Your Personal Health Information Isn’t as Safe as You Think It Is… Should You Care?

Today’s Twitter thread summarizes my latest publication in the American Journal of Medicine with co-author Arnold J. Rosoff, building upon a series of papers and presentations we’ve done over the past couple years on data privacy in the most personal parts of your life: your body and your health…

Continue reading “Your Personal Health Information Isn’t as Safe as You Think It Is… Should You Care?”

New Data Settles the Debate: Obamacare Is Making Health Insurance More Affordable, Not Less

Change in Obamacare Premiums, 2014-2015

It’s that time of year again.

No, not the holiday season. I’m talking about Obamacare season.

In the second year of our new annual tradition, the exchanges are open for enrollment, which begs the question: What have we learned since last time? Were the naysayers proven right, or did Obamacare really make health insurance more affordable, as was intended?

With a new year of data to answer these questions, once more into the breach we go…

At this time last year, the inaugural enrollment period was not going well. The website was malfunctioning, people were losing plans they wanted to keep, and the media was running scare stories about “sticker shock.” I argued, on the contrary, that the website would get fixed in a hurry, most people were getting better plans, and the exchanges were actually reducing the cost of health insurance.

The first prediction was clearly vindicated. The website got fixed, and 8 million Americans enrolled.

The second prediction was also a victory for Obamacare. Before the exchanges opened, 16.4 percent of Americans were uninsured. A year later, only 11.3 percent were uninsured.

And this isn’t only due to the Medicaid expansion. In states that did not expand Medicaid, the uninsured rate fell from 18.2 percent to 13.8 percent. Clearly, the exchanges didn’t just replace old plans. They created new ones for people who didn’t have any.

They didn’t reduce coverage. They expanded it.

And according to the latest Gallup poll, the people who got that coverage are just as happy with it as the people with non-exchange insurance — and the people on the exchange are actually happier with their costs than everyone else.

Which brings us to the third prediction. This one was more controversial.

Earlier this year, I analyzed the many studies of pre- and post-Obamacare costs and came to the conclusion: “On average, Obamacare clearly lowered the cost of health insurance.”

Two of the experts who wrote one of those studies, Paul Howard and Yevgeniy Feyman, disagreed with me. They argued that I misinterpreted their estimates by comparing Kaiser’s estimate for all ages to their estimate for 27-year-olds. But they’re the ones who made the mistake. Apparently, they misread the Kaiser estimate I cited, which referred to 18-to-34-year-olds, not all age groups. I chose this estimate specifically because it was comparable to theirs.

Then, they cited other studies that used the same faulty methodology that they used, and they claimed that I “ignored” those studies — when in fact I explained exactly why those kinds of studies were inaccurate.

Finally, they suggested that I was conflating premiums before subsidies with the cost after subsidies, overlooking the price paid by taxpayers. At this point, I was wondering whether they even read my original article, where I made a clear distinction between the two. The evidence suggested, I wrote, that the average premium increase before subsidies was small — maybe zero. And even if it did increase, that increase was due to people buying more generous plans because now they could afford them. And the point of the subsidies was to make health insurance costs go down for the people who needed it the most — which is exactly what happened.

Whew. You can see what I meant when I said it was controversial.

The good news is, now we have a second year of data to settle the debate, and this data is better because we can compare the same level of plans with the same amount of coverage on the same exchanges, apples-to-apples, as opposed to the pre-Obamacare plans, which were all over the map. Literally.

The nonpartisan Kaiser Family Foundation has examined the “benchmark” silver plans in major cities in all 50 states, and they’ve found that the monthly premiums have increased 2 percent, on average, since last year. That is slower than health insurance premiums have grown in any year since we’ve started recording the data. Only a couple years ago, health insurance costs were growing 5 percent per year. During the Bush administration, they were growing more than 10 percent per year. Two percent is unheard of.

And that’s only the average. In nearly half of those cities, premiums are falling on the exchanges. That’s unprecedented. Health insurance premiums almost never fall. And when you compare premiums after subsidies, 90 percent of cities are paying less than they did last year!

Now, maybe you still don’t like Obamacare. Maybe you’d prefer a simpler, cheaper system. (Who wouldn’t?) But there is one thing you simply cannot deny: Over the past year, health insurance has become more affordable for the non-group market, and the result will be better health care for millions of Americans who need it and wouldn’t have it if Obamacare didn’t exist.

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This op-ed was originally published in today’s Huffington Post.

Does Obamacare Infringe on Our Liberty? Or Does It Give Us Even More Freedom?

What right does the government have to make you buy health insurance?

That’s the question that riles Obamacare critics the most. It’s not the premiums or the website or the dropped coverage. It’s the infringement on their liberty.

Does Government Threaten Our Freedom?You hear it all the time: “This is a free country!” That’s what everybody says. But what do they really mean? Do they know what freedom is?

It seems obvious at first. Freedom is lack of coercion. Therefore, anything the government makes you do infringes on your freedom.

But there are different types of coercion, and the government isn’t the only one doing the coercing.

Let’s say that you want your daughter to attend the best school in America. But you can’t afford the tuition. Do you really have freedom of choice? If you choose the school you want, they won’t let you through the front door. If you force your way in, they’ll arrest you.

So you “choose” a more affordable school. You wanted a better school, but they forced you to settle for a different one. Sounds like coercion to me.

Let’s consider another example. You want to retire at the age of 65. You’ve worked hard throughout your entire adult life. Unfortunately, wages haven’t risen, and the bills kept piling up. You saved as much as you could, but it’s only enough to live off for a couple years. Oh, and one more thing: Social Security and Medicare don’t exist.

If you “choose” to retire, you’ll go broke. You’ll go without preventive health care. Your chances of dying early will increase significantly.

So you have a choice: Keep working or die young.

In this case, you actually have less freedom because the government is less involved. Without Social Security and Medicare, you do not have the freedom to choose a long, healthy retirement.

Freedom requires more than the absence of laws and taxes. True freedom of choice requires the capability to make that choice — and the free market doesn’t always give us that capability.

Jobs are scarce. Most of us don’t have the freedom to work anywhere we want. We take what we can get. For many of us, that means working at a company that doesn’t pay for our health insurance. So we “choose” to buy insurance on the individual market.

Before Obamacare, the individual market charged really low rates to healthy people and really high rates to sick people. So the people who needed insurance the most couldn’t afford it. They didn’t have the capability — and therefore the freedom — to buy it.

Obamacare outlaws that kind of discrimination. It requires insurers to charge the same rates to healthy and sick people alike, and that means that healthy people will have to pay higher rates. Some of them won’t want to, so they’ll stop buying insurance. When they drop out, they leave behind the sicker people who are most costly to insure, forcing insurers to raise rates even more. It’s a vicious cycle, a “death spiral,” that results in almost everyone being priced out of the market.

Virtually no one will have the freedom to buy health insurance on the individual market.

And that’s why we have an individual mandate. If the healthy people don’t drop out, there’s no death spiral, and the insurance remains affordable for the people who need it the most.

The government gives them a freedom that the free market cannot. It gives them the capability to purchase health insurance.

If we choose not to buy insurance, we pay a penalty. As Supreme Court Chief Justice John Roberts has written, “it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income.” Those taxes pay for our roads and Army and Navy and Social Security and Medicare — and those things give us the freedom to live a life that we often take for granted. Without those taxes, without those government-funded investments, we could not call ourselves a free country.

In the same way, without Obamacare, without the government making us buy health insurance, we would be condemning millions of Americans to lives without health care. We would be restricting their freedom. And what right do we have to do that?

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This op-ed was published in today’s South Florida Sun-Sentinel and Huffington Post.

Those Obamacare Stories Aren’t as Scary as They Sound

One of Many Plan-Cancellation Letters

‘Tis the season to be scary — and no one is getting in the Halloween spirit more than Obamacare critics. Forget the ghost stories this year, kids. You really want to scare your friends? Tell them some health insurance stories!

Did you hear the one about Dianne Barrette from Winter Haven, Florida? Dianne used to pay $54 a month for health insurance from Blue Cross and Blue Shield. But not anymore. Under Obamacare, her plan has been cancelled…and replaced with a new plan costing $591 a month!

Then there’s the one about Allison Denijs. Allison already pays a lot for insurance. She has a preexisting condition, and her plan covers her husband and one of her two daughters. All told, it costs her $20,000 a year. But Obamacare is cancelling her plan too!

Or maybe you heard the one about Robbie and Tina Robison from Franklin, Tennessee. They too are losing their current plan. In its place, Blue Cross is offering them a new plan that costs over 50 percent more!

And they’re not alone. In Florida alone, 300,000 customers have received letters from Blue Cross and Blue Shield notifying them that they will lose their current plan in 2014. All across the country, millions of Americans are receiving the same news!

But wait. Do you notice anything strange about these scare stories? None of them tell you why they’re losing their plans.

I’ll tell you why: Because the insurance companies wanted to make those plans worse.

Back in 2010, you probably remember President Obama saying, “If you like your health-care plan, you can keep your health-care plan, period.” He was referring to the “grandfather” clause of the Affordable Care Act.

The ACA requires that all health-insurance plans meet minimum standards. For example, they all have to cover prescription drugs, ambulatory services, mental health services, and several other categories that are currently excluded from many plans on the individual market. If you signed up for your insurance plan before the law went into effect on March 23, 2010, however, you’re exempt from this requirement. Your plan is “grandfathered” in.

Unless your plan becomes worse — say, because your insurance company wants to take away some of your coverage or raise your co-payments faster than the medical cost of inflation. In that case, it’s no longer exempt because it’s not the same plan anymore.

So, yes, you can keep your old plan. Unless the insurance company changes it. In which case it isn’t your old plan anymore.

That’s what the President meant.

In every one of those cases, the customers who lost their plans are being offered better plans — either by their current insurance carrier or on the government-run exchange.

What CBS and Fox News didn’t tell you about Dianne Barrette, for example, is that her $54-a-month plan didn’t cover hospital stays or ambulance services or brand-name drugs or…really, most of the things she’d need if she ever got really sick. Under Obamacare, she will receive coverage for all of those things.

Not so scary after all, is it?

But what about those premium increases? Those seem pretty scary…if you take the insurance company’s word for it.

After Allison Denijs appeared on Fox News, Salon reporter Eric Stern contacted her and asked if she’d found a new plan on the Obamacare exchange. She hadn’t looked yet, so Stern did it for her. He found a plan that covers her entire family — including her currently uninsured daughter — for $7,600, less than half of what her old plan cost.

Then Stern called the Robison’s. They refused to shop on the Obamacare exchange, which is a shame because Stern found a plan that they could get that would cost them 63 percent less than their old plan — and it would cover more services.

Of course, that doesn’t mean that everyone will pay less under Obamacare, but the point of the law is to make health insurance affordable for people who need it the most. For young, healthy Americans, it may result in a slight cost increase, but we must remember why their insurance was so cheap before Obamacare came along: Because insurance companies were discriminating against the sick, excluding the most desperate and most costly customers.

Someday, when they’re not so young and healthy anymore, those Americans are going to be thankful that Obamacare is there — and that they can buy affordable health insurance that covers all the healthcare services they need. You might say Obamacare has given them one less thing to be…scared of.

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An abbreviated version of this op-ed was published in today’s South Florida Sun-Sentinel.

What to Read on Implementation of the Affordable Care Act

More Solid Proof That Obamacare Is Working — Rick Ungar

The provision of the law that permits young adults under 26…to remain on their parents’ health insurance program resulted in at least 600,000 newly insured Americans during the first quarter of 2011.

…every one of the young immortals we add to the rolls of the insured is one less young adult who will turn to the emergency room to fix a broken leg and then find themselves unable to pay the bill — leaving it to the rest of us to pay the tab.
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Because the under 26 crowd tends not to get sick, adding them to the insurance pools helps bring the very balance that was intended by the new law. The more healthy people available to pay for those in the pool who are ill (translation: the older people), the better the system works and the lower our premium charges should go.

[And] there has been a significant uptick in small businesses taking advantage of the tax benefits offered by the ACA to provide health insurance to employees where they previously did not do so.

Do Pay-for-Performance Health Programs Really Work? — Jake Marcus

Earlier this month, Medicare finalized the rules of a new program — mandated by the Affordable Care Act — that will pay hospitals based on the quality, not just the quantity, of care they provide.

In general, there are two ways to reward healthcare providers: 1) based on the health outcomes of patients or 2) based on how closely hospitals adhere to recommended processes of care.

Medicare has started relatively small by choosing to redistribute only 1 percent of reimbursements, so it will have the chance to evaluate the effects of a promising program without it having disastrous consequences if it fails.

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