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Posts Tagged ‘health’
October 22nd, 2014 at 2:43 pm
Insurance Companies Got CMS Okay to Cancel Policies If ObamaCare Subsidies Invalidated

“Amy Lotven of the trade publication Inside Health Reform reports that before insurers agreed to sell coverage through the Patient Protection and Affordable Care Act’s health insurance Exchanges in 2015, they demanded that the federal Centers for Medicare and Medicaid Services explicitly agree to let them cancel policies if any of the Halbig cases succeed in blocking the subsidies that carriers had been receiving in the 36 states whose ObamaCare Exchanges were not, as [ObamaCare] requires before subsidies can flow, ‘established by the State’”, writes Michael Cannon.

You’ll recall that there is a big fight over whether the Obama administration is blatantly violating its own law by making subsidies available to people who don’t qualify under the statute. And, as Cannon points out, making illegal subsidies available also subjects up to 57 million individuals and employers to illegal penalties under ObamaCare’s individual and employer mandates.

That insurance companies demanded the right to cancel policies relying on subsidies shows how concerned the industry is at being blamed for high-cost coverage when and if the government’s policy is ruled illegal. That the Obama administration agreed indicates the strength of the argument that even the executive branch should follow the law.

October 21st, 2014 at 1:50 pm
Report: Without Subsidies, ObamaCare Enrollment in Death Spiral

“Without [ObamaCare’s] premium support, premiums rise by nearly 45 percent, and enrollment falls by nearly 70 percent,” says a report by RAND Health.

The analysis is part of an evaluation commissioned by the federal Department of Health and Human Services (HHS), the agency in charge of ObamaCare implementation.

The report’s publication follows on news that a federal district judge in Oklahoma ruled ObamaCare’s premium support (i.e. subsidies) mechanism is not available in states that use Healthcare.gov, the federal ObamaCare exchange. According to the text of the law, eligibility for subsidies depends on a citizen’s state operating its own exchange. If the law’s plain meaning is followed, RAND’s analysis will apply to citizens in more than half of the states.

The RAND Health report confirms a simple truth about ObamaCare – if people must pay the full freight of its “affordable” insurance, they will refuse.

H/T: The Daily Caller

October 14th, 2014 at 12:06 pm
ObamaCare: Welcome to Politicized Medicine

Next year’s ObamaCare premiums won’t be available through Healthcare.gov – the federal insurance portal servicing 26 states – until the week after the November 4th midterm elections.

“Insurers say one big challenge for next year will involve millions of returning customers,” the AP reports. “It’s not really a technology issue, but a time crunch that also coincides with the Thanksgiving and Christmas holidays.”

In this case, it’s not the health insurance companies who are to blame, but rather the Obama administration. Late last year when Healthcare.gov was glitching its way into infamy, news leaked that the enrollment period for 2015 would be pushed back a month – from October 15 to November 15. Everybody who could read a political calendar knew the primary motivation was to hide the true cost of ObamaCare’s second year premiums from voters before going to the polls.

This is just one more reason why it’s a bad idea to have the government in control of health care pricing – those responsible will never allow the public to hold them accountable.

H/T: Townhall Tipsheet

September 30th, 2014 at 7:25 pm
HHS’ Burwell Caught Low-Balling Congress on Cost of Healthcare.gov

A new report by Bloomberg Government indicates that Sylvia Burwell, the Secretary of Health and Human Services (HHS), gave a potentially misleading answer when she told Congress that Healthcare.gov – the federal government’s ObamaCare portal – cost taxpayers $834 million to build.

Nicole Kaeding at the CATO Institute teases out some of the unstated, but related, costs that balloon the overall price tag to $2.14 billion, far north of Burwell’s testimony.

I’ve summarized them here as bullet points:

  • $300 million contract to process paper applications to serve as backups to electronic files
  • $387 million for real-time interfacing between the IRS and Healthcare.gov to verify income and family size for insurance subsidy calculations
  • $400 million in accounting tricks HHS used to pay for creating Healthcare.gov when 26 states refused to take federal start-up grants to build their own. Congress made no appropriations to build Healthcare.gov, so HHS shifted money from other units to fund the project.
  • $255 million in spending between February 2014 – the end of Burwell’s timeline – and August 20, 2014, the most recent information available. Bloomberg also included projected spending at current levels through September 30, 2014, the end of the fiscal year.

These are the kinds of expenses that Members of Congress would expect the HHS Secretary to include when testifying about full cost of a program. The fact that Burwell gave a low-ball estimate when these figures were easily accessible to her or her staff weakens her credibility as an honest broker of information. As her departing colleague Eric Holder knows, once Congress loses its ability to trust a Cabinet official, the gloves come off.

September 29th, 2014 at 5:07 pm
California’s ObamaCare Exchange Can’t Match Doctors to Plans

If you purchase an ObamaCare plan in California, good luck trying to find a directory that matches your insurance policy with a specific doctor.

“Altogether, the 10 insurers in Covered California have contracted with an estimated 75% of California’s licensed physicians, or nearly 90% of those considered active in the state,” reports the Los Angeles Times. “However, many of those doctors are available in just one or two health plans.”

That is, if you can find them.

“There’s no timetable for a state provider directory after the exchange scrapped an initial version that was riddled with errors. Instead, Covered California refers people to insurance company websites that vary in usefulness,” says the paper.

The resulting anger and confusion has spawned almost 300 complaints to state regulators and two consumer lawsuits against some of the biggest insurance companies in California.

Doctors are getting hosed too, according to the report. “Insurers say they can pass along savings by paying doctors less and rewarding that select group with higher patient volume. It’s also hoped those doctors will take on a bigger role coordinating patient care.”

To clarify, in return for getting paid less doctors that accept ObamaCare-compliant plans are getting more patients and more exposure to medical malpractice lawsuits.

No wonder there’s no directory matching providers to plans. The docs want to hide!

September 24th, 2014 at 3:05 pm
ObamaCare’s Coverage Gaps Will Kill Good Health Insurance

If you’ve tried to buy insurance on an ObamaCare exchange, you’re familiar with the four levels of coverage available: Bronze, Silver, Gold and Platinum. Each level covers a set percentage of costs should you incur health-related expenses.

For example, a Bronze plan covers 58-62 percent, a Silver plan 68-72 percent, Gold 78-82 percent and Platinum 88-92 percent.

Notice, however, that there are gaps between the coverage levels.

Recall as well that ObamaCare’s coverage requirements get tweaked from year-to-year, changing the actuarial value – i.e. the percentage of covered benefits the insurance company is expected to pay – each year.

Here’s the problem.

“Suppose you are in a Bronze plan with an actuarial value of 58 percent. Then, a year from now, because of price changes, technology changes, or some other kind of change, your plan suddenly covers 64 percent of expected expenses. That’s good for you, right? Wrong. Because your plan no longer fits into one of the metallic corridors, it’s no longer a valid plan – despite the fact that it has become a better plan,” explains John C. Goodman, a conservative health policy expert.

The same is true at the other end of the coverage spectrum.

“Now let’s suppose you have a really good plan – a plan that pays 98% of expected health care costs,” writes Goodman. “Given the large number of Democrats who believe that health insurance should pay almost every medical bill, you would think that the law passed by a Democratic Congress without a single Republican vote would strongly encourage such a plan. If you’re inclined to think that, you are mistaken, however.

“Any plan that pays more than 92% of expected health care costs for the average enrollee is illegal under Obamacare.”

Get ready to change your health insurance more often than you change your auto insurance.

September 23rd, 2014 at 5:24 pm
New ObamaCare Glitch Could Cost Doctors Millions

Doctors who spent heavily trying to comply with ObamaCare’s electronic health records mandate could still be hit with costly penalties.

ObamaCare gives doctors until October 1, 2014, to switch from paper-based to electronic health records. Failure to comply results in losing 1 percent of federal reimbursements for treating Medicare patients.

Here’s the rub.

“[P]hysicians who went electronic for the first time this year are discovering that [the Centers for Medicare and Medicaid Services, or CMS] won’t be ready to officially register the evidence of their work until mid-October. That means they will miss the Oct. 1 deadline, and CMS will withhold 1 percent of their 2015 Medicare payments,” reports Politico.

That means that a doctors’ group like Morganton Eye Physicians in North Carolina spent $1.3 million to buy and implement new software – and added $250,000 to its annual operating budget – only to be threatened with a $65,000 penalty because the federal government can’t meet its own compliance deadline.

One would think CMS has a moral obligation to waive compliance until the agency is able to do its job, but so far it’s requiring doctors to submit to a cumbersome hardship process. How does a business politely explain that the hardship exists completely because of government ineptitude?

Welcome to ObamaCare’s bureaucratic hell. More episodes to follow.

September 22nd, 2014 at 6:49 pm
ObamaCare’s 7.3 Million Enrollments May be False

Last week the Obama administration released its first official headcount of ObamaCare enrollments since applauding itself for 8 million initial sign-ups.

The current enrollment is 7.3 million, according to the Centers for Medicare and Medicaid Services (CMS).

But there’s reason to be suspicious.

“Under ObamaCare, after a person has paid their first premium, a health plan can’t cancel anyone until they have gone three months without making a payment,” writes health care policy expert Bob Laszewski.

By saying that the 7.3 million number includes all enrollments that have occurred through mid-August, CMS is “effectively double counting by including the ‘adds’ while also keeping the ‘deletes’.” That means the 7.3 figure “also still includes every person who has failed to make a premium payment in June, July, and August – since the carriers can’t yet knock them off the rolls,” explains Laszewski. “The health plans tell me there is a 2% to 4% monthly attrition rate. That means the 7.3 million could be overstated by 6% to 12% of the total.”

Unfortunately, the most transparent administration in history refuses to release the monthly enrollment numbers since ObamaCare went online. That makes it impossible to verify whether the 7.3 million is accurate.

If the Obama administration is so proud of its new number, why not release the data on which it’s based?

September 16th, 2014 at 7:03 pm
Top Minnesota ObamaCare Insurer Leaving Exchange

The largest player on Minnesota’s ObamaCare exchange is dropping out, and not even the promise of federal subsidies can get it back.

Earlier today PreferredOne – an insurance company that covered 59 percent of Minnesota’s ObamaCare population – announced that it will not offer health care plans next year paid for with ObamaCare subsidies.

Apparently, the decision is being driven by high administrative costs associated with doing business with MNsure. Even after hiring an additional 50 workers to handle the exchange’s post-launch fixes and tweaks, PreferredOne says continuing to participate is financially unsustainable.

The move makes it likely that MNsure’s ObamaCare rates will jump since PreferredOne sold the lowest cost option. Those rates will be released sometime in October – just weeks before the midterm elections.

September 12th, 2014 at 1:31 pm
Workers Paying More for Health Insurance under ObamaCare

As ObamaCare’s next open enrollment period draws near, some of the controversial law’s biggest backers are cheering a seven city survey claiming that health insurance premiums associated with it are dropping.

This leads liberal health policy expert Ezra Klein of Vox to say that “Obama’s signature accomplishment is succeeding beyond all reasonable expectation.”

But not if you get your health insurance from your employer, however.

“Employees are on the hook for more and more of their health care costs. Premiums are increasing so slowly in part because employers are continuing to shift toward higher deductibles, requiring employees to pay more out of their own pockets before their health care plans kick in,” explains Sam Baker in National Journal.

Comparing monthly premium rates year-to-year makes sense if that’s the best single indicator of how ObamaCare is impacting paychecks. But it isn’t. For employees working in the real economy the shift to high deductible plans means more out-of-pocket spending every time they visit the doctor.

Translation: ObamaCare makes health insurance for workers more expensive.

When it comes to measuring ObamaCare’s success, we need to make sure we’re looking at the most relevant data. Otherwise, we risk scoring political points at the expense of the truth.

September 9th, 2014 at 7:51 pm
ObamaCare’s Popularity Dropping Ahead of Midterms

“Just 35 percent of voters now support the Affordable Care Act, down 3 percentage points from May, according to a monthly poll by the Kaiser Health Foundation,” reports The Hill.

Moreover, the poll found that 47 percent of respondents feel negatively about the law, otherwise known as ObamaCare.

The RealClearPolitics average of six national polls is even worse: 53.8 percent say they oppose the law, with only 40.3 percent in favor.

Little wonder that the controversial health law is so unpopular. States are continuing to resist Medicaid expansion under ObamaCare’s terms for fear of a Trojan horse spending spree, and consumers are getting shut out of some of the country’s best hospitals.

All this and it is still almost two months until the midterm elections.

President Barack Obama may not be on the ballot this year, but his eponymous health law surely is.

August 21st, 2014 at 2:38 pm
Avik Roy Updates His ObamaCare Alternative

Credit Avik Roy for being open-minded.

A week after unveiling his ambitious – and controversial – reform of ObamaCare, Roy, a well-respected health policy expert, is incorporating some of the best criticisms as amendments to his plan.

Most of the changes are highly technical, and not worth delving into in a short blog post. For readers interested in specifics, here is the link to Roy’s updates page.

What’s refreshing about Roy’s response to his fellow conservatives is his willingness to defend his ideas, but not to the point of brushing aside legitimate improvements.

As to the biggest concern – that preserving ObamaCare’s insurance exchanges makes it possible that Democrat congressional majorities in the future might use them as a springboard to a single-payer system – Roy replies, “No health-reform plan can singlehandedly prevent Democrats from doing whatever they want if they ever again have 2009-size, filibuster-proof majorities. But if that’s the standard for constructive GOP reform plans, well, let’s just call it a day.”

Roy’s point is well taken, but it highlights a central tension among conservatives whenever federal policymaking is considered – Which is more important: Market efficiency or federalism?

Policy wonks like Roy tend to favor efficiency as a way to lower spending and improve citizen-customer experiences. Constitutionalists like myself tend to favor federalism and the policy diversity that it affords. Of course, different regulatory regimes produce market inefficiencies. However, that just may be the price of freedom.

Roy should be applauded for trying to make his ObamaCare alternative as strong as possible. Time will tell whether conservatives will come to favor an efficient, federally-regulated national market, or continue to favor a system that lets states and their citizens decide what works best for them.

August 21st, 2014 at 1:23 pm
Ninth Circuit: IPAB Challenge Must Wait

Uncharacteristically, a three judge panel on the Ninth Circuit Court of Appeals has given constitutional conservatives a reason to smile.

The Ninth Circuit, a bastion of liberalism that gets routinely reversed by the Supreme Court, ruled that a constitutional challenge to the Independent Payment Advisory Board (IPAB) is not yet “ripe” for judicial review. Ripeness is the term judges use to denote when a case has a live issue that a court of law can decide. In the IPAB case, the agency hasn’t yet been created, so any challenges to the harm it might do must wait until they actually occur.

And make no mistake, there is much to fear from a fully functioning IPAB. For example, “IPAB is not dependent upon annual appropriations from Congress, need not follow traditional administrative processes, and is not subject to judicial review. As if that were not enough,” writes Jonathan Adler, “[ObamaCare] provides that Congress may dissolve IPAB only if it follows a specified procedure during a seven-month period in 2017 – a statutory provision even the Obama administration has acknowledged could not hold up in court.”

Each of the characteristics of IPAB cited by Adler above are intentionally designed to separate the agency from legislative, judicial and ultimately public control. This is dangerous because “IPAB is authorized to develop self-executing recommendations for limits on Medicare reimbursement rates and other cost controls should the rate of Medicare spending growth exceed a specified target.” That is, IPAB is empowered to ration care for Medicare beneficiaries without any oversight. If allowed to go into effect, IPAB could very well be the biggest step toward a European-style, centrally controlled nationalized health system.

So, how is a loss today really a win for the future? By dismissing the current challenge to IPAB for lack of ripeness, the Ninth Circuit panel is allowing those opposed to the agency to fight another day. At the trial level where this case began, the district judge was not so kind. He ruled against the challengers on the merits, foreclosing future attacks when IPAB actually gets going.

By allowing the challengers to refile later, the Ninth Circuit – at least for the time being – is leaving the door open to another, perhaps more successful assertion of constitutional principle.

August 14th, 2014 at 8:35 pm
Indiana Jumps on the Halbig Bandwagon

Add Indiana to the list of states arguing that ObamaCare’s subsidies can’t be used on Healthcare.gov, the federal exchange.

The challenge is the same mounted by other states contesting the IRS’s unilateral decision to go against the clear language of ObamaCare which makes subsidies available only on state-based exchanges, a restriction intended to induce states to shoulder the implementation costs for fear of angering residents by exposing them to ObamaCare’s real costs.

U.S. District Judge William T. Lawrence will decide whether Indiana’s case has merit in October. Precedent from other circuits isn’t all that helpful, since the D.C. Circuit upheld the statutory scheme while the Fourth Circuit sided with the IRS.

The silver lining: Whatever Lawrence and the appellate circuit decide will further fragment ObamaCare’s implementation, increasing the likelihood that the Supreme Court will weigh in.

Whenever that happens, hopefully there will still be five votes to uphold the plain meaning of the law.

H/T: Indianapolis Star

August 12th, 2014 at 6:06 pm
Signs Emerge that ObamaCare Enrollment Is Dropping

It looks like the Obama administration’s much celebrated achievement of 8 million ObamaCare enrollments is actually dropping over time.

“The nation’s third-largest health insurer [Aetna] had 720,000 people sign up for exchange coverage as of May 20,” writes Jed Graham of Investor’s Business Daily. “At the end of June, it had fewer than 600,000 paying customers. Aetna expects that to fall to ‘just over 500,000’ by the end of the year.”

While no other insurance company has publicly reported declines as steep as Aetna, many others have not denied it is happening during recent conference calls discussing earnings.

Some attrition in ObamaCare signups is to be expected since a number of major life events could cause a change in status. Getting a new job with health benefits, for example. But the Obama administration’s refusal to publicize monthly enrollment numbers makes it impossible to get a clear picture of how well the law is working.

Which may be precisely the goal.

August 11th, 2014 at 2:24 pm
HHS to Fund Coming ObamaCare Bailout of Insurance Companies

What makes conservatives so sure that the Obama administration will bailout insurance companies losing money under ObamaCare?

“According to a recent investigation conducted by the House Oversight and Government Reform Committee chaired by Darrell Issa, insurers widely expect to receive funds from the bailout program,” writes U.S. Senator Marco Rubio (R-FL). “One large insurer recently filed financial statements claiming they expect part of their revenue to come from American taxpayers via the ObamaCare bailout ‘fund.’”

Thwarted by the GOP majority in the U.S. House of Representatives who refuse to appropriate money for this part of ObamaCare, the Department of Health and Human Services “figured out a way to use general funds available through the Centers for Medicare and Medicaid Services to pay off health insurers,” says Rubio. “The effect is to circumvent Congress’ power of the purse for the purpose of bailing out health insurers with taxpayer funds.”

Whether it’s the CIA lying about spying on congressional investigators or IRS officials conveniently losing potentially damaging emails, executive branch officials in the Obama administration are destroying the ability of anybody outside their clique from being able to trust anything they say.

August 7th, 2014 at 3:24 pm
The Coming ObamaCare Bailout

Because of ObamaCare’s mismatched incentive structure, some savvy commentators are warning of an impending, multi-billion dollar bailout of the insurance companies selling health care policies under the law.

“Pre-ObamaCare,” writes Dan McLaughlin, “insurers had to price their policies mainly by reference to market forces (albeit in an already heavily-regulated market)… Guess wrong and you lost money. But under ObamaCare, consumers no longer have the choice whether or not to buy policies, and insurance companies no longer face any risk of losing money, because they’ve been promised a bailout. Money will still be lost, but it will be taxpayer money, and you never run out of that, do you?”

McLaughlin is talking about ObamaCare’s “3 R’s” – reinsurance, risk corridors and the risk adjustment program. I’ve written about this multi-year, $20 billion bailout before. In different ways, each is designed to subsidize insurers for lost revenue traceable to the health law’s dysfunctional mandates. The threefold scheme was buried in the legislation to buy the support of large insurance companies who would have refused to participate without it.

Now the bill is coming due.

Based on interviews and documents containing discussions between Obama administration officials and insurance industry executives, a House Government Oversight report reveals that insurers are expecting the following payments:

1)      $640 million from the Risk Corridor program for the 2014 plan year

2)      $346 million from the Risk Adjustment program

The reinsurance program redistributes money among private insurance companies, as determined by the federal government.

The numbers quoted above are two to three times higher than originally anticipated because of the high level of adverse selection – i.e. too many older and sicker enrollees, not enough younger and healthier ones. The latter group is avoiding enrollment, preferring to pay ObamaCare’s relatively low penalty. But even that is a mirage. Reports are surfacing that as many as 25 million uninsured Americans are getting ObamaCare penalty waivers for next year; further increasing the federal budget deficit.

Bailouts can be nice, if they apply to you. But as a governing strategy, they eventually bankrupt the entire system.

August 6th, 2014 at 1:36 pm
Vermont Latest to Fire ObamaCare Website Maker

After nearly a year of failed attempts, Vermont is firing CGI Federal – the company that bungled both the federal healthcare.gov and Massachusetts’ online insurance exchange – as its web designer.

“With Vermont still lacking a fully functioning health website more than 10 months after its glitch-plagued debut last October, Vermont officials said late Monday that they were pulling the plug on CGI’s CGI Technologies and Solutions’ contract,” reports Newsweek.

The decision will cost CGI almost $20 million, but at least Vermont has agreed not to sue the company for damages.

Vermont’s announcement follows several other states that have abandoned their original – and very expensive – ObamaCare websites. Some, like Nevada, Hawaii, and Oregon, are planning to cut their losses and transition to the federal healthcare.gov website. Others, like Massachusetts, Maryland, and now Vermont, are switching to new contractors hoping to recoup at least some of their investments.

Of course, there are success stories. State exchanges in Kentucky and Connecticut are routinely cited as well-functioning websites – though even these have glitches. However, the prevalence of so many high-profile failures indicates that this massive experiment in public-private partnerships has resulted in a huge transfer of wealth with precious little to show for it.

July 31st, 2014 at 1:10 pm
House Passes Bill to Sue Obama

The House of Representatives made history today when it passed a bill allowing Congress to sue the President of the United States for failing to implement a federal law, reports the L.A. Times.

The legislation authorizes House Speaker John Boehner (R-OH) to file suit in federal court demanding that President Barack Obama enforce ObamaCare’s employer mandate, which requires companies with 50 or more full-time workers to purchase ObamaCare-compliant health insurance or pay a penalty.

House Republicans have been critical of President Obama’s unilateral delays in enforcing the mandate – now scheduled to go into effect in 2016 – because it spares Democrats and the Obama administration substantial political pain. If the law is so great, Republicans reason, then it should go into full effect.

As with other anti-ObamaCare measures to pass the House, this bill has virtually no chance of clearing the Senate where Democrats are in the majority. Still, it’s very presence helps Republicans draw a clearer contrast over where each party stands on the rule of law; in particular the president’s ability to pick-and-choose which parts of a statute he will – as he swore upon taking office – to faithfully execute.

June 30th, 2014 at 2:08 pm
Obama Goes Outside Military Brass, Medical Community for New VA Chief

Robert McDonald, former CEO of Procter & Gamble, is President Barack Obama’s nominee to run the scandal-ridden Department of Veterans Affairs.

McDonald’s nomination is catching some in the veterans’ community off-guard. Unlike previous VA Secretaries, he’s not a general – though he did graduate from West Point and serve for five years as an Army paratrooper before jumping to P&G.

He’s also neither a medical doctor, nor does he have experience administering a hospital; traits that some think would be useful for a person stepping into the nation’s largest health system with 1,700 facilities.

Indeed, the case being made for McDonald is that his background in brand management and customer service signals that Obama thinks the main problem at the VA is bad leadership.

Which brings us to an interesting question – Is McDonald’s job just to make the VA’s public face more attractive, or is it to get the sprawling department into tip-top, customer satisfaction shape?

The answer depends on how much latitude President Obama is giving McDonald to operate. For example, in places like Phoenix where staff and administrators falsified records to get performance bonuses, does McDonald have the authority to fire and hire political appointees as well as career civil servants? Does he have the flexibility to outsource patients to private medical providers in regions where the VA hospitals are overbooked?

Senate Republicans should ask McDonald these and other questions during his confirmation hearings. Veterans and their families deserve to know whether the VA’s new chief has the power to be a turnaround artist, or just a place warmer.