lambert's blog

Here's Klein's riff, and he's right within its limits:

[T]here were a lot of moments when Obama seemed to be subverting the rules of the evening in order to get away with telling harsh truths that he could later claim were just jokes.

“Some folks still don’t think I spend enough time with Congress,” the president said. “‘Why don’t you get a drink with Mitch McConnell?’ they ask. Really? Why don’t you get a drink with Mitch McConnell?”

Everyone laughed. But do you detect an actual joke there? And lest you think I’m cutting the punchline, here’s Obama’s next sentence: “I’m sorry. I get frustrated sometimes.”

OK (again), so how about this one? Read below the fold...

Hilarity:

Arizona’s very conservative governor Jan Brewer, hardly inclined to support much coming from the Obama Administration, recognized this gap in coverage, which got her to switch her position to one in favor of expanded Medicaid coverage. Her compatriot Republican governors, Rick Perry in Texas and Rick Scott in Florida, have not changed their stances. So, immigrants who could and should have been covered by Medicaid will have an opportunity to buy subsidized healthcare coverage on the exchanges, but those current citizens with low incomes who don’t get access to expanded Medicaid will not. As national healthcare coverage rolls toward full implementation, nonprofit advocates are going to have to function as real-time watchdogs, identifying the areas where the implementation of the law reveals areas that need to be patched or fully overhauled.—Rick Cohen

Thing is, though, all schadenfreude aside, there's a lot wrong with this item: Read below the fold...

My Eyes Glaze Over: Read below the fold...

Pew stateline:

When the Affordable Care Act was written, its authors assumed that Medicaid — the federal-state health care plan for the poor — would be expanded to low-income adults in every state.

But the U.S. Supreme Court’s decision in July 2012 largely upholding the law made the expansion optional. Since then, governors in nearly half of all states have refused to take it up.

In states that choose not to expand Medicaid, small businesses may be liable for substantial penalties they would not have had to pay if the expansion had remained mandatory, according to a recent analysis by Brian Haile of Jackson Hewitt Tax Service. Based on actuarial estimates of the number of low-income workers who would have qualified for Medicaid in the 22 states that so far have said they will not expand, Haile estimated that small businesses could be liable for as much as $1.3 billion in penalties each year. In Texas alone, the penalties could amount to as much as $448 million each year, Haile wrote.

OK, a tax service talking their book of tax savings. Read below the fold...

Joe Klein:

A few weeks ago, I gave the President a tough time about the slow and messy implementation of his health care plan. But there’s been some progress in recent weeks—and I’m happy to pass it on.

Well, then you couldn't have been all that tough. Read below the fold...

Ed Kilgore: Read below the fold...

I'd hate for the processing of paying for health care to be boring! Desmoines Register:

The soft-spoken former life insurance company executive expects the turmoil to last a while. Eventually, he said, people will adjust to the new realities of the health insurance market and won’t face unpredictable costs or changes in coverage. “But I think that’s at least three years out,” he said at his Des Moines office. “I think it’s probably going to be a few years before the market can really digest what’s happening. There’s just a lot of unknowns right now.”

But nobody knows anything: Read below the fold...

Columbus Dispatch:

[I]n Ohio and 33 other states that opted for federally run or partnership exchanges instead of setting up their own, there won’t be much money from the federal government to help get the word out.

The Ohio Department of Insurance said it is waiting for more information from the federal government about its outreach plans before determining what its role will be, said spokesman Chris Brock. As for spending state funds on public awareness, Brock wrote in an email: “We see that as a responsibility of the federal government since they are running the exchange.”

Officials at the Centers for Medicare & Medicaid Services did not respond to Dispatch questions in time for publication.

Well, it's not like the Columbus Dispatch is a serious paper or anything. Read below the fold...

Remember, one idea behind ObamaCare is that savvy health care consumers will seek out the cheapest and/or best kidney transplants or slings for their broken arms because magic marketplace. And transparency! This theory is also called "patient empowerment," blaming the victim, the privatization of public health, and #FAIL.. Another idea behind ObamaCare is that health insurance companies will compete on the health exchanges to offer the best polices and/or the lowest prices instead of colluding to bankrupt the hapless patient consumer, again because magic marketplace. Of course, ObamaCare is implemented state by state, so that this theory won't work in states where there are monopolies. So how many of those states are there?

[E]ven some stalwart supporters of the Affordable Care Act worry that in many states, people won’t have a lot of health insurance choices when the exchanges launch in October.

Health economists predict that in states that already have robust competition among insurance companies—states such as Colorado, Minnesota and Oregon -- the exchanges are likely to stimulate more. But according to Linda Blumberg of the Urban Institute, "There are still going to be states with virtual monopolies." Currently Alabama, Hawaii, Michigan, Delaware, Alaska, North Dakota, South Carolina, Rhode Island, Wyoming and Nebraska all are dominated by a single insurance company. The advent of the exchanges is unlikely to change that, according to Blumberg.

So, in those -- one moment, I have to count -- ten states with insurance monopolies, the health exchanges aren't going to have the "choice" ObamaCare was supposed to provide. So, if you live there, no magic marketplace for you, Mr. or Mrs. Second Class Citizen! Read below the fold...

Modern Health Care:

Uncle Sam has perhaps the biggest hill to climb, especially since final guidance for federally facilitated exchanges has yet to be released. Not only does the government need to be involved in those states, but they also are required to operate a federal data hub, the huge IT system that will electronically communicate with states in determining Medicaid and Children's Health Insurance Program coverage as well as eligibility for premium tax credits

The state-run exchanges appear to be farther along in their exchange preparations, according to policy experts who have been following exchange process. Still, there is some concern about meeting the fall deadline.

“Oct. 1 might get pushed,” says Dan Schuyler, director of exchange technology at Salt Lake City-based consultancy Leavitt Partners. Schuyler, a former technology director for the Utah Health Insurance Exchange, thinks that systems such as the federal data hub as well as state systems that interact with it may not be ready in time, leading to a delay in open enrollment. Without a system to determine premium tax subsidies, “then you would have delayed eligibility verification,” he says.

That could discourage the uninsured from signing up. Medicare subsidies and tax credit determinations need to be made in real time. Applicants can't wait days, weeks or even months to find out whether they qualify for subsidies and how much they will get. Those determinations will factor heavily in their plan selections and could determine whether they sign up at all.

And even if they do sign up, “if (the determination) gets too far down the line, say past 90 days, then an enrollee won't have effective coverage on Jan. 1,” Schuyler says.

Yep. Of course, Sibelius has put a stake in the ground already on the October 1 date: Read below the fold...

Pravda:

On the millions Sheldon Adelson spent to try to unseat him: “[OBAMA:] That’s Oprah money! You could buy an island and call it Nobama. Adelson would have been better off calling me up and offering me $100 million to drop out of the race. I probably wouldn’t have taken it. But I’d consider it.”

Um. Read below the fold...

I am so looking forward to this.* Kaiser Health News:

The federal government has awarded a $28.2 million contract to a General Dynamics subsidiary to run a call center to handle consumer questions about the new online insurance marketplaces that are slated to begin selling insurance policies Oct. 1.

Note the change in vocabulary: These have been called "Health Insurance Exhanges" but they are not being called "marketplaces" (I think this terminology originated from inside CMS).

The call center will be responsible for all inquiries related to the insurance marketplaces in at least 34 states that will be run wholly or partly by the federal government. Sixteen states are setting up their own online insurance marketplaces. The call center will also communicate via e-mail, Web chat, fax and the U.S. mail system.

The call center for the new insurance marketplaces is expected to be in operation by June.

That's well before the actual roll-out of the system. How can it possibly deliver accurate information? Read below the fold...

Op-Ed News, all the way at the last paragraph:

I still feel the way I did in 2009 when I wrote that "progressive groupthink hindered health reform." The reflexive instinct to support a Democratic-proposed policy led to the mind-bending spectacle of liberals from Rachel Maddow to Paul Krugman cheering for an "individual mandate" policy which was designed in a conservative think tank as a boon to private corporations.

Well, that is a very charitable view. AFAIK, Hamsher is the only one in all that shameful crowd to have reflected, and changed her mind. Read below the fold...

I tend not to quote the Motley Fool, but I haven't seen this argument elsewhere, so:

The Supreme Court's role in deciding the fate of the ACA probably isn't over despite last year's ruling. Multiple cases are winding their way through lower-level courts. One, in particular, stands out as a quite serious challenge for the ACA, in large part because it hinges on the initial Supreme Court determination that the individual mandate is a tax.

Read below the fold...

Nobody could have predicted.... Reuters:

Heavy use of the world's most popular herbicide, Roundup, could be linked to a range of health problems and diseases, including Parkinson's, infertility and cancers, according to a new study.

The peer-reviewed report, published last week in the scientific journal Entropy, said evidence indicates that residues of "glyphosate," the chief ingredient in Roundup weed killer, which is sprayed over millions of acres of crops, has been found in food.

"Entropy"? No shit. Read below the fold...