The Real Reason Healthcare Insurance Companies Are Now Encouraging Obamacare Enrollment: Fear of a pro-public-option or pro-single-payer political juggernaut
I’ve expected this for some time, and here it is: The Wall Street Journal reports that insurance companies are set to unleash hundreds of millions of dollars in advertising to entice potential customers on to the exchanges created by Obamacare. As the Journal puts it: Insurers … are capitalizing on an unprecedented opportunity in a shifting health-care market. Some seven million Americans are expected to buy health coverage on the new consumer exchanges, where people can compare insurance plans side by side.
— Greg Sargent, Washington Post, this morning
Sargent goes on to say that these plans were long in the works but were delayed because of the dysfunction of the federal website. I assume that’s accurate, but elsewhere in Sargent’s column, in the form of two new polls are hints of why this project has taken on real urgency. One poll, by Pew, published today in USA Today, shows a dramatic drop in support for Obama and Obamacare among 18- to 29-year-olds, results similar to those in another recent poll. Undoubtedly, although this won’t occur to most pundits, this drop reflects fallout from the Snowden revelations and also anger at Obama’s less-than-progressive (and certainly less-than-energetic) agenda. But there also is this: Only 41% of members of this age group approve of “his signature health care policy, while 54% disapprove.”
But also there is this, from the other poll released this morning, taken for the Associated Press:
In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year – mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law’s passage.
Sixty-nine percent say their premiums will be going up, while 59 percent say annual deductibles or copayments are increasing.
Each time I read something of that sort I am struck momentarily by dismay that Obama has failed to tell the public, as often as is necessary to halt the effect of the disinformation, which as it happens is coming mainly from employers and … insurance companies. Something along the lines of: Gosh, folks, listening to these people, you’d almost think that your employee contributions, co-pays and deductibles had remained steady and fine until the fall of 2013. Maybe a few statistics would drive home the point.
But we are after all talking about Obama, not, say, a normal president. And Obama just doesn’t do refutations, much less refutations citing actual statistics.
But one of these days a genuine progressive who has been fighting in the congressional trenches for progressive legislation–Sherrod Brown, I hope, or maybe Jeff Merkley–will show signs of interest in running for president in 2016. And–who knows?–the press might even begin paying attention to what he (Elizabeth Warren is not going to run) says. And what he says will include specific refutations to employer and insurance company claims that Obamacare is to blame for what Obamacare is not to blame for. And then he’ll propose … the public option or even single-payer, leaving Obamacare in place until one of these now-quite-real options begins. And this time there will not be an absurdly long four-year delay before implementation.
I expect that the experience with Obamacare as sabotaged by Republican state legislators and governors and unremitting campaigns of disinformation, and by shortsighted insurance carriers engaged in their own campaign of deception and trickery toward their current premium holders, will make possible (in fact, likely) what was not possible when Obamacare was being drafted and negotiated.
Republicans and, almost certainly, nearly all mainstream pundits see the 2014 and 2016 political debate as between Obamacare repeal and Obamacare “fixes”. They don’t consider that the public will recognize a failure of Obamacare for what it is: a failure of “federalism” and, like the pre-Obamacare system, a failure also of the free market regarding healthcare. And they certainly don’t consider that many , many of the people who have turned against Obamacare now in large part because of the gamesmanship of employers and insurance companies–young people, and employees who’ve seen their employer-based insurance benefit deteriorate annually in key respects–are likely to elect candidates who propose to change the system dramatically, to add a public option or to convert the system to single-payer. They now know, after all, that the system really can be dramatically changed.
Employers would benefit from single-payer, if not from a public option, so they’re concerted scapegoating of Obamacare might serve their interest. But the insurance companies are drastically overplaying their hand. The Democrats have no competent spokesperson right now; that’s certainly true. But that is temporary; they likely soon will. Once this epiphany occurs to the insurance industry, they might start reining in their members in order to give Obamacare some chance to succeed. By then, though, it may well be too late, and the previously impossible will be on its way to fruition.
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UPDATE: In light of some of the comments to this post, I want to make clear that by single-payer I do not mean Medicare-for-all. Single-payer would be, in essence, “the public option” extended to everyone rather than limited to the 5% of people who have private healthcare insurance through the non-group (i.e., non-employer-provided) market. It is not tax-funded identical-for-all healthcare insurance, which is what Medicare is. I do think that eventually this country will have Medicare-for-all-type healthcare insurance, but not in the nearterm. If single-payer works well, then of course that would be the longterm solution, with no need for Medicare-for-all.
I also want to make a point, in light of EMichael’s comment, about federalism as it relates to Medicaid and, for that matter, any other federal social-safety-network program. Federalism has been a disaster for Obamacare, and the only reason it works under current pre-Obamacare Medicaid is that that program came into being and was effectuated before the hard-right turn of the Republican Party. The really weird but successful argument by rightwing governors and state attorneys general to the Supreme Court in the ACA litigation on the Medicaid-expansion provision in the ACA is that, well, y’know, now that traditional Medicaid has been a part of each state’s law for decades, and is popular, it would be politically impossible for state legislators to end that program–the result under the ACA as the statute was written, if a state refused to agree to the ACA Medicaid expansion. This, they argued–successfully!–meant that the ACA was effectively coercive of state legislators and therefore infringed upon state sovereignty. On that “ground,” the Supreme Court struck down that part of the Medicaid portion of the ACA.
That’s also known as the conservatives-having-their-cake-and-eating-it-to theory of constitutional law. The argument was so deeply hubristic that its actual success is stunning and outrageous. But I have no idea why anyone would think that federalism must be a part of a national healthcare insurance law. It does not.
As for whether or not the public will catch on that the main problems with the Obamacare-exchanges-and-private-policies part of the Act is a failure of the healthcare insurance market and of the healthcare market itself–a question that several commenters raised–well, that was what my post was about. Yes, the public will catch on, once the Dems have a smart, committed, knowledgeable and articulate spokesperson with a high enough national profile to educate them about it. I expect that that will happen fairly soon.
I would love to agree, and I am born and raised in the US, but Americans are too stupid (brainwashed) to allow this to happen. The media campaign unleashed, if this were to ever come into the realm of possible, would be equivalent to D-Day landings. My wife is from Europe and the healthcare there is AWESOME!!! Dental included. It is one of the states that is actually doing well right now so no saying healthcare is driving them into the ground.
This all ties into the idea that government is ineffectual at best and harmful more often. I don’t understand this philosophy but I accept it as the truth as understood by my peers. Look at Social Security being untenable (false but true), the housing mess created by the government (false but true). The list could go on.
In response to another article I postulated that the government could not get anything done unless someone made a boat load of money from it. This does not escape that rule. I think what we are headed for is less faith in government, less reliance on it’s solutions (resulting in erroneous, expensive, or no solutions), People are not going to vote even if the candidate seems genuine because they all seem genuine. That’s their job!
I think Obama took a-lot of energy out of the electorate the last time around and it’s spent. True liberals don’t believe the party, centrists have no place to go, and the right is the right. So they will once again come out on top. I read an interesting quote over at Brad DeLong’s site: ‘In 1975, only 18 percent of Americans were willing to call themselves ‘Republicans’. Internally, the talk was whether the party should change its name. George Will said visiting Republican National Committee headquarters was like visiting ‘the set for a political disaster flick, a political Poseidon Adventure’…. They came back in 1978—too late for the political scientist Everett Carll Ladd to save face…. They did pretty good in 1980, too. Don’t gloat.’
Crazy beats big.
Bev:
Most Americans would not repeal the PPACA; but instead, they want it improved. Maybe that improvement migrates to Single Payer? The Same as what I see in the Livingston Daily, the argument of I am paying more for it, it does not support this or that, or it is too expensive is explainable with some being totally false and the other have reasons or information supporting it. It is not clear cut as some would make it out to be.
My employer insurance is changing (the company is going to a single national provider probably mainly to streamline after aquisitions), but the new plan has some ACA like features, and seems just somewhat better overall.
It has virtually identical deductibles, reimbursement rates, and premiums, but has a much bigger list of zero-out-of-pocket and copay-only services.
So kind of the upsides of an ACA plan vs what was previously normal in insurance without the higher deductible, lower reimbursement rate downside.
This made me realize that at first glance ACA style plans can look simply worse. Higher deductibles, lower reimbursements, etc. If you look a bit closer you find a big list of common services that are zero-out-of-pocket even things out a lot (may be worse or better depending on individual circumstance).
However it also looks like we are in a bit of a “doughnut hole” situation. (Ironic as ACA closed the medicare drug doughnut hole) If you are quite healthy, or have one of the selected low out of pocket problems, you’ll pay very little. But you can also end up paying $5000 a year or so year in year out. But you won’t really pay more than that.
$5000 will pretty severely impact the finances of a person of less than median income, but won’t be a big deal to a person in the top 10%.
Very like the medicare prescription drug benefit. Healthy people were fully covered, and high income people could easily afford to pay the costs up until the insurance kicked in again, but lower income people with problems would face unaffordable costs.
List of PPACA covered services:
Maggie Mahar at Health Beat Blog covered what is now included in the PPACA. The total $ saved is nebulous; however, the $ saved is the result of these services added as coverage without copay or deductible. While not detailing a specific figure, it is a cost save for the insured whether they have a high deductible or a large co-pay.
Preventive health services for adults
Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans.
Preventive care benefits
Preventive care helps you stay healthy. A doctor isn’t someone to see only when you’re sick. Doctors also provide services that help keep you healthy.
Free preventive services
All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copaymenthttps://www.healthcare.gov/glossary/co-payment or coinsurancehttps://www.healthcare.gov/glossary/co-insurance . This is true even if you haven’t met your yearly deductiblehttps://www.healthcare.gov/glossary/deductible . This applies only when these services are delivered by a network provider.
1. Abdominal Aortic Aneurysm one-time screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-to-your-doctor-about-abdominal-aortic-aneurysm for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/drink-alcohol-only-in-moderation
3. Aspirin usehttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/talk-with-your-doctor-about-taking-aspirin-every-day to prevent cardiovascular disease for men and women of certain ages
4. Blood Pressure screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-blood-pressure-checked for all adults
5. Cholesterol screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-cholesterol-checked for adults of certain ages or at higher risk
6. Colorectal Cancer screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-colorectal-cancer for adults over 50
7. Depression screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/talk-with-your-doctor-about-depression for adults
8. Diabetes (Type 2) screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/take-steps-to-prevent-type-2-diabetes for adults with high blood pressure
9. Diet counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/eat-healthy for adults at higher risk for chronic disease
10. HIV screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hiv for everyone ages 15 to 65, and other ages at increased risk
11. Immunization vaccineshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/shotsvaccines/get-important-shots for adults–doses, recommended ages, and recommended populations vary:
o Hepatitis Ahttp://www.vaccines.gov/diseases/hepatitis_a/index.html
o Hepatitis Bhttp://www.vaccines.gov/diseases/hepatitis_b/index.html
o Herpes Zosterhttp://www.vaccines.gov/diseases/shingles/index.html
o Human Papillomavirushttp://www.vaccines.gov/diseases/hpv/index.html
o Influenza (Flu Shot)http://www.vaccines.gov/diseases/flu/index.html
o Measleshttp://www.vaccines.gov/diseases/measles/index.html , Mumpshttp://www.vaccines.gov/diseases/mumps/index.html , Rubellahttp://www.vaccines.gov/diseases/rubella/index.html
o Meningococcalhttp://www.vaccines.gov/diseases/meningitis/index.html
o Pneumococcalhttp://www.vaccines.gov/diseases/pneumonia/index.html
o Tetanushttp://www.vaccines.gov/diseases/tetanus/index.html , Diphtheriahttp://www.vaccines.gov/diseases/diphtheria/index.html , Pertussishttp://www.vaccines.gov/diseases/pertussis/index.html
o Varicellahttp://www.vaccines.gov/diseases/chickenpox/index.html
12. Obesity screening and counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/watch-your-weight for all adults
13. Sexually Transmitted Infection (STI) prevention counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for adults at higher risk
14. Syphilis screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for all adults at higher risk
15. Tobacco Use screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/quit-smoking for all adults and cessation interventions for tobacco users
Preventive health services for women
Most health plans must cover additional preventive health services for women, ensuring a comprehensive set of preventive services like breast cancer screenings to meet women’s unique health care needs.
Comprehensive coverage for women’s preventive care
All Marketplace health plans and many other plans must cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.
This applies only when these services are delivered by an in-network provider.
1. Anemia screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/have-a-healthy-pregnancy on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA)http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/cancer/talk-with-a-doctor-if-breast-or-ovarian-cancer-runs-in-your-family for women at higher risk for breast cancer
3. Breast Cancer Mammography screeningshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-breast-cancer every 1 to 2 years for women over 40
4. Breast Cancer Chemoprevention counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/cancer/talk-with-a-doctor-if-breast-or-ovarian-cancer-runs-in-your-family for women at higher risk
5. Breastfeeding comprehensive support and counselinghttp://healthfinder.gov/HealthTopics/Category/pregnancy/getting-ready-for-your-baby/breastfeed-your-baby from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
6. Cervical Cancer screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-cervical-cancer for sexually active women
7. Chlamydia Infection screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for younger women and other women at higher risk
8. Contraceptionhttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/choose-the-right-birth-control : Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
9. Domestic and interpersonal violence screening and counselinghttp://healthfinder.gov/HealthTopics/Category/everyday-healthy-living/mental-health-and-relationship/take-steps-to-protect-yourself-from-relationship-violence for all women
10. Folic Acidhttp://healthfinder.gov/HealthTopics/Category/nutrition-and-physical-activity/nutrition/get-enough-folic-acid supplements for women who may become pregnant
11. Gestational diabetes screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/talking-with-the-doctor/gestational-diabetes-screening-questions-for-the-doctor for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
12. Gonorrhea screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for all women at higher risk
13. Hepatitis B screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/have-a-healthy-pregnancy for pregnant women at their first prenatal visit
14. HIV screening and counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hiv for sexually active women
15. Human Papillomavirus (HPV) DNA Testhttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-cervical-cancer every 3 years for women with normal cytology results who are 30 or older
16. Osteoporosis screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-a-bone-density-test for women over age 60 depending on risk factors
17. Rh Incompatibility screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/have-a-healthy-pregnancy for all pregnant women and follow-up testing for women at higher risk
18. Sexually Transmitted Infections counselinghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for sexually active women
19. Syphilis screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for all pregnant women or other women at increased risk
20. Tobacco Use screening and interventionshttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/quit-smoking for all women, and expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/have-a-healthy-pregnancy for pregnant women
22. Well-woman visitshttp://healthfinder.gov/HealthTopics/Category/everyday-healthy-living/sexual-health/get-your-well-woman-visit-every-year to get recommended services for women under 65
Preventive health services for children
Most health plans must cover a set of preventive health services for children at no cost when delivered by an in-network provider. This includes Marketplace and Medicaid coverage.
Coverage for children’s preventive health services
All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.
1. Autism screeninghttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 for children at 18 and 24 months
2. Behavioral assessments for children at the following ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
3. Blood Pressure screening for children at the following ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
4. Cervical Dysplasia screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-tested-for-cervical-cancer for sexually active females
5. Depression screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-teen-screened-for-depression for adolescents
6. Developmental screeninghttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/watch-for-signs-of-speech-or-language-delay for children under age 3
7. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
8. Fluoride Chemoprevention supplementshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/take-care-of-your-childs-teeth for children without fluoride in their water source
9. Gonorrhea preventive medicationhttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/talk-with-your-doctor-about-newborn-screening for the eyes of all newborns
10. Hearing screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/talk-with-your-doctor-about-newborn-screening for all newborns
11. Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
12. Hematocrit or Hemoglobin screeninghttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 for children
13. Hemoglobinopathies or sickle cell screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/talk-with-your-doctor-about-newborn-screening for newborns
14. HIV screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-hiv for adolescents at higher risk
15. **Hypothyroidism screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/talk-with-your-doctor-about-newborn-screening for newborns
16. Immunization vaccineshttp://healthfinder.gov/HealthTopics/Category/doctor-visits/shotsvaccines/get-your-childs-shots-on-schedule for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
o Diphtheriahttp://www.vaccines.gov/diseases/diphtheria/index.html , Tetanushttp://www.vaccines.gov/diseases/tetanus/index.html , Pertussishttp://www.vaccines.gov/diseases/pertussis/index.html
o Haemophilus influenzae type bhttp://www.vaccines.gov/diseases/hib/index.html
o Hepatitis Ahttp://www.vaccines.gov/diseases/hepatitis_a/index.html
o Hepatitis Bhttp://www.vaccines.gov/diseases/hepatitis_b/index.html
o Human Papillomavirushttp://www.vaccines.gov/diseases/hpv/index.html
o Inactivated Poliovirushttp://www.vaccines.gov/diseases/polio/index.html
o Influenza (Flu Shot)http://www.vaccines.gov/diseases/flu/index.html
o Measleshttp://www.vaccines.gov/diseases/measles/index.html , Mumpshttp://www.vaccines.gov/diseases/mumps/index.html , Rubellahttp://www.vaccines.gov/diseases/rubella/index.html
o Meningococcalhttp://www.vaccines.gov/diseases/meningitis/index.html
o Pneumococcalhttp://www.vaccines.gov/diseases/pneumonia/index.html
o Rotavirushttp://www.vaccines.gov/diseases/rotavirus/index.html
o Varicellahttp://www.vaccines.gov/diseases/chickenpox/index.html
17. Iron supplementshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months for children ages 6 to 12 months at risk for anemia
18. Lead screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/getting-ready-for-your-baby/protect-your-family-from-lead-poisoning for children at risk of exposure
19. Medical History for all children throughout development at the following ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
20. Obesity screening and counselinghttp://healthfinder.gov/HealthTopics/Category/parenting/nutrition-and-physical-activity/help-your-child-stay-at-a-healthy-weight
21. Oral Health risk assessment for young children Ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 .
22. Phenylketonuria (PKU) screeninghttp://healthfinder.gov/HealthTopics/Category/pregnancy/doctor-and-midwife-visits/talk-with-your-doctor-about-newborn-screening for this genetic disorder in newborns
23. Sexually Transmitted Infection (STI) prevention counseling and screeninghttp://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/hiv-and-other-stds/get-tested-for-chlamydia-gonorrhea-and-syphilis for adolescents at higher risk
24. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 monthshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-babys-visit-to-the-doctor-ages-0-to-11-months , 1 to 4 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-1-to-4 , 5 to 10 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-5-to-10 , 11 to 14 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-childs-visit-to-the-doctor-ages-11-to-14 , 15 to 17 yearshttp://healthfinder.gov/HealthTopics/Category/parenting/doctor-visits/make-the-most-of-your-teens-visit-to-the-doctor-ages-15-to-17 .
25. Vision screeninghttp://healthfinder.gov/HealthTopics/Category/doctor-visits/screening-tests/get-your-childs-vision-checked for all children.
“They don’t consider that the public will recognize a failure of Obamacare for what it is: a failure of “federalism” and, like the pre-Obamacare system, a failure also of the free market regarding healthcare.”
I only wish the public recognizes the second half of the failure(the free market).
The right will not do so because this is Obamacare (not the ACA) and most of the left will not do it because it detracts from their fantasy of Medicare For All and their belief that if they find enough to blame on Obamacare their fantasy will come true(and they will all get a pony, too!)
Amazing to me that intelligent people somehow think that the failure of healthcare reform that contains a little bit of federalism would be easily replaced by healthcare reform which would be all federalism.
So what the ACA has to do is fight off attacks from people that believe the answer to our healthcare problems can be solved by no federalism and from people that believe the answer to our healthcare problems can be solved by all federalism.
Tough crowd there.
Yes indeed Beverly.
The biggest risk for Big Insurance on the one hand and Republicans on the other is that a year from now the only piece of Obamacare that rolled out seamlessly and actually delivered immediate results was the expansion of Medicaid in Blue States.
A lot of self-identified Progressives like to tout ‘Medicare for All’ and see it flowing downwards from retirees to first 55 and olders and then so-on but frankly a more viable path is the gradual extenstion of ‘Medicaid for All’ from the young and poor upwards.
One of the few positive outcomes of Clinton’s Welfare ‘Reform’ was the decoupling of Medicaid from AFDC per se and the attachment of it to income. Before 1996 the transition from being a single mother on welfare to being a single mother in the working poor was the loss of medical coverage for your children. Which was kind of a steep price for gaining ‘the dignity of work’. But with the delinking and the introduction of SCHIPS and the acceptance of the idea that denying little children access to basic health care was both cruel and economically stupid an opening was made to the idea that denying health care to bigger children and no longer children, say like single working poor men might be so as well.
Under PPACA and in the states which fully embraced it we may see a really, really odd result: that the only population with real health care certainty are the working and not working poor. And that the cost for actual upwards mobility will be to be tossed into the Exchange and the not so tender mercies of the private insurance companies. And I suspect that this will result in pressure to extend the income threshold for Medicaid up from 133% of FPL and/or what would amount to the same thing an introduction of a Public Option directed at those Exchange eligible folk just north of 133%. Because the costs to actually put in place a near or total 100% subsidy via the income tax system to people making 150% of FPL just so that they can have ‘private’ insurance will seem faintly ridiculous as opposed to giving those same folks a Medicaid Card and so cutting both Big Insurance and the IRS out of the picture.
That is PPACA has the potential to flip the American health care system on its head and have a system where the only people with secure medical coverage are the poor and the old with only the broad working and middle classes left grappling with Open Enrollment and Schedule Whatever on your 1040 to make sure that your private insurance company didn’t get too much or too little.
Plus it would seem that the only firewall against the spread of Medicaid/Public Option up would be some resistance among providers to participate. But frankly vendors of Bronze and lower level Silver plans are going to have a hard to impossible time keeping totally open provider networks anyway and in the end we will find providers willing to serve a single payer patient base.
Which BTW may be the basis for a post or series of posts I have been mulling since 2009. Because the business model for the Community/Free/Rural/Reservation based Clinic just got turned on its head, at least in States that accepted Medicaid expansion. Starting RIGHT NOW just about every person who goes to the Berkeley Free Clinic (one of the oldest such in the country) is at least a potentially paying customer if not on their way in the door then on their way out. That is in contrast to the situation even a few months ago every single homeless adult you might pass by on a city sidewalk has an opening to get basic health care, including mental health care. They just have to sign up or be signed up. Which in our increasingly Dickensian society is an amazing thing. You can actually be a big-hearted Save the Children/Physicians Without Borders kind of ‘bring health care to the poor’ kind of guy or gal and actually make a reasonble living just by opening a clinic in the most underserved urban or rural neighborhood in your city or county. IF you practice in a state that accepted Medicaid expansion.
It sets up an interesting dynamic going forward: poor and black in Compton, poor and brown in East LA, you get a Medicaid card and preventive health care for your kids. Poor and white in Mississippi, well sucks to be you. I am thinking that particular Cup of Tea will start tasting pretty stale pretty soon. Because thanking the Man in the $1000 suit for protecting you from the hell of being able to take your kid to the doctor while all the Blahs and Brahs in Neew Yaahk City have access has got to bite. I mean SHOOT they already got the Welfare Cadillacs and the T-Bone Steaks and the Free Obama-phones now they get Health Care TOOO! With the exception that the Health Care piece will be real.
ACA wil underwrite ALL Exchanges in 2014 with Stop Loss Coverage of $45,000.Every insurer with half a brain will start or promote the Exchanges!
Few know the implications of that fact!
Government will soon be picking up the cost of ALL catastrophic loss.
The insurance Industry through their effective corruption of our Government is now GUARANTEED profits previously unimaginable before the ACA!
Dumb and dumber – defines the american consumer, who are constantly manipulated by wealth to extract as much as possible for the benefit of the .1% who essentially pay no TAXES.
When some genius finally runs the numbers it will shock America and its budget!!!!!!!
Yea, I (with my employer provided insurance) used a clinic which did mostly charity care a few times because it was very near my home, the kind of place that very often sends a patient home with sack full of fresh clothing. It’s amazing to think that the vast majority of its patients will now be paying customers.
The care there seemed great, by the way. The doctors were obviously super passionate (if they weren’t they would be working elsewhere). I chuckle a bit to remember the distinct air of “ahh this is an easy one” from everyone working there with a regular young middle-class patient with just a sinus infection or whatever and an insurance company to bill, rather than the diverse overlapping issues of their usual patients.
“…the vast majority of its patients will now be paying customers.”
This was in Washington State, which is doing medicaid expansion.
“That is PPACA has the potential to flip the American health care system on its head and have a system where the only people with secure medical coverage are the poor and the old…”
That’s pretty much how it was before. Just the definition of “poor” was incredibly narrow in most states and pretty much required having dependent children.
The definition of “poor” is much looser now, but the real security winners have to be the upper middle class who can no longer end up excluded from insurance because of pre-existing conditions if unable to obtain employer insurance.
The only people who have really had secure healthcare were over 65 on medicare, federal retirees, and veterans disabled in the course of duty. Everybody else had pretty clear routes to situations where care would be very tenuous.
Thanks, Jeff Fisher, very good summary on reality of present system. Yes, you can have employer insurance and that might be OK for your dependents but if you yourself get sick, you will eventually NOT be employed and will lose the access you need (COBRA doesn’t last forever even if you can afford it).
As screwed-up as the new system is, it is certainly relaxing for me to realize that there’s likely some way for those close to me to get some sort of decent insurance should they lose it through being laid off or something.
Cobra also doesn’t exist at all if the former employer is ending their health insurance plan, like if they are going under entirely. In neither of the two layoffs I have uhh… experienced has Cobra been an option. In one case the company was just gone (rather spectacularly: CEO to prison for two years!), in the other it continued for about six months but without health benefits).
A lot of people seem to think Cobra coverage is some sort of guarantee. It really isn’t.
EMichael, I think you’re conflating Medicare-for-all with single-payer. Single-payer would be, in essence, “the public option” extended to everyone rather than limited to the 5% of people who have private healthcare insurance through the non-group (i.e., non-employer-provided) market. It is not tax-funded identical-for-all healthcare insurance, which is what Medicare is.
Also, I am not clear at all on why you think states must play some role in a national healthcare insurance system. Federalism has been a disaster for Obamacare, and the only reason it works under current pre-Obamacare Medicaid is that that program came into being and was effectuated before the hard-right turn of the Republican Party. The really weird but successful argument by rightwing governors and state attorneys general to the Supreme Court in the ACA litigation on the Medicaid-expansion provision in the ACA is that, well, y’know, now that traditional Medicaid has been a part of each state’s law for decades, and is popular, it would be politically impossible for state legislators to end that program–the result under the ACA as the statute was written, if a state refused to agree to the ACA Medicaid expansion. This, they argued–successfully!–meant that the ACA was effectively coercive of state legislators and therefore infringed upon state sovereignty. On that “ground,” the Supreme Court struck down that part of the Medicaid portion of the ACA.
That’s also known as the conservatives-having-their-cake-and-eating-it-to theory of constitutional law. The argument was so deeply hubristic that its actual success is stunning and outrageous. But I have no idea why anyone would think that federalism must be a part of a national healthcare insurance law. It does not.
As for whether or not the public will catch on that the main problems with the Obamacare-exchanges-and-private-policies part of the Act is a failure of the healthcare insurance market and of the healthcare market itself, well, that was what my post was about. Yes, the public will catch on–once the Dems have a smart, committed, knowledgeable and articulate spokesperson with a high enough national profile to educate them about it. I expect that that will happen fairly soon.
Thanks for that Jeff.
I was living in Washington State until November 2011 and they were making fairly heroic attempts to extend health care via the (I think) Basic program even prior to PPACA. But like everywhere had the problem securing the funding to go along with the vision. States that were ready willing and able to expand their Medicaid programs more widely, which includes my former State of Washington and my really former and now current State of California had the tools in place to hit the ground running. (Which shouldn’t be a mixed metaphor but seems to be).
After some years of being uninsured and BTW really sick (as in nearly dying) without really knowing that (I just thought I was ‘down’) I found out I was eligible for VA coverage at no cost to me. Turns out that even if your ailments are not service related if you are poor enough the VA will take you in. (HEY VETS OUT THERE!!!!). And they have been very, very good to me, in fact even extending to dental and vision which you don’t find in a lot of employer plans. Plus they are paying me to go back to school in a way that will have me earn too much to get care from them anymore. At which time I will have the Exchange. Even though I have pre-existing conditions that would make your standard insurance underwriter go white in the face.
Until you have been uninsured and also vaguely aware that you are really really sick but won’t really know until you collapse on a sidewalk and get takien to the Emergency Room you can’t imagine the piece of mind knowing that you have coverage. Because no pun intended thereis no sicker feeling in your stomach than being sick in your stomach and not being able to see a doctor. Been there, almost died. Don’t want to go back.
Without the VA I would be dead. And I was eligible for them just because a previous time of joblessness had me enlisting in the Navy for four years a couple of decades before. That relatively short time job in my 20s was the difference between living and dying in my 50s. That is no way to run a country, living because you happened to have the right employer from 1977 to 1981 and dying because you went to work somewhere else. But that was the pre-PPACA world. Or in other words the next two weeks.
As I understand it the VA provides care to poor vets basically on a “fill the slots” basis, so who qualifies shifts with demand and funding. The only people really guaranteed VA care are those injured in the line of duty, which I can’t remember the definition of.
It ends up like a better version of medicaid for veterans (ie single men could qualify).
One of my uncles was on VA care for a while via prior service and poverty.