UPDATE: Forecast of 2012 election

Election Projection [EP][ now has Obama beating Romney by 126 electoral votes—332 Obama to 206 Romney.  270 electoral votes are needed to win.  The last time I reported the EP projections, they had Obama with 303 electoral votes to 235 for Romney.  Obama’s expanded lead comes largely from Florida moving from Weak Romney to Weak Obama.  Also, EP now says Obama is ahead of Romney in Ohio, Pennsylvania, and Virginia, all key battleground states. EP now has Obama winning 50.3% of the popular vote to 48.2% for Romney.

EP has Republicans taking control of the Senate.  EP says Republicans would control the Senate with 52 seats to 46 seats for Democrats and 2 Independents.

EP now says Republican Brown will retain his seat in Massachusetts, defeating Democratic challenger Elizabeth Warren. 

EP now projects that there will be little change in the House with Republicans holding 243 seats to 192 Democratic Party seats.  Currently Democrats have 193 seats to 242 for Republicans, so the makeup of the House would stay pretty much the same.

Read complete details here: http://www.electionprojection.com/2012elections/president12.php

Republicans once again protect the 1%

Who are the Republicans protecting from the individual mandate penalties?  I did some calculations. 

The Congressional Budget Office (CBO) estimates that there will be approximately 272 million non-elderly people in the U.S. in 2014 when the individual mandate of Obamacare would take affect.

CBO estimates that 80% of these non-elderly or approximately 218 million would be insured in the absence of Obamacare so they are not affected by the mandate.

That leaves 54 million who could be potentially subject to the individual mandate.

However, 40% or approximately 22 million of those potentially subject to the mandate will be exempt from the penalties because they are members of certain religious groups and Native American tribes; undocumented immigrants (who are not eligible for health insurance subsidies under the law); incarcerated individuals; people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples); and people for whom health insurance is considered unaffordable (where insurance premiums after employer contributions and federal subsidies exceed 8% of family income).

That leaves approximately 33 million people subject to the penalties.

However, according to a poll of the uninsured conducted for Demos (http://www.demos.org/data-byte/what-explains-your-personal-lack-health-insurance ) 83% of these people or approximately 27 million are uninsured because they can’t get coverage, can’t afford the coverage available or for some other non-voluntary reason.  These people want coverage and will be able to obtain it under Obamacare so the penalties will not apply to them.

That leaves approximately 6 million people who voluntarily refuse to purchase health insurance and are thus actually subject to the penalties from the individual mandate.

So, out of 272 million non-elderly Americans, the whole individual mandate is about penalties that only 6 million, about 2% might be required to pay.

However, experience in Massachusetts suggests at least half of these voluntarily uninsured people who are actually subject to the penalty will just go ahead and get the cheapest insurance they can under Obamacare in order to avoid the hassle of a penalty.

That leaves less than 1% of the non-elderly adult population in 2014 who would actually pay a penalty, about the percentage that paid a penalty in Massachusetts in 2009. 

Once again, Republicans are punishing the 99% to protect the 1% or less.

Mysteries of Obamacare

You can’t follow the debate and court proceedings regarding the Affordable Care Act (Obamacare) for very long without finding some of the debate around the act very, very strange, and I’m not just talking about the effort to equate being forced to buy insurance with being forced to eat your broccoli.  Here are two mysteries that I find very interesting.  I don’t have their solutions but I offer some plausible explanations. 

Mystery #1: A few words of boilerplate language could have saved the Affordable Care Act from being declared unconstitutional in its entirety.  Why was this standard wording left out?

Here I’m talking about something called the “severability clause.”  It is a standard piece of boilerplate language Congress inserts in most legislation to make it nearly impossible for the Supreme Court or any other court to strike down the entirety of an act simply because it declares one section to be unconstitutional.   A robust version of the severability clause would read something like this:

Every provision in this Act and every application of the provisions in this Act are severable from each other as a matter of law. If any application of any provision in this Act to any person or group of persons or circumstances is found by a court to be invalid, the remainder of this Act and the application of the Act’s provisions to all other persons and circumstances may not be affected.

See more on the severability clause and different versions here:

http://www.ncsl.org/documents/lsss/Insulating_Worksheets.pdf

Democrats say they meant to include a severability clause when they were writing the final draft of the Affordable Care Act but somehow the clause got left out.  That hardly seems plausible.  Here we have a major piece of legislation, historic legislation, legislation that will be a center piece of Obama’s first term, and Democrats forget to include a piece of standard boilerplate. 

A Plausible Solution:  Could it be that the severability clause was left out on purpose?

The health insurance industry has offered little opposition to the Affordable Care Act even though there are a number of provisions in it, such as the requirement that they justify their rate increases, that they don’t like.  Of course, insurance companies stand to gain a large number of new customers if the individual mandate stands.  Could it be that there was a deal?  The insurance companies liked the individual mandate because it would bring them new customers.  On the other hand, if the individual mandate was declared unconstitutional but the other portions of the law remained, in others words they were severable, then the insurance companies could be stuck with costly requirements such as not being able to refuse coverage because of per-existing conditions.  So, the Democrats agreed to accidentally leave out the severability clause in return for insurance companies not fighting passage of the act.  The insurance companies bet that if the court struck down the individual mandate, it would also strike down the rest of the complex law, if for no other reason than that the court would not want to wade through thousands of pages deciding what was severability and what wasn’t.  So, no mandate, no worry about the rest of the act going into effect. It looks like the insurance companies were right about that.

Mystery #2: Why are Republicans opposed to their own idea and one that fits nicely with their professed social and political philosophy?

The Individual Mandate was a Republican idea.  As ProCon.org notes:The concept of the individual health insurance mandate is considered to have originated in 1989 at the conservative Heritage Foundation. In 1993, Republicans twice introduced health care bills that contained an individual health insurance mandate. Advocates for those bills included prominent Republicans who today oppose the mandate including Orrin Hatch (R-UT), Charles Grassley (R-IA), Robert Bennett (R-UT), and Christopher Bond (R-MO).  http://healthcarereform.procon.org/view.resource.php?resourceID=004182   

Not only is the individual mandate a Republican, it fits with conservative philosophy that stresses personal responsibility.  If you oppose the individual mandate, you are siding with those who would ask the federal government to provide them something for nothing—pay the cost of their health care when they are unable or refuse to do so.  In other words, you abet freeloaders.  Opposition to the individual mandate would be more in line with classical liberalism than conservatism

A Plausible Solution:  So, why did Republicans reject their own idea?  Maybe they did so for the very simple reason that Obama embraced the idea and made it part of a piece of signature legislation.  Could it be that Republicans opposition to the individual mandate is part of their announced political strategy to undermine the Obama administration at all costs, even if it means reject what was their own idea? 

Think about it.

What do we lose if the court overturns Obamacare?

Based upon what they heard during oral arguments over the last three days, most pundits, myself included, are predicting that the Supreme Court will declare the individual mandate portion of Obamacare to be unconstitutional.  Additionally, most are predicting that the court will find that other elements of the law ARE NOT severable and therefore that the entire law must go.  If the pundits are right, sometime this summer, probably in June, the Supreme Court will strike down Obamacare in its entirety by a vote of 5 to 4.  One justice will cause the following damage to our country and Americans’ access to affordable health care.

U.S. citizens and legal residents who would have been required to obtain health insurance coverage in 2014, WILL NOT be required to obtain such coverage.  An uncovered individual, even someone who could have afforded coverage and voluntarily chose not to do so, will continue to be able to go to an emergency room or other care facility and receive treatment without regard to their ability or willingness to pay.  If they can’t pay for the cost of their treatment or refuse to do so, then the cost of their treatment will be picked up by the U.S. taxpayer and/or by insured individuals and families through increased premiums.

Employers WILL NOT be required to provide their employees with health insurance coverage.  It will be legal for them to drop coverage or dramatically change coverage at any time.

Children, pregnant women, parents, adults and others who are not currently eligible for Medicare or Medicaid but would have been covered under Obamacare WILL NOT receive coverage and will remain uninsured unless they can somehow find affordable coverage, which is unlikely.

States WILL be allowed to raise eligibility requirements for children in Medicaid and the Children’s Health Insurance Program (CHIP) AND federal funding for CHIP WILL NOT be extended.

Health Insurance Exchanges where Americans could shop for affordable coverage from private insurance providers in a competitive marketplace as planned under Obamacare WILL NOT be created.

Low income working families who have too much income to qualify for Medicaid WILL NOT receive premium subsidies or credits to help them purchase health insurance.  Most will be forced to continue to go without coverage.

Small companies WILL NOT receive tax credits to help them purchase health insurance from their employees.  Providing health insurance for workers WILL remain too costly for most such employers.

There will be NO funding to foster the creation of non-profit, member-run health insurance companies that could provide better policy options and offer lower-premiums to members.

There will be NO national requirement that health insurance companies offer a basic package of essential health benefits thus making it possible for companies to continue to offer worthless junk policies to consumers.

There will be NO national requirement that insurers guarantee renewability of a policy to a policy holder, even one who has not used his/her coverage and has had no adverse changes in his health.

There will be NO restrictions on how much insurance companies can vary their premium rates by age, rating area, family composition, or any other criteria they may choose.   

There will be NO requirement that health insurance companies spend a minimum amount of their premium dollars on clinical services, quality and meeting the needs of policy holders.

There will be NO limit on the amount of premium dollars health insurance companies can spend for marketing, overhead, paying executive salaries, profit and so on.

There will be NO requirement for insurance companies to provide coverage for children up to age 26.

Insurance companies will be ALLOWED to continue to place lifetime limits on the dollar value of coverage.

Insurance companies will be ALLLOWED to continue to rescind coverage for any reason.

Insurance companies will be ALLOWED to continue to deny coverage to anyone, children or adults, for pre-existing conditions.

There will be NO limit on the deductibles or out-of-pocket costs insurance companies can demand.

There will be NO limit on waiting periods insurance companies can require before the start of coverage.

There will be NO website established to help individuals easily compare help coverage offerings.

There will be NO requirement that insurance companies provide information about benefits and coverage in a standard format so that consumers can easily understand benefits and compare policies.

There will be NO effort to reduce the cost of Medicare or the rise in Medicare premiums.

Proposals under Obamacare to reduce waste, fraud, and abuse in Medicare and Medicaid WILL NOT be implemented or funded.

There will be NO grants to states to allow them to consider options to tort reform that might reduce current tort litigations while enhancing patient safety through a reduction in medical errors and adverse events.

There will be NO effort to develop a national quality strategy to improve the delivery of health care services, patient health outcomes, and population health and no effort to develop measures of health care quality.

There will be NO funding to support employer-based wellness programs.

There will be NO requirement that chain restaurants and vending machine companies post the nutritional content of foods they sell.

There would be NO funding for improving training and development of health professionals or to increase the number of primary care physicians.

There would be NO additional funding for research on improving trauma centers and the provision of emergency medical services and NO funding for pediatric medical research.

32 million uninsured Americans who would like to carry health insurance and otherwise would have obtained coverage under Obamacare will remain uninsured.

The U.S. deficit will INCREASE by an additional $124 BILLION over the next ten years compared to what it would have been like under Obamacare.

All of this will happen because one Supreme Court Justice decides that if Congress is allowed to mandate that Americans purchase health insurance it might someday decide to require Americans to eat broccoli.  I kid you not. 

To see a complete summary of the benefits of Obamacare that we will lose, go here:

http://www.kff.org/healthreform/upload/8061.pdf

Polling: the wording of the questions matters

I’ve posted about this before but here is a recent and vivid example.  Results of a public opinion poll cans be shaped greatly by the way questions in the poll are worded.  Here is a good and recent example.

The Pew Research Center asked Americans about their support or opposition to the individual mandate in Obamacare.  The results of the poll as reported by Pew were that 41% of Americans approved of the mandate while 56% opposed.  Clearly, Americans are set against the individual mandate.  Right?  Not necessarily.

To its credit, Pew reported how results from the poll changed as a result of changes in the wording.

The question about the individual mandate read as follows:

As you know, by 2014 nearly all Americans will be required to have health insurance. [People who do not buy insurance will pay a penalty.] while [People who cannot afford it will receive financial help from the government.]  Do you approve or disapprove of this policy?

The order of the portions of the question were changed on a random basis.  Sometimes the segment about the penalty was stated last.  Sometimes the statement about financial help was stated last.  The order made a tremendous difference in the results.  When the last thing Americans heard was that people who did not buy insurance would have to pay a penalty, only 34% of Americans said they supported the policy, while 63% opposed.  However, when the last thing Americans heard was that people who did not buy insurance would receive financial help to do so, 47% of Americans supported the policy, while 49% opposed.  The results were within the margin of error, in other words Americans were about evenly split in their support or opposition to the policy.  Here are the results:

Lesson: The wording of interview questions has a great impact on the result.  In other words, you can’t really gauge the accuracy of the results if you aren’t told the exact wording of the questions AND whether the pollsters took steps to minimize any kind of bias in the wording.

Whenever polls results are impacted to such an extent by the wording of the questions, it is a good indication that Americans have not yet formed firm opinions about the issue being polled and that consequently later polls on the subject could yield different results, perhaps quite different results.

UPDATE: Justice Kennedy’s possible vote on individual mandate

In an earlier post, I said comments by Justice Kennedy-a key swing vote on the court—might indicate that he would side with the conservative members of the court to declare the individual mandate portion of Obamacare unconstitutional.

Lyle Denniston at Scotusblog.com says after the competition of today’s arguments, it may be premature to predict how Kennedy might vote.  Denniston writes:

If Justice Anthony M. Kennedy can locate a limiting principle in the federal government’s defense of the new individual health insurance mandate, or can think of one on his own, the mandate may well survive.  If he does, he may take Chief Justice John G. Roberts, Jr., and a majority along with him.  But if he does not, the mandate is gone.  That is where Tuesday’s argument wound up — with Kennedy, after first displaying a very deep skepticism, leaving the impression that he might yet be the mandate’s savior.

If the vote had been taken after Solicitor General Donald B. Verrilli, Jr., stepped back from the lectern after the first 56 minutes, and the audience stood up for a mid-argument stretch, the chances were that the most significant feature of the Affordable Care Act would have perished in Kennedy’s concern that it just might alter the fundamental relationship between the American people and their government.   But after two arguments by lawyers for the challengers — forceful and creative though they were — at least doubt had set in. and expecting the demise of the mandate seemed decidedly premature.

Read Denniston’s complete post here: http://www.scotusblog.com/2012/03/argument-recap-it-is-kennedys-call/