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The ACA: Another Story Behind The Numbers

Category: Health Care
Posted: 07/24/14 18:26

by Dave Mindeman

We hear so many talking points from Obamacare opponents that we almost take it for granted that the ACA is extremely unpopular. The polling seems so overwhelming that nobody bothers to even look at the real numbers.

Well, right now we are going to do that.

A recent (July 18-20) CNN poll gave us the usual headline. Obamacare is favored by only 40% of Americans.

Here are the total numbers:

Favor 40%
Oppose 59%
No Opinion 1%

Even the fact that only 1% have no opinion means that our attitudes have been firmly entrenched.

But CNN asked a follow up question.

(IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?

They only asked that question of the people who stated they opposed Obamacare. And they found the percentages ended up like this:

Favor....................................40% (the original number favored)
Oppose (Too Liberal)..............38%
Oppose (Not Liberal Enough)....17%
No Opinion...............................5%

No only did they find out that 17% didn't think Obamacare went far enough, they confused another 4% enough that they went to undecided.

I would speculate that the 17% are single payer advocates. And there are probably also a number of single payer advocates (like me) that will poll in favor of Obamacare because we assume that we can't get what we really want - single payer...or at least some kind of government option.

If you extrapolate that into the poll, you could surmise that some kind of government health care system is favored - 57% to 38%.

But that requires some nuanced thinking and probably a more detailed poll to be completely accurate. And we are not getting that kind of in depth coverage on this issue.

What is interesting is that CNN has been polling with this method for the last 4 years....and that 17% number is the highest it has ever been. In fact, it is up 5% since the last poll in March. Why don't we hear about that? Because the narrative has already been established.

I believe that Obamacare would not be having the credibility problems it is having presently if the technology of the websites (Federal and State) had not failed us. If only the preparation and testing had been more thorough, the controversies could have been avoided.

The bottom line is that Obamacare did succeed in its main goal. More people have health care than ever before. Massachusetts has nearly 100% coverage....and even Minnesota, with its website debacle is moving in that direction.

In Minnesota, we have an opportunity to put all of these problems behind us by passing the Minnesota Health Plan. It is languishing in our legislature, ready to be debated and passed. With it, we can stop the website issues. We can cover every one of our residents. We can cut costs and end all the duplication. And we can do what it would seem that 57% of Americans want - health care for all.
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GOP Guv Candidates Still Talking MNsure

Category: Health Care
Posted: 07/18/14 13:42

by Dave Mindeman

The GOP candidates for governor are still making MNsure a main component of their campaigns. But are they offering any real alternatives?

1. Scott Honour - He wants to scrap the state exchange and opt into the Federal exchange. The Federal exchange had as many, if not more, problems than MNsure had at the beginning....and the Fed exchange has maybe made a little more progress on fixing it. But the essential dynamics of the ACA will not change - so what Honour is really talking about is changing tech venues. Does that mean he now supports the ACA iteself? Minnesotans generally like to be in control of their own processes and since we already have used our allowed Fed subsidy to make our own exchange - and we have made progress on identifying the tech problems, why not keep it Minnesota based and invest a little more to make it right? I doubt Honour's idea will fly.

2. Jeff Johnson - The GOP endorsed candidate wants to keep the exchange and local control. But he does want to apply for a waiver to remake health care in our state. He doesn't have anything specific which probably means he doesn't know what to do about that. Besides, even with a waiver, he still has to meet the basic goals of the ACA and its guidelines. I doubt he can find any compromise in that vein which will be accepted by the GOP base. So, essentially, Johnson is using rhetoric as an answer.

3. Kurt Zellers - Zellers wants a waiver as well, but he thinks he is going to get Democrats to join him in his quest. He puts it this way...

"Time is going to be on our side. You look at it. The federal system isn't working," Zellers said. "We were supposed to have everybody insured. We were supposed to keep our doctor. We were supposed to keep our clinic."

The first problem with that is that what he is saying is not true. Minnesota has the second highest insured population in the country. Only Massachusetts is higher at this point. And about keeping your doctor -- prior to the ACA and with the ACA, when have we ever had that guarantee? When we have to use employer based coverage, we have to go with the network chosen by our employer. That can change from year to year and with that, what doctor is in the network can also change. Since which insurance determines this - and since the ACA uses insurance in the exchanges - nothing really changed. Same goes for clinics.

Now if Zellers wants to get a waiver and go for John Marty's Minnesota Health Plan (single payer), then he will get a lot of Democrats on board. Trouble is, he would lose all the Republicans.

4. Marty Seifert - Seifert wants to include more insurance companies in the exchange. He said allowing for-profit and out of state companies to offer insurance on the exchange would lower costs and improve quality. But, as I understand it, for-profit insurers are allowed, they just have administrative expenses capped. Minnesota may have more restrictions on that, but allowing other insurers from out of state would require that they meet MN's regulations and the minimum ACA regs. So, as I have stated before, what rates they have in their own states would have to be completely reformulated to do something in Minnesota. This has been suggested by GOP circles before and it still has the same problems. Nothing new from Seifert on this one. But given all of that, I do think that there will be more insurance companies headed for the exchange anyway.... many were waiting to see how things happened in the first year before taking the plunge. Seifert's premise is really just status quo.

****************************************

I continue to defend the basics of MNsure and still agree with the criticism of the website itself. The ACA works on getting the uninsured covered. Universal coverage is a basic health care concept that must continue to be worked on. But if you want to make things work more smoothly and get rid of an awkward employer based, problem filled basic system, then apply for that waiver and head for single payer (the Minnesota Health Plan).

Problem solved. Health care for all. And no religious conflicts.
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MNsure Tech Problems Still There - But ACA Still Has The Results

Category: Health Care
Posted: 06/19/14 13:46

by Dave Mindeman

There is a new report on MNsure which indicates that the disastrous website still has a large number of things to fix. That is disappointing on a number of levels, but makes it all the more remarkable that 240,000 Minnesotans got coverage and our uninsured rate dropped 40%.

This report will be the new report card for MNsure. The problems are identified - and if MNsure can't find the methods necessary to fix them before the next round of sign-ups, then they will deserve the deluge of criticism that will come.

But this is still about a website. Not about the ACA. Republican Guv candidates have already begun the next round of critiques.

But, as usual, they go beyond the website issue (which is the legitimate one) and try to tie the ACA into the mix. It is pretty clear that the ACA has accomplished its goals. The numbers (despite a horrible web site) prove that.

But here is another indicator of how the MN GOP is clueless on health care. Sen. Michele Benson tweeted this in response to a MNsure discussion....

Sen. Michelle Benson @SenatorBenson
@larryrjacobs @bgolnik @markhdrake public program coverage (largest expansion) could have been accomplished via existing systems. #mnleg


She is referring to the larger portion of sign-ups via Medical Assistance and MNCare.

And the idea that this could have been accomplished via "existing systems" has a small bit of truth to it. So let's discuss.....

The MN Republicans had control of both Houses of the legislature during the critical period when the ACA needed to be set up in Minnesota. They did nothing.

They refused to back a website for the state. They refused to accept the Medicaid expansion. And there were existing state medical programs that still could have accomplished getting some of the uninsured signed up, but they refused to enhance those programs.

When the DFL took over, they quickly moved on getting the MNsure bill in place. The expanded Medicaid was accepted from the Feds and MNCare was used as a means of accomplishing new coverages. All of this had to be done quickly because the ACA deadlines were looming after the GOP inaction in the previous session.

Now, did rushing the legislation have a detrimental effect on the MNsure site? Probably some - but I don't think that should be an excuse. Those in charge of MNsure made bad choices and decisions at the beginning and we are still paying for them. So, I won't blame that on GOP intransigence even though a case could be made.

But getting back to Sen. Benson's assertion. The Medicaid and MNCare expansion did have the existing infrastructure in place. And they could have accomplished a lot of the new sign-ups if they had had the authority. But Sen. Benson's GOP didn't give it to them....and to say that they didn't need the new MNsure authorities is just wrong.

The GOP has been a roadblock for health care in Minnesota. Always has been and will always continue to be.

It is unfortunate that the MNsure website continues to be a problem. The vendors selected to set the system up were horribly bad and I still wonder why they are not sued for their incompetence.

But these are still technology issues. And they can still be fixed. The ACA, on the other hand, has and is accomplishing the goal of affordable health care, of access, and reductions in the numbers of uninsured.

Republicans will try to expand the criticism - they have to. But the results from the ACA speak for themselves.
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