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Tara Mack needs help with healthcare policy

by Eric Ferguson on January 9, 2016 · 3 comments

State Rep. Tara MackI’m starting to believe state Rep. Tara Mack’s claim that she and state Rep. Tim Kelly were really just exchanging healthcare papers, because somebody sure needs to fill her in on the basics, judging by how much she got wrong in her Star Tribune guest column, “Counterpoint: MNsure is hurting folks, not helping them”. She mentions how often she hears from Minnesotans with “heartbreaking stories” from “the so-called Affordable Care Act.” Maybe she’s unaware that it’s not so-called. That’s actually the name. It’s not a nickname. “Obamacare” is a nickname, as is, technically, the many names I imagine Republicans give it in private. Or maybe she’s flunking Clever Phrasing 101.
Anyway, the implication is that the ACA is destructive for many and working for nobody, even though the percentage of the US population without health insurance has plunged. It’s not exactly secret or hard to check. They do have staff in the MNGOP House caucus, don’t they? Via Paul Krugman:

Since Mack is getting complaints without apparently understanding the full context, let me explain: having access to the healthcare system is better than not having access to the healthcare system. The percentage uninsured plunged when the ACA kicked in fully, and no, it’s not a coincidence. In fact, it would be even lower had state governments under the control of Mack’s party not taken advantage of the US Supreme Court’s rewriting of part of the law to create the “Medicaid gap”. That happens when states choose not to accept the Medicaid extension, which the court made voluntary for no reason grounded in law (though sure, I’m grateful they didn’t chuck the whole law for ideological reasons as four conservatives wanted to do). The Medicaid extension covers people who are too poor to buy insurance with subsidies on state exchanges, but have too much income for existing Medicaid. Fortunately, Minnesota’s Republicans were unable to leave this portion of the state’s poor without healthcare access, but they gave it their best effort.
After showing she doesn’t understand the ACA in general, Mack followed that with a simple and extremely checkable false claim.

Late last month, MNSure’s latest CEO, Allison O’Toole, admitted in “The ACA: Trending up” (Dec 27) what legislators already knew: MNSure’s website is still failing to deliver basic services and functions that were promised when it was first created. They remain unfixed to this day.

I know one of the most popular activities on the internet is commenting on articles without actually reading them, but it’s still not good to reveal that fact with a gross error. Had Mack read O’Toole’s guest column, she would not only know it was published on the 23rd, not the 27th, but more important, she would know O’Toole said no such thing. Read what O’Toole actually wrote … especially if you plan to make comments about it. She admitted to issues, but also said it’s working much better. Presumably Mack would want to find someone who ran into technical issues, but that’s an anecdote and we can always find rival anecdotes. I have insurance I bought through MNSure, and it worked smoothly. I find that pretty impressive given the complexity of what it does. This isn’t just regular online retailing. I’m not saying online retailing is simple, it’s quite complex, but Amazon doesn’t have to explain to its customers how books work. Health insurance is complex, it changes yearly, and Amazon doesn’t have to have its customers run through a process for determining eligibility for subsides.
MNSure and the federal version are not only the most complex web sites probably ever, given the many things that have to be hooked together on the backend, but it was also the only web site with a go-live date set in law. Unless a retailer decides to launch something new on Black Friday, web sites go-live when they’re ready and not before. They have target dates for launches, and ask anyone who has worked on complex sites how often they meet those targets. The answer isn’t never, but private or public sector, speaking as someone who has worked on web sites in both sectors, it’s close to never. So maybe I let the Republicans set my expectations too low, but in one instance at least, it worked without glitches; which means implying it never works is false.
This next bit, again, left me wondering if Mack checked with anyone on how the law is supposed to work:

MNsure claims that its tax credits shield some Minnesotans from insurance prices that have doubled or tripled in the past two years. But that is cold comfort for the 80 percent of those Minnesotans who buy insurance on their own who don’t receive a tax credit.

That’s not a “claim”. That’s how the exchanges work. If your premium goes up but your income doesn’t, the subsidy goes up. 80% of Minnesotans aren’t buying insurance on their own. Most who have private insurance get it through their employer, so they get it subsidized in the form of the employer picking up most of the premium, and it’s pre-tax dollars so health insurance is part of most workers’ compensation. No Rep. Mack, you don’t get a tax credit for your income. If we’re to be generous and say she meant that people who buy individual plans outside the exchange don’t get a subsidy, that would be right but again misses that this is how the law works. The exchange is intended to foster competition by making it possible to compare prices and coverages which is generally difficult to do with private plans. Presumably competition will lower prices, according to economic theories conservatives believe in any other part of the economy. The subsidies, besides making private health insurance affordable, encourage customers to use the exchange and engage in plan comparisons, thereby applying downward pressure to premiums.
I loved this bit:

Second, Republicans proposed eliminating MNSure and transitioning to the federal exchange. This would save taxpayers over $17 million per year and prevent taxpayers from being on the hook for hundreds of millions in additional website fixes.

Does she not get that the federal exchange is just as complicated as MNSure, and there will be transition costs to a new system? She’s not even seeing the irony of wanting to move the state to the federal exchange. The whole idea of having separate state exchanges was a sop to conservatives, just because they didn’t trust federal, brace yourselves, big government. So we have state exchanges just for the sake of ideological correctness, and now the MNGOP wants to spend a bunch of money to shift to Ironically on the liberal side, we swallowed our anger that single-payer wasn’t even considered, and 50 separate exchanges would be a less efficient way to handle insurance if we just had to rely on private health insurance, because we knew that doing it this kludgey but politically possible way would still help a whole lot of people. So states with Democratic governments cooperated with the new law and built exchanges, while Republicans states, doing everything they could to obstruct the law’s implementation, dumped it on the feds. From the time states decided whether to build their own exchange, this outcome has always struck me as ideologically reversed, though I’m not surprised on the liberal side. The whole point was to get more people access to the health care system, by whatever means were available. I guess I’m surprised the likes of Tara Mack can’t see the irony. Of course, they keep trying to kill too, so maybe they’re just hoping for maximum efficiency killing.
Facepalm time!

Finally, House Republicans led the charge for increased oversight and other reforms to ensure that tax dollars are being spent wisely and that MNSure is conducting itself in a transparent manner and that it is able to be held accountable for mistakes.

This is coming from the party that has done everything it can to sabotage the law, that has refused free federal money for Medicaid expansion in states it controlled, that refuses to allow bills just making technical fixes to be considered, and Minnesota Republicans even objected when Gov. Dayton expanded Medicaid ahead of the law requiring it. Denying access to healthcare is how you help Minnesota families? This seems like the sort of story you give the cop who finds you in the park with your pants down.
From Dan Burns: So Mack must be planning on running again, despite her very well-publicized and embarrassing “incident,” or is angling for a job with some right-wing propaganda mill. Perhaps even both.
From Mac Hall: I, too, have acquired health insurance through MNsure.
Acknowledging its not-surprising rough start (as you alluded to any launch of a new system is likely to have problems especially if you did not have Google Chrome), MNsure’s site has performed well.
Yet, somehow she is blaming MNsure for rising healthcare costs … using your Amazon comparison, isn’t that like blaming Amazon for increases in prices of products it sells ? Take for example a product that Amazon does sell — Prolisac … a product that has seen price increases — 70% from 2003 to 2014. Now, if Congress were to approve Amy Klobuchar’s S.122 : Safe and Affordable Drugs from Canada Act of 2015, consumers could see the cost cut in half (or more).
Instead of blaming intermediary (MNsure), why isn’t she attacking the cause (i.e. the drug companies, medical device makers, etc.) ?
Hopefully, your readers saw the story about Pfizer raising prices
“Pfizer Inc., the nation’s biggest drugmaker, has raised prices on 133 of its brand-name products in the U.S. this year, according to research from UBS, more than three-quarters of which added up to hikes of 10 percent or more. It’s not alone. Rival Merck & Co. raised the price of 38 drugs, about a quarter of which resulted in increases of 10 percent or more. Like its competitors, Pfizer has been raising prices on older drugs in its portfolio for years. The increases in the U.S. have added $1.07 billion of quarterly revenue from mid-2012 to the middle of 2015.”
Do you think that production workers wages were increased by 10% or that raw material costs went up 10% … or do you think that shareholder dividends ? (Hint : Pfizer increased its dividend 8.4% last year.)
Prescription drugs represent the fastest-growing component of health care costs. Patients eventually will pay more in copayments and premiums to cover the rising costs of drugs. What’s a small price to pay for a pill that correct a medical problem … take the price of a 250 miligram tetracycline (antibiotic used to treat bacterial infections such as urinary tract infections, chlamydia and acne) now has a cost of $4.60 … okay, maybe 5 bucks a pill may not sound like much if you only use it for a small time frame … but in 2013 – two years ago – that same pill cost 6 cents.
That isn’t the only example, consider digoxin, a heart medication pill, that went from 12 cents to 98 cents.
Do we blame MNsure or ObamaCare ?
Why blame MNsure because the government cannot negotiate better prices ? How about blaming Congress for failure to enact Amy Klobuchar’s S. 31 Medicare Prescription Drug Price Negotiation Act of 2015 ?
And remember that because of Al Franken’s provision in the Affordable Care Act — the Medical Loss Ratio — insurance companies base their premiums on patient services. ACA policies provide more value for the consumer.
Yeah, health insurance might be expensive … but imagine what it would be without MNsure and the ACA ? I was able to acquire a policy at a lower price through MNsure than what I was paying on the open market (and those people that got a subsidy, saved even more.)
Considering the cost if you see a doctor (or pharmacy) without insurance, and you will find ObamaCare makes healthcare affordable. Affordable and the policies are “value-added” … as MNsure includes “essential benefits” in every policy.
Heck, before MNsure, I got my annual premium notice with a “take this new price because if you quit us you are subject to being excluded because of pre-existing conditions” … now, every year, I can compare a number of insurers offerings … and switch if another one offers a better value.
So, Tara Mack has rallied her troops … something that Republicans do quite well … but the question is why are Democrats not promoting the positive impacts of ObamaCare (instead of working with Republicans to help defund it (i.e. the “suspension” of the medical device tax which now is being reported as a $5 billion windfall for the industry). Sure would like to hear Erin Maye Quade’s reaction to the Mack piece.
Single payer is the way to go but with certain Congressional “Democrats” joining with Republicans that will never happen in my lifetime.

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