An Inconvenient Obamacare Truth

SNL spoofBy Peter Galuszka

It is highly amusing to watch Obamacare detractors mock news that the Affordable Care Act has more than reached it goal by signing up 7.1 million Americans.

This inconvenient truth turns the Fox News echo chambers on its head. You also read a bit of that on this blog – there’s an unassailable assumption that Obamacare is a certain failure, the Website is a mess and that it will be rejected hands down by consumers. Therefore, it’s a given that it must be repealed or undergo massive surgery.

Obamacare deniers also link expanding Medicaid to the fray. That is why the General Assembly has not passed a budget. Hard right Republicans in the House of Delegates, led by House Speaker Bill Howell, have set up expansion along the lines of their Obamacare fight. Medicaid is DOA, they claim, and they are quite right risking shutting down state government July 1 to make their point.

Of course, they are plowing ground for November elections in which they assume (underlined) that Obamacare will be a killer topic for their allies.

Problem is, if Americans keep signing up (early problems with the Website notwithstanding), they kinda lose some of their thunder. They may have to come up with a new mule to beat.

Anyway, I caught this skit on Saturday Night Live last night and immediately thought of Bacon’s Rebellion. Enjoy!

6 Responses to An Inconvenient Obamacare Truth

  1. Medicaid expansion in Virginia is built on fraud. The premise given (including by Senator Barbara Favola and Delegate Bob Brink on Saturday, April 5, in McLean) is that expanding Medicaid will provide better coverage at less cost. Both the Senator and Delegate said expansion of Medicaid would cut down on ER use by the uninsured, the costs of which are passed along to care givers, insured, insurance companies and taxpayers. Senator Favola was asked: what about the Oregon experiment where the newly covered Medicaid recipients made greater use of ERs that, in turn, resulted in even higher Medicaid costs. Senator Favola responded that Virginia would use a managed care approach that would not permit replication of the Oregon experience.

    Senator Favola was part correct. Virginia’s Medicaid program uses managed care (a covered person must get referrals from his/her primary care physician) and is more cost-efficient than other states. But implicit in her argument was the assumption that a Medicaid recipient must first contact her/his primary care physician before going to the ER. How absurd the argument. If a Medicaid recipient is going to see the PCP to get a referral to an ER, why wouldn’t the PCP treat the patient, rather than sending that person to the ER. Of course, there will be situations where a sudden illness or accident occurs, such that a trip to the ER is the only sensible solution. But in other cases, the trip to the ER is what Medicaid expansion is supposed to prevent. Is Medicaid going to refuse to pay ER charges unless the patient has a referral from the PCP? And if so, under what circumstance? And if Medicaid pays for ER visits without a referral, what stops the Oregon result from being replicated in Virginia. And if the Oregon result is replicated here, the argument that Medicaid expansion will save the public money by reducing the number of costly ER visits by the uninsured is wrong. And isn’t making a lie? So where is the statutory fix to prevent the Oregon result from occurring in Virginia?

    The other area of serious concern not adequately addressed was the cost savings. Both the Senator and the Delegate gave a good explanation of how many of the cost of uncompensated care are passed along to the public in the form of higher costs for medical services, higher premiums for insurance and higher taxes and how expanding Medicaid would reduce those costs. To the ordinary thinking person, this means the cost of expanding Medicaid will be less than the costs for not providing any insurance to those covered by expansion and that these savings will be passed along to those who pay them.

    To the Governor’s credit, he has started down this path by proposing to pull some $250 M (?) from money appropriated to pay for indigent care. McAuliffe proposes to bank some funds to pay the Commonwealth’s future share of Medicaid costs and to use other moneys for different purposes, such as a raise for state employees and teachers. But what about the other monies? Delegate Brink said to trust the market as he was sure cost savings would be passes along to health insurance premium payers and did not even want to insist the VSCC address the issue. The “Janet Howell” dance was done.

    I can see giving some time for the process to work, such that other costs and charges should not be reduced on Day 1. But if the promised savings aren’t there, why is this not fraud?

    Jury Instructions from our sister state of Maryland (I could not easily locate the corresponding Virginia instructions) speak to fraud in the inducement as:

    “Now, fraud or fraudulent inducement means that a party has been led to enter into an agreement to his or her disadvantage as a result of deceit. Deceit means that the person entered the agreement based on the other party’s willful non-disclosure or false representation of a material fact, which the other party had a duty to disclose.

    “A fact is material if under all the circumstances a reasonable person would attach importance to that fact in deciding whether to enter into the agreement or the person willfully not disclosing or making the material misrepresentation knows the other party with whom he or she is dealing probably will regard it as important in determining whether to enter into the agreement[, e]ven though a reasonable person would not attach importance to it in determining whether to enter into the agreement.”

    Why is Medicaid expansion so important that we are willing to accept fraud by the Commonwealth to get it? Is this the Virginia way?

  2. MedicAid is pretty simple.

    right now you are paying subsidies for those without insurance.

    would it be cheaper for people to get care from Primary Care than ER doctors?

    could that change over time ? could people who have never had care other than go to the ER start getting more used to going to a doctor?

    they could..

    I’d be fine with a true alternative but I’m not buying the opposition only to stick with the status quo.

    either lead or follow or get out of the way.

    on the right wing echo chamber.. they’re like a herd.

    one of them will jump up and say something totally ignorant like “Obama is cooking the books” or “Benghazi” or “IRS’ and all the others in all the print and broadcast and internet media will murmur in collective agreement like a herd of screaming meemies”.

    the last few days they’ve been blathering that they’re still going to go for “repeal” and someone asked them if they meant after 2017… and they said “yep”.

    these guys are unbelievable.. they’re just totally out of touch with reality..

    we’ve refused to deal with reality starting in 2008 and it’s going to go to 2017 and that assumes they’ll win the House, Senate and POTUS…

  3. Larry, why won’t you accept an expansion of Medicaid with all the money now spent on indigent care being shifted to Medicaid with the excess taken away from indigent care and being shifted to other government uses and private premium reductions? I am just trying to hold the Democrats to their promises? What I don’t accept is allowing Medicaid spending to exceed what we do now because the Democrats in my area are saying it will cost less to expand Medicaid than it costs to pay for uncompensated care. I’m willing to give the system some time to work through the issues, but by year two savings ought to be flowing back to those who are paying for Medicaid expansion. The consistent refusal of the Democrats to support this bargain, which would get them Medicaid expansion, suggests to me that they know damn well Medicaid expansion will cost more than the status quo. So they are likely lying to get their program passed. Sounds like fraud to me.

  4. Here’s a picture for ya.

    “I really like this new insurance I got. But my job doesn’t come with bennies. If I want to go to the doc, well I gotta give up a day’s pay. Ain’t gonna do that cuz I might get fired too. There’s policies for that you know. So I will just stay at work sneezing into the burgers until I get off. And since I don’t have an appointment I’ll just hop over to the ER and sleep in the waiting room.”

    “I read an article the other day while I was waiting to see ER. It seems many companies are getting out of the paid leave game. In fact, they are getting out of the benefit game all together. Bet that’s going to be a real eye opener for the well schooled crowd used to paid amenities. Imagine when all those high paid folks with unpaid student loans and maxxed out credit cards start camping out with us low paid peons in the ER. Now THAT will be an education.”

    Sincerely,
    Low on the pole Joe.

  5. Two simple questions:

    1. What percentage of Americans are uninsured now that 7.1M americans have signed up for Obamacare?

    2. What percentage of Americans were uninsured when Barack Obama was first elected in 2008?

    According to the latest numbers I’ve seen from Gallup:

    Nov, 2008 – 15.8%
    Today – 16%

    In February of 2008 (during the administration of the evil GW Bush) the number was 14.1%

    Given that many Americans had policies canceled which they liked and given that they then had to sign up for OFraudma Care against their will – should we really count these people as successes?

    What percentage of Americans is uninsured today vs 10 years ago?

    OFraudma Care was going to guarantee that everybody had health insurance, right? Does everybody have health insurance?

  6. DJR,

    HAH! Tell THAT to the polar vortex!

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