Your ‘ObamaCare’ survival guide to Thanksgiving dinner

Posted by AzBlueMeanie:

Freedom_from_want_1943-Norman_RockwellIt's almost Thanksgiving and you know what that means — sitting down to dinner with your crazy uncle or brother-in-law who listens to FAUX News all day and wants to spout wild conspiracy theories and GOPropaganda just to ruin everyone's dinner. FAUX Nation seems to take a perverse pleasure in being assholes. Just sayin'.

(h/t Norman Rockwell, Fredom From Want, 1943)

Since the Tea-Publican party has become a single issue party, the anti-ObamaCare party, you already know what the topic will be so you can prepare yourself in advance. Sarah Kliff has this helpful post, A guide to surviving Obamacare debates at Thanksgiving:

Ah, Thanksgiving: That treasured, American holiday where you can eat an incredibly uncomfortable amount of food and have incredibly uncomfortable political conversations, all at the same time!

This Thanksgiving, it's a pretty safe bet that debates over Obamacare will be just about as central as turkey. As Wonkblog readers hit the road and head home, we didn't want to leave you totally unprepared. Here's a guide to the questions you might get — and their answers.

Your mom wants to know whether Obamacare is a total disaster. 

This is probably the most obvious question to come up on Thursday: How busted is this law? These questions might refer to recent reports that HealthCare.gov might not be fixed by the end of December or that a third of the computer system still hasn't been built.

It's fair to say the launch of HealthCare.Gov has not exactly gone as the White House would have hoped. Officials promised that Americans would be able to purchase coverage on Oct. 1. That turned out to be true for exactly six people. For many more, it was impossible–and shopping remains difficult even today.

Only a fraction of the people the Obama administration expected to sign up for insurance in October actually bought coverage. If that trend continues, the law won't get anywhere close to its projections that 7 million people will sign up for coverage in 2014.

That's the part of the health-care law that isn't working. But in some states that built their own insurance marketplaces, Obamacare is working–and the health law is meeting enrollment projections. California, for example, has signed up 80,000 people for coverage and Washington has enrolled nearly 12,000. These examples are limited, but the suggest that the problem isn't with demand but a technical one. We won't know whether this is true everywhere, though, until HealthCare.gov is fixed.

Your father is convinced that Obamacare is a total disaster, and recovery is impossible, because: Death spirals. Young people won't sign up this year, premiums will spike and, by next Thanksgiving, Obamacare is pretty much done for. 

This is a riff on the so-called "death spiral" and it calls to mind something that Kaiser Family Foundation vice president Larry Levitt recently told my colleague Ezra Klein: "You give a little bit of actuarial science to people and they go nuts."

Yes, there would eventually be a "death spiral" if we had an insurance program where only the really sick people signed up for coverage. That would make insurance incredibly expensive and unappealing to young people.

The thing is, the health-care law includes a number of safeguards meant to mitigate the impact of lousy enrollment and make it a bit easier for insurance companies to weather the first few years. These include policies that give extra payments to insurance companies that end up with really sick enrollees  and those who set their premiums too low to cover their costs.

If by some freak accident you happen to be born into a family of actuaries, you can call these risk adjustment and risk corridor payments. If that does not happen to be the case, just describe these as transitional policies that stretch until 2017 and give the health law a bit of breathing room. These policies essentially guarantee that premiums won't spike in 2015–or 2016. They might in 2017 but, before then, we're not looking at imminent failure.

Your grandfather has some concerns about getting death paneled.

You can reassure any elderly relatives that there is absolutely, definitely, without a doubt no death panel in the Affordable Care Act. There is an Independent Payment Advisory Board, which would be allowed to recommend payment cuts for doctors who serve Medicare patients. This board is not allowed to deny patients' care; they only get to tinker with reimbursement rates.

On top of that, the IPAB isn't going into effect this year--or in the foreseeable future. That's because it only kicks in when health-care costs are growing faster than the rest of the economy, and right now they're growing at about the exact same rate. So, at least until Thanksgiving of next year, there is no chance of any panel changing his benefits.

* * *

Your brother who has insurance at his job wants to know if he needs to pay attention to this slightly uncomfortable fight.

Probably not: We're really not seeing much in the way of employers dropping workers into the marketplaces. He can keep his focus squarely on such important issues as when will Hannukah and Thanksgiving overlap again, or how long he has to stay at the dinner table.

Your uncle who is losing his health insurance plan thinks he'll pay more under Obamacare. Perhaps he brings out his cancellation notice after a few glasses of wine, who knows.

There are about 7 to 12 million people losing insurance coverage under the health-care law this year and, while they make up less than 5 percent of the population, it's not unfathomable that one of them will turn up at your Thanksgiving table.

Your uncle has a right to be angry, given that he got a promise he could keep his plan, if he liked it. But it also turns out there's a chance that he can: The president announced earlier this month that insurers have the option of re-issuing cancelled plans, provided the state insurance commissioners go along with the plan. If he wants to know whether his insurance regulator is on board, he can check this list.

If your uncle does have to get a new insurance plan, chances are it will include more benefits than what he has now, since all compliant plans need to cover 10 essential benefits. But more benefits cost more money, which means his premium might go up. It's possible though, depending on what he earns, he might qualify for a subsidy to purchase that plan. You know what goes great with pumpkin pie? A whirl on the Kaiser Family Foundation subsidy calculator to get an estimated Advance Premium Tax Credit!

* * *

Your cousin's significant other who has a bachelor's degree in computer science thinks if the administration just did [insert thing they should do here], the Web site would be fixed.

Maybe the suggested fix would work, maybe it wouldn't. Either way, there's a decent chance that whatever suggestions come up at the dinner table are unlikely to be the one silver bullet to get HealthCare.gov up and running. That's because there are lots of problems that range from difficulty sending enrollment forms to health insurance plans to getting subsidy calculations right. Unless your suggested solution includes a way to connect all of the agencies in this diagram, it, sadly, is unlikely to be HealthCare.gov's magical fix.

Anatomy

Alternatively, if the proposed fix does involve all the agencies above, you should probably get your cousin's significant other on the phone with Jeff Zients immediately.

I hope this helps.

UPDATE: “Democrats are providing supporters with prep for debating ‘your Republican uncle’ heading into the holidays. The Democratic National Committee (DNC) set up a website Wednesday with talking points on the economy, climate change, healthcare and immigration reform to use with family members on Thanksgiving.”

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