Closing in on the Obamacare "magic number" -- meanwhile lying up a storm about the facts

Steve Sack

"Republicans in [states that have rejected ACA-endowed Medicaid expansion] can laugh all the way to election night. They got to screw the poor, which, let’s be honest, they were inclined to do anyway, and in doing so they also did political damage to the Obama administration. Quite a trick."

-- Paul Waldman, in his Tuesday "Morning Plum" post,
"What the Obamacare enrollment numbers mean"

by Ken

As I mentioned Wednesday, in passing along Washington Post "Loop"-master Al Kamen's update of his earlier report on the play All the Way starring Bryan Cranston as Lyndon B. Johnson, Al also announced a new "In the Loop" contest, in which readers are asked to guess the actual number of Obamacare signups by the March 31 non-penalty deadline. As I wrote then, "Since this takes us into the whole area of wholesale lying on the subject by the usual right-wing suspects, I think we should look at this separately tomorrow," but yesterday we had to tend to the unfortunate passing of scumbag extraordinaire Fred Phelps ("Rot in hell, Fred Phelps (1929-2014)").

First, here's Al K's contest announcement:

Guess that enrollment!

Long before Web site foul-ups snarled its launch, the White House had hoped for 7 million enrollees in the Affordable Care Act’s first year. It has since adjusted expectations a bit, although a number close to that is still the goal.

Through the end of February, there were 4.2 million enrolled. On Monday, the White House said it had broken 5 million. The Obama administration is making one last push to reach a million or so more uninsured Americans before March 31, the deadline to enroll without facing a fine.

So with the big day rapidly approaching, the question for Loop fans is: How many people will enroll in Obamacare in its first year?

Yes, it’s the Loop Obamacare Enrollment Contest! Simply guess the number who will sign up by the deadline. The 10 entries closest to the actual number will get a coveted Loop T-shirt and lifetime bragging rights.

Send entries -- only one prediction per person -- by noon March 28 to intheloop@washpost.com. Subject line: Obamacare. Be sure to provide your name, profession, mailing address and T-shirt size (M, L or XL), in case you’re a winner. You must also include a phone number -- home, work or, preferably, cell -- to be eligible.

(Obama administration and congressional employees may enter “on background.”)

THE RIGHT-WING CRUSADE OF OBAMACARE LIES

As it happens, this past Tuesday on the washingtonpost.com "Morning Plum" blog Paul Waldman put up quite an interesting post, called "What the Obamacare enrollment numbers mean," taking a look at the numbers and, more importantly, focusing on the campaign of obfuscation and outright lies the Republicans have used as the principal strategy for what they think will bring them control of the Senate.

Goodness knows there's a lot to complain about in the ACA. But almost none of that is what the lying liars of the Right-Wing Noise Machine have been screeching about. And for the most part they've gotten away scot-free with a firestorm of intentionally disinformative propaganda, on the apparent theory that Americans don't want the truth, can't handle the truth, but want instead a pack of lies crafted to tickle their deep-rooted ignorance and prejudices.

EXCEPTIONS TO THE FREE PASS FOR
RIGHT-WING ASSAULT AND BATTERY

Denver's KUSA actually tried to fact-check an Americans for Prosperity TV spot aimed at Colorado Sen. Michael Bennet, and while crediting the ads with "pointing to real problems that real people are running into with the healthcare law, adds: "However, AFP doesn't have proof that millions of people are dealing with the worst case scenario. To that end, we find that this ad is attempting to puff up the problems."

Then the Tampa Bay Times's PolitiFact got into the act, rating the ad's first two claims -- that "millions of people have lost their health insurance" and that "millions of people can’t see their own doctors" as "False" and "Mostly False" -- as already known to be "false" and "mostly false," respectively, then looking into the claim that "millions are paying more and getting less" and found that "at worst, [people are] paying more to get more," and "in many cases they’re actually paying less." They rated this claim as well "false."

Anyway, here's what Paul Waldman wrote (with lots of links onsite):

The Obama administration announced late yesterday that 800,000 people have signed up for new health insurance so far in March. That brings the total under the Affordable Care Act to over 5 million and makes it likely that 6 million will have enrolled by March 31, the last day to sign up before getting a fine. That 6 million number would meet a projection made by the Congressional Budget Office. So what are we to make of those numbers?

To a degree, targets like these are arbitrary when we’re judging the law’s success. It isn’t as though we’ll say that if 5,999,999 people signed up by the end of the month then the law has failed, while if 6,000,001 sign up then it has succeeded. Nor does that number include the millions of people who have been enrolled in Medicaid, many of whom are getting health coverage for the first time. And the number of people signed up will continue to rise, particularly since the fines are quite small in the first year but get larger over time. But it’s worth remembering that for all the time we spend gaming out the political winners and losers of Obamacare, there are real people’s lives at stake.

If you were just watching political ads, you’d think that there were precisely zero Americans who had actually been helped by the ACA, since for some rather strange reason, the law’s advocates seem reluctant to actually tell the individual stories of those who have gotten covered for the first time, or can now get coverage despite a pre-existing condition. Meanwhile, the law’s opponents have spent millions of dollars blanketing the airwaves in states with upcoming elections, telling horror stories of people whose lives have allegedly been devastated by the ACA. And yes, nearly every one of those stories turns out to be utterly bogus when it is examined. But how many voters know that?
Another reality works against the administration: It’s now easy to blame everything that goes wrong in anything having to do with health care on the ACA. Sure, premiums have gone up every year for as long as anyone can remember. But this year’s increase? Obamacare! Your boss decided to cut back your benefits to pad his bottom line? Obamacare! And did you know that under Obamacare, people will continue to fall ill and even die?

And Republicans work like dogs to undermine the law and make sure it helps as few people as possible, then hold up their success at denying the law’s benefits to their own citizens as evidence that the law was misconceived in the first place. Nowhere is this more evident than on the issue of the expansion of Medicaid, where most Republican-controlled states have said no to the federal government’s offer of billions of dollars in what is essentially free money to get coverage for poor Americans.

Most cruelly, many of the states that have refused to accept the Medicaid expansion are those where Medicaid benefits are most stingy to begin with. Each state sets its own eligibility levels, and not too surprisingly, states run by Republicans tend to set them extremely low. So for instance, if you’re a single parent in Alabama with two kids and you earn a princely $3,221 a year, the state considers you too wealthy to get Medicaid. In Texas, which has more people living without health insurance than any other state, that figure is $3,737. Millions of the working poor could have gotten coverage from Medicaid through the expansion, but their state legislators and governors quite literally believe that it’s better for a poor person to have no health coverage at all than to get coverage from the government.

By one analysis, 5.2 million Americans who could have gotten Medicaid if their states had accepted the expansion will remain uninsured. And if you asked those people in a poll whether Obamacare had helped them, they’d quite reasonably say no.

So Republicans in those states can laugh all the way to election night. They got to screw the poor, which, let’s be honest, they were inclined to do anyway, and in doing so they also did political damage to the Obama administration. Quite a trick.

Republicans may well get political benefit from the issue in this year’s election, particularly if Democrats continue to do such a weak job of defending the law. But that doesn’t really matter in the long run. The law isn’t going to be repealed, something Republicans know as well as Democrats. For all its complications and the difficulty of implementation, the ACA has already done an extraordinary amount of good for those millions of people. If Republicans took their newfound concern for (some) people’s access to health care and used it to actually work to make the law work as well as possible, millions more might be helped as well. If only.

MORE ON THE MEDICAID-EXPANSION PICTURE -- WILL
IT GET BETTER ONCE OBAMA'S OUT OF THE PICTURE?

This afternoon on "The Plum Line" Paul took a look at the question "Is the tide starting to turn on the expansion of Medicaid?," recalling the argument of "some ACA supporters" that even for Republican governors, all that federal money --

would just be too enticing to pass up. After all, pre-ACA, Medicaid costs were split 50-50 between the states and the federal government, while the feds were to pick up 100 percent of the costs of expansion through 2016, ratcheting down only to 90 percent by 2020, after which it stays at 90 percent. It's an incredibly good deal for the states: they get the economic boost of a healthier population, they can stop paying for the uncompensated care that happens when sick or injured people without insurance show up at hospitals, and they get it for nothing at first, then pennies on the dollar afterward. Studies from non-partisan observers such as the Rand Corp. showed that even after they start contributing, states will get a net economic benefit. And that’s not even mentioning the moral consideration of taking the opportunity to bring some measure of security to all those people who can’t afford health insurance.

"The thinking," Paul says, "was that some of those Republican governors would make noise about it, but eventually they’d come around. After all, it took years for all the states to accept the Medicaid program in the first place after its passage in 1965; one, Arizona, held out for 17 years. And this is a much more favorable deal for the states."

The current tally, he says, is 25 states plus the District accepting Medicaid expansion, 19 rejecting, and six still debating it. He notes the suggestion by National Journal's Lucia Graves that opposition is beginning to crack, but declares himself "less optimistic," arguing that in a lot of states, "opposition to the ACA will continue for some time to be the clearest way for a Republican politician to establish his or her conservative credentials," and of course their anti-Obama bona fides.

Which leads Paul to wonder: "Might conservative loathing of Obamacare begin to dissipate once Obama himself leaves office in January 2017?"

Maybe. Ironically, the best thing for the spread of Medicaid expansion might be a Republican in the White House. If the GOP is in charge in the nation’s capital, suddenly it isn’t as important for Republican governors to shake their fists at Washington, and accepting the expansion no longer looks like a favor to a president they hate. The state's own self-interest could finally win out. That may or may not be enough to make you wish for a Republican victory in 2016.

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