Is Obamacare turning the corner?

The Washington Post

By Ezra Klein and Evan Soltas, November 26, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

A spin through HealthCare.Gov this morning went smoothly. The site loaded quickly. The process progressed easily. There were no error messages or endless hangs. I didn't complete the final step of purchasing insurance but, until then, the site worked -- or at least appeared to work -- exactly as intended.

My experience isn't rare. There are increasing reports that HealthCare.Gov is working better -- perhaps much better -- for consumers than it was a few short weeks ago. "Consumer advocates say it is becoming easier for people to sign up for coverage," report Sandhya Somashekhar and Amy Goldstein in the Washington Post. "The truth is, the system is getting stronger as it recovers from its disastrous launch," writes Sam Baker in the National Journal. Applying "was no problem at all, with no delays," says Paul Krugman.

Reports from inside the health care bureaucracy are also turning towards optimism. People who knew the Web site was going to be a mess on Oct. 1st are, for the first time, beginning to think HealthCare.Gov might work. Data backs them up: By mid-November, the pace of enrollment in the federal exchanges had doubled from what it was in October.

The Obama administration is certainly acting like they believe the site has turned the corner. Somashekhar and Goldstein report that they're "moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented 'youth summit' aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success."

The White House had held off on this kind of outreach because they believed it would simply drive people to a useless Web site. If they're restarting the outreach, it's because they believe, rightly or wrongly, that HealthCare.Gov will be able to convert the interest into enrollments.

The worry, at this point, is that the site is working in ways that are visible but broken in ways that are harder to see. The Obama administration won't answer direct questions on the percentage of "834s" -- the forms insurers need to sign people up for the correct policies at the correct prices -- that are coming through with errors. Robert Laszewski, a health-industry consultant with deep contacts among the insurers, told the National Journal the problem is getting better, but that his clients are still seeing a five percent error rate. That's still too high.

The systems that determine whether applicants are eligible for insurance are also improving. But inside the administration there's a recognition that it was error-ridden in the first six weeks of Obamacare -- and so the question is how to handle the many people who unknowingly received an eligibility determination that can't be trusted.

Still, it's clear that HealthCare.Gov is improving -- and, at this point, it's improving reasonably quickly. It won't work perfectly by the end of November but it might well work tolerably early in December. A political system that's become overwhelmingly oriented towards pessimism on Obamacare will have to adjust as the system's technological infrastructure improves.

The next challenge for the law, as the White House knows, will be the outreach challenge of signing up enough young-and-healthy people to balance out its risk pools. That's a challenge the White House spent quite a lot of time thinking about before this IT nightmare. The question is whether they still have enough time, and enough clout, to get it right.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/26/wonkbook-is-obamacare-turning-the-corner/?print=1

Senate filibuster, Boehner and pics

Here are some reflections on two significant events in Washington last week concerning Senate productivity and Obamacare.

The Senate voted to return some degree of democracy to that chamber.   Senate Majority Leader Harry Reid allowed a simple majority of the Senate to approve allowing Presidential nominations (other than for the Supreme Court) to be approved by a simple majority of Senators.  The response to this feared “nuclear option” was, well, just more of the same passive filibustering by the minority opposition refusing to allow the Defense authorization bill to advance.   Requiring a “talking filibuster” to hold up any legislation in the Senate should be the next rule change.

Last week also saw a major step forward for Obamacare.  House Speaker John Boehner enrolled in a health insurance plan through an online healthcare marketplace.  The world didn’t end.  No one lost their job.  And the government did not get between Speaker Boehner and his doctor.  Take notice Obamacare-haters.  Your leader willingly and successfully enrolled in Obamacare. 

Below are some pics from my meeting last week with Deputy Secretary of the U.S. Department of Energy Daniel Poneman in Charleston.  The bottom pic includes Sandy Bridges, owner of Palmetto Hammock (49 S Market St, Charleston) and big supporter of our sea level rise education project (SCBARS.org) for small businesses.

 

 

This chart is amazing news for our health cost problem

The Washington Post
By Sarah Kliff, Published: November 20 at 3:55 pm

This just might be my favorite chart about health care costs as of late. And it's one that contains billions of dollars' worth of good news!

The chart, from the Council of Economic Advisers, shows the Congressional Budget Office constantly revising downward how much it thinks the federal government will need to spend on health care costs over the next decade. That's because health care costs have been growing a lot more slowly over the past few years than they typically do. You can see that below, with a breakdown of health care cost growth by source of coverage.

In private insurance, the average spending growth rate per person has slowed a lot over the last few years. In Medicare, there was no spending growth between 2010 and 2013 and, in Medicaid, per person costs actually decreased some.

All told, health care costs have been growing more slowly over the last three years than any other time period since 1965. More recently, yearly health cost growth slowed from an average rate of 3.9 percent between 2000 and 2007 to 1.3 percent between 2011 and 2013.

The big health policy parlor game for the past few years has been to ask: How much of this change is cyclical, owing to the recession, or structural, partially due to the health law's payment reforms?

The White House has long argued that the changes are structural, and it made that case again Wednesday in a briefing with reporters.

"The slowdown is indisputable," Council of Economics Advisers chairman Jason Furman said. "A very important part of that is structure, and a very important part of the structural story is the Affordable Care Act."

Most health care economists now agree, at least to some extent, with this more structural view.  Even those who argue that the current slowdown is unlikely to last, such as Harvard's Amitabh Chandra and Dartmouth's Jonathan Skinner, still expect slower health care cost growth in the next decade compared with the previous one.

And in some cases, that translates into better health care, too. This chart from the council's report shows a significant drop in preventable readmissions to hospitals (when  treatment goes wrong the first time and the patient must return to the hospital). That happened right around the time Medicare began penalizing such return trips to the hospitals.

Cost savings aside, that's great news for patients, suggesting that the quality of care hospitals are delivering is improving at the same time that spending on that care is slowing down.

Original Article

Just be patient

With all the negative news surrounding the Health Insurance Marketplaces, it sure is nice to hear success stories.

WBTV in Charlotte ran this story last Friday.  This couple is going to save 3 to 4 thousand dollars a year and get better benefits through their successful use of Healthcare.gov.  And the money they’re saving has nothing to do with a government subsidy because they don’t qualify. 

Then this weekend the Governors of Washington, Kentucky and Connecticut, all states that are running their own health insurance marketplaces, authored an opinion editorial in The Washington Post that included this statement:

“The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.”

As more of these positive stories come to light, the supporters of Obamacare will hopefully stop being so defensive.  This is going to work.  Just be patient.

Under Health Care Act, Millions Eligible for Free Policies

The New York Times
November 4, 2013

By REED ABELSON and KATIE THOMAS

 

Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.

Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.

The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.

Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.

The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.

“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”

Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.

Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.

“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.

The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.

The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.

The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.

Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.

The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.

Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.

The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.

It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.

For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.

About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.

“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.

All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.

For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.

“We’re in good health,” Mr. Horst said.

Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”

Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.

“It was astounding,” she said. “I almost started crying, and called my mom.”

In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.

“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!' ” she said. “But the reality is, I know what my risks are in my life.”

http://www.nytimes.com/2013/11/04/business/under-health-care-act-millions-eligible-for-free-policies.html?adxnnl=1&pagewanted=all&adxnnlx=1383664168-KWv3q73RZKdGIjFlNug2Zg

Debunking Obamacare horror stories

The stories of how individuals and small businesses are being harmed by Obamacare are being pushed by the ACA-haters and some gullible journalists are regurgitating the stories without checking them out.

Watch this segment from last night’s MSNBC program The Last Word.  Lawrence O’Donnell interviews Michael Hiltzik of the Los Angeles Times who debunks one of these stories.

http://www.msnbc.com/the-last-word/watch/the-truth-about-the-affordable-care-act-59129923503

Good news from NFIB survey

Good news from our friends at the National Federation of Independent Business (NFIB) even if they don’t think it is good news.  According to a non-random survey of 921 small business owners and operators released today by the NFIB, “64 percent reported that they pay more for insurance premiums per employee in 2013 than they did in 2012.”

This is great news!  No one was predicting that Obamacare would result in actually a decrease in health insurance premiums for small businesses.  The best hope was that the double-digit increases of the past 15 or more years that almost all small businesses were experiencing would be less prevalent and that many small business would find insurance even less costly because of the health insurance tax credits made available through Obamacare.

Now, even the Obamacare-hating NFIB is admitting that 36% of their selected small businesses are paying less in premiums in 2013 compared to 2012.  The NFIB doesn’t give us a lot of detail about the increases that were experienced but we should assume that that is also good news for the Obamacare effect.

Here is how the NFIB report dealt with the rate increase issue: “36 percent of those under 20 employees saw premium rate increases of less than 10 percent last year (when they experienced increases) compared to 45 percent among firms over 20 employees.”

So let’s make the assumption (and that’s dangerous) that 36% of businesses with fewer than 20 employees and 36% of businesses with 20 or more employees had no premium increases.  That would mean that more than 50% of all the small businesses in this survey had no increase in premiums or an increase less than double digits in 2013 compared to 2012. 

This is an outstanding improvement over pre-Obamacare rates for small businesses.  And this does not count possibly even better small business rates that these companies might find in the SHOP program of the Health Insurance Marketplaces when they are open.

Thanks, NFIB, for this good news.  We’re heading in the right direction for small businesses.

Good-news stories about Obamacare

As the Health Insurance Marketplace creeps toward being fully operational and the Obamacare-haters use the technical problems to continue their attacks, the good news is starting to get out.

Over 330,000 Americans have checked to see if they are eligible for a federal subsidy to make their health insurance more affordable.  About 700,000 applications for health insurance have been made through the states and federal Marketplaces.  

Then there are the personal stories of happy Marketplace shoppers.  Below are examples of Americans who have had great results.  Thanks to the Franklin Forum for this information.

Three Hours Saved Man $6,000 - Andrew, Freelancer, 34 yrs old
It took three hours, but Andrew Stryker managed to be among the first people to purchase health insurance through Obamacare’s new insurance markets. Stryker is 34 years old and lives in Los Angeles, where he now does freelance work. He pays a monthly premium around $600 to stay on the COBRA plan from a job he left four years ago. He has high blood pressure and says insurance companies have previously denied his applications for coverage on the individual market. ‘I figured this might cut my premiums in half and I’d be getting better service for half the price,’ he says. … ‘I’ve been watching the news about the government shutdown,” he says. “Obviously three hours is a long time to wait, but it will save me over $6,000. For that, I would have waited all day.’” [Washington Post’s Wonkblog, 10/1/13]

Formerly Uninsured Woman Found $60 Plan
“In Mississippi, one of 34 states letting the federal government operate the online health insurance marketplace created by the health law, consumers continue to face long delays and other technical difficulties as they try to log on and shop for affordable coverage. Sixteen other states and the District of Columbia are operating their own marketplaces. ‘Why keep trying?’ asked Meredith Stark, 29, a hotel desk clerk in the northeast Mississippi town of Blue Springs. ‘Because this is something we need. We have a right to life, liberty and pursuit of happiness. And, I am sorry, but not having health insurance denies life.’ Stark says she has a chronic blood condition and had been skipping medication for three years while uninsured because of its cost. The marketplace, also known as an exchange, will offer plans based on four categories -- gold, silver, bronze and platinum -- with varying deductible costs, copayments and other consumer cost sharing. But the combination of heavy traffic – federal officials reports hits in the millions -- and programming problems has made the web site difficult to access since its Oct. 1 launch. After a week of trying, though, Stark managed to complete the online process and enroll her husband and herself in a plan that will cost $60 a month.” [Kaiser Health News, 10/11/13]

Better Coverage For At Least $13,000 Less - Butch Matthews, small business owner, 61 yrs old
Butch Matthews is a 61-year-old former small business owner from Little Rock, Arkansas who used to wake up every morning at 4 A.M. to deliver canned beverages to retailers before retiring in 2010. A lifelong Republican, he was heavily skeptical of the Affordable Care Act when it first passed. 'I did not think that Obamacare was going to be a good plan, I did not think that it was going to help me at all,' he told Think Progress over the phone. But after doing a little research, Matthews eventually realized how much the law could help him. And on Tuesday, his local Blue Cross Blue Shield (BCBS) provider confirmed that he would be able to buy a far better plan than his current policy while saving at least $13,000 per year through Arkansas' Obamacare marketplace... I still am a very strong Republican, but this... I'm so happy that this came along," he continued. "Our home is paid for, vehicle's paid for, this is our expense that we have. We have more expense on medical care than everything else put together, so this is going to be a great help for us.'" [ThinkProgress, 10/21/13]

Indiana Catholic Couple Can Now Afford to Have a Second Child - Steven, Freelancer, 39 yrs old
“Our story isn't terribly exotic, but it's ours. My wife and I (42 and 39) are both freelancers working at home, which means—among other things—we've been blessed with being able to raise our 7-year-old child without outside child care. Although solidly middle class by dollars, we don't earn health care through our employment, which means a large chunk of our money ($600 per month) goes toward health insurance, despite being mostly healthy nonsmokers. We're most interested in the provision of the ACA that requires insurers to cover maternity. It's nearly impossible for single buyers to purchase in our home state of Indiana: one-year waiting period, an extra $10,000 in annual premiums. Basically, you're prepaying for a standard delivery. Because of the lack of coverage—and earnings that have kept us from being certain of Medicaid benefits—we've limited ourselves to one child (which has been tricky, since we're practicing Catholics). We hope for coverage that's either better or cheaper than what we have now—and preferably both!” [Slate, 10/2013]

Colorado Republican Expects “Substantial Savings” - Eric Powell, Small-business owner, 32 yrs
"I grew up a staunch Republican, voted for Bush twice, but the combination of Sarah Palin and the baffling Republican response to Obamacare has caused me to have a major identity crisis in my political beliefs... I grew up in House Speaker John Boehner's district, and we're longtime family friends. My grandpa held the same congressional seat, my dad was a township trustee with him when they both were starting out, and I went to school with his kids. I've honestly never disagreed with any significant Republican positions until this one, but I voted for Obama in 2012—the only Democratic vote I've ever made...I spent an hour or so Tuesday morning browsing plans at the Colorado insurance exchange. My goal was to find coverage for myself and my two children for less cost than we’d incur through my wife’s employer. My children are currently on my wife’s employer-based plan, and my coverage is through the state’s soon-ending high-risk pool. While my wife’s employer coverage is inexpensive for herself, covering our entire family would cost us an additional $1,000 per month out-of-pocket (for a less-than-ideal $3,500 deductible plan).... Browsing and filtering plans is fairly straightforward, and I was impressed by the number of options. For myself and my two children, I was shown a total of 78 plan options from about 10 different carriers. The plans ranged from $357 to $1,024 per month (some including dental coverage), and it was pretty clear that we’d find substantial savings compared to insuring our entire family through my wife’s employer.” [Slate, 10/2013]

Illinois Couple Kept Coverage, Saved $390 - Kathy Kanak, 57 Year Old
“Kathy Kanak beat the system. Late Wednesday, the 57-year-old, of Libertyville, became one of the first known enrollees for health insurance at the glitch-stricken online marketplaces operated by the federal government for 36 states, including Illinois. … ‘I just kept trying,’ she said. ‘Tell people to just keep trying and (they'll) get in eventually.’ With federal tax credits, the Kanaks will pay about $260 a month in 2014 on premiums for medical coverage with Blue Cross and Blue Shield of Illinois and dental insurance through Delta Dental, a savings of about $390 a month from their current coverage. They'll be able to retain their family doctor and their dentist, and their annual deductible will drop to $1,500, from $5,000 this year.” [Chicago Tribune, 10/04/2013]

Small Business Forum on Health Insurance

This Thursday the City of Columbia will be holding an open forum on the impact of the Affordable Care Act on small businesses.  I will be moderating the panel presentations and discussions.  Another forum will be held October 23rd.


Registration is free: https://columbiaaffordablecareactforum.eventbrite.com

This is a great opportunity to learn how small businesses can effectively use the Health Insurance Marketplace (when it is fully functional) to not only make sure that employees have affordable health insurance that best fits their needs but also possibly how a small business can compete with companies that offer health insurance to employees without directly offering the employee benefit.  Small business owners might also find other options that could actually increase their bottom line.

 

 

Affordable Care Act Forum:

The Impact on Small Businesses

This forum will offer details and solutions on the Affordable Care Act for small businesses. The forum will feature a panel of experts from the insurance, legal and accounting industries who will help attendees understand the requirements, opportunities and benefits of the Affordable Care Act. Panelists will discuss:

 What does the Affordable Care Act do and not do for small businesses?

 What will be the impacts on small businesses in South Carolina?

 How can small business owners save more money?

 What are the opportunities for small businesses in South Carolina?

Session I

Thursday, October 17

9-11 a.m.

Columbia Metropolitan Convention Center 1101 Lincoln St.

Register by Tuesday, October 15

 

Session II

Wednesday, October 23

6-8 p.m.

Earlewood Community Center

1111 Parkside Dr.

Register by: Monday, October 21

Registration is free: https://columbiaaffordablecareactforum.eventbrite.com

For more information, contact Angelo McBride at 803.545.3960 or email aamcbride@columbiasc.net.

Health insurance industry targets Charleston's hospitality workers during Obamacare launch

Charleston City Paper
October 9, 2013

by Corey Hutchins @coreyhutchins

Nick Johnson is a 33-year-old Folly Beach bartender who hasn't had health insurance since he was 18. He also hasn't seen the inside of a hospital or a doctor's office for more than a decade, but two weeks ago he injured his left hand playing baseball with his nephew. It still hurts in the mornings, but he says he can deal with it.

Last week, the Affordable Care Act's online health insurance marketplaces opened for the first time, giving those without insurance the opportunity to buy it at, hopefully, reduced rates. In fact, some individuals can even receive government-subsidized coverage if they meet certain income levels. But Johnson is uncertain how much he'd be willing to pay for good coverage even if he did shop around. For the Folly Beach bartender, getting health insurance isn't a big concern.

And like many his age, Johnson doesn't have any idea what he'd do if he suffered a major accident and hospital bills started piling up. "I've never thought about it because I've never needed it," he says. "It just doesn't seem worth it to me."

Frank Knapp, president of the S.C. Small Business Chamber of Commerce and an advocate for the new healthcare law, says there's no reason a 33-year-old single male bartender shouldn't take responsibility for his own healthcare. As for those who are 30 and younger, the ACA offers low-cost catastrophic health care plans that cover major accidents but offer high deductibles, a good deal for those Knapp calls "young invincibles" who rarely go to the doctor. "I've heard some reports of these plans being almost free," Knapp adds.

The food and beverage industry is full of the kind of uninsured healthy young people the government hopes will sign up through the new exchanges. After all, the more people paying for coverage who aren't using it, the better the system is.

Here in South Carolina, state GOP leaders chose not to create state health care exchanges, so the federal government is operating them instead. While there are groups that are designed to help people navigate the process of getting signed up — like those who received federal Navigator grants — they can't reach everybody. And when it comes to Navigators, they can't recommend a healthcare plan, but they can show you your options. Licensed brokers, however, can do both.

One of them is Clark "Corky" Ullom, president of the Georgia-based HIX Marketplace who works for a private company licensed in 48 states to help people figure out the process of getting covered. Last Wednesday, he was stationed outside a giant Health Aviator tour bus parked in Marion Square as young guys tossed around frisbees and girls in bikinis sunbathed nearby. The insurance companies that are on the exchanges pay Ullom and his company for each individual they sign up. The Health Aviator bus will be in Charleston for the next three weeks, and Ullom says they've zeroed in on one specific industry.

"Hospitality is our main focus," he says from behind a pair of sunglasses.

His company has already partnered with the Greater Charleston Restaurant Association, and thousands of his business cards will end up in the envelopes of Lowcountry service industry workers when they get their next paycheck.

"You've got hard-working young people who don't have an opportunity for any type of reasonably priced health insurance," he says. "It's the biggest market out there." He also notes that a lot of these uninsured workers are confused about the recent government rollout and are looking for people like him to help them sign up.

One such worker is a local bartender and recent College of Charleston graduate named Charlotte Woodward. Most of what the 22-year-old has heard about the exchanges has centered around the right-wing/left-wing talking points. "I don't know much about the details," she says.

While she was in college, Woodward had cut-rate coverage that was rolled into her tuition, and she says it wasn't great. But now she's uninsured. Since she's under 26, she could technically be on her parents' plan, but she says that isn't an option.

Right now, Woodward's plan is to pursue another job outside the hospitality industry that will offer her an affordable and solid health plan. "I've done OK without it this far, but there have been some things health-wise I've been putting off and that's never good," she says.

Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center and a supporter of the federal healthcare law, hopes Woodward gets covered. "I want the people bringing food to my table to be healthy," she says. "It's worth it to start thinking about how you care for your health and well-being and look at that as part of your expenses."

Berkowitz says Woodward should visit healthcare.gov and see if she's eligible for a subsidy. Berkowitz says the bartender could probably get an affordable plan that offers coverage and preventative care, including screenings and physicals, with co-pays as low as $30 or $20 for a visit. Prescriptions like birth control would be covered with a similarly-priced co-pay, the Appleseed director adds.

Berkowitz blames the state's Republican leaders for why many young people are largely unaware of the ACA. South Carolina is one of the states choosing not to expand Medicaid, and Republican lawmakers had opposed implementation of the law. In fact, a failed bill in the state Senate would have made it a crime for public officials to implement the law here. More recently, Republican Gov. Nikki Haley told the media the state was doing all it could to help people sign up, but pointed out that the healthcare.gov website hasn't been working for everybody. "We're going to continue doing what we can," Haley said, "but this is continuing to be the mess we thought it would be."

Problems with the federal website underscore something of a disconnect. Yes, there may be so many people clamoring for healthcare that the website is overwhelmed, but there are plenty of uninsured people with no clue that it even exists.

Consider Matt Vliet, a 26-year-old uninsured student in a welding program at Trident Technical College who works at night as an independent contractor for a local pedicab company. He's isn't sure how the ACA might affect him. When he was told about the healthcare.gov site and what it does, Vliet says he'd be willing to check it out, but he is also willing to go without coverage for the time being. He hopes he'll get a good job with a decent health plan after he graduates.

Vliet is clear about one thing. He knows he will be fined if he doesn't get coverage. After 2014, most Americans without coverage will have to pay $95 or 1 percent of their income (whichever is higher) when they pay their taxes if they don't have health insurance. That fine will go up the following year and could be as much as $695 by 2016. The Congressional Budget Office estimates the federal government could net some $7 billion from the roughly six million people who could end up paying fines. One of them might be Vliet.

"Just because of my age and my invincible nature, I probably would be willing to pay the fine instead of health insurance at this point in my life," he says while parked on King Street outside PURE Theater Wednesday night. "I think most people under 30 would be willing to pay the fine."

And it's that attitude that some anti-Obamacare groups are banking on. Actually, they're actively pushing such a message on college campuses. Virginia-based Generation Opportunity, for instance, is running an ad campaign called Opt Out. In one ad, a college-aged girl who signed up for Obamacare is led into a gynecologist's office and asked to put her feet in stirrups. After the nurse leaves, someone dressed in a creepy Uncle Sam costume rises from between her legs brandishing a speculum. "Don't let government play doctor," the onscreen text reads. "Opt out of Obamacare."

Part of the right-wing war on the new healthcare law could be an attempt to cripple its effectiveness, and people like Vliet are the ones caught in the middle.

Back on the King Street pedicab, Vliet thinks about some of his colleagues who have been hit by cars or injured on the job. He says if someone showed him how to shop around for coverage and he could get it really cheap, he might sign up. But even then he's doubtful he would purchase health insurance.

"I wouldn't be willing to pay $150 right now while I'm in school," he says.

http://www.charlestoncitypaper.com/charleston/health-insurance-industry-targets-charlestons-hospitality-workers-during-obamacare-launch/Content?oid=4772288

The elderly...gotta love them

On June 29, 2009, I and three friends went up the road to Simpsonville, South Carolina, to here Congressman Bob Inglis (R-S.C.) speak at a town hall meeting being held at the Senior Center.  Little did we know that we would be witnessing history and the leading edge of Tea Party takeovers of similar events that summer.

During the discussion of healthcare reform, one elderly gentleman stood up and defiantly said, “Keep your government hands off my Medicare.”

It was the statement heard around the world.  Congressman Inglis held his composure in front of the rowdy crowd and tried to explain that Medicare is a government health program.  But no matter how hard Inglis tried, his Tea Party constituents didn’t want to hear reason or compassion for the uninsured.  Another man said that he had no problem stepping over someone without insurance who lay dying on the street instead of allowing the person to receive medical assistance at a hospital. 

Fast forward to the present and an equally selfish and hypocritical objection to Obamacare.  Here is the story from the AP.

Back in Crowder, Okla., Lonnie Anderson is cheering on (Congressman) Mullin in the high-stakes showdown with Obama and Democrats. The 71-year-old retired nurse likes some elements of the health care law, such as the requirement for insurers to cover individuals with pre-existing conditions, and allowing young people up to age 26 to remain on their parents' plans.  But she fears that the law derided as "Obamacare" is a path to socialism …

And keep your government hands off her Social Security checks, too!