It’s coverage day for hundreds of thousands of people across the country as key provisions of the Affordable Care Act kick in.
Those provisions:
- Ban on discriminating against children with preexisting conditions: as of tomorrow, insurance companies can’t deny coverage to children under age 19 for a pre-existing condition. The ban will go into effect for adults in 2014.
- Ban on rescission: insurers will be prohibited from dropping a customer when they get sick or to search for errors in customers’ applications to use as a basis for rescinding coverage or denying payment for services.
- Ban on limiting coverage, lifetime caps: Insurers will no longer be able to impose lifetime dollar limits on benefits–particularly hospital stays or expensive treatments for chronic diseases, cancer, etc. By 2014, they will phase out annual caps.
- Ban on limiting doctor choice in new plans: insurers will have to allow primary care physician status for OB/GYNs and pediatricians so that patients don’t have to get pre-authorization or referrals to see these providers.
- Ban on restrictions on emergency services: insurers will have to cover all emergency care, in or out of network.
- Guaranteed right to appeal insurer decisions to independent third party in new plans;
- Young adults can stay on their parents’ plans til 26 unless they have access to coverage in their workplace;
- New plans will cover preventive care with no customer costs–well-baby, mammograms, colonoscopies, etc. will be covered with no co-pays or deductibles.
Many of these changes will not apply to existing plans. Health plans that existed on March 23, 2010 are “grandfathered,” meaning they are exempt from implementing these new provisions. So free preventive care, unrestricted provider choice, level charges for emergency care, and the right of appeal do not apply to existing plans. Additionally, the coverage for adult children on family plans can only be extended if an employer plan is not available to them.
The New York Times has assembled some stories of people who will be affected.
A child with a preexisting condition:
Joe and Mary Thompson had agreed to adopt Emily before her birth in 1999, and it never occurred to them to back out when she was born with spina bifida. But that same year, their residential remodeling business in Overland Park, Kan., went under, prompting job changes that left the family searching for health coverage with a child who was uninsurable.
The insurers were willing to cover the Thompsons and their older daughter, but not Emily, who was later discovered to have mild autism as well, or her 13-year-old brother, who had a diagnosis of attention deficit disorder.
Starting Thursday, the insurers will not be able to do that, as the new health care law prohibits them from denying coverage to children under 19 because of pre-existing health conditions. In 2014, the change will extend to people of all ages.
Families worried about lifetime benefits caps: Bill and Victoria Strong’s daughter has a terminal degenerative condition.
Suddenly, it became vital that their family policy, with Health Net of California, had a generous $5 million limit on benefits. With the help of hugely expensive care at their home in Santa Barbara, Calif. — ventilators, nebulizers, feeding tubes, suction machines — Gwendolyn has defied the odds to survive to nearly 3. And she has already consumed $2 million in care, about half of it from three hospitalizations in her first eight months.
“Anxiety was high,” said Mr. Strong, now 34, “because we were marching pretty quickly toward that $5 million cap. It was always in the back of my mind.”
Starting Thursday, the health care law prohibits lifetime caps, thereby extending coverage to the 20,400 people that the government estimates may exceed their limits each year. The law also begins to restrict annual limits on benefits, eliminating them fully in 2014.
Young adults who aren’t insured by their employers:
Once Lacey E. McLear turned 23 and aged out of her parents’ health insurance, she changed her route home from work to circumvent dangerous intersections. When she came down with the flu, she continued to wait tables (“I know, it’s gross,” she conceded) because she could not afford a doctor and could not skip work without a note. At Christmas, she strung lights only halfway up the tree, to avoid climbing a ladder.
But soon, Ms. McLear, now 24 and still a college-degreed waitress in Richmond, Va., will be able to return to her parents’ policy thanks to the health law provision that requires insurers to offer coverage to children until their 26th birthday. Ms. McLear said she was angry that it might not be until Feb. 1, when her mother’s policy renews, as is allowed under the law. But the sense of relief is already palpable, she said, because she can then seek treatment, and perhaps surgery, for a bum knee that aches under the strain of trays heavy with pasta.
There are still going to be struggles. As Susan detailed yesterday, insurers are looking every which way for loopholes and ways to keep screwing people over when they’re at their most vulnerable. But several key loopholes have closed, several major new rights have been established, and lives are actually improving as a result.
Tags: Affordable Care Act, Health Care
Here’s how Wal-Mart’s US CEO describes what happens in the chain’s stores at midnight the last night of the month:
“And you need not go further than one of our stores on midnight at the end of the month. And it’s real interesting to watch, about 11 p.m., customers start to come in and shop, fill their grocery basket with basic items, baby formula, milk, bread, eggs,and continue to shop and mill about the store until midnight, when electronic — government electronic benefits cards get activated and then the checkout starts and occurs. And our sales for those first few hours on the first of the month are substantially and significantly higher.
“And if you really think about it, the only reason somebody gets out in the middle of the night and buys baby formula is that they need it, and they’ve been waiting for it. Otherwise, we are open 24 hours — come at 5 a.m., come at 7 a.m., come at 10 a.m. But if you are there at midnight, you are there for a reason.”
Note that this isn’t just a few people in one place. Wal-Mart sales are “substantially and significantly higher” during those hours. Wal-Mart, in case you hadn’t noticed, is a very large chain. To noticeably affect its overall sales statistics, you have to be talking about a lot of people. Which means there are a lot of people out there in such need that they can’t wait until morning and are going out at midnight to buy baby formula and bread.
Not that there’s an economic crisis or anything.
(Via Susie Madrak)
From MoJo – health insurance companies plan rate hikes, even as the number of insured Americans continues to decline:
The number of people with health insurance decreased from 255.1 million in 2008 to 253.6 million in 2009. Since 1987, the first year that comparable health insurance data were collected, this is the first year that the number of people with health insurance has decreased.
Between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, while the number covered by government health insurance climbed from 87.4 million to 93.2 million. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million. The number with Medicaid coverage increased from 42.6 million to 47.8 million.
Jobless Americans are losing their private health insurance, which means Medicaid enrollment is increasing dramatically.
In the wake of health care reform, insurance companies are raising their rates—apparently, in preparation for the tepid new rules that won’t go into effect for years, and thus give the industry plenty of time to jack up their prices and protect their profits. The Wall Street Journal reports that premiums for individuals and small businesses will go up in 2011, in some cases by as much as 20 percent.
Unfortunately, there was nothing in the health insurance reform bill to prevent insurance companies from continuing to jack up their rates. Soon they will be blaming rate increases on the decreasing numbers of people buying insurance.
From the LA Times:
A number of big insurance companies will no longer sell child-only insurance policies. Families that might have only been able to afford to insure their children are going to be out of luck.
Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.
Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation’s new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.
The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents’ employers. An estimated 80,000 California children currently without insurance — and as many as 500,000 nationwide — would be affected, according to experts.
It’s amazing that a business so deeply involved in a crucial aspect of our lives could be so utterly lacking in any sort of moral compass.
Tags: Health Care
On my way to work today, I saw a Washington Post headline: Recession is officially over, but anxiety lingers.
To be fair, the Post article offers a few reasons that might be the case, but Atrios gets right to the point:
So the recession was over in June ’09. Huzzah!
I know I’m a broken record on this, but there is no great mystery why the Dems are looking at potentially major problems in November. The economy is truly atrocious and has been for a long time. I remember just before the ’08 election – almost two years ago – betting a friend that unemployment would rise above 7.6%. At the time to many people 7.6% seemed to be a pretty crazy number, even in the middle of the unfolding crisis. Soon after the administration projected that unemployment would peak at 9% from Q1-Q3 2010, and then start declining without any stimulus. It’s now been above 9% since May 2009, including 3 months where it was 10%+. If I had traveled back in time to warn them of this state of affairs, they would have been more likely to believe the time travel part.
Tags: economy, recession
From the Wall St. Journal:
It’s not as easy to be rich as it used to be.
Once upon a time, America’s most wealthy people barely felt the ups and downs of the economy. Over the past few decades, though, the roller-coaster ride has become more extreme for them than for any other income group, according to a new paper by two Northwestern University economists.
and
Overall, since 1982, the income of the top 1% of earners has been about 2.4 times as volatile as the average for everyone, the paper’s authors find. That’s a big change from the years 1947 to 1982, when the income of the top 1% fluctuated about 30% less than average.
*sniffle*
To be sure, the greater volatility doesn’t mean poorer folks should feel sorry for the rich. On average, households in the top 1% had a pre-tax income of about $1.4 million in 2006, so they were well able to absorb big losses.
Whew – that’s a relief. I don’t have to go dig under the couch cushions for change, so that I can go buy a box of tissues to use as I weep for the plight of the wealthy.
According to Paul Krugman in the NY Times, the rich are angry:
These are terrible times for many people in this country. Poverty, especially acute poverty, has soared in the economic slump; millions of people have lost their homes. Young people can’t find jobs; laid-off 50-somethings fear that they’ll never work again.
Yet if you want to find real political rage — the kind of rage that makes people compare President Obama to Hitler, or accuse him of treason — you won’t find it among these suffering Americans. You’ll find it instead among the very privileged, people who don’t have to worry about losing their jobs, their homes, or their health insurance, but who are outraged, outraged, at the thought of paying modestly higher taxes.
and
These days, however, tax-cutters are hardly even trying to make the trickle-down case. Yes, Republicans are pushing the line that raising taxes at the top would hurt small businesses, but their hearts don’t really seem in it. Instead, it has become common to hear vehement denials that people making $400,000 or $500,000 a year are rich. I mean, look at the expenses of people in that income class — the property taxes they have to pay on their expensive houses, the cost of sending their kids to elite private schools, and so on. Why, they can barely make ends meet.
Uh-oh, I may have to go back to the couch cushions….but yet. Krugman points out that the rich have political power and influence, and so a number of politicians from both sides of the aisle are fighting to keep the tax cuts for the wealthy in place, in spite of the price tag.
NOW it’s time for the tissues:
And when the tax fight is over, one way or another, you can be sure that the people currently defending the incomes of the elite will go back to demanding cuts in Social Security and aid to the unemployed. America must make hard choices, they’ll say; we all have to be willing to make sacrifices.
But when they say “we,” they mean “you.” Sacrifice is for the little people.
Bob Herbert writes in his column “Two Different Worlds”:
I didn’t notice much when a terrific storm slammed into parts of New York City on Thursday evening. I was working at my computer in a quiet apartment on the Upper West Side of Manhattan. The skies darkened and it began to rain, and I could hear thunder. But that’s all. I made a cup of coffee and kept working.
While I remained oblivious, the storm took a frightening toll in the boroughs of Brooklyn, Queens and Staten Island.
[...]
The movers and shakers of our society seem similarly oblivious to the terrible destruction wrought by the economic storm that has roared through America. They’ve heard some thunder, perhaps, and seen some lightning, and maybe felt a bit of the wind. But there is nothing that society’s leaders are doing — no sense of urgency in their policies or attitudes — that suggests they understand the extent of the economic devastation that has come crashing down like a plague on the poor and much of the middle class.
The American economy is on its knees and the suffering has reached historic levels. Nearly 44 million people were living in poverty last year, which is more than 14 percent of the population. That is an increase of 4 million over the previous year, the highest percentage in 15 years, and the highest number in more than a half-century of record-keeping. Millions more are teetering on the edge, poised to fall into poverty.
[...]
What is desperately needed is leadership that recognizes the depth and intensity of the economic crisis facing so many ordinary Americans. It’s time for the movers and shakers to lift the shroud of oblivion and reach out to those many millions of Americans trapped in a world of hurt.
This coming Friday, at a public session in New York titled ‘Which Way for the Working Class? Elections 2010 and Beyond’, Bob Herbert will join AFL-CIO President Richard Trumka, Working America Executive Director Karen Nussbaum, and journalist Eric Alterman in a panel moderated by The Nation Editor and Publisher Katrina vanden Heuvel.
Tags: Bob Herbert
Kicking back and reading a mystery novel doesn’t necessarily mean turning your brain off. Mystery novelist and friend of Working America Tim Sheard will demonstrate just that when he comes to Washington, DC on Tuesday, September 21 to read from his latest novel, Slim to None. You’re invited to his reading and discussion of crime novels and class conflict in today’s society.
Slim to None is Sheard’s fourth mystery featuring Lenny Moss, a hospital janitor and union shop steward. When a hospital worker is wrongly accused of murder, his co-workers ask Lenny to clear his name. By sticking together, the workers are able to save their friend and solve a murder.
Tim Sheard is a veteran nurse whose decades of experience add real-life detail to his hospital setting and characters. He will be reading from Slim to None and discussing the conventions of crime fiction—asking why fictional detectives only investigate simple acts of murder and not the mass murders perpetrated by powerful financial elites? What is a crime in today’s society and who writes the definitions?
The reading will be held at 6:30 PM on September 21 at Busboys & Poets, 1025 5th St. NW (at K St.). It is free and open to the public. For more information, call 202 332-6433.
We hope to see you there.
Major and timely new report from EPI (PDF):
The data analysis in this paper, however, indicate that public employees, both state and local government, are not overpaid. Comparisons controlling for education, experience, hours of work, organizational size, gender, race, ethnicity and disability, reveal no significant overpayment but a slight undercompensation of public employees when compared to private employee compensation costs
on a per hour basis. On average, full-time state and local employees are undercompensated by 3.7%, in comparison to otherwise similar private-sector workers. The public employee compensation penalty is smaller for local government employees (1.8%) than state government workers (7.6%).
There are, however, substantially different approaches to staffing and compensation between the private and public sectors. On average, state and local public-sector workers are more highly educated than the private-sector workforce; 54% of full-time state and local public sector workers hold at least a four year college degree compared to 35% of full-time private-sector workers. State and local governments pay college-educated labor on average 25% less than private employers. The earnings differential is greatest for professional employees, lawyers, and doctors. On the other hand, the public sector appears to set a floor on compensation. The compensation of workers with a high school education is higher for state or local government employees, when compared to similarly educated workers in the private sector.
Benefits are also allocated differently between privateand public-sector full-time workers in the United States. State and local government employees receive a higher portion of their compensation in the form of employerprovided benefits, and the mix of benefits is different from the private sector. Some benefits are more generous in the public sector, but it is a serious error to imagine that comparability requires that each and every element of compensation is the same. What is important when considering both the employer-provided benefits and direct pay is whether state and local government workers have a total compensation package that costs what they would receive if employed in the private sector. It is the total cost of the compensation package—not the mix of cash and benefits—that is important in making a comparison.
There’s a lot more—it’s a 14-page report—but the significant takeaway is right there at the top: public sector workers are slightly undercompensated (considering pay and benefits) compared with private sector workers.
There’s something else really important in the middle paragraph I quoted, though:
State and local governments pay college-educated labor on average 25% less than private employers. The earnings differential is greatest for professional employees, lawyers, and doctors. On the other hand, the public sector appears to set a floor on compensation. The compensation of workers with a high school education is higher for state or local government employees, when compared to similarly educated workers in the private sector.
I’d argue that floor is a big part of the reason public sector workers are under attack. Corporations have worked long and hard to destroy the compensation floor for workers with high school diplomas, just lower it into the basement. So they really, really don’t want any reminders walking around that a janitor could be paid a living wage. That undermines their whole racket.
The fact that public sector workers are compensated differently helps the anti-worker warriors. They can pick things out selectively, pointing to a pension here, a health care plan there, a raised floor under their feet, and suggest that these combine to create a different picture than they actually do. That’s been a successful tactic for them. But what we need to realize, all of us, is that the end goal is to lower the floor for everyone.
Tags: public sector workers
Paul Krugman:
So, about those tax cuts: back in 2001, the Bush administration bundled huge tax cuts for wealthy Americans with much smaller tax cuts for the middle class, then pretended that it was mainly offering tax breaks to ordinary families. Meanwhile, it circumvented Senate rules intended to prevent irresponsible fiscal actions — rules that would have forced it to find spending cuts to offset its $1.3 trillion tax cut — by putting an expiration date of Dec. 31, 2010, on the whole bill. And the witching hour is now upon us. If Congress doesn’t act, the Bush tax cuts will turn into a pumpkin at the end of this year, with tax rates reverting to Clinton-era levels.
In response, President Obama is proposing legislation that would keep tax rates essentially unchanged for 98 percent of Americans but allow rates on the richest 2 percent to rise. But Republicans are threatening to block that legislation, effectively raising taxes on the middle class, unless they get tax breaks for their wealthy friends.
That’s an extraordinary step. Almost everyone agrees that raising taxes on the middle class in the middle of an economic slump is a bad idea, unless the effects are offset by other job-creation programs — and Republicans are blocking those, too. So the G.O.P. is, in effect, threatening to plunge the U.S. economy back into recession unless Democrats pay up.
Tags: Bush tax cuts
