No, Congress is not exempting themselves from Obamacare

The Affordable Care Act began enrollment on October 1. The site has had many hits, more than anticipated. However, as was expected, there have been glitches in the system—some not so small. The Washington Post’s Wonkblog offers an explanation of why these technical glitches are occurring and what is being done to resolve them. We shall see in the coming months how it all plays out as the kinks get worked out.

These glitches, however, serve as easy ammunition for opponents of the law looking to kill it. Another weapon being used to derail the law and raise the ire of Americans is the claim, mostly in conservative media, that the President and Congress are exempting themselves from Obamacare. This is a falsehood that has been fact checked. But as one knows, if a claim is repeated enough times people will believe it.

This piece explains all of this exemption brouhaha quite well. I guess it all comes down to who you trust.

Friends referred to me these two articles:

These articles refute the above pieces:

I’ve also heard the claim that somehow these government employees are not contributing to the cost of their healthcare plans at all. That is false. Per Wikipedia:

“Premiums vary from plan to plan and are paid in part by the employer (the U. S. government agency that the employee works for or, for annuitants, OPM) and the remainder by the employee. The employer pays an amount up to 72 percent of the average plan premium for self-only or family coverage (not to exceed 75 percent of the premium for the selected plan), and the employee pays the rest.”

Now, one can make the argument that perhaps they should contribute more to their own coverage; that is legitimate. However, to state they don’t contribute at all is incorrect because they do.

This information can also be found directly from the OPM website. See their latest statement regarding this issue below.

The Office of Personnel Management issued a proposed rule on Aug. 7 explaining that members of Congress and applicable congressional staff will be required to purchase health insurance coverage through the exchanges created by the law. However, according to the proposed rule, the federal government, as the employer, will still be able to make a contribution to health insurance premiums as it currently does. The contribution will be no greater than that now offered to members and their staffs under the FEHB program, and members and their staffs will not be eligible for premium tax credits made available to other persons purchasing health insurance through the exchanges.

Obamacare enrollment begins today, despite government shutdown

Despite House Republicans’ forty plus attempts to repeal and defund “Obamacare,” the six-month enrollment period starts today. House Republicans dead set on making sure this legislation fails have used the ACA as leverage to threaten a government shut-down. Mission accomplished. However, the President, Democrats, and some Senate Republicans are refusing to use the ACA as a bargaining chip. Good. The law was passed by Congress and upheld by the Supreme Court. reported yesterday that recent polling shows only 33% of Americans think the federal law should be repealed, delayed, or defunded, and the majority definitely don’t want a government shut-down over it.

The Affordable Care Act (aka Obamacare) is essentially health insurance reform. It is a far cry from the “socialized medicine” its opponents claim it to be. While the state health insurance exchanges become effective January 1, 2014, other components of the law have been postponed until a later date and therefore full implementation will not occur until 2015 or later.

If you don’t want to read about the Affordable Care Act, watch this YouToons Video for information about the law. I urge you to check it out. It’s comprehensive and easy to understand.

Opponents who make claims about ACA’s negative impact are not being honest because until it is fully implemented an accurate assessment of the legislation cannot be made. (The same can be said about those making overly optimistic statements about the law’s benefits and cost-containment.) Some people may see higher insurance premiums, others will see their costs decrease; some health care costs will be contained, others likely will not. However, what the ACA will do is bring millions of uninsured Americans into the system. It is the first serious attempt since the Clinton administration to provide affordable quality health care to all Americans, though sadly, it is estimated that 30 million Americans will still remain uncovered, for various reasons.

Over a quarter of uninsured Americans are unaware of ACA enrollment. This is a problem. One reason for this is that the Obama administration, HHS, and supporters of the ACA have only recently begun disseminating information through advertising campaigns, social media, and community networks. Another reason is that there is much misinformation out there about the ACA. Most people cannot tell you the provisions in it or the benefits they will receive, or why they hate it so much, except for the mandate that requires they must now purchase insurance coverage.

Recent polls have found that 46% of people disapprove of Obamacare, but only 37% disapprove of the Affordable Care Act. It’s one and the same. Still, Americans are largely supportive of its main provisions. There is a major disconnect between the perception of Obamacare and what it is in reality.

So what is in it? Since March 2010, pre-existing conditions for children have been eliminated; come January 2014, that will be extended to all people. Young adults can stay on their parents’ plan until they are 26 years old. Mammograms have been covered in full and will continue to be. You can read more about the benefits and provisions here on the timeline.

Full implementation of this legislation is further imperiled by GOP-led states or states where the legislatures are dominated by conservatives who have refused to set up their state exchanges (Nevada being one exception) but are deferring to the federal government do it. Some states have refused to expand Medicaid, which would allow more low-income Americans to have medical coverage, even though the federal government is paying for it initially, and by 2020 would still be responsible for 90% of state Medicaid funding.

To make matters worse, these states are obstructing the enrollment process and making it harder for navigators to assist residents in their states to access information and to enroll. This is reprehensible. Even in the reddest of states there are people who need health insurance that may save their lives—even conservative lives. This is not an ideological issue, it is a human issue. I expect the fact that these legislators are actively working to make it more difficult for their constituents to receive health coverage will at some point come back to bite them—hard—and it should.

Currently, we are seeing in states where implementation has been going on for months, the exchanges are not perfect, but they are ready for enrollment and these states are willing to assess where the challenges lie and address them on an ongoing basis. We also see that in many states premiums are coming in lower than expected. A Rand Corp analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market. However, in states like FL, TX, LA where they are not expanding Medicaid under the ACA, premiums could increase 8-10%.

Arguments against the ACA include: the mandate is too coercive, it goes against our idea of “freedom,” that Obamacare is already causing insurance premiums to increase, or it is the biggest job-killer right now. First of all, the fine for foregoing insurance coverage is not highly punitive. In the first year, it is $95 or 1% of  income, whichever is higher. Furthermore, if you are too poor and still cannot afford coverage, the fine will be waived.

The penalty for not purchasing coverage should be high enough to at least make people stop for a moment and ask if it is worth the cost to not be insured. The idea of the mandate, is to increase the risk pool, including old and young and sick and healthy. Spreading the risk this way brings down/contains the cost of coverage. Right now, those of us with insurance, subsidize those who do not have it when they need medical care. That’s unfair. Furthermore, it’s the freeloader issue that conservatives are always bemoaning, so one would think this would be an element of the law they would like: everyone taking personal responsibility for their medical coverage.

Providers will offer four plan-levels in the exchanges: bronze, silver, gold, and platinum. Anyone with income up to 400% of the poverty level—$45,960 for an individual, $94,200 for a family of four—will get subsidies to help cover the cost. Disclosure: I am not eligible for subsidies. I make too much money, which isn’t a lot for the NY/NJ area, but even though I do not qualify for them, I do not begrudge those who do. I know how important it is to have decent coverage. I am a leukemia survivor and my healthcare story is a cautionary tale. I was one of the lucky ones.

The second criticism above about increased premiums that people want to assign to solely to Obamacare is also false. Think about it, health care costs have been increasing steadily over the past decades, much higher than wages. This is nothing new. From 2003 to 2011, family premiums for employer-based coverage increased 62% while average median incomes grew only 10%. Some insurers, guaranteed, are setting huge premium increases to fatten their bottom line and blaming it on Obamacare because it’s a great excuse, and most people won’t look for information to refute this subterfuge.

Not only have healthcare costs gone up over the years, but employers have also made employees share more  of those costs. Employers have also decreased pensions as well as their contributions to employee 401K plans. All these costs placed on the American worker have been happening for years, not only in healthcare. The entire system is pushing more costs onto workers.

As for the ACA being the number one job-killer in America—not so much. Read it here, here and here.

No matter what you think of Obamacare the one thing you should remember is that it gives American people choices. If you are fired, or laid off, or want to leave your job, you can do so without the fear of having no affordable health care options for you and your family. That’s liberating. People stay in jobs they hate because they need health insurance. That is ridiculous. Healthcare should not be tied to employment. Furthermore, if businesses did not have this expense they would be much more competitive, globally and domestically. Getting healthcare out of the employment equation is a positive goal because it makes American businesses more competitive and provides Americans the choice and freedom to move to a different job or to start their own business.

The ACA is far from perfect; it is not what I would have designed. However, it is a start to providing universal healthcare to the people of this country. Its implementation will not be complete until all elements of it are in place. And as stated previously, some components have been postponed. The initial enrollment period is for six months (October 1, 2013 – March 31, 2014). In subsequent years, it will be three months (October 1 – December 31).

Furthermore, if Obamacare is delayed for a year, as House Republicans want, it will never get implemented. That is their goal because they are hoping that in the near future there will be a Republican President and a Republican Congress then they can obliterate the law. Our current system is broken, it’s costly to American taxpayers, there are already “death panels” and “rationing” going on in the insurance industry, and have been for years. It’s time to try a different approach, and if that doesn’t work, try another one. The status quo is not an option; our healthcare system is unsustainable.


SOURCE: Data from OECD, Health Data 2013, June 2013. Compiled by PGPF.

Once we see what is working and what isn’t then we can put policies in place to improve it. But trying to prevent people from accessing a system that though imperfect may help them, possibly even save their lives, is a bad strategy.

There will be obstacles and glitches initially with Obamacare, but perhaps many will be minor. We will never know how a different health care system will work if we don’t try, and even if there are problems, we can improve upon it. We’re Americans. We can meet these challenges. The Affordable Care Act will not affect the majority of Americans or their current coverage. However, if you are uninsured, enroll. The exchanges are open.

Cross-posted at The Feisty Liberal

Get Ready, Enrollment for “Obamacare” begins October 1

Despite House Republicans’ 37 attempts—yes, 37— to repeal the Affordable Care Act (ACA), it will be fully implemented on January 1, 2014, including the state health insurance exchanges, the mandate to buy insurance, and no more pre-existing condition clauses in insurance policies. Congressional GOPers have worked diligently over the past couple of years to undermine the law. You must give them credit—they are persistent. Now, instead of trying to make it fail, they should help Democrats try to make it work and even improve upon it. I know, that’s asking a bit much, but I am an eternal optimist.

My last post about the ACA bemoaned the fact that the Obama Administration and the Health and Human Services (HHS) Department had done very little to raise awareness for the open enrollment period that commences October 1. Participation is important to the success of the exchanges. A Kaiser Family Foundation poll in April found that 42% of people were unaware that the ACA was still being implemented. Since then Organizing for Action, HHS, and healthcare advocates have begun a campaign to raise awareness and set-up a platform for enrolling Americans in the health insurance exchanges and answer questions.

This effort should have been initiated well before now, so timing is a concern for many involved in operating the exchanges. As of June 14, only 26 states have committed to expanding Medicaid, so many low-income people will remain uninsured. Further complicating the roll-out is how the exchanges are being established: some states are handling the exchanges themselves, some are working in tandem with the federal government, and others, like New Jersey (my state), are leaving it up to the federal government to organize.


Guaranteed there will be confusion and systemic glitches in the beginning, but hopefully not so many that healthcare reform opponents can fan the flames of opposition more than they already do. Healthcare advocates are hoping, as with Medicare Part D after its problematic roll-out in 2006, once the initial ACA problems are resolved, people will discover not only do they benefit from the program but they like it.

Steps are being taken to increase awareness and assist with the enrollment process. Organizing for Action and other pro-healthcare reform groups are spending millions of dollars on an advertising and public relations campaign, “Get Covered America,” and Doctors for America is training 500 doctors and medical students to educate patients about the enrollment process. The Enroll America website is a comprehensive resource for information about the healthcare law and provides enrollment assistance.

It is important for people to educate themselves about the provisions included in the ACA because there is much misinformation floating around about it. It is shocking the number of people who do not know what is in this legislation. There is a health reform quiz on the Kaiser Family Foundation site. I encourage you to take it. Knowledge is power and you may find that knowledge to be quite beneficial in making insurance coverage decisions for you and your family, especially those not covered under an employer-paid plan.

Wendell Potter, author of Deadly Spin and a former health insurance industry insider turned watchdog, has been writing extensively for several years about the topic of healthcare reform and how insurance companies manipulate the American public against reforming the system through media and public relations spin. Visit his site for articles that will help you separate fact from fiction. There is a lot of fear mongering about the ACA; Mr. Potter alleviates many of those fears.

The healthcare  reform legislation is far from perfect. However, there are many benefits people have already been receiving since March 2010. Sadly, the ACA won’t cover everyone—there will be people left out. Some individuals will have higher premium costs but with those costs should come better coverage as opposed to the “junk insurance” that is akin to having no coverage at all.

So, ready or not, Obamacare is happening. Are you informed and prepared for it?

Cross-posted at The Feisty Liberal

The Affordable Care Act…where is the campaign to promote it?

On April 25, Politico reported: “Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul.”

An exemption request like this is totally expected from Republicans who are determined to undermine the Affordable Care Act (ACA), but from Democrats it is absolutely appalling because they are supposed to be proponents of the ACA. They worked diligently to pass it, though sadly and to the law’s detriment, many distanced themselves from it once implementation commenced.

After some commiserating with like-minded people and searching for further information, I stumbled upon Ezra Klein’s piece in the Washington Post, basically stating that this is much ado about nothing. Then later in the day, Senate Majority Leader Harry Reid’s office made the following statement:

“Senator Reid is committed to ensuring that all members of Congress and Congressional staff experience the benefits of the Affordable Care Act in exactly the same way as every other American. He believes that this is the effect of the legislation as written, and that therefore no legislative fix is necessary. There are not now, have never been, nor will there ever be any discussions about exempting members of Congress or Congressional staff from Affordable Care Act provisions that apply to any employees of any other public or private employer offering health care.”

Much of the initial political firestorm has been extinguished. However, this is a perfect example of the outrage people feel when those in power exempt themselves from programs in which the rest of us are required to participate. It sends the wrong message: They are above adhering to the same standards as their constituents. It not only looks bad but also further erodes the public’s faith in government and democracy.

Furthermore, it is always the negative side of this legislation that makes headlines. Where is the campaign to promote the ACA’s benefits as well as provide information about the upcoming enrollment period, starting October 1? If someone like me, who pays close attention to happenings in the political world, doesn’t possess a good understanding of how the ACA will be rolled out, how is someone less informed expected to know about it?

The Obama administration, Health and Human Services (HHS) Secretary Kathleen Sebelious, and democratic legislators have been dismal communicators of the ACA’s benefits and enrollment procedures. The high-risk health insurance plan, PCIP (Pre-Existing Condition Insurance Plan), is a perfect example of why it is so important to employ a nationwide educational campaign about health care reform. Enrollment peaked at 110,088 people, far below the 375,000 expected participation number. This is mainly due to a general lack of knowledge of PCIP’s existence, as of July 1, 2010.

In February PCIP enrollment halted because of a funding shortage. These insureds will be rolled into the state health exchanges open to all citizens starting January 1, 2014, when there will no longer be pre-existing exclusion clauses in medical insurance plans.

There is growing concern that the state exchanges won’t be ready in time. Many states, mostly GOP-led, have refused to establish insurance exchanges, leaving implementation up to the federal government. If exchanges are not established and systems are not in place by October, confusion and chaos will reign, as enrollees try to figure out how to maneuver through the application process.

New Jersey, where I reside, has approximately 1.3 million uninsured residents and is a state where the federal government will operate the exchanges. In addition to refusing to establish a health care exchange, Governor Chris Christie originally turned down funds for Medicaid expansion; he eventually had a change of heart on that matter. Only 20 states and DC have agreed to Medicaid expansion, which covers everyone below 133% of the federal poverty line.

There is much contention surrounding the ACA and it is not without its flaws. It is, more accurately, health insurance reform as opposed to health care reform. Despite its limitations, it is a much-needed first step in the right direction toward achieving affordable, quality health care for all Americans.  However, to benefit from the ACA, Americans must know what provisions are included, how and where to sign up, what it will cost, and have their concerns addressed and questions answered quickly.

If the exchanges are rolled out amidst confusion and disorganization, its success will be jeopardized and every “Obamacare” hater will pounce with “I told you so.” Health and Human Services and the Obama administration better have a plan—and if they currently have one, it’s not apparent—to educate the public in order to attain the participation rates necessary for the ACA to succeed. Where is the high-profile campaign to inform Americans about the upcoming changes?

If these actions aren’t taken soon, they better have a strategy in place to stanch the political bleeding that will no doubt result from an angry, confused, and frustrated American public. They must get it right.

To learn more about the Patient Protection and Affordable Care Act, visit

Cross-posted at The Feisty Liberal