Why the AFP ads suck

Both Tim and Kevin Drum are asking a good question — where are the Obamacare losers on the Americans for Prosperity (for the 1%) ads?

if this is the best AFP can do, does that mean that no one is truly being harmed by Obamacare? Hell, I’m a diehard defender of Obamacare, and even I concede that there ought to be at least hundreds of thousands of people who are truly worse off than they were with their old plans. But if that’s the case, why is it that every single hard luck story like this falls apart under the barest scrutiny?

There are a couple of categories of people who are undeniably worse off under Obamacare than they would have been under a no change policy. They can be clustered into a few broad groups.

  • People earning over $250,000 per year in Modified Adjusted Gross Income who have employer sponsored health care or Medicare and are paying more in taxes
  • Young single males with absolutely no health problems, no relatives with health problems and incomes over 250% Federal Poverty Line that previously had a $42 a month, $25,000 deductible plans that did not cover maternity or mental health needs. Those policies got cancelled and they actually have to buy good insurance. Young guys making under $25,000 a year usually will get decent subsidies, past that, it is hard to be sympathetic to someone bitching that they (a member of a high accident group) have to buy decent insurance. Avik Roy has been trying to make this class sympathetic and failing miserably)

Those are the two big classes of losers under the law. Neither are particularly sympathetic. Most insurance companies (mine included) have a very unofficial directive of “Don’t make us the highlight of a sob story on all four major local news channels tomorrow” to their employees. There are bumps, there are gaps in transition, and there are screw-ups but the insurance companies are trying not to fuck up transitions of care. The AFP ads have been “horror” stories for transitions of care as that is a privileged subset of people who are touching PPACA policies — people who had pretty decent insurance before Jan. 1, 2014.

58 replies
  1. 1
    Baud says:

    So the losers are (1) Republicans and (2) Republicans.

    Nice.

  2. 2
    Mnemosyne says:

    @Baud:

    Don’t forget (3) Republicans who claim to be “libertarians.”

  3. 3
    jl says:

    I am sure Mr. Mayhew is correct, as far as his parochial little ‘fact and reality based’ world go.

    But we are talking about ad campaigns that feature people who seem to be hurt by the ACA aimed at scared white people who are not really in emotional or informational shape to think straight.

    For example, re the ad discussed by Tim F. and Drum, there is nothing about the ACA policy that can be objectively identified as being worse than her previous policy. The poor woman just thinks somehow it is not as good or less secure, or there is something else bad about it, somehow.

    There is another ad where a woman in TN with a pre-existing condition had a big jump in premium, but it is unclear whether that is due to the ACA or the lack of Medicaid expansion in TN. I suspect the latter had a lot to do with it, since there is a some incomprehensible technobabble at the tail end of that ad about Obama not approving the TN application for Medicaid waivers, which means absolutely nothing in the context of the ad. so, I suspect that little complaint at the end of the ad about how unfairly TN was treated is some CYA in case the ad lands up at some fact checker joint for public review.

  4. 4
    SamR says:

    I’m sort of in group 2, though it was actually a plan with a $5,000 deductible that cost $120 a month. So yeah, my costs went up from that by a hefty amount, though its still very affordable.

    However, the cost had gone up annually anyway, and now I’m more confident that my coverage actually covers me, and also dental was so cheap now that I added it (my cost went up outside of dental, but before dental was super-expensive and I just paid my dentist with a credit card).

    AFP gimme a call! “My costs increased, and all I got in return was more and better coverage! OPPRESSION!”

  5. 5
    Brendan in NC says:

    I’m seeing fewer of those AFP ads, and seeing more of the original ones…you know, with the blonde who “hates political ads”, but is starring in one…

  6. 6
    jl says:

    But, RM definitely has a point. The 250K plus set is not good fodder for scaremongering ads, though I’m sure some sad stories are being shopped around to places like the NYT ‘sadly not quite rich enough’ section.

    And some brogrammer emitting glibertarian bromides and complaining about how much the ACA premiums will eat into his daily latte and brogrammer perks budget will not be very persuasive.

  7. 7
    mikefromArlington says:

    So, someone new to my company was told by out insurer their pre-existing condition wasn’t going to be covered. I thought that went away. And if it did, who can they talk to? Thanks

  8. 8
    Baud says:

    @mikefromArlington:

    Obama delayed the large company mandate for a year and small company mandate for two years, so if the insurance is through your work, the preexisting condition ban might still be in place.

  9. 9
    Mnemosyne says:

    @mikefromArlington:

    Are you in Virginia? If so, the Virginia Bureau of Insurance would probably be a good place to start.

  10. 10
    aimai says:

    I am so sick of hearing about the “out of pocket costs.” We have pretty good health insurance through Mr. Aimai’s employer and we have a 6000 dollar deductible. We never reach it so I don’t even know if thats 6000 dollars for the family or if we’d have to multiply it four times. We get negotiated insurance rates for stuff but we have to pay out of pocket for basically everything that the ACA didn’t mandate gets covered. If I had a chronic, expensive, illness like Lupus I’d expect to be paying a shitload of money, regardless of how I was insured. We pay a ton and we don’t have any real health problems.

  11. 11
    Mnemosyne says:

    @mikefromArlington:

    Also, here’s an explanation of HIPAA. Basically, if he received treatment for his pre-existing condition within the previous six months, he could be excluded for up to a year, but they have to take him after that. If that’s the situation, he may want to look into an exchange policy to cover him for that year since the exchange insurers are not allowed to exclude him.

  12. 12
    Richard Mayhew says:

    @mikefromArlington: Is your insurance offered through work? If the plan design is a grandfathered plan (in effect the day PPACA was signed by Obama with minimal changes), exclusions are allowable. Other than that, I can’t think of too many scenarios where that is allowable.

  13. 13
    Mnemosyne says:

    @Richard Mayhew:

    So here’s a question: if someone’s employer-provided insurance refuses to cover them due to pre-existing conditions, can they get a subsidy on the exchanges? I know that normally you can’t do it if your employer offers “affordable” insurance, but you’d think there would have to be an exception if the employer insurance refuses to cover you.

  14. 14
    JPL says:

    @mikefromArlington: A friend told me recently that preexisting conditions were still covered but cost a lot more. I went to the healthcare.gov site and read aloud to her what the exemptions were.
    Pretty much it is for policies that were grandfathered in temporarily.
    As time goes by, there will be more stories like the one you heard about and my friend but there’s a time limit on those policies.

  15. 15
    Redshift says:

    @Richard Mayhew: You’re the expert, but that doesn’t seem to be what healthcare.gov says. It says “the only exception is for grandfathered individual health insurance plans.”

  16. 16
    gelfling545 says:

    @Baud: But hasn’t the pre-existing deal been in place for a while now?

  17. 17
    IowaOldLady says:

    My understanding is that the pre-existing condition problem for children has been gone for a while, but the change in the one for adults just kicked in.

  18. 18
    IowaOldLady says:

    Hm. I seem to have answered a comment that’s no longer there and I never have an edit button. Sorry!

  19. 19
    JPL says:

    In GA healthcare news, several rural hospitals are threatening closure. Although the state decided not to expand medicare, the local news has blamed ACA.

  20. 20
    NotMax says:

    Americans for (Just Our Bosses’) Prosperity has been, is and ever shall be a scam factory.

  21. 21
    Bokonon says:

    One thing that needs be factored in is that lots of private sector employers are using “Obamacare” as an excuse for making dramatic benefits cuts – whether that is true or not.

    I should know. My former employer did exactly that. They got rid of the company’s HMO options and replaced them with high deductible health care plans (that were also more expensive than the old coverage options). My company’s management pointedly blamed this on Obama and the ACA, and claimed that their hands were tied. None of that was true. But lots of people still believed it – and they were absolutely enraged. Not at our employer so much, but at the Obamacare scapegoat.

    This sort of thing travels under the radar, since it is happening in people’s day-in-and-day-out worklives, and is the accumulation of thousands of individual experiences and conversations and workplace frustrations. But I think that this is part the reason for the renewed anger and controversy over the ACA.

  22. 22
    IowaOldLady says:

    Basically, this is all reasons for single payer. Then we can (and will) all bitch converage and wait times and everything else. But at least we’ll know who to blame.

  23. 23
    Richard Mayhew says:

    @Redshift: That is why I’m scratching my head. If the policy is being offered through work as a group sponsored plan, there is pure community underwriting. Everyone in the group pays the same rate. That rate may change if a new member has a pre-exisiting and expensive condition, but a pre-exisiting condition is not grounds to exclude.

    Now on the individual market, any policy written with an effective date of 1/1/14 has to be PPACA compliant which means no pre-exisiting condition exclusions.

    Something is not adding up here….

  24. 24
    Richard Mayhew says:

    @Redshift: But grandfathered individual policies can’t be sold to new people.

  25. 25
    Redshift says:

    @Richard Mayhew: The whole thing seems pretty fishy. My bet is that the HR person who told him that was seriously confused, because the only other alternative seems to be someone trying to get away with something illegal.

  26. 26
    Villago Delenda Est says:

    @Baud:

    I’m not seeing a downside here. At all.

  27. 27
    imonlylurking says:

    Technically I am worse off. I have a heart, though-I admit I’ve whined a bit, but I don’t really mean it. And I am certainly not going to vote Republican because of it.

  28. 28
    Villago Delenda Est says:

    @Mnemosyne:

    Still not seeing a downside.

  29. 29
    Villago Delenda Est says:

    OT, from the comedy giants of Noisemax:

    Cruz: Here’s Why Americans Hate Congress

    Yes. Big arrow pointing at himself.

  30. 30
    Mnemosyne says:

    @imonlylurking:

    There are definitely some tweaks that need to be made — has anyone ever explained why the exchange prices are so much higher in Colorado than in any of the surrounding states? Also, it seems as though some people with complicated child custody or divorce decrees are having a hard time getting all of the pieces to fit together, especially if they’re underwater on their mortgages or have other financial problems.

    But I think most people on the left know that these are matters of tweaks and fixes, not repealing PPACA.

  31. 31
    Mike in NC says:

    Is there anybody outside of the 27% who’d fall for any of these lame AFP ads? Do they think the Koch brothers are on their side?

  32. 32
    p.a. says:

    What is the schedule for taxing employer provided insurance? My one-person plan, $1,000 deductible $54/month premium is valued at $8,600 for 2013 on my w-2.
    Once the tax hits there may be a lot more people who feel worse off.

  33. 33
    imonlylurking says:

    @Mnemosyne: I would really like to see some regional coverage. To be honest, a lot of the complaints I see are really good reasons to go to single payer-I would gladly pay the premium I pay now to the feds in exchange for access to nation-wide access to Medicaid doctors.

  34. 34
    Mnemosyne says:

    @p.a.:

    It starts at $10,200 for an individual plan. Sorry, your plan’s a Camry, not a Cadillac.

  35. 35
    p.a. says:

    @Mnemosyne: thanks for the info. Are the numbers indexed to CPI? Decided by HHS? Congressional action? (Heaven forbid).
    Camry? At times seems more like Al Bundy’s Dodge.

  36. 36
    PopeRatzo says:

    The accuracy of this story depends on whether or not the exchange plan is really “decent insurance”.

    If, between the deductible and premiums, a subsidized insured person could end up paying more than 1/3 of their income in health care costs, I’m not sure it’s very “decent”.

    One-third of the income of a sick person making less than $30,000/yr places them in poverty and at risk of bankruptcy. That is indecent.

    Add in the clawbacks with which the ACA seizes the assets of poor seniors and “balance billings”, you end up with a system that’s much more about helping the rent-seeking parasites in the insurance industry than the uninsured. And the poor will still pay the highest medical costs, not just in percentage of income, but in actual dollars.

  37. 37
    Ronnie Pudding says:

    Alternative theory: the ads fall apart under scrutiny because it doesn’t matter if they hold up. Why expend any effort to find a real victim when fake ones tend to work about as wee, given our political discourse?

  38. 38
    Mnemosyne says:

    @PopeRatzo:

    If, between the deductible and premiums, a subsidized insured person could end up paying more than 1/3 of their income in health care costs, I’m not sure it’s very “decent”.

    Please present your example. A factual one that actually happened, not a hypothetical one.

  39. 39
    jl says:

    @PopeRatzo:
    @Mnemosyne:

    I second Mnemosyne. Look at the Kevin Drum link. The point is that the two policies look about the same in terms of care delivered and cost, with ACA plan better in some respects. PopeRatzo, if you can find a mistake there, let us know.

  40. 40
    Talentless Hack says:

    @Bokonon: Our Planet Fitness is bumping the black card price by 6 cents, blaming it on the Obamacare tanning tax. Six cents. Spread over all their black card members, they probably spend more than that on pizza night. Given that just covering it would have made a barely perceptible dent in their bottom line, I think they just took the opportunity to spread some propaganda without appearing “lunkish,” as they might say if I started talking about it while working out.

  41. 41
    StringOnAStick says:

    @Mnemosyne: The Colorado problem is mostly an issue with high coverage costs in the mountain areas, meaning the ski area region. The providers in those areas are expensive (like everything else up there), and didn’t offer much of a price break for the new insurance plans. The costs for policies outside of the ski town region aren’t nearly as high, so it is basically a problem related to those being expensive areas to live in and any cheaper health care is a long drive to someone place far away, unlike driving from Manhattan to a cheaper part of the NYC area.

  42. 42
    PopeRatzo says:

    @Mnemosyne:

    Please present your example. A factual one that actually happened, not a hypothetical one.

    OK, but remember, you asked for it:

    http://www.nakedcapitalism.com.....-lies.html

    Also, @jl, you’ll want to see this too, since you seconded Mnemosyne’s challenge.

  43. 43
    jl says:

    @PopeRatzo: I was referring to the AFP ads (as I thought Mnemo was as well), but the link you present is surely fair game for discussion. Unfortunately, while the author of the Naked Capitalism link accuses the ACA proponents of making big assumptions that fix the comparison in favor of the ACA policies, the author also has to make a lot of assumptions to make the opposite case.

    Why don’t you email Richard Mayhew with the link and ask his opinion? I would trust his expertise on which side makes the most reasonable assumptions, or perhaps he can find out.

  44. 44
    Mnemosyne says:

    @PopeRatzo:

    Okay, this part made me laugh:

    Before the end-of-year window closes I’d urge anybody in my position – middle-class people with healthy families – to shop for and purchase private non-Obamacare plans.

    Dude — there are no private non-Obamacare plans. None. All healthcare plans sold since 2009 have to meet Obamacare’s rules. Unless you have a pre-2009 plan that has not changed since 2009, any new plan you buy is an Obamacare plan whether you buy it on the exchanges or not.

    Mr. Olenick may also want to check his zip code. Notice something there? Something interesting about his state? Let’s just say, if his zip code was 95162 instead of 33405, he would be doing a lot better on the exchanges. But his governor made a deliberate choice to fuck over consumers in his state, which is of course all Obama’s fault, because shut up, that’s why.

    Notice again: all of the “Obamacare horror stories” trace back to decisions made by red states to fuck over their own citizens and then blame “Obamacare.”

    So, once again, I must issue you my challenge: find me an actual Obamacare horror story, not a My governor fucked me over and I’m going to blame Obama for it story.

  45. 45
    Mnemosyne says:

    @PopeRatzo:

    Man, it just gets funnier:

    But until we come to our senses and adopt Medicare For All it is time that the self-employed middle-class force the ACA into a death spiral by purchasing private insurance.

    Yes, pay more to purchase your Obamacare-compliant policies directly from the insurance companies and don’t take the subsidies you’re entitled to! That’ll show Obama!

    Still not getting how this guy is any different than the right-wingers who have similarly decided to shoot themselves in the foot by foregoing subsidies because OBAMACARE!

  46. 46
    David M says:

    @Mnemosyne:

    Before the end-of-year window closes I’d urge anybody in my position – middle-class people with healthy families – to shop for and purchase private non-Obamacare plans.

    Or you know, they could buy on the exchange even without subsidies if the plans priced the same or better, as the subsidies are retroactive. Meaning if they are unlucky, they can get the subsidies when they unexpectedly become eligible.

    In some states, most plans are and prices are identical on and off exchange, so there isn’t even a true non-Obamacare market that they can force into a death spiral.

  47. 47
    PopeRatzo says:

    @Mnemosyne:

    So, once again, I must issue you my challenge: find me an actual Obamacare horror story, not a My governor fucked me over and I’m going to blame Obama for it story.

    How can a national health care system that relies on getting good local governments elected be any kind of a solution?

  48. 48
    Mnemosyne says:

    @PopeRatzo:

    How can a national health care system that relies on getting good local governments elected be any kind of a solution?

    Ask Canada:

    Instead of having a single national plan, Canada’s health care program is made up of provincial and territorial health insurance plans, all of which share certain common features and standards. Canada’s public health care system is funded through taxes and administered by the provinces and territories.

    Technically, even the NHS isn’t a “national health care system” by that standard — there are four separate systems, for England, Wales, Scotland and Northern Ireland. So, no, having things divided up by state or province is not some weird new innovation of the Obama administration. It’s how everyone does it, including the countries everyone points to as being better than us at healthcare.

  49. 49
    PopeRatzo says:

    @Mnemosyne:

    Still not getting how this guy is any different than the right-wingers who have similarly decided to shoot themselves in the foot by foregoing subsidies because OBAMACARE!

    The challenge was not to find someone who had a sensible reaction to the difficulties he had, but rather to provide a single, honest, real example of an American working family for whom Obamacare was a problem rather than a solution. Not someone making more than $250,000/yr. Not a member of the 1%. Not someone in unusual circumstances.

    And aren’t you the same guy who got all mad at me some months ago because I said Obama would end up further delaying the employer mandate? Do you still believe that there will ever be an employer mandate?

    I just don’t see how you can see legislation which will guarantee Republican House majorities for at least the next decade, and allow the Republicans to take the Senate in 2014, and further entrenches insurance companies in their position of control over Americans’ health care, and doesn’t even solve the problem for which it was enacted can be considered any kind of success.

  50. 50
    Mnemosyne says:

    @PopeRatzo:

    The challenge was not to find someone who had a sensible reaction to the difficulties he had, but rather to provide a single, honest, real example of an American working family for whom Obamacare was a problem rather than a solution.

    Yes, and you did not provide one, because his problem originates with the state of Florida, not with Obamacare. His state decided to fuck him over, and he’s blaming Obamacare rather than directing his blame where it should go. His beef is with Rick Scott, not Barack Obama.

    Do you still believe that there will ever be an employer mandate?

    I’m pretty sure I’m not the person you were arguing with, but the delay in the employer mandate is only for portions of it, and most of the delay benefits companies with fewer than 100 employees. Large companies still have to meet the mandate by the end of 2015. Given that the healthcare marketplace for small businesses was delayed, I don’t really have a problem with delaying the small employer mandate until those are up and running so they know what their options are and can get the best possible deal.

    I just don’t see how you can see legislation which will guarantee Republican House majorities for at least the next decade, and allow the Republicans to take the Senate in 2014, and further entrenches insurance companies in their position of control over Americans’ health care, and doesn’t even solve the problem for which it was enacted can be considered any kind of success.

    So the Civil Rights Act of 1964 should never have been passed? After all, it birthed the Southern Strategy that allowed Republican domination for the next 30+ years. We should have delayed passing that until we were sure there would be no political repercussions against it?

    And as far as the doesn’t even solve the problem for which it was enacted, I guess the millions of people who now have health insurance should have continued to die until you could get the exact health reform you wanted rather than the stopgap solution we have. You may want to chat with a few of the regulars right here at Balloon Juice who have been able to see a doctor for the first time in years — if not decades — thanks to Obamacare and ask them if they think they should have continued to go without care until you got what you wanted from healthcare reform.

  51. 51
    Mnemosyne says:

    @PopeRatzo:

    Also, in case you didn’t notice, you’re stating your assumptions about what will happen in 2014 as facts rather than, you know, assumptions. Unless you jumped in your T.A.R.D.I.S. and are bringing back actual information from the future, you don’t know any more than the rest of us what will happen in November.

  52. 52
    Diana says:

    Because I used to buy my health insurance directly from the New York City bar association, my insurance was one of those professional group umbrella policies cancelled by the ACA. As the NYC bar association provided insurance from UnitedHealth, and since I am (thank God) neither sick nor poor, I just waited to see what would happen. December 30th I got a letter informing me that although “these changes are required by federal health care reform, called the Affordable Care Act (the “ACA”),” it further informed me that I had a new policy, also from United Health, at exactly the same price ($527 a month) and spelled out the details of coverage.

    I haven’t compared it to my old coverage, but it all sounds vaguely similar.

    Also, now that I’m in the general pool, my mailbox is full of pitches from other health insurers. Sometime in March I’m actually going to compare them all and see if I should switch. If one of them promises access to Ponce de Leon’s fountain of youth I’ll switch, but otherwise I probably won’t bother.

    So, no suffering here. YMMV, but it’s good to know that no-one’s really hurting.

  53. 53
    Nutella says:

    I’m one of the people who are worse off, but that’s because I had a really good deal before. I work for a company where the average employee is a single 25 year old male white collar worker in excellent health so our group plan was cheap. It went up significantly this year (50%) but it’s still not bad.

  54. 54
    Mnemosyne says:

    @Diana:

    Definitely check the exchanges before you make a decision — a lot of insurance companies were sending out letters trying to convince their existing customers that “Obamacare” required them to upsell their customers to a more expensive policy. A lot of people (I think Digby was one who blogged about it) got suspicious, went to the exchanges, and discovered they could get a policy that was almost identical to their previous coverage for several hundred dollars less than they had been paying.

  55. 55
    GHayduke (formerly lojasmo) says:

    @PopeRatzo:

    10.5% does not equal 33.3%

    Try again, trollio.

  56. 56
    ezra abrams says:

    geez, it aint hard
    ezra abrams said…

    K Drum et al didn’t look v hard
    N Y Times, Frid 21 Feb 2014
    page A12 (national)
    headline: Public sector capping partime hours to skirt health care law
    Robert Pear
    “Cities, counties, pubic schools and community colleges around the country have limited or reduced the work hours of part time employees to avoid having to provide them with health insurance under ACA, state and local officals say.
    ..Medina, Ohio, mayor says city limits all PT people to 29 hours a week, from 35. Wages cut accordingly..claims health care costs to blame

    Lawrence County PA reduced limit all PT employees from 32 to 28 hours a week
    American Fed of Teachers lists 3 dozen pulbic colleges restricted hours part time adjucnts..
    University of Akron cut hours 400 part time faculty teaching more then 29 hours

    you can say this is anecdotal, not clear how many, but k drum et al are pretty lazy they can’t find anyone who is hurt by ACA

  57. 57
    William Zame says:

    I make over $200,000/year (single) and I have employer-based health insurance … so I have the same coverage as before and pay more in taxes. But I do not feel I am “harmed” — my taxes help to pay for a very important public good, just as my property taxes help to pay for schools (that I do not use because I have no children) and various other taxes help to pay for other public goods that I do not use personally. We live in a society; we all pay taxes so that society can benefit — even if we do not personally benefit from all of those taxes.

  58. 58
    Kathleen Curry says:

    Why is no one talking about the “Estate Recovery” clause?? Are those who qualify for Expanded Medicaid being informed that the government can confiscated and sell their entire estate upon their death? My understanding is that the “estate recovery” includes everything, even things with a POD designation and family heirlooms. Know this: Medicaid is NOT free! And the mantra that no one should lose everything because they get sick…. that apparently doesn’t apply to those in poverty or near poverty. Ohhh… after they’re dead, they don’t need assets, right?? But what about leaving something to their kids who grew up in poverty… something to give them a start. Not an option here. Seems to me that this “glitch” further entrenches generational poverty. Maybe the “estate recovery” should be replaced with a windfall type of recovery in case someone wins the lottery.

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