Why conservatives are so obsessed with guns.

Don’t Blame Health Law for High Part-Time Employment – Real Time Economics – WSJ

Don’t blame the health law for high levels of part-time employment. In fact, using the law’s definitions, part-time work isn’t increasing at all as a share of employment, at least not yet.

Nearly 8 million American were working part-time in September because they couldn’t find full-time work. Overall, 27 million people — nearly a fifth of all employees — are working part-time, well above historical norms.

Many critics of the Obama administration have pointed the finger for the prevalence of part-time jobs at the Affordable Care Act, the 2010 law better known to some as “Obamacare.” The law’s so-called “employer mandate” requires most midsize and larger companies to offer health insurance to their full-time employees. That, critics argue, provides companies with an incentive to hire part-timers instead.

The Obama administration earlier this year said it would delay the requirement until 2015 to give companies more time to comply. But some employers have said they are nonetheless cutting back on full-time hiring. Indeed, part-time employment rose early this year, while full-time employment growth stalled.

But a closer look at the data provides little evidence for the notion that the health law is driving a shift to part-time work, although it could as the mandate deadline approaches.

First of all, over a longer time frame, part-time work has actually been falling as a share of employment in recent years. Before the recession, about 17% of employed Americans worked 35 hours or less, the standard Labor Department definition of “part time.” During the recession, that figure rose, briefly hitting 20%. It’s been trending down since then, but only slowly, hitting 19% in September.

Don’t Blame Health Law for High Part-Time Employment – Real Time Economics – WSJ

What Do PPACA Standards Mean for Employers’ Health Plans? | Towers Watson – Towers Watson

Large employer and self-insured plans

Employers with 101 or more employees may not purchase coverage for their employees through the state insurance exchanges, at least until 2017.⁶ Employer plans need not cover all 10 essential benefits or classify their plans into actuarial value tiers. Nevertheless, the PPACA requires large-employer-insured plans and all self-insured plans, whether offered by large or small employers, to meet similar standards for benefit generosity and plan affordability:

Actuarial value: Under the PPACA’s employer pay-or-play mandate, employers with 51 or more full-time employees must offer at least one plan with an actuarial value of at least 60% or face potential penalties. Employees of large firms that fail this “minimum value” standard may become eligible for federal premium assistance tax credits to buy coverage in the exchanges. When employees qualify for these credits, the employer must pay a penalty of $2,000 per full-time employee or $3,000 per full-time employee receiving a premium assistance tax credit, whichever is less. Large firms that do not offer a health plan to all full-time employees also face a penalty of $2,000 per full-time employee.⁷

“Core” benefits: Most plans offered by large employers already include benefits similar in scope to the 10 statutory essential health benefits, but the law does not require large-employer-insured plans or any self-insured plans to satisfy this standard. The Internal Revenue Service (IRS) has proposed basing actuarial value calculations for these plans on four “core” categories of health services: physician and midlevel practitioner care, hospital and emergency room services, pharmacy benefits, and laboratory and imaging services.⁸ The four core categories include 95% of the charges covered by a benchmark plan with broad coverage.⁹ In practical terms, this difference is likely to have little material impact on actuarial value estimates.

Employer premium contributions: Employees of large firms that offer coverage meeting the minimum value standard are not eligible for premium assistance tax credits or cost-sharing subsidies in an exchange unless their share of the employee-only premium in the employer’s lowest-cost plan exceeds 9.5% of family income. Employers whose coverage does not meet this affordability standard must pay the same financial penalty as firms that fail the minimum value requirement. The IRS proposed regulation applied the affordability standard only to single coverage, but the final regulation suggested that future guidance will address family affordability. The regulation could make nonemployee family members eligible for premium tax credits where the self-only coverage is affordable but the family coverage is not.

How do current employer plans compare with exchange standards?

Figure 1 depicts key cost-sharing provisions for prototypical plans that might be offered in the four exchange tiers in the individual market. These plan designs are largely similar to plans that employers currently offer with the exception of the bronze plan, which has considerably higher cost sharing than most current employer plans. The $3,000 deductible is about $1,100 higher than the average deductible for an account-based health plan (ABHP) in 2010.¹⁰ The PPACA might cap deductibles for all employer-sponsored plans at $2,000 (see sidebar), potentially making it difficult for employers to design a plan with a 60% actuarial value.¹¹

Figure 1. Prototypical health plans in each exchange tier

What Do PPACA Standards Mean for Employers’ Health Plans? | Towers Watson – Towers Watson

Michigan’s Approach to Medicaid Expansion and Reform — NEJM

Five core principles are evident in Michigan’s approach to expanding and reforming Medicaid under the ACA. First, the state must achieve sufficient savings to offset its contributions for the Medicaid expansion when federal funding drops from 100% to 95% in 2017 and to 90% in 2021. Medicaid coverage of some state-financed health services, including mental health and prison health programs, is expected to result in approximately $200 million in savings for the state budget in 2014. If the state’s costs are not offset by such savings, Michigan will withdraw from the Medicaid expansion in 2017 or later years. But current projections indicate that the state’s cumulative savings should cover the additional costs through 2027.5

Second, Michigan will introduce financial incentives for new Medicaid enrollees to control their use of health care services and to maintain healthy behaviors. For 150,000 new enrollees with incomes between 100% and 133% of the federal poverty level, cost sharing amounting to as much as 5% of their annual income (approximately $580 to $775 for a single adult) is slated to begin 6 months after Medicaid enrollment. After 48 months of Medicaid coverage, cost sharing for these new enrollees will increase to 7% of their annual income, or they can choose to enroll in subsidized private insurance offered through the state’s health insurance exchange. A system resembling health savings accounts will be created for individuals or their employers to deposit funds to cover copayments for health care services. Cost sharing can be reduced to 2% of annual income for new enrollees who demonstrate that they engage in healthy behaviors.

Third, the state will enroll newly eligible adults in private health plans rather than in traditional fee-for-service Medicaid. Health plans will be eligible for financial bonuses for effectively managing enrollee cost sharing required by the state and for achieving cost and quality targets. Health plans will also be directed to implement value-based insurance design by varying cost sharing according to the clinical value of services provided.

Fourth, Michigan’s new law addresses health care delivery by requiring that new enrollees have access to primary care and preventive services. New enrollees will also be offered the opportunity to complete advance directives for end-of-life care when they enroll in Medicaid — part of a broader state initiative to encourage residents to express their preferences regarding end-of-life care.

Fifth, Michigan’s new Medicaid law enhances the state’s capacity to monitor the costs and quality of health care. The Department of Community Health, which oversees the Medicaid program, will assess opportunities for improving the Medicaid program and make Medicaid data available to outside vendors that can help participating health plans to pursue innovations in the program. The Department of Insurance and Financial Services will evaluate the effect of the Medicaid expansion on private insurance premiums in the state; some reduction in these premiums is anticipated.3,5 A new Health Care Cost and Quality Advisory Committee will be created to promote greater transparency with respect to the costs and quality of care.

Michigan’s Approach to Medicaid Expansion and Reform — NEJM

Final Word On Obamacare Coverage: Cheaper Than Expected

It’s the definitive look at the insurance market with less than a week to go until the marketplaces open for enrollment.

"We’ve done a pretty good job of getting affordable options on the shelves," Jeanne Lambrew, deputy assistant for health policy to Obama, told reporters Tuesday in advance of the report’s public release. "That is success that we’ve gotten to the point where we can say that."

On average, people will have a choice of 56 different insurance plans — depending on which state you live in, though, that figure could range from seven (in Alabama) to 106 (in Arizona). The average number of insurers in a state is eight, though that again ranges from one to 13 in different states.

As for premiums, before tax credits kick in, they will average 16 percent below the Congressional Budget Office’s original estimates for a silver-level plan (which covers 70 percent of costs). The number of insurers in a state is directly tied to how low premiums will be, Lambrew noted. Arizona, with an average of 106 plans to choose from, had the second-lowest average premiums for a 27-year-old adult: $166 a month. Wyoming, with an average of 16 plans, had the highest average premium at $342 a month.

But then the tax credits take effect. Those knock the premium for that 27-year-old, projected to earn $25,000, down to $145 in most states. For a family of four making $50,000, the credits take the premium price down from more than $1,000 in some states to $282.

The numbers before and after tax credits drop even further for bronze-level plans (which cover 60 percent of costs), often below $100 on average when tax credits are accounted for. White House officials routinely note a recent study that found 6 in 10 uninsured Americans will be able to purchase coverage for less than $100 a month.

Some might still find it preferable to pay the individual mandate penalty ($95 for the year or 1 percent of their income, whichever is greater), as Kaiser Health News reported Tuesday.

Final Word On Obamacare Coverage: Cheaper Than Expected

Uninsured in Texas and Florida – NYTimes.com

A new Census Bureau report documents the alarming percentages of people in Texas and Florida without health insurance. Leaders of both states should hang their heads in shame because they have been among the most resistant in the nation to providing coverage for the uninsured under the Affordable Care Act, the law that Republicans deride as “Obamacare.”

Uninsured in Texas and Florida – NYTimes.com

“Secretary of ‘splaining” – NYTimes.com

“I have agreed to give this talk today because I am still amazed at how much misunderstanding there is about the current system of health care, how it works, how it compares with what other people in other countries pay for health care,” Mr. Clinton told the crowd assembled in a hall around the corner from a montage of black-and-white photographs of the 1992 presidential campaign. The audience of about 250 included Gov. Mike Beebe, a Democrat, and Speaker Davy Carter of the Legislature and Michael Lamoureux, president of the State Senate, both Republicans.

Despite the bipartisan show, health care is a contentious topic in Arkansas politics that conservatives have seized on in local campaigns. Mr. Pryor did not attend the event for risk of being too closely associated with the health care law, according to one person with knowledge of his plans, but who was not authorized to discuss them publicly. A campaign spokesman has said that Mr. Pryor had a scheduling conflict.

With the new insurance markets set to open on Oct. 1 for an initial six-month enrollment period, the White House has asked cabinet officers and other presidential appointees to step up efforts to promote the law. The administration has also recruited actors and entertainers and is seeking athletes and disc jockeys to whip up enthusiasm. Last week, the singer Katy Perry retweeted a Twitter post from President Obama encouraging young people to sign up for coverage. He responded, “Thanks for spreading the word.”

Mr. Clinton’s speech, which the White House broadcast live on its Web site, was not the first time that the former president, whose own attempt to sell a universal health care law failed drastically in his first term, has stepped into the debate over the new law. At the Democratic National Convention last September, Mr. Clinton delivered an endorsement of Mr. Obama that included concrete, well-received explanations of his policies, including on health care. That speech in particular signaled to the White House that Mr. Clinton could be an effective surrogate to sell the highly complicated Affordable Care Act.

On Wednesday, the former president carefully laid out Mr. Obama’s plan without delving into politics. But his mere involvement in selling the law provides him with a platform to reframe the failed battles of “Hillarycare” from his own administration.

“It would not be in her interest to be running for president and have this be a huge controversial issue in 2016,” said Robert J. Blendon, a professor of health policy at Harvard who closely follows public opinion of the law. “The Clintons have a lot of interest in getting this up and working and making it a legacy for the Democratic side.”

Reading glasses perched on his nose, Mr. Clinton struck a professorial tone as he explained in extensive detail the intricacies of the act. He laid out who would qualify for federal subsidies to help pay for the cost of coverage through the new markets and even ticked off Web addresses and phone numbers where Americans could find information.

Clinton Urges Americans to Sign Up for Health Care Exchanges – NYTimes.com

Obamacare Showdown Over a Ham Breakfast in Kentucky – NationalJournal.com

Beshear’s advocacy, by contrast, was striking in its intensity and in how personally he approached the issue, picking up on the idea that many people who don’t have health insurance are embarrassed by that and don’t talk about it.

The governor compared health insurance to "the safety net of crop insurance" and said farmers need both. He said 640,000 Kentuckians—15 percent of the state—don’t have health insurance and "trust me, you know many of those 640,000 people. You’re friends with them. You’re probably related to them. Some may be your sons and daughters. You go to church with them. Shop with them. Help them harvest their fields. Sit in the stands with them as you watch your kids play football or basketball or ride a horse in competition. Heck, you may even be one of them."

Beshear went on to say that "it’s no fun" hoping and praying you don’t get sick, or choosing whether to pay for food or medicine. He also said Kentucky is at or near the top of the charts on bad-health indicators, including heart disease, diabetes, cancer deaths, and preventable hospitalizations. He said all that affects everything from productivity and school attendance to health costs and the state’s image.

"We’ve ranked that bad for a long, long time," he said. "The Affordable Care Act is our historic opportunity to address this weakness and to change the course of the future of the commonwealth. We’re going to make insurance available for the very first time in our history to every single citizen of the commonwealth of Kentucky."

About half the audience burst into applause at that point while the other half sat on their hands. But he wasn’t done. He cited a study that showed the law would inject about $15.6 billion into the Kentucky economy over eight years, create 17,000 new jobs, and generate $802 million for the state budget.

"It’s amazing to me how people who are pouring time and money and energy into trying to repeal the Affordable Care Act sure haven’t put that kind of energy into trying to improve the health of Kentuckians. And think of the decades that they have had to make some kind of difference," Beshear finished pointedly.

Obamacare Showdown Over a Ham Breakfast in Kentucky – NationalJournal.com

Engaging confidently on health care reform | Battleground Surveys

Republicans will run on health care reform in 2014 and 2016, so get used to it. But do not believe that it will give them a better chance of securing their seats or the best shot at putting competitive Democratic seats in danger. Democrats in the most rural and the strongest Romney seats will have to be inventive as usual, but Democrats have a lot to say on health care: fix it, don’t repeal it, don’t put the insurance companies back in charge and take your hands off Medicare.

Health care is just not a wedge issue that threatens to change these races very much – as we saw in the 2012 elections where Republicans played out this strategy. This is basically a 50-50 issue in the battleground districts and the country, and it remains a 50-50 issue after voters have heard all of their toughest attacks, including one on the role of the IRS in the new system. These attacks have power, and it is important to engage on the issue. But there is no reason to think the debate changes the dynamic in these competitive House seats: we actually show Democrat members gaining on handling health care reform in their own seats.

Why is it that the popularity of the Republican Congress keeps going down as the Republicans vote now 40 times to repeal the Affordable Care Act, despite that the law is not popular with the public? We suspect because the House Republicans are associated with gridlock, extreme partisanship, and intense anti-Obama sentiment; because voters have other serious priorities and their steadfast focus on health care alone says Republicans are not focused on them and their issues; because Democrats are more trusted than Republicans on health care; and most important because voters do not want to repeal the law. The more voters hear “repeal,” the less they are interested in voting Republican.

We know Republican base voters feel intensely about health care reform, but voters rank “government takeover of the health care system” pretty low as a concern about Democrats in Congress.

These results suggest Democrats should engage the issue with some confidence — they can undermine the Republican attacks and indeed gain an advantage by educating the public on the reforms.

Engaging confidently on health care reform | Battleground Surveys

If this health plan is ‘socialism,’ we need more of it — latimes.com

If this health plan is ‘socialism,’ we need more of it

As Obamacare’s exchanges take shape in California, true, transparent, capitalistic competition will be seen among insurance firms, going toe to toe to win consumers.

David Lazarus

6:18 PM PDT, May 23, 2013

So this is what socialism looks like: Private companies competing for people’s business in an open marketplace.

Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don’t receive health insurance from employers.

In southern Los Angeles County, for example, Health Net is charging $242 a month for one of its plans. Blue Shield is charging $287 and Kaiser Permanente $325 for the same coverage.

For the first time, consumers are in a position to make an informed decision about health insurance. They can opt for the lowest-priced plan or they can factor in other considerations, such as personal convenience.

Insurers, meanwhile, are going toe to toe to win customers, keeping prices as low as possible and stepping up quality of service.

Amazingly, the sky hasn’t fallen and the world as we know it hasn’t come to an end.

Critics of Obamacare have long warned of the dire consequences of reforming the U.S. healthcare system. The federal Affordable Care Act constitutes a government takeover of healthcare, they have said. We might as well be living in Cuba.

In reality, what we’re seeing is some much-needed sunlight being cast upon a market that for too long has operated largely in the shadows, denying consumers the information they need to make choices about medical treatment.

Private insurers will have to meet minimum standards for coverage when they begin open enrollment in October, allowing people to compare apples to apples for the first time when shopping for individual or family policies.

Insurers also will have to post their prices in a clear and easily accessible fashion, introducing a long-absent element of competition to the market.

"It will be a one-stop shop for selecting policies," said Devon Herrick, a healthcare economist at the National Center for Policy Analysis. "That should make things a lot easier for people."

If this health plan is ‘socialism,’ we need more of it — latimes.com

Market, insurers will keep premiums low, analysts say

Just how much premiums will change depends on the state you live in, Kingsdale said.
Individual premiums decreased when Massachusetts’ health care took effect, he said, because the state already had high-priced and insurers were not allowed to turn away the sick and could not charge large premium differences based on age, gender and health.
“Other states will see exactly the opposite happen,” he said. “Their premiums tend to be quite low, but they’re getting skimpy insurance.”
In Oregon, Ario said, large differences in premium prices have already appeared.
In one case, a 40-year-old non-smoker in Oregon could buy a low-cost or bronze-level plan for $162 a month from one company or the same plan from another for $400 a month, Ario said. Anti-trust laws prevented the insurers from comparing pricing before developing their premiums.
When the companies with the higher rates saw their competitors’ lower premiums, he said, they asked the state to allow them to file for reduced premiums.
“The good news is that in most marketplaces, there will be some carriers that will be bold and price competitively to get more market share,” Ario said.

Market, insurers will keep premiums low, analysts say

For a quick rundown on what the “gold, silver, and bronze” plans will cover, go here.