A red state that can’t adopt Obamacare fast enough

From Mike King

I used to live in Kentucky. It’s a great state. I’d be hard pressed to say that most of the state is any more or less conservative than Georgia. It is, after all, home to the Senate Majority Leader (Mitch McConnell) and an up-and-coming tea party favorite who may be a presidential candidate in 2016 (Rand Paul). On the political color spectrum, it’s very red.

But it isn’t a one-party state. Steve Beshear, the governor, is a Democrat. He’s a former Attorney General for the state and a long-time political figure in Kentucky. And he was smart enough to understand, quickly, how Obamacare can help his state economically while at the same time improving the health and welfare of Kentucky residents by moving thousands of them from no insurance to Medicaid. He also quickly signed Kentucky up to manage its own health insurance exchanges and, by doing so, seemed to generate enough competition in the bluegrass to help keep policies affordable.

Here’s Beshear’s explanation of his decision in today’s New York Times

Contrast that with Georgia, a similarly red state. Unfortunately one-party domination (and the accompanying fear of tea party tail wagging that now controls that party) will leave Georgians to fend for themselves on the federal insurance exchanges. Meanwhile, 650,000 of the state’s residents who could have qualified for Medicaid will be left out altogether.

Georgia’s claim is the state can’t afford it. The state has a $20 billion annual budget. It is much healthier than Kentucky. Georgia can afford it. Kentucky has a visionary governor. Georgia has an intimidated governor who probably, deep down, knows it would have been the right thing for the state to expand Medicaid and set up its own exchanges. But he lacked the political fortitude to do it.





About those companies dropping insurance…


UPS, Delta, now Home Depot. There’s a lot going on in the employer-based insurance market. And because the changes these companies are enacting come at the same time Obamacare is rolling out, it’s easy to connect them to the new law.

Today’s story is just the latest

But, as these stories unfold, it’s important to keep a few things in mind before jumping to conclusions:

* This is the time of year all large companies, including those that are self-insured, make changes in their employee benefit plans. Changes like dropping spouses from the employee plan if the spouse qualifies for a plan because he/she works for another company that offers group health benefits have been accelerating in recent years. There’s nothing new about this change, but with health insurance about to become much more widely available it may make sense for some companies to do this.

* Go back over the last 10-12 years and think about how often during open enrollment employees were shocked to read about higher premium costs, higher deductibles and higher co-pays, just to keep the plans they had. Then consider that for many workers those costs continued to rise year after year while wages stayed stagnant, and in many cases (because of furloughs and other cost-cutting measures), were cut. It was during those years that momentum began to build for major reforms in the system.

* Keep in mind that the employer-based insurance market has fluctuated widely in the plans available to part-timers. They go from bare-bones plans that don’t cover much and don’t cost much (for employees, as well as their employers) to more traditional plans that can come with a hefty price tag for both. Again, with the insurance exchanges about to open up, it only makes business sense for companies to think about whether they want to continue to offer a plan to their part-timers that may not be as good, or even as affordable, as one the employee will be able to buy on the exchange.

*Speaking of part-timers, it’s important to remember that if the job at Home Depot, or Wal-Mart, or anywhere else that hires a huge volume of part-timers is the only job the employee has — for whatever reason he or she can’t find full-time work — then these employees will more than likely qualify for a subsidy to help pay for their insurance. And because these plans must meet basic minimum benefit standards — paying for preventive care, prescription drugs, etc. — the employees could be much better off buying on the market than having to re-enroll in the plan they now get on the job. Unfortunately, because some states have decided they would rather try to obstruct the new law by any legal means necessary, Home Depot workers in California will more than likely find a more affordable plan on their state exchange than Home Depot workers in Georgia. That’s why it was important for states to create their own exchanges, so they could negotiate with insurers on behalf of consumers for a more competitive marketplace. Georgia didn’t do that. State officials couldn’t muster up even that little amount of political courage to help the state’s residents get a better deal. So Georgia consumers will have to take the prices Ralph Hudgens and his friends in the insurance industry stick them with. Still, it’s better than nothing…but, wait, I digress, that’s another post on another day.

* From the perspective of recent history anyway, it’s also important to remember that many of these large, part-time-employee-based companies were pretty damn late to the notion that while they were fat and happy they ought to be providing decent benefits to this huge volume of workers. They may have been good about providing those benefits to supervisors and full-timers, but it wasn’t that long ago that workers advocates and others shamed these companies into providing at least something to part-timers. In other words, if it took them years to start offering their employees a health plan, it shouldn’t surprise us when they choose the first opportunity they can to get out of it. Only this time, with the new law in place, their employees won’t be left out in the cold. In fact they could be better off.

So read these and future stories about employer changes in health care plans carefully. No doubt, with the market about to change so dramatically, some of the decisions being made by companies are being implemented because of the new law. But more than likely they are the result of accountants showing executives how the bottom line can be improved by diminishing — if not eliminating altogether — the continuing cost of insuring some of their employees. Come to think of it, when hasn’t it always been that way?




A lot of info to cram into a video

Sister Rose Patrice, a Dominican nun who was principal at my elementary school, once told me while she was preparing me for a speech, “Michael, even if you don’t have much to say, say it with vigor.” This guy has a lot to say, and he says it with vigor — maybe a little too much vigor. But, as we used to say in the newspaper business, he can back up more than half of what he reports. This video has been making the rounds on Facebook. It deals with why medical costs are so high and challenges some of the usual talking points on the issue. I recommend giving it eight minutes or so of your time. Here’s the link:

A helpful look at Georgia’s priorities

My friend, and former AJC reporter/editor Tom Baxter has a great column discussing the difference in how Georgia’s political leaders think about spending money on a project like deepening the Port of Savannah versus expanding the Medicaid program to cover an additional 650,000 uninsured Georgians. It’s on the Saporta Report website. The standard brush off line that the governor’s office gives to reporters asking about why Georgia won’t take advantage of Obamacare’s offer to pay the full cost of the expansion for the first three years and at least 90 percent of the costs after that is “the state can’t afford it.” Georgia has a $20 billion annual budget. The “cost” to the state to expand Medicaid would run about $200 million a year. Do the math. It ain’t much. But can we afford a lot more than that to expand the port? Sure we can. An expanded port provides jobs, right? (Well, hopefully, although the promised benefit is pretty much a best, most optimistic guess.) Whereas the Medicaid expansion results in more Georgians being covered, a revitalized health care sector and, more than likely saved lives that might actually help the state improve its dismal health rankings. We could probably afford to do both. But you won’t hear that from the state’s leaders. It’s a matter of priority. What Nathan Deal and Ralph Hudgens mean to say about the Medicaid expansion is not that “the state can’t afford it,” it’s that we don’t think its worth spending any more money on poor people. They ought to at least be honest about that.

Here’s the link to Tom’s column.

Welcome to Comment on Health

This site is devoted to helping understand all the changes happening in our nation’s health care and insurance system. It is open to thoughtful, serious, sometimes comical and, hopefully, always engaging commentary. Opinions are welcome. Made up stuff isn’t. Nor is re-posting unverified and/or demonstrably false “facts” about health care reform.¬† Don’t be bringing that crap here. Do your homework. If you want to spew unchallenged, non-factually based opinions, take them back to your respective campfires and discuss it among yourselves. They won’t be posted here. (Yeah, yeah, I’m elitist and old school about this.) Having said that, all informed opinions that challenge conventional wisdom and common narratives about the subject of health care are otherwise welcomed. Still, part of what we want to do here is some helpful myth-busting. That means, from time to time, I will dissect some of the misinformation that makes its way into the mainstream, on Facebook, Twitter and other venues. I apologize in advance for even referencing some of these whoppers — putting anything on them World Wide Internets nowadays, even the blatantly false stuff — can sometimes result in extending the very life of the lie itself, despite the best effort to lay it to rest. (Think “death panels,” and “government takeover of health care.”) So I promise to do this with only¬† the most despicable of these claims, and only then with the aim of explaining who created it and why they want to mislead you.


Here’s what you need to know about me. I spent nearly 40 years in the daily newspaper business, much of it covering science, health and health care policy. I still write a lot about it, mostly as a freelance journalist. I don’t consider myself an expert on policy, but I know something about how the system works for real people and how to help people understand the issues connected to it. I am unabashed proponent of expanding both government and private programs so that all Americans are covered by an affordable, quality health insurance plan. It is not only good for the nation’s economy, it is — bottom line — the right thing to do. I consider it a sad commentary on our nation’s standing in the world that we have yet to come to grips with this basic societal need. One day we will. Until then, let’s talk about how best to get there. See you around the blog. — mike king