to sock away tax-free dollars that can be used to pay for medical expenses such as drug co-pays, deductibles and treatments not covered by insurance plans. Up until now, there hasn’t been an official limit to how much you could contribute to an FSA, although IRS rules dictated that employers create some kind of maximum contribution. Many employers cap the amount in the $2,000 to $5,000 range according to a 2009 report by the Center on Budget and Policy Priorities in Washington, D.C.
Starting Jan. 1, 2013, FSAs will have annual limits of $2,500 per year. Going forward, the limit will rise annually based on the rate of inflation. Still, it likely will remain above the average employee contribution, which was $1,424 in 2009, according to Mercer’s National Survey of Employer-Sponsored Health Plans, an annual report on health care benefits.
In addition, FSAs will remain “use-it-or-lose-it” accounts. That is, any unused balance for one year can’t be used to fund health care spending in the next year.”
FSA’s are use it or lose it – so there is no incentive to go larger than you will know you will spend that year (who one is supposed to “know” that before Jan 1st is beyond me).
HSA’s roll over. So it makes sense that the government would need to limit these to lesser sums (but still plenty to cover the deductible plus other misc items).
I really don’t see the issue here? It’s pre-tax money and doesn’t expire; sounds good to me.
Yeah, I don’t have an FSA (for one, that would assume I have an employer-sponsored plan, which I don’t), I have an HSA —
I’m opposed to HSA’s and FSA’s. Why should the tax code be used as an incentive to save money (and get a bonus on top of that by making it tax free) for medical care? Every rule opens up an opportunity for more legislative tinkering.
Also, Mark, all it would take would be one single trip to the emergency room to generate a bill that would eat up most if not all of that deductible. The people who are getting subsidies are not setting aside $5000 for those expenses. They will be in the same boat they are in now.
Isn’t this an argument FOR requiring people have health insurance? So then at the worst the hospital would only have to write off some portion of the deductible amount and then they would get the rest from the insurance company? And the person, while they might have to pay it off over some period of time, at least has some hope of paying it. It’s when that bill gets up into 5 and 6 digits that people have no hope of paying it and it causes large amounts of pain for everyone.
Let me be clear: I think people SHOULD buy insurance. I don’t think they should be MANDATED to buy it nor do I think they should receive subsidies to pay for it. There should be two options: you buy it or you are on Medicare/Medicaid.
If someone says “I can’t afford it at its true cost” then I want that person to prove they don’t have cable TV, a cellphone, an Xbox, or eat meals out. Insurance should come before all those expenses.
I don’t want other people to be responsible for my stupidity and I don’t want to be responsible for other people’s stupidity.
If you have a family with a couple kids, what do you think the chances are that you will have a medical event that would cost $5-$10K sometime during their childhood?
Sometime possibly! Not every year!
This is a grey world situation. I get that some people are more fluid in these conceptualizations than black and white thinkers. But everyone needs to understand these things in a rudimentary way.
So… MD Anderson, Sloan Kettering, and Cedars-Sinai aren’t going to be available under Obamacare? That’s the top two cancer centers in the word and probably the top research/teaching hospital in the US.
From The Economist –
“Obamacare’s design all but guaranteed limited choice and high out-of-pocket expenses. The insurance sold on the exchanges must comply with many rules: plans must cover a long list of “essential health benefits”, must not charge more to sick patients and must have a set “actuarial value”. (An actuarial value of 60% means that, for an average person, the health plan will cover 60% of health costs. The patient will have to cover the rest from his own pocket.) Obamacare plans are classified as bronze (60% actuarial value), silver (70%), gold (80%) or platinum (90%).
These standards make it easier to compare one plan with another. But they also give insurers relatively little room to differentiate their products. To compete on sticker price, they have to cut costs. They typically do this by restricting choice. Out-of-pocket costs are limited by Obamacare’s actuarial rules—patients who buy bronze plans, by definition, can expect to pay for more care with cash. But insurers can also compete by trying different assortments of co-pays and deductibles.
…
However there are drawbacks, particularly for the sick and the poor. Obamacare limits out-of-pocket spending, with caps on a sliding scale based on income. Even so, individuals with chronic ailments will likely shell out thousands of dollars, according to Avalere Health, a consultancy. A man earning just $23,000 will have to pay $5,200 in deductibles and co-pays before reaching Obamacare’s cap on out-of-pocket costs. That is a whopping one-quarter of his income.”
Let’s do a little recap. Everyone has some good points. First, it is very clear that the old way was not working very well. Many of the problems Doug, Bryan and others make actually did exist before Obamacare. Costs were rising. There has always been this in-network issue. And we had the pre-existing conditions problem, young people were not signing up. Many insurance plans were junk. Folks were going bankrupt and dying because of the system. Those are pretty much unimpeachable facts so we have to assess the ACA compared to that not some cornicopian ideal that really didn’t exist.
Are there winners and losers with the ACA? Absolutely. Doug continues to come up with examples of the losers. Not sure in the individual market a whole lot of people are really losers once you factor in what certainly would have happened absent the ACA, I would maintain there are more winners but it’s hard to know. Young people who can stay on their parents plan, moderately poor in states accepting the Medicaid money and especially folks with pre-existing conditions are winners.
We really won’t know for sure until the dust settles and we see who is covered but my take is the ACA is too complicated and divisive to be considered a rousing success. I really don’t feel comfortable defending it with great enthusiasm because of it’s complexity. But it does seem a necessary first step toward where the rest of the world is on healthcare. I’m content to sit back and see how it works for a few years then move on to phase 2.