Republicans Celebrate The Affordable Care Act's One-Year Anniversary By Reviving Old Lies
This morning on Fox News, Sen. Orrin Hatch (R-UT) declared that President Obama and supporters of the Affordable Care Act "keep saying things that aren't true" about the law, while Republicans continue to "put the facts out and our facts are backed up by the authorities." Of course, Hatch has it exactly backwards, which was evident today as Republicans commemorated the health care law's one-year anniversary by repeating worn out lies about a "government takeover" that will destroy jobs, cut Medicare benefits, increase the deficit, and raise premiums. Let's examine the real facts about the Affordable Care Act.
CLAIM: Health Care Law Is A "Government Takeover"
McConnell And Boehner Call Health Care Law A "Government Takeover Of Health Care." In a joint op-ed in the Cincinnati Enquirer, Senate Minority Leader Mitch McConnell and House Speaker John Boehner called the health care law, "...the Democrats' $2.6 trillion government takeover of health care..." [Cincinnati Enquirer, 3/22/11]
Boehner: Health Care Law Was A "Government Takeover Of Health Care." In a video blog, Rep. John Boehner said: "For all that, a more fundamental promise was broken when the government takeover of health care was pushed through." [Rep. John Boehner Blog, 3/21/11]
FACT: The Health Care Law Is Not A "Government Takeover" Of Health Care
PolitiFact: Law "Relies Largely On The Free Market." As explained by PolitiFact.com:
"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:
• Employers will continue to provide health insurance to the majority of Americans through private insurance companies.
• Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.
• The government will not seize control of hospitals or nationalize doctors.
• The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
• The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine. [PolitiFact.com, 12/16/10, emphasis added]
Non-Partisan Fact Checkers PolitiFact.com Named "Government Takeover Of Health Care" Their "Lie Of The Year" For 2010. According to PolitiFact: "In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama's ambitious plan to overhaul America's health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a 'government takeover.' 'Takeovers are like coups,' Luntz wrote in a 28-page memo. 'They both lead to dictators and a loss of freedom.' The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the 'public option' concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan. But as Republicans smelled serious opportunity in the midterm elections, they didn't let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry. PolitiFact editors and reporters have chosen 'government takeover of health care' as the 2010 Lie of the Year." [PolitiFact.com, 12/16/10, emphasis added]
CLAIM: The Health Care Law Cuts Or Destroys Jobs
Sen. McConnell And Rep. Boehner: "The Health Care Law Will Result In The Loss Of More Than 800,000 Jobs." Sen. McConnell and Rep. Boehner wrote in their Cincinnati Enquirer op-ed: "According to the independent Congressional Budget Office, the health care law will result in the loss of more than 800,000 jobs over the next 10 years alone." [Cincinnati Enquirer, 3/22/11]
Rep. Cantor: the Health Care Law "Will Eliminate Nearly One Million Jobs From The Economy." In press release on the one year anniversary of the health care law, Rep. Eric Cantor issued a statement saying in part: "Furthermore, Congressional Democrats and the Obama Administration have been forced to admit the law will eliminate nearly one million jobs from the economy increase health care costs by over $300 billion, and reduce health choices for individuals and families." [Rep Cantor Press Release, 3/22/11]
Gov. Scott: The CBO "Estimates The Law Will Reduced The Number Of Jobs By A Net 800,000 Within 10 Years." In a Tampa Tribune op-ed, Gov. Rick Scott wrote: "The Congressional Budget Office estimates this law will reduce the number of jobs by a net 800,000 within 10 years, which doesn't even count the temporary spells of unemployment the law will create." [Tampa Tribune, 3/23/11]
Sen. Hatch: Americans Are Surprised That "They've Lost 800,000 Jobs" Because Of The Health Care Law. Appearing on Fox and Friends, Sen. Orrin Hatch said: "They're surprised that they're -- they've lost 800,000 jobs. They not only have not created jobs, they've lost 800,000." [Fox News, Fox and Friends, 3/23/11]
FACT: Health Care Reform Doesn't Kill Jobs
CBO Report Says Health Care Law Will "Reduce The Amount Of Labor That Workers Choose To Supply." From a CBO report discussing the health care law:
The Congressional Budget Office (CBO) estimates that the legislation, on net, will reduce the amount of labor used in the economy by a small amount — roughly half a percent — primarily by reducing the amount of labor that workers choose to supply.
[CBO, The Budget and Economic Outlook: An Update, August 2010, emphasis added]
AP: Republican Distortion Of CBO Is "A Story Of How Statistics Get Used And Abused." From the Associated Press:
[The GOP] cites the 650,000 lost jobs as Exhibit A, and the nonpartisan Congressional Budget Office as the source of the original analysis behind that estimate. But the budget office, which referees the costs and consequences of legislation, never produced the number.
What follows is a story of how statistics get used and abused in Washington.
What CBO actually said is that the impact of the health care law on supply and demand for labor would be small. Most of it would come from people who no longer have to work, or can downshift to less demanding employment, because insurance will be available outside the job.
"The legislation, on net, will reduce the amount of labor used in the economy by a small amount -roughly half a percent- primarily by reducing the amount of labor that workers choose to supply," budget office number crunchers said in a report from last year.
That's not how it got translated in the new report from Speaker John Boehner, R-Ohio, and other top Republicans.
CBO "has determined that the law will reduce the 'amount of labor used in the economy by roughly half a percent,' an estimate that adds up to roughly 650,000 jobs lost," the GOP version said.
Gone was the caveat that the impact would be small, mainly due to people working less.
[Associated Press, 1/18/11, emphasis added]
PolitiFact Rated Claim That Health Care Reform Kills Jobs "False." From PolitiFact.com's fact check of House Majority Leader Eric Cantor's claim that the health care law is "job killing":
Republicans have used the "job-killing" claim hundreds of times — so often that they used the phrase in the name of the bill. It implies that job losses will be one of the most significant effects of the law. But they have flimsy evidence to back it up.
The phrase suggests a massive decline in employment, but the data doesn't support that. The Republican evidence is extrapolated from a report that was talking about a reduction in the labor supply rather than the loss of jobs, or based on measures that weren't included in the final health care law. We rate the statement False. [PolitiFact.com, 1/19/11]
McClatchy: "Saying That The Law Is A Job Killer Doesn't Necessarily Make It One." According to McClatchy:
Republicans have titled their effort to overturn the law the "Repealing the Job-Killing Health Care Law Act," and that's their favorite talking point against it. The House of Representatives will start debate on repeal Tuesday and probably vote Wednesday.
Saying that the law is a job killer doesn't necessarily make it one, however, and independent experts say that such a conclusion is at least premature, if not unfounded.
"The claim has no justification," said Micah Weinberg, a senior research fellow at the centrist New America Foundation's Health Policy Program. [McClatchy, 1/17/11]
CLAIM: The Health Care Law Will Cut Billions From Medicare
Sen. McConnell: "Half A Trillion Dollars Will Be Cut From Medicare." In a YouTube video, Sen. McConnell said: "And half a trillion dollars will be cut from Medicare to be spent on new government programs." [McConnell Video, 3/22/11, via YouTube.com]
Sen. Hatch: The Health Care Law "Tak[es] $529 Billion Out Of Medicare." Talking about the health care law on Fox and Friends, Sen. Hatch said "They're taking $529 billion out of Medicare, if you can believe it. That's a program that is $38 trillion in unfunded liability as sit here." [Fox News, Fox and Friends, 3/23/11]
FACT: The Supposed Cuts In The Affordable Care Act Are Actually Savings From Phasing Out Medicare Advantage
FactCheck.org: Cost Saving Provisions "Not A Slashing Of The Current Medicare Budget Or Benefits." According to FactCheck.org: "Whatever you want to call them, it's a $500 billion reduction in the growth of future spending over 10 years, not a slashing of the current Medicare budget or benefits. It's true that those who get their coverage through Medicare Advantage's private plans (about 22 percent of Medicare enrollees) would see fewer add-on benefits; the bill aims to reduce the heftier payments made by the government to Medicare Advantage plans, compared with regular fee-for-service Medicare. The Democrats' bill also boosts certain benefits: It makes preventive care free and closes the 'doughnut hole,' a current gap in prescription drug coverage for seniors." [FactCheck.org, 3/19/10]
Changes To Medicare Advantage Come With Extra Benefits For All Medicare Enrollees. FactCheck.org reported: "The CBO has estimated that the move would change the value of the extra benefits Medicare Advantage participants get, but they would not receive fewer benefits than the rest of seniors who aren't on the Advantage plans. The bill does add some extras for Medicare beneficiaries, eliminating copays and deductibles for preventive services, for example." [FactCheck.org, 12/2/09, emphasis added]
Health Care Reform "Will Keep Paying Medical Bills For Seniors." According to PolitiFact.com: "The government-run Medicare program will keep paying medical bills for seniors, but it will begin implementing cost controls on health care providers, mostly through penalties and incentives. The legislation would reduce payments for hospital-acquired infections or preventable hospital admissions. For Medicare Advantage, the federal government intends to reduce extra payments, taking away subsidies to private insurance companies. Insurers will likely cut benefits in order to not lose profits. The bill does not address the 'doctor's fix,' an expected proposal that Congress usually passes to prevent doctors' Medicare payments from severe cuts." [PolitiFact.com, 3/18/10, emphasis original]
New England Journal Of Medicine: The Affordable Care Act Phases Out "Substantial Overpayments" To Medicare Advantage Plans. From the New England Journal of Medicine:
A phased elimination of the substantial overpayments to Medicare Advantage plans, which now enroll nearly 25% of Medicare beneficiaries, will produce an estimated $132 billion in savings over 10 years.
The ACA also produces nearly $200 billion in savings by assuming that providers can improve their productivity as firms in other industries have done. On the basis of this presumed improvement, the law reduces Medicare's annual "market basket" updates for most types of providers - a provision that has generated controversy. [New England Journal of Medicine, 7/8/10]
Changes Would Only Affect Medicare Advantage Plans. As reported by Kaiser Health News:
The new health law will cut $136 billion in spending on the Advantage program by 2019, which currently pays private plans to administer Medicare benefits and pays them about 14 percent more than the per-patient cost of the traditional Medicare program. Plans use that subsidy to lure members with lower premium costs or extra benefits not normally paid for by Medicare, such as vision care or better prescription drug coverage. Some Democrats and analysts have argued the higher rates are wasteful.
Even experts who support the change concede that the impact of the cuts could be evident. Robert Berenson, a scholar at the Urban Institute and former Medicare official, said some Advantage plan members will notice skimpier benefits, "but the Republicans have really exaggerated that this will wipe out the Advantage plans."
Marsha Gold, a health policy analyst for the private research group Mathematica, said, "Over time, there will be less rich benefits or higher premiums, but it's going to be gradual," noting that the largest cuts do not begin until 2015. [Kaiser Health News, 4/6/10]
Medicare Advantage Costs Taxpayers 14% More Than Traditional Medicare. As reported by PolitiFact.com:
Let's back-up for a minute and explain Medicare Advantage: There are two basic ways most people get Medicare coverage. They enroll in traditional Medicare and a prescription drug plan through the government and maybe buy a supplemental policy to cover most out-of-pocket costs. Or they enroll in Medicare Advantage programs (they include drug plans), which are run by private insurers. Medicare Advantage programs typically have more generous benefits such as dental and vision coverage. Some plans even pay the patient's monthly Medicare premium, which can amount to about $100.
The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn't worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use. [PolitiFact.com, 9/20/10]
CLAIM: The Health Care Law Increases Health Care Costs And Will Increase The Deficit
Sen. McConnell And Rep. Boehner: "The Law Will Increase National Health Care Costs By $311 Billion" And "Will Increase Federal Health Care Spending By Nearly Half A Trillion Dollars." In a Cincinnati Enquirer op-ed, Sen. McConnell and Rep. Boehner wrote: "Another chief selling point of the health spending law was the promise that it would lower costs. Yet the administration's own top actuary at the Centers for Medicare and Medicaid Services in Washington now estimates that the law will increase national health care costs by $311 billion. And the Congressional Budget Office estimates that the law will increase federal health care spending by nearly half a trillion dollars over the next decade." [Cincinnati Enquirer, 3/22/11]
Sen. McConnell: "Federal Health Spending Is Estimated To Go Up More Than $450 Billion." In a YouTube video, Sen. McConnell said: "Federal health spending is estimated to go up more than $450 billion over the next decade." [McConnell Video, 3/22/11, via YouTube.com]
Sen. Thune: Health Care Costs "Are Expected To Grow By More Than $310 Billion." In a Politico op-ed, Sen. John Thune wrote: "According to the chief actuary for Medicare, total health costs in the United States are expected to grow by more than $310 billion by the end of the decade." [Politico, 3/23/11]
Rep. Cantor: The Health Care Law Broke The Promise Of Lowering Costs. In a press release, Rep. Cantor said: "People were promised that the law would lower costs — it did not. ... Furthermore, Congressional Democrats and the Obama Administration have been forced to admit the law will eliminate nearly one million jobs from the economy increase health care costs by over $300 billion, and reduce health choices for individuals and families." [Rep. Cantor Press Release, 3/22/11]
Rep. King: The Health Care Law Will Cost $2.7 Trillion To Implement. In a Des Moines Register op-ed, Rep. Steve King wrote: "Certainly, the facts...that ObamaCare will cost $2.7 trillion to implement over the next ten years, contribute to its rejection by Americans." [Des Moines Register, 3/22/11]
Gov. Scott: The Health Care Law "Will Increase Our Immorally High Federal Deficits." In a Tampa Tribune op-ed, Gov. Rick Scott wrote: "Experts, from Richard Foster to the CBO, to the International Monetary Fund, have poured cold water on claims that ObamaCare will lower the deficit. It will increase our immorally high federal deficits and debt precisely because Congress will ultimately rescind the inhumane rationing tools." [Tampa Tribune, 3/23/11]
Sen. Hatch: The Health Care Law Is "Running Us Into Bankruptcy." In an appearance on Fox and Friends, Sen. Hatch said: "We've got to change it and make it so that it's something that the American people can afford. It's running us into bankruptcy. I mean, my gosh, everybody admits now, it's at least 2.6 trillion over ten years. We have no way of paying for that." [Fox News, Fox and Friends, 3/23/11]
FACT: Health Care Reform Controls Health Care Costs And Reduces The Federal Deficit
Affordable Care Act Insures 34 Million New People With 1 Percent Health Care Spending Increase. According to the Washington Post's Ezra Klein:
First, be clear about what's being estimated. The Congressional Budget Office's estimates look at the deficit. CMS is looking at total national health expenditures. This often confuses people into thinking that there's conflict between the two sets of numbers when there isn't: CBO says that federal spending is going to go up to pay for the coverage expansion, but that savings and revenue will go up by even more, leading to a net reduction in the federal deficit. CMS is looking only at the spending side. And here's what it finds: In 2019, implementation of the Affordable Care Act will reduce the ranks of the uninsured by 34 million people and increase nation health expenditures by 1 percent. One percent... So that's the bottom line of the report: We're covering 34 million people and come 2019, spending is expected to be one percentage point — and falling — above what it would've been if we'd done nothing. [Washington Post, 4/23/10, emphasis added]
After One-Time Spending Increase In 2014, Costs Grow More Slowly Than They Would Without Reform. According to the Washington Post's Ezra Klein:
[W]e're covering about 10 percent of the country and increasing spending growth by 0.2 percent. Seems like a good deal to me. But it's actually a better deal than that. Here's what the cost curve — or maybe I should say cost line — looks like:
What you're seeing here isn't the cost curve bending up. It's a one-time increase in the level of spending. That's the big jump in 2014, the year the exchanges and subsidies come online. So when you compare 2014 to 2013, spending growth seems like it's gone up a bunch. But by 2016, we're back to normal. In fact, we're better than normal [according to a September CMS report]: "For 2015-19, national health spending is now projected to increase 6.7 percent per year, on average -- slightly less than the 6.8 percent average annual growth rate projected in February 2010."
In other words, 2014 is a one-time increase in spending level as we get 30 million new people covered. After 2014, costs grow more slowly than they would without the health-care reform bill. [Washington Post, 9/10/10, emphasis added]
CBO: Health Care Reform Package Would Reduce The Deficit By $138 Billion By 2019. According to the Congressional Budget Office: "The reconciliation proposal includes provisions related to health care and revenues, many of which would amend H.R. 3590. It also includes amendments to the Higher Education Act of 1965, which authorizes most federal programs involving postsecondary education. CBO and JCT estimate that enacting both pieces of legislation - H.R. 3590 and the reconciliation proposal - would produce a net reduction in federal deficits of $138 billion over the 2010-2019 period as result of changes in direct spending and revenue." [CBO, 3/18/10]
CBO: Health Care Reform Repeal Would Increase The Deficit By $230 Billion. In a letter to Speaker John Boehner (R-OH), CBO Director Doug Elmendorf writes:
Because CBO and JCT estimated that the March 2010 health care legislation would reduce budget deficits over the 2010-2019 period and in subsequent years, we expect that repealing that legislation would increase budget deficits. The resulting increase in deficits projected for fiscal years 2012 through 2019 is likely to be similar in size to-but not exactly the same as-the reduction in deficits that was originally estimated to result from the enacted legislation.
As a result of changes in direct spending and revenues, CBO expects that enacting H.R. 2 would probably increase federal budget deficits over the 2012-2019 period by a total of roughly $145 billion (on the basis of the original estimate), plus or minus the effects of technical and economic changes that CBO and JCT will include in the forthcoming estimate. Adding two more years (through 2021) brings the projected increase in deficits to something in the vicinity of $230 billion, plus or minus the effects of technical and economic changes. [CBO, 1/6/11, emphasis added]
CBPP: Even If You Didn't Count Social Security And CLASS Act Revenues At All, The Bill Reduces The Deficit. According to the Center on Budget and Policy Priorities:
CBO and the Joint Committee on Taxation have concluded that the health reform legislation will reduce employer spending on health insurance, in part because the new excise tax on high-cost insurance plans will lead employers to shift some employee compensation from health insurance to cash wages. Workers will pay Social Security payroll contributions and income taxes on the additional wages.
The legislation also establishes a new, voluntary program of long-term care insurance, called the CLASS Act. Benefit payments from CLASS will be fully financed by premiums that beneficiaries pay and interest earnings. In its early years, as the program starts up, premium collections will substantially exceed benefit payments.
Congressional leaders crafted the health reform bill so that it would be fully paid for without relying on these additional Social Security payroll contributions or the CLASS Act premiums. The CBO estimate clearly shows that if one excludes the net revenues of $29 billion from Social Security contributions and $70 billion from CLASS Act premiums, health reform still reduces the deficit by $44 billion over the first ten years. [CBPP.org, 3/25/10, emphasis added]
CLAIM: Premiums Will Increase By An Average Of $2,100 Per Family
Sen. McConnell and Rep. Boehner: The Health Care Law Will Cause Premiums To Increase. In a Cincinnati Enquirer op-ed, Sen. McConnell and Rep. Boehner wrote: "What about the cost to individuals and families? Well, according to the same independent analysts at the CBO, the new law, once fully implemented, is expected to cause premiums on family insurance policies to increase by an average of $2,100 per year." [Cincinnati Enquirer, 3/22/11]
Sen. McConnell: The CBO Says Premiums Will Increase $2,100 For Working Families. In a YouTube video, Sen. McConnell said: "According to the independent Congressional Budget Office, working families will see premiums go up by twenty-one hundred dollars." [McConnell Video, 3/22/11, via YouTube.com]
Sen. Thune: Premiums For Individual Plans "Are Predicted To Increase By $2,100 Per Family." In a Politico op-ed, Sen. Thune wrote:
When Sen. Barack Obama was running for president, he repeatedly promised that he was going to reduce "every family's premiums by as much as $2,500." We were supposed to see these savings by the end of 2012.
Despite these promises, the amount individuals and families pay for health care and insurance continues to rise. Average premiums for individual plans, according to the nonpartisan Congressional Budget Office, are predicted to increase by $2,100 per family over the next five years under the law.
Instead of receiving the $2,500 reduction promised, families will be paying more and more for their health insurance, thanks in no small part to the new government mandates.
Sen. Hatch: Premium Costs Have Increased $2,100 Because Of The Health Care Law. In an appearance on Fox and Friends, Sen. Hatch said: "They've seen that there is $2,100 in additional premium costs when they were told that this would bend the cost curve and the premium costs would go down." [Fox News, Fox and Friends, 3/23/11]
FACT: For Most People, Premiums Will Not Increase Under The Health Care Law
FactCheck.org: CBO Report Says Most People's Premiums Would Decrease, Majority Of Others WouldGet Subsidies. From FactCheck.org:
What that report actually says is that for the largest segment of the health insurance market, amounting to about 70 percent of those with coverage, "the legislation would yield an average premium per person that is zero to 3 percent lower in 2016 (relative to current law)." That's on page 7 of the report, and it refers to those in the "large group" market - those with policies through employers who have more than 50 workers.
The CBO's analysis isn't much different for the "small group" market, which makes up another 13 percent of the market. For those employees who get coverage through small businesses (those with no more than 50 workers), CBO predicts "an increase of 1 percent to a reduction of 2 percent."
The only big increases that CBO predicts are for those in the "nongroup" market - which makes up about 17 percent of the overall insurance market. These are people who aren't getting coverage through their employers or other large pools. Single individuals buying coverage would see premiums only about $300 higher than they would have been without the law, but those buying family coverage would see an average increase of $2,100 a year. (The cost would go from $13,100 under previous law, to $15,200 under the new legislation - an increase of just over 16 percent.)
But most of those buying insurance on their own would get help paying their premiums, a fact simply ignored by the ad. The CBO report says that about 57 percent of those in the nongroup market would receive federal subsidies, covering nearly two-thirds of the total premium cost, on average.
[FactCheck.org, 8/30/11, emphasis added]
Commonwealth Fund And Center for American Progress: The Affordable Care Act Will Lower Premiums For Families. According to a report from the Commonwealth Fund and the Center for American Progress: "Without reform, premiums are expected to increase from $13,305 in 2010 to $21,458 in 2019. Relative to this increase, premiums under reform increase only three-quarters as much. By 2019, family premiums are nearly $2,000 lower. Adding reductions in out-of-pocket costs and lower taxes for Medicare and Medicaid will result in estimated savings for the typical family of over $2,500 that year." [Commonwealth Fund and the Center for American Progress, "The Impact of Health Reform on Health System Spending," May 2010, emphasis added]
PolitiFact.com: The Health Care Law Helps Hold Down Premium Costs For Most People. From PolitiFact.com:
The vast majority of people will not see significant declines in premiums. When President Obama talks about premiums going down, he usually means they won't go up as much as they would otherwise. For the four out of five people who get their insurance through their employer, the savings would land in the 0 to 3 percent range by 2016, according to the nonpartisan Congressional Budget Office, or CBO. People who buy insurance on their own, but who don't qualify for government subsidies, could actually see their premiums rise by as much as 10 to 13 percent, but that's largely because they'll be getting beefed-up policies that would pay for more basic services, especially preventive care. Low-income people who qualify for new credits to buy insurance would see the biggest drops. [PolitiFact.com, 3/18/10, emphasis added]
Boston Globe: The Affordable Care Act Cracks Down On Excessive Premium Rate Increases. According to the Boston Globe: "The health care overhaul, which aims to provide coverage for millions of uninsured people, created a five-year, $250 million grant program to help regulators challenge unreasonable rate hikes. HHS officials said Tuesday they will consider several factors to decide what constitutes unreasonable. They will examine whether a rate would produce a medical loss ratio, which measures the percentage of premiums spent on medical care, below 80 percent. They also will question whether assumptions that go into the rates are based on substantial evidence. After 2011, the 10 percent increase threshold that triggers a review will be replaced by percentages that are specific to each state. By 2014, states will be able to exclude insurers that show 'a pattern of excessive or unjustified' rate hikes from health insurance exchanges that will become available to consumers, HHS said." [Boston Globe, 12/21/10]