NanoCare Update

The Congressional Budget Office, as you may recall from yesterday's post, warned that a couple million fewer people than originally intended would be covered under the Affordable Care Act (ACA). The CBO today revised that figure yet again, and the outlook is even grimmer: it now predicts, in what it called a "worst case scenario" that 20 million people may actually lose their employer-based coverage in the next decade as a direct result of the legislation.

Then again, three million more people could be covered. Nobody really knows, because all the estimates are based on the future state of the economy, the political state of the states administering the programs and exchanges, and the fact that this is all a great big guessing game based on suppositions and theories and what-ifs. In other words, whether or not we receive medical coverage will still be pretty much dependent on the vagaries of the semi-regulated free market. How sick is that?

Here is the CBO techno-speak in its second press release in 24 hours:

Despite the care and effort that CBO and JCT (Joint Committee on Taxation) have devoted to modeling the health insurance system and the provisions of the ACA, there is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under that legislation. In response to questions from Members of Congress, CBO and JCT have prepared an analysis showing how the effects of the ACA on health insurance coverage would differ under alternative assumptions about the behavior of employers.

Ohhhh-kay -- whether or not workers get health care will depend not only on the future economy, but also on their employers' mood and behavior on any given day. Hmmm. I guess the bosses are destined to turn into Scrooges, because last year the CBO forecast that only a million poor slobs would lose health insurance through their crapola jobs. They were only wrong by a factor of several hundred percentage points.

The White House is scrambling to contain the damage, dismissing the new CBO report as "what's a few million uncovered people in the grand scheme of things?"  And besides, if fewer people are covered, the budget can be balanced and the deficit cured. Letting sick people stay sick will save the taxpayers a bundle! I wish I were kidding about this tone-deafness, but I'm not. Here's the official line from the Obama Administration blog:

This suggests that taxpayers will save $50 billion more, on net, through 2021 and Americans will pay even less for private insurance than CBO previously projected – which is good news..... the bottom line is clear: the Affordable Care Act will reduce our deficit, control health care costs, and make health care more affordable.

Naturally, the vast majority of people expected to lose their employment-based coverage will be low-wage workers. According to the CBO, of the 11 million poorly-paid individuals to have benefits cut, three million of them will qualify for Medicaid. And then it's always possible that employers who drop or threaten to drop their employee health plans will get "incentivized" to provide at least a modicum of subsidized coverage. The Hill has more.

Math was never my strong suit, so I confess I do not understand all the number crunching and the convoluted prognostications. But then, I suspect, neither do the so-called experts.

Medicare for All, though, where everyone pays a progressive tax based on income? That is eminently understandable, and equitable to boot. 

Obama/Bloomberg '12?

Before getting into the speculation du jour, how's this for plutocratic chutzpah: Mayor Mike Bloomberg of NYC is spending millions of his own dollars on annoying TV commercials to try and convince us that public sector workers are enemies of the people. Unless we do away with the pension plans of future hires, our houses will burn down and there will be no cops to patrol our streets. Or so Bloomberg's ubiquitous TV ads imply.


And then there is the speculation that President Obama actually wants this odious little man, fellow deficit hawk, and sworn enemy of the Occupy movement as his running mate to replace Joe Biden. But first, the local stuff, just to give you an idea of what Bloomberg is all about. Clue: it isn't about you or your interests.


As I was watching TV last night, a whole series of commercials popped up as often as every five minutes. On every channel. There was literally no escaping them. These spots, sponsored by the "Committee to Save New York" big business lobby, ominously warn us that greedy teachers and cops and firefighters will destroy the entire state unless Gov. Andrew Cuomo keeps the taxes of Wall Street financiers and real estate moguls at their current low levels. Of course, the ads don't say this in so many words. They are very insidious and oblique. If you have seen those "I Vote" flag-draped commercials sponsored by the oil and gas industry, you know what I am talking about. Those greedwashing ads try to convince you that polluting the water and causing earthquakes via toxic hydrofracking is the patriotic thing to do.


But back to Bloomberg. As an elected official, he is not allowed to contribute directly to the Committee to Save New York propaganda effort. But as the 12th richest person on the Forbes List (net worth $19.5 billion) there is nothing to stop him from running a parallel propaganda campaign of his own. At a speech this week, he referred to public unions as "special interests", public pensions as "ticking time bombs" (union benefits are terrorists, my friend) and oligarchies as "people":

“Too often in Albany, it is only the special interests who are heard; we want to make sure that the people are heard,”Bloomberg said today at a breakfast sponsored by the Long Island Association, an 85-year-old organization of business groups, unions, nonprofits and government agencies representing Nassau and Suffolk counties, which have each declared fiscal emergencies.

You can see Bloomberg's ad here.


And the complementary multimillion-dollar ad campaign from the Committee to Save New York is just another in a series of pro-Cuomo commercials which largely praise the fiscally conservative Democrat for not raising taxes on the wealthy. The so-called Millionaires surtax was allowed to expire last year, thus reducing revenue to the state by an estimated $4 billion a year, and thus causing the manufactured disaster of budget shortfalls and imminent bankruptcies in many of our towns. That cloying ad can be seen here.


If you are saying to yourself, "Well, Bloomberg will be out of power next year and besides, he doesn't live in my back yard" here is a little factoid that might give you pause. According to the New York Times, President Obama recently hosted Mr. Moneybags at a long, intimate, private White House luncheon to discuss the mayor's future plans (the parenthetical speculations are mine and mine alone):

They traded thoughts about education (privatization via charter schools, teacher union destruction via mass layoffs through a phony race to the bottom program?), ruminated on the state of immigration ( chewed the cud on deporting more people while kicking reform down the road, and how to profit from all those private detention centers being built with public money?) and discussed the federal deficit. (how to win another term and finally be able to cut Social Security and Medicare?)

But most intriguingly, they talked about the future. Over a long private lunch at the White House, President Obama posed a question to Mayor Michael R. Bloomberg: what are you interested in doing next?

Mr. Bloomberg’s precise response is unknown. But their meeting a few weeks ago, confirmed by aides to both leaders and previously undisclosed, was potentially significant for both men, as Mr. Obama seeks support for his presidential campaign and Mr. Bloomberg ponders his post-mayoral career.

The New York Daily News speculates that Obama asked Bloomberg to be his running mate, or offered him the leadership of the World Bank, or wants him to be (heaven forfend) his next treasury secretary. The opinion piece lists five reasons why the shrillionaire mayor would be an ideal running mate for Barry: $$$money$$$, business connections, "post-partisanship" (my translation -- neoliberalism or phony centrism, which amounts to privatization of profits and the socialization of costs), the Jewish vote and electoral math (Florida!) and Tough on Terrorism. (both men have deemed the Constitution and civil liberties to be optional things.)


Remind me again why a President Romney would be any different than Bush's Fourth Term. Nothing would spell doom to our democracy more than a Vice President Bloomberg, an arrogant oligarch with more than enough money to eventually buy himself the presidency in 2016. And the second and third terms to which he is accustomed. (He is already a spry 70, so there would probably be a limit, even for him). Nothing. Just ask the spied-upon Muslims and the Occupiers rousted and pepper-sprayed with impunity by the mayor's private NYPD army, the thousands of laid-off teachers, the neighborhoods whose fire stations he closed, the patients and staff of the charity hospital he shut down to make room for luxury condos.

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A Pondering Plutocrat

The Putting Panderer and the Peevish Ponderer

Update 3/15: The New York State Legislature did its job the usual sneaky middle of the night way: under cover of darkness, it gave Bloomberg a little of what he paid millions for. The retirement age for state workers has been raised, and they will have to contribute more to their pension plans. Bloomberg's reaction? If people don't like it, they don't have to accept state employment. Let them get a better deal at WalMart! More here.



When ObamaCare Becomes NanoCare

I bet you didn't see this one coming: the Affordable Care Act is not going to be covering nearly as many people as originally thought. Since it was passed on the assumption that employers would be purchasing much of the mandated private insurance for workers, and millions of jobs have been and continue to be lost, the Congressional Budget Office now estimates that two million fewer people will be covered by 2016. More than 27 million Americans will still be uninsured four years from now. That is, if the Supreme Court rules favorably on the constitutionality of forcing people to purchase products from private vendors. 

In theory, this revised government estimate should make the deficit hawk critics happy -- since so many people will be getting thrown under the bus, it will also cost about $50 billion less than originally thought, too. People not getting the medical care they need will actually help balance the federal budget. Hooray for austerity!

But not to worry, says the CBO -- more people than ever will be eligible for the state-administered Medicaid programs because poverty is going up, up, up. So if you live in a state like Texas, which hopes to opt out of Medicaid entirely, you might want to think about emigrating.

Still, the CBO report goes on, the number of employers expected to pay penalties for noncompliance with the law is expected to increase, as are the individuals having to pay fines because they lack insurance. (That part is confusing. I am guessing that after the uninsured pay their fines, they can then qualify for Medicaid. Eligibility requirements for Medicaid are supposed to be looser once the law kicks in. And meanwhile, the Obama Administration is gifting Scrooge employers like WalMart and McDonalds with waiver after waiver after waiver. What an unholy mess). 

The CBO, to its nonpartisan credit, also takes note that American wages continue to stagnate. Therefore more children of struggling parents than expected will be eligible for the government-subsidized CHIP program. The CBO simply hadn't dreamed that one in four American children would be thrust below the poverty level when they started crunching their numbers two years ago in Obama's misguided effort to make his delayed health care plan deficit-neutral.

Julian Pecquet of The Hill offers a summary: 

The combined effects of the revised estimates over the 2012–2021 period add up to:

■ An increase of $168 billion in projected outlays for Medicaid and CHIP;

■ A decrease of $97 billion in projected costs for exchange subsidies and related spending;

■ A decrease of $20 billion in the cost of tax credits for small employers; and

■ An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlay, with most of those effects reflecting changes in revenues.

As I laid out in a previous post, the Supreme Court will hear arguments on the individual mandate in less than two weeks. The libertarian Koch Brothers are transporting busloads of "Keep Your Hands Off My Healthcare" astroturfers to demonstrate against the ACA, and the Obama administration is "facilitating" counter-demonstrations, even prayer vigils, to keep its behemoth of a signature accomplishment alive. Now that the CBO has estimated that the law is becoming ever more unwieldy because of the reality of the crappy economy, will the Court be that much more inclined to strike down the individual mandate? Without the provision that we all be forced to buy policies from insurance leeches, the whole law is kaput.

Obama blew it when he abandoned the single payer option. If he had really wanted to, he could have forced it through Congress via the reconciliation tactic.  So, while a declaration of unconstitutionality may be a blow to those lucky few people now benefiting from the measure, it will be a blessing in disguise to most of us. Almost two-thirds of those polled have expressed a preference for a Medicare for All program.

As former Labor Sec. Robert Reich puts it when making the case for Single Payer, nobody from either left or right would object to a payroll tax deduction, which is how it would be paid for. No court has ever struck down a payroll tax as being unconstitutional. Reich says:

Other federal judges in district courts - one in Virginia and another in Florida - have struck down the (ACA) law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli, the Virginia judge to asparagus.) Social Security and Medicare aren't broccoli or asparagus. They're as American as hot dogs and apple pie.