Ever since passage of the Affordable Care Act, a fierce debate has been waged over whether the law would work as advertised. While advocates promised that the design of new insurance markets would transform the way consumers buy health insurance, critics warned that the new market would never succeed. Reed Abelson and Margot Sanger-Katz have had front-row seats to the debate, and the two reporters took a few minutes to discuss when — and if — the market would stabilize.
Margot: It’s been a few weeks of bad news about the Obamacare marketplaces. On Friday, we learned that UnitedHealth has decided to pull out of Obamacare marketplaces in two states. The week before, the Blue Cross and Blue Shield Association put out a paper offering not-too-subtle hints that some members were losing money. Reed, you wrote recently about how surprising stasis in the employer insurance market means we can look forward to much smaller Obamacare marketplaces than most people expected when the health law passed. And the parade of struggling start-up insurer companies has extended to Maine’s Community Health Options, one of the co-ops that had long been held up as one of the most successful. Health insurers need to submit their rates to regulators in the next few weeks — or decide to exit markets. Should we be worried about a health insurance apocalypse?
Reed: I think people have a tendency to catastrophize, especially when it comes to Obamacare. UnitedHealth, which is one of the nation’s largest health insurers, has only reluctantly embraced the new market, and the company is always held up as an example of why the sky is falling and why Obamacare is going to crash and burn: If United can’t make it, no one can.
United has only a small fraction of the individual market, but some of the Blues are also struggling. What is most troubling is the fact that many insurers are losing money. You may not sympathize much with the insurance companies — and no one does — but they have to make enough money to pay claims. Do you think those losses are temporary — or a sign that the market is fundamentally unstable and potentially unsustainable?
Margot: I think some of both. It seems clear that some insurers just made pricing mistakes. I’d include a lot of the nonprofit co-op plans that have gone belly up in that category. United may fall in that category, too, in some places. That doesn’t seem to me like a permanent problem. If everyone priced too low, they can just raise their prices in future years, and it’ll be O.K. That’s not great for middle-class people who pay their own premiums, but most people in the exchanges won’t notice a difference because of the way the subsidies work.
These markets also turned out to be more complicated than some insurers expected. Some regulatory choices didn’t go their way. And it does look as if more customers than you might expect are staying enrolled in plans for only part of the year, which makes it hard for the insurers to collect premiums. But I think they’ll probably figure it out.
Reed: But isn’t it a vicious cycle? The big players won’t stay in markets unless they can attract enough customers to make it worth their while. Those who say Obamacare is doomed argue that the premiums are just too high for people who don’t qualify for a subsidy. If you are insured and relatively healthy, you may not feel as if the coverage is a good deal. The deductibles are steep, meaning you end up paying for a lot of your care before you see the first dollar of coverage, and you can’t always see your choice of doctor.
The result is that the market could be too small and therefore too volatile to attract mainstream insurers like United.
How do you solve that?
Margot: Well, it seems clear that you need some competition in every market to keep prices low. But maybe we don’t need the big carriers to play everywhere. As you noted, United barely showed up in the exchanges in the first place, and customers in most markets still have a lot of choices. The Medicaid-managed care plans seem to be having some success in this market, so maybe they will be a big part of the exchange mix.
I also think it’s worth looking at the states where things are going well and the insurers are making money: California, Vermont, Washington. Those state exchanges made some different regulatory choices early on that got more people into the new markets right away, so their markets stabilized more quickly.
Reed: You’re right that you may not need the established players for the market to work. The market may not look the way we thought it would, with the same insurers and same characteristics as the employer market. But one of the reasons insurers are leaving is because of the market’s instability. There’s tremendous churn in this market, with most people switching plans every year to try to find a cheaper alternative.
I’m not sure I know what the business model is for an insurer, if the expectation is that you’re going to keep your customers for only a year. It makes achieving long-term goals like keeping people healthier and focusing on preventive measures much harder because there may be no payoff for the insurer.
Margot: Yes, I think this is one of the contradictions of the Affordable Care Act’s design. The whole idea was that competition between the insurance companies would help to hold down prices, the way it does for, say, electronics or groceries. In order for that system to work, you need people to actually switch plans if their plan starts charging more than the competition. The fact that people are actually switching seems like a sign that this market is functioning as it was designed. But as you point out, all that churn sure makes it hard for an insurer to make money by investing in its customers’ long-term health. But the individual market, pre-Obamacare, also had a lot of churn.
Reed: Yes, there’s always been churn, but the insurers got pretty good at figuring out which people they wanted to insure by turning away the people who were most likely to cost them the most money. They definitely figured out how to make money.
It’s easier to smooth all of this out if you insure more people. Do you think there’s opportunity to see the market increase in size? I know insurers in the early years suffered when some states allowed people to keep their existing plans. Those plans that were grandmothered, as it is called.
Margot: My sense from talking to folks in the industry is that the grandmothered plans really wrecked their early calculations. The Obama administration, responding to a political freakout about people whose plans were getting canceled in 2014, let states keep them for a few more years. The result was that healthy people tended to hold onto their old, cheaper plans, while sick people went to the exchanges. You can see how that might make the exchange market unprofitable for new entrants.
I do think the market size is a bit of a chicken-or-egg question. Your story last week on stability in the employer market did such a good job of laying this out. Everyone (including the Congressional Budget Office) expected that employers would start dropping coverage once the marketplaces were up and running. That didn’t happen. It means that Obamacare has been much less disruptive to the status quo than many people thought. But it also means that the exchange markets are smaller and probably more expensive than people thought, too. If prices keep going up, maybe they’ll never grow much. It certainly seems like everyone is cutting down their long-term estimates for exchange enrollment.
Reed: The other possibility would be to expand the pool of people who qualify for subsidies. Is that a political nonstarter?
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Margot: It’s such an interesting question. Every time I write a story about the health law, I get comments and emails from people just above the income cutoff for subsidies. These are the people who have been most hurt by the health law. Plans on the exchanges are just really expensive for them, and often come with big deductibles, too. And if premiums keep rising, they’ll keep getting squeezed. Analysts from the Urban Institute have done the math and found that some of them are paying more than 25 percent of their income on health care now. Still, it is awfully hard to imagine Congress approving massive new spending to make Obamacare more generous. Hillary Clinton has some proposals about affordability, but they don’t include expanding subsidies.
Reed: One of the strengths of the law, and its main weakness, is its emphasis on keeping the status quo. While President Obama may have overpromised when he said you can keep your plan if you like it, the insurance isn’t radically different. The only way companies can seem to bring down prices is by narrowing networks of hospitals and doctors or hiking deductibles. While Bernie Sanders seems to be offering the most dramatic change by proposing that everyone switch to a government plan like Medicare, I’m still looking for a market response — some real change in how care is delivered that is much less expensive or at least more effective.
Margot: This is the thing I say whenever anyone asks me what I think about the health law. It basically baked in all of the complexity and dysfunction of the pre-existing American health care system.
Reed: We’re heading into the season when insurers and state regulators start talking about next year. Any thoughts on what we might expect?
Margot: I’m expecting them to ask for rate increases! The insurance companies are doing everything they can to broadcast their intentions to charge more. There are reasons we should expect the plans to do so even if the markets were already stable. Some of the early training-wheel programs set up by the law expire, which means the plans have to pay out more claims for really expensive patients. Last week, I heard Peter Lee, who runs Covered California, the most stable market of all, say he’s expecting bigger rate hikes next year than the last two. The Department of Health and Human Services has even signaled it expects rates to go up. This week, it put out a research paper to remind the public that requests to hike rates don’t always matter for individual consumers.
What will you be keeping your eyes open for to shape your thinking about how these markets will do long term?
Reed: We should keep watching for the exits.
But we should also look at what happens with some of the newer players, like Oscar, the for-profit company in New York that has a lot of capital. And I know that some of the big health systems — I’m thinking of another hometown player, Northwell Health, formerly North Shore-LIJ Health System — have started offering plans. Some of these systems, like Northwell, have had some success in attracting customers and think they can make a go of it.
And we should watch the Department of Justice. If it approves some of those big health insurance mergers like Anthem and Cigna and Aetna and Humana, my guess is those companies will not be leaving the marketplaces anytime soon.
RALEIGH, N.C. — North Carolina has been pummeled with boycotts, criticism and cancellations in the wake of its new law on gay and transgender rights. Now liberals and conservatives in the state have turned to pummeling one another.
For North Carolina, a state that has long been considered one of the South’s most moderate, the intense reaction to the law, especially from business interests, has provided an ego-bruising moment.
But beyond ego and self-image, the legislation is exacerbating the political divisions in a state almost evenly divided between conservative and liberal forces. The acrimony is certain to play out not just in one of the nation’s most closely contested races for governor but also in the rare Southern state that can be up for grabs in presidential politics.
And while the state has been pilloried from the left, it is not at all clear who will be the ultimate winner in the battle set in motion by the law, which restricts transgender bathroom use and pre-empts local governments from creating their own anti-discrimination policies.
Democrats inside and outside North Carolina have been supported by a number of corporations, and the opposition looms large in a state with a long pro-business tradition.
Over the weekend, the Rev. Dr. William J. Barber II, president of the North Carolina N.A.A.C.P., vowed that the Moral Mondays movement, which flooded the State Capitol with liberal activists in the past to protest the policies of the Republican-controlled legislature, would begin “a campaign of mass sit-ins at the General Assembly.” The protesters plan to take the action if the General Assembly does not repeal the bill before it meets again in regular session on April 25.
But Republicans have been sweepingly dismissive of the fallout. When PayPal said it would cancel its plan to open a global operations center in Charlotte and employ more than 400 people there, Lt. Gov. Dan Forest said, “If our action in keeping men out of women’s bathrooms and showers protected the life of just one child or one woman from being molested or assaulted, it was worth it.”
WASHINGTON — When it comes to nominating presidential candidates, it turns out the world’s foremost democracy is not so purely democratic.
For decades, both major parties have used a somewhat convoluted process for picking their nominees, one that involves ordinary voters in only an indirect way. As Americans flock this year to outsider candidates, the kind most hindered by these rules, they are suddenly waking up to this reality. And their confusion and anger are adding another volatile element to an election being waged over questions of fairness and equality.
In Nashville a week ago, supporters of Donald J. Trump accused Republican leaders of trying to stack the state’s delegate slate with people who were anti-Trump. The Trump campaign posted the cellphone number of the state party chairman on Twitter, leading him to be inundated with calls. Several dozen people showed up at the meeting at which delegates were being named, banged on the windows and demanded to be let in.
Backers of Senator Bernie Sanders, bewildered at why he keeps winning states but cannot seem to cut into Hillary Clinton’s delegate count because of her overwhelming lead with “superdelegates,” have used Reddit and Twitter to start an aggressive pressure campaign to flip votes.
Javier Morillo, a member of the Democratic National Committee and a superdelegate from Minnesota, said he discovered his email posted on a website called a “Superdelegate Hit List.”The list had an illustration of a donkey, the party’s symbol, with two crossbow arrows behind its head. “I was a little annoyed,” he said.
The mother of Christopher Dorner expressed her sympathies for his victims and the families they left behind. She released this statement to Fox 11: It is with great sadness and heavy hearts that we express our deepest sympathies and condolences to anyone that suffered losses or injuries resulting from Christopher’s actions. We do not condone Christopher’s actions.The family has no further comments and ask that our privacy be respected during this difficult time. – Nancy Dorner
In a phone interview with Fox 11, Nancy Dorner also said there could be some validity to the claims her son made in his manifesto, but stressed that she didn’t condone his crimes. Police have linked Christopher Dorner to the murders of Monica Quan and Keith Lawrence, as well as Riverside police officer Michael Crain and San Bernardino County Sheriff’s Deputy Jeremiah McKay. Instead of going on a murderous rampage, Nancy Dorner wishes her son had simply contacted a journalist about the allegations of Los Angeles Police Department racism and corruption in his manifesto. Nancy Dorner was reportedly spotted at a Mexican restaurant near her home in La Palma, Calif. watching news coverage of a man believed to be Christopher Dorner engaging in an hours-long standoff with police in a cabin in Big Bear. She and her daughter have been cooperating with authorities in the investigation against Christopher Dorner, reports the Los Angeles Daily News.
Today the Washington Post released the latest short film in a three-part series that explores the lives of black men in the U.S. The series titled “BrotherSpeak” asks black men about their fears, loves and dreams. The second installment of “BrotherSpeak” released today focuses on Love. The video includes interviews with a former all-star running back from the Dallas Cowboys and Washington Redskins; an internationally renowed pastor from Prince George’s County , MD; a nationally syndicated columnist; a hip-hop artist and educator, a Baltimore pastor and a community advocate.
Chris Jenkins describes the project on The Root DC: > Six years ago, The Washington Post embarked on an unprecedented project: a several-months-long journey exploring the lives of black men. Through pictures and one-on-one interviews, in-depth stories and award-winning video, The Post’s series, titled “Being a Black Man”, revealed the sometimes complex lives of African American men.
Today, The Post, in cooperation with the Maynard Institute for Journalism Education, is starting another project that explores the experiences of black men in America. Titled “BrotherSpeak,” the three-part video series is another chance to hear from the black men about what matters most to them. For the series, we asked a range of black men to discuss three words: Fear, love and dream. Each video focuses on one word.
We chose these words because we believe they represent fundamental human emotions and impulses that many black men’s experiences provide them a unique relationship with and perspective on. The point of our series is to highlight the three dimensions of these qualities as they relate to black men, while also touching on the universal human qualities illustrated by each. We believe a discussion of these words can help round out the image of black men in popular culture and touch spaces in our experience rarely explored by mainstream media.
New York City’s stop-and-frisk program has exploded by 600 percent under Mayor Michael Bloomberg — garnering outrage from critics who believe that the practice forces Black and Latino residents to live under a separate-and-unequal police state, subject to random violations of their Fourth Amendment constitutional right against unreasonable search and seizure. Though originally intended to curb gun violence, the program has become carte blanche for New York Police Department officers to racially profile young males in predominantly Black and Latino neighborhoods. With the help of the New York Civil Liberties Union, city residents sued the NYPD — seeking justice from those sworn to protect and defend them. In a case specifically focused on the Trespass Affidavit Program, or TAP, which allowed officers to stop and question residents both inside and outside private property (in residences dubbed “clean halls” buildings), plaintiffs argued that the NYPD “has a widespread practice of making unlawful stops on suspicion of trespass.” The lead plaintiff, Jaenean Ligon, filed suit after her 17-year-old son was stopped for no reason outside his apartment building during a trip to the store to purchase ketchup. Yes, ketchup. This week, U.S. District Judge Shira Scheindlin issued an injunction prohibiting NYPD officers from engaging in stop and frisk outside buildings designated by TAP. The facts of the case reveal that patrolling officers never differentiated between potential criminals and citizens. Black and Latino residents were stopped on suspicion of being Black and Latino alone. In addition to Ligon, other plaintiffs included Charles Bradley, a 51-year-old African-American security guard, who was arrested while visiting his fiancee in the Bronx. Bradley was stopped, frisked, transported to a police station, strip-searched and fingerprinted — all while being asked questions about his potential involvement with guns and drugs.
In a move sure to upset privacy advocates across the country, and perhaps spark action from the Supreme Court, the Senate on Friday morning passed the Foreign Intelligence Surveillance Act (FISA) by a vote of 73-23 and will send it to President Obama’s desk for signature. FISA allows the government to tap any conversation involving U.S. citizens without previously obtaining a warrant, as long as officials suspect those talks involve at least one person located outside of the United States. The bill passed the House in September, led to contentious arguments on the Senate floor this week, and extends a modern debate that became especially heated in the Bush era as the National Security Agency extended its powers without court regulation. Wired’s David Kravets explains the details of the latest legislation:
The FISA Amendments Act generally requires the Foreign Intelligence Surveillance Act Court, a secret tribunal set up in the wake of President Richard M. Nixon-era eavesdropping, to rubber-stamp terror-related electronic surveillance requests. The government does not have to identify the target or facility to be monitored. It can begin surveillance a week before making the request, and the surveillance can continue during the appeals process if, in a rare case, the secret FISA court rejects the surveillance application.
Secret tribunals? Spying? Why would this matter if the only international calls are (speaking from personal experience) the ones you’re making to your Filipino grandma talking about her day?Salon’s Alex Pareene details the big-picture of why FISA is so tricky:
The FISA Amendments Act makes a joke of the entire Fourth Amendment “warrant” requirement, as the government now can seek “programmatic warrants” that allow them to indiscriminately collect massive amounts of data from broadly defined “targets” over the course of a year.
There is a tiny sliver hope if you aren’t a fan of FISA and really like the Fourth Amendment. AsThe Verge’s Adi Robertson reports, there have have been efforts to get the Supreme Court involved.