THIS IS A SUMMARIZED REPORT CARD WRITTEN BY CHRISTOPHER CONOVER A PROFESSOR AT THE CENTER FOR HEALTH POLICY AND INEQUALITIEWS RESEARCH AT DUKE UNIV.
IT IS LONG BUT AN INTERESTING READ ON HOW HE SEES THE BILL:
Like it or not the public and historians are likely to base their assessment of his performance on how well his “signature piece of domestic legislation” is implemented.
PROMISES VS PERFORMANCE # 1 UNIVERSAL COVERAGE.
Obama has made at least 80 promises related to health care and this report is based on 8 of the most consequential. 6/23/07 “I will sign a universal health care bill into law by the end of my first tem as president that will cover every American.” CBO projections as of the end of 2013 OBC will have reduced the number of nonelderly uninsured by less that 4%. This figure excludes 1 million unauthorized immigrants (51% of whom are uninsured). Fully implemented in 2017 it will cover on 92% of the nonelderly population. (Nearly everyone age 65 and above is already covered by Medicare) and 84.7% of that group already had coverage in March 209. Other countries relying on individual mandate have failed to drive their uninsured rate below 1% or 1.5%. OBC will close only 53% of the gap that existed when Obama was sworn into office-
PROMISE #2—NO NEW TAXES ON THE MIDDLE CLASS:
9/12/08—“I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase-not you income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” Using official estimates form the CBO and Joint Committee on Taxation and the House Ways and Means committee, projects that OBC will increase federal revenues by $1.058 trillion between 2013 and 2022. Only 30% of this total will be raised form taxes that exclusively target taxpayers earning over $200,000. The remaining 70% will be borne by households at all other income levels. Tax Policy Center figures show that such households do not account for more than half of all federal taxes. That still leaves at 35% to be borne by families at or below middle-class incomes. These figures do no include the hundreds of billions of dollars in new revenue that will have to be collected by states to pay for their share of OBC induced growth in Medicaid. Nor do they include the impact of “taxation by regulation”, the tens of billions in higher premiums that your Americans are being forced to p[ay under OBC. In order to subsidize predominantly higher-income people who happen to be older. His promise at best was 65% true and more likely 50% or less true—GRADE-“F”
PROMISE #3—ANNULA PRMIUM SAVINGS OF $2500.00 PER FAMILY:
6/5/08 “we’ll lower premiums by up to $2500.00 for a typical family per year—we’ll do it by the end of my first tem”. This promise was reiterated at least 14 times, most recently 7/16/2012. His claim was a “misstatement”, what was originally intended was that total health spending would decline by this amount. Giving the benefit of the doubt—reframing his promise as a prediction about HC spending rather than Premiums and allowing OBC a full 12 years to achieve the promise instead of taking candidate obama rash claim ”by the end of my first term.” The latest report form the Medicare actuaries shows that in its first dozen years, OBC will boost health spending by “roughly $621 billion”—or an average of $7,579.00 for a family of four. GRADE—“F”
PROMISE #4—BEND THE COST CURVE:
12/15/09 the bill “will finally reduce the costs of health care”. While conceding that health spending would go up in the first 10 years as a result of the expansion of coverage, PolitiFact scored this statement, as Half True on it will “bend the cost curve”. That is, in the final year of the 10-year projection used by the Medicare would be slightly lower (6.9%) than under the status quo (7.2%). Medicare actuaries, CBO and GAO are either wise of politically sustainable in light of their potentially devastating effects on access to care. Medicare spending by 2085 will absorb 9.8% of GDP rather than only 6.5% of GDP under the less realistic current laws projection that was used by the CBO.
PROMISE #5 NO INCREASE IN THE DEFICIT:
9/9/09 obama promised, “I will not sign a plan that adds one dime to our deficits.” The CBO scored the plan as reducing the deficit in its first 10 years, Paul Ryan eloquently and decisively revealed the “gimmicks and smoke-and- mirrors” underlying that assessment (which counted 10 years of revenue but only 6 years of spending). Charles Blahous documenting that some of the conventional assumptions used in CBO’s analysis contravene actual laws. CBO director Douglas Holtz-Eakin and Michael Ramlet who concluded that “the new reform law will raise the deficit by more than $500 billion during the first 10 years and by nearly $1.5 trillion in the following decade.” ACA has put us on a path to add $6.2 trillion (2011 dollars) to the deficit over the next 75 years.
PROMISE #6—YOU CAN KEEP YOUR PLAN IF YOU LIKE IT:
6/15/09 obama promised, “if you like your health care plan, you’ll be able to keep your health care plan, PEROID. No one will take it away not matter what”. This promise was made 3 dozen times as of 12/11/13, some 6 million American had lost their coverage as a result of the cancellation of nongroup policies that id not meet OBC coverage standards. RAND corporation projects that 17.7 million who would have had nongroup coverage in 2016, only 0.2 million will retain that coverage. But for the one-year delay of the employer mandate, many would have seen their employer based plans canceled. Estimates lose their employer based coverage because their employer drops it are all over the map, ranging from 11 million (CBO) to 14 million Medicare actually to 17.2 million (Lewin Group) to as high as 35 million (American Action Forum). OBC will slash payments to Medicare Advantage plans, the Medicare actuary has calculated cutbacks are fully phased in by 2017, about half of Medicare Advantage plan members (7.4 million) will lose their Part C coverage and be forced back into the wasteful and inefficient Medicare. Advantage plans are low-income seniors who had discovered it was much less expensive to join a Part C plan that pay premiums for regular Medicare. In short leaving aside the tens of millions who will pay higher premiums for “enhanced” coverage they may not want or need. PolitiFact declared this promise the lie of the Year for 2013.
PROMISE #7—IF YOU LIKE YOUR DOCTOR, YOU CAN KEEP YOUR DOCTOR:
6/15/09 obama “if you like your doctor, your will be able to keep your doctor, PERIOD.
New plans have more restrictions on access to specific doctors, hospitals and RX drugs”. The law requires those in the individual and small group markets to purchase coverage that is more comprehensive than some buy today. It is difficult to say how many of the nearly 6 million who have lost their nongroup coverage have been unable to find a plan that lets them keep their doctor. Tens of millions who may eventually lose their employer-based coverage and the 7.4 million affected by the Medicare Part C cutbacks. Mid January, 4.5 million have signed up for Medicaid (and CBO projects that when fully implemented in 2015, Medicaid will cover a total of 12 million newly eligible). RAND simulations indicate that 27% of newly Medicaid eligible people will be individuals losing employer based coverage. Since one third of doctors are currently unwilling to see new Medicaid patients, at lease some unknown fraction on newly Medicaid eligible people will lose their doctors. GRADE “F”
PROMISE #8—I’M NOT GOING TO TOUCH MEDICARE:
7/29/09 In a town hall meeting: Medicare is a government program. But don’t worry’ I’m not going to touch it.” The chief actuary for Medicare scored the law less than a month after its passage- he found that it would cut Medicare by $575 billion in its firs 10 years. In four consecutive annual reports actuary reported that if these steep cuts in provider payment rates were actually implemented, 15% of hospitals, skilled nursing facilities and home health agencies would be operation in the red by 2019. OBC would drive Medicare payment rates to physicians to less than half the levels [paid by Medicaid, which most experts agree would push providers to abandon Medicare in droves. Medicare Advantage plans are 9% less expensive. OBC will also slash payments to such plans by $145 billion in its first 10 years. In a 50% reduction in Medicare Advantage plan memberships by 2017. GRADE-“F”
MIDTERM GRADE, PROMISES VS PERFORMANCE—“F”
OBAMA HAS A PERSISTENT TENDENCY TO MAKE OUTLANDISH PROMISES THAT TOO OFTEN HAVE TURNED OU TO BE THE OPPOSITE OF WHAT THE SUTUDENT PREDICTED. NOT ONE OF THE PROMISES WAS INHERENTLY IMPLAUSIBE WHEN UTTERED, BUT THE PROSPEST OF ACHIEVING EVEN ON OF THEM BY THE FINAL GRADING PERIOD SEEMS VANISHINGLY REMOTE. THIS STUEDENT WOULD DO WELL TO CONSIDER ABANDONING THIS PROJECT IN FAVOR OF STARTING OVER WITH A NEW APPROACH..
Sources—weekly standard, Washington post, politifact, rand, AAF, lewin group, cbo,