ObamaCare

[philunderwood]

www.qando.net/?tag=obamacare

Rule of man, not of law? See ObamaCare (and much else)

By Bruce McQuain


Apparently our laws are arbitrary if you’re in a favored group. All you have to do is appeal to the King for an exemption:


Back in 2009, when Democrats were writing the massive new national health care scheme, Iowa Republican Sen. Chuck Grassley offered an amendment. Obamacare created exchanges through which millions of Americans would purchase “affordable” health coverage. Grassley’s amendment simply required lawmakers, staff, and some in the executive branch to get their insurance through the exchanges, too.

To every Republican’s amazement, Democrats accepted the amendment. It’s never been fully clear why; the best theory is they intended to take the provision out in conference committee, but couldn’t do so because they lost their filibuster-proof 60-vote majority. In any event, Obamacare — the law of the land, as supporters like to say — now requires Congress to buy its health care coverage through the exchanges.

That has caused Democratic panic as the formal arrival of Obamacare nears. Right now, all lawmakers and staff are entitled to enjoy generously-subsidized coverage under the Federal Employees Health Benefits plan. Why give up that subsidy and go on the exchanges like any average American?

But that’s the law. It could be amended, but Democrats, who voted unanimously for Obamacare, couldn’t very well expect much help from Republicans, who voted unanimously against it. So over the summer Democrats asked President Obama to simply create an Obamacare exception for Capitol Hill.

And the King, looking down upon his faithful minions waved his hand and came up with a “solution” by executive fiat that uses tax dollars to circumvent the law:


Not long after — presto! — the Office of Personnel Management unveiled a proposed rule to allow members of Congress, their staff, and some executive branch employees to continue receiving their generous federal subsidy even as they purchase coverage on the exchanges. No ordinary American would be allowed such an advantage.

However, a rebellion was cooking:


Vitter watched the maneuvering that led to the OPM decision. He began work on what became the Vitter Amendment, which he likes to call “No Washington Exemption from Obamacare,” that would reverse the OPM ruling. It specifies that members of Congress, staff, the president, vice president and all the administration’s political appointees buy health coverage through Obamacare exchanges. If any of them earn incomes low enough to qualify for regular Obamacare subsidies, they will receive them — just like any other American. But those with higher incomes will have to pay for their coverage on the exchanges — just like everybody else.

Vitter hasn’t exactly thrilled his colleagues. “There has been a lot of pushback behind the scenes, including from many Republicans,” he says. Political types have complained that the requirement will cause “brain drain” on the Hill as staffers escape the burden of paying for their own coverage. “My response is, first of all, it’s the law,” says Vitter. “Look, this is a disruption. It’s exactly what’s happening across America, to people who are going to the exchanges against their will. To me, that’s the point.”

Ron Johnson, the Republican senator from Wisconsin, is one colleague delighted by Vitter’s move. The idea of equal Obamacare treatment for Washington is enormously popular around the country, Johnson points out, which means even lawmakers who don’t like it will be afraid to oppose it.

“I think most members don’t want to vote to reject the OPM ruling,” Johnson says. “But I think most members would vote to do that, if they were forced to, because it is so politically unpopular to have special treatment for members of Congress and their staff.”

Seems it should be unnecessary to again make it clear that Congress should have to obey the law – to the letter – just like everyone else. That was what the original law said, no? Yet they managed a workaround that defeated the intent of the law, didn’t they?

So now another amendment is now necessary?

And here I thought that these folks were servants of the people and not a ruling elite (by the way, the big excuse is there’ll be a huge “brain drain” if the law is left in place. Let me be the first to say, given the shape our country and government are in at the moment, I’d welcome the ‘brain drain’).

Make ‘em obey the law. Make them navigate the same atrocity they foisted on the public. No exemptions, no exceptions. And that goes for every law they pass.

Period.

~McQ

[Ritty77]

[Ritty77]

I have a healthcare policy with BCNEPA. It costs about $200/month. It covers 100% of preventative stuff and emergencies. I don't use it much, but when I did, so long as I was "in network," which is huge and already includes my PC doctor, all I pay is the $25 co-pay. Thankfully, I'm pretty healthy (knock on wood) and was super happy with my little policy.

Officially now, as of 12/31/2013, it is cancelled. The lowest replacement plan is twice the rate. I can't afford that, plain and simple. Private plans are not eligible for any subsidies. I will now have to buy a more expensive policy through the exchange and then figure out how it gets subsidized. A tax refund/credit at the end of the year doesn't cut it; I won't be able to pay the monthly premium in the meantime.

So, I am going from buying my own insurance to your grandchildren paying for most of the cost of a new plan. Is it better coverage, very probably, but it's up to me to upgrade my insurance when I can afford to, not to have an upgrade forced on me at someone else's expense. And younger people sure as hell aren't going to run out and get themselves a new monthly payment. either.

Hopefully, they will delay this a year so they can kill it. The best way to make insurance more affordable is to lower heath care costs. Having someone else pay has the opposite effect. They're doing it wrong.

Anyone else have an Obamacare story?

[philunderwood]

I have Geisinger Gold as a supplement to Medicare and so far nothing has changed regarding premiums. The premiums are $133 per month for me and $177 per month for my wife. I get expensive medications through the VA and hers covers some medication costs. The only thing I’ve noticed is that some things like labs and tests now require me to pay something to the hospital to make up for charges the insurance and Medicare don’t pay. It’s not a lot but it’s significant. When I had expensive cardiac testing done about five years ago and during the first part of knee replacement surgeries a few years back, which spread over a few years, I didn’t have to pay anything, so something is going on.

[Ritty77]

[philunderwood]

www.qando.net/?tag=obamacare

ObamaCare – it just keeps getting better and better

By Bruce McQuain


Or not:


16 million people are now receiving letters from their carriers saying they are losing their current coverage and must re-enroll in order to avoid a break in coverage and comply with the new health law’s benefit mandates––the vast majority by January 1.

And how many have managed to enroll? Well it appears that number is in the thousands, and as we mentioned on the podcast last night, most of those are enrolling in Medicaid.

Meanwhile, the failed law continues to impact the lives of fellow citizens negatively.

New Jersey:


Hundreds of thousands of New Jerseyans opened the mail last week to find their health insurance plan would no longer exist in 2014 because it does not cover all the essential benefits required by the Affordable Care Act. … The changes will impact more than 800,000 people in New Jersey who purchase insurance on the individual and small-employer markets, according to Ward Sanders, president of the New Jersey Association of Health Plans.

Florida:


Florida Blue is dropping 300,000 customers whose policies the health insurer says aren’t sufficiently comprehensive under the health care overhaul. The Jacksonville-based insurance company said Thursday that the 300,000 policyholders have plans that don’t include all of the 10 categories of benefits required under the Affordable Care Act.

California:


Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state. … Blue Shield of California sent roughly 119,000 cancellation notices out in mid-September, about 60 percent of its individual business.

Virginia, Maryland and Washington DC:


CareFirst BlueCross BlueShield is being forced to cancel plans that currently cover 76,000 individuals in Virginia, Maryland, and Washington, D.C., due to changes made by President Obama’s health care law, the company told the Washington Examiner today. That represents more than 40 percent of the 177,000 individuals covered by CareFirst in those states.

Pennsylvania and surrounding regions:


Independence Blue Cross is canceling coverage for 24,000 members in the Philadelphia region because their insurance plans don’t comply with new rules from the Affordable Care Act, Newsworks reported.

[...]

Insurer Highmark in Pittsburgh is dropping about 20 percent of its individual market customers, while Independence Blue Cross, the major insurer in Philadelphia, is dropping about 45 percent.

And these are just the tip of the proverbial iceberg. 16 million dumped after they were promised what?


“If you like your current plan, you will be able to keep it. Let me repeat that: if you like your plan, you’ll be able to keep it.”

Because, you remember, that was a MAJOR FEATURE of ObamaCare:


“In fact, one of our core principles is that if you like the health care you have, you can keep it.” (Sen. Reid, Congressional Record, S.8642, 8/3/09)

Ah yes, the lying liars that brought us the biggest lie of the 21st century to date.


“All we’ve been hearing the last three years is if you like your policy you can keep it… I’m infuriated because I was lied to.”

How’s it feel to have been “had” this badly?

~McQ

[philunderwood]

Obamacare is not a left/right issue; it's a fraud issue

By Mark Steyn

www.JewishWorldReview.com |

CNN has been pondering what they call “a particularly tough few days at the White House.” “Four out of five Americans have little or no trust in their government to do anything right,” says chief political analyst Gloria Borger. “And now Obama probably feels the same way.” Our hearts go out to him, poor wee disillusioned thing.

We are assured by the headline writers that the president was “unaware” of Obamacare's website defects, and the National Security Agency spying, and the IRS targeting of his political enemies, and the Justice Department bugging the Associated Press, and pretty much anything else you ask him about. But, as he put it, “nobody's madder than me” at this shadowy rogue entity called the “Government of the United States” that's running around pulling all this stuff.

And, once he finds out who's running this Government of the United States rogue entity, he's gonna come down as hard on him as he did on that video-maker in California; he's gonna send round the National Park Service SWAT Team to teach that punk a lesson he won't forget.

Gloria Borger and CNN seem inclined to swallow the line that the president of the United States is not aware that he is president of the United States: for the media, just a spoonful of manure makes the Obamacare medicine go down. It remains to be seen whether the American citizenry will be so genially indulgent. Hitherto, most of what the president claims to be unaware of, they are genuinely unaware of: few people have plans to vacation in Benghazi, or shoot the breeze with German Chancellor Angela Merkel on her cellphone. But Obamacare is different: whether or not the president is unaware of it, the more than 2 million Americans (at the time of writing) kicked off their current health care plans are most certainly aware of it.

For as long as I can remember, I've been opposed to government health care because, as I've said in at least two books, it fundamentally redefines the relationship between the citizen and the state into one closer to that of junkie and pusher. But that's a philosophical position.

Others prefer constitutional arguments: the federal government does not have the authority to do what it's doing. Dear old John Roberts, chief justice of the United States, twisted himself into a pretzel to argue that, in fact, the government does. But he might as well have saved himself the trouble and just used House Minority Leader Nancy Pelosi's line: asked by a journalist where in the Constitution it granted the feds the power to do this, she gave him the full Leslie Nielsen act and said, “You're not serious?” She has the measure of her people. Most Americans couldn't care less about philosophical arguments or constitutional fine print: For them, all Obamacare has to do is work. That is why the last month has been so damaging to Big Government's brand: in entirely non-ideological, technocratic, utilitarian terms, Obamacare is a bust.

The Canadian and British health systems get by on the principle that, as bad as they are, for enough people they're good enough, and you don't have to think about it. Obamacare doesn't even meet that modest standard, and it's not clear it ever will.

You have to think about it constantly, alert to every potentially catastrophic regulatory tweak that might scuttle your next prescription refill. On Day One, the junkies were eager for their fix: as the administration crowed, the site received 4.7 million unique visits. By the following morning, the Health and Human Services “war room” was informed that “six enrollments have occurred so far.” That's six as in half-a-dozen, as in fewer people than in just one vehicle of Obama's 40-car motorcade. Kathleen Sebelius had successfully enrolled one American for every assistant secretary of Health and Human Services. Oh, no, wait: she has seven assistant secretaries, so there was one free, waiting for that seventh enrollee. One in every 783,333 visitors managed to close the deal: Dr. Obama could make house calls to every one and still have time for a round of golf.

In order to meet its target of 7 million enrollees by March 1, Obamacare needs to enroll approximately 46,358 Americans per day. So on its opening day it fell 46,352 short. Were it to maintain that enrollment rate, Obamacare would reach its target of 7 million enrollees in the year 5209. That's longer than waiting for a hip replacement on the Scottish National Health Service.

At the same time as dozens of Obamacare enrollees were being signed up, millions of other Americans were having their health insurance canceled – including so many pundits of left (Kirsten Powers), right (Michelle Malkin), and center (David Frum) that the Pulitzers should introduce a prize for Best Suddenly Uninsured Writing. Among their number was Matthew Fleischer, who wrote in the Los Angeles Times:

“Most young, middle-class Americans I know are happy that millions of previously uninsured people will receive free or heavily subsidized insurance under the Affordable Care Act.

“We just didn't realize that, unless we had health insurance at work, we'd be the ones paying for it.”

The reason he didn't realize it is because the president lied to him, not just once in a casual aside, but on dozens of occasions, and very bluntly: “If you like your health care plan, you can keep your health care plan. Period.” But the entire premise of Obamacare was that, in order to cover (some of) the uninsured and (in many cases) uninsurable, other Americans were going to have to pay significantly more.

Obamacare was always intended to be the Great Disruptor: Avik Roy, senior fellow, Manhattan Institute, reports that, by 2010, administration officials knew that 93 million Americans would lose their current plans under Obamacare. Small businesses are cutting back on full-time workers; medium businesses are dumping employees' spouses and children from their plans; and the largest businesses are eating nine-figure bottom-line increases. Delta Airlines claims it will spend an extra $100 million on health care expenses next year: even with cutbacks on complimentary mini-pretzels, a tenth of a billion is a big sum to recover. Meanwhile, the Obamacare plans won't recognize your preferred doctor, and major hospitals won't recognize the Obamacare plans.

My old comrade David Frum was somewhat insouciant about the extra $2,400 a year he'll have to find for his new Obama-approved health arrangements. These days, comparatively few Americans are that liquid, and for most an extra $200 a month will have to be clawed away from real things of value. “Not only will I pay more,” grumbled Mr Frum, “but I have had to divert many otherwise useful hours to futzing around with websites and paperwork.”

But that's life in the Republic of Paperwork, isn't it? The remorseless diversion of time and energy to “futzing around.” That's why so much of American life seems to be seizing up, why so many routine features of human existence require time-consuming bureaucracy-heavy painstaking navigation (to borrow a term from Obamacare's “customer-service representatives”).

America would benefit from an opposition party that offered a serious de-futzing of the nation: a platform on the scale of Mrs. Thatcher's privatization program in 1979 or Sir Roger Douglas' in New Zealand in the Eighties that offered to make ordinary life comprehensible to non-wonks once more.

Instead, the Obama crowd have bet that, after the usual whining, you'll settle down and get used to it: higher co-pays, higher premiums, higher deductibles, higher mountain of paperwork, higher futzing. But the fact remains that nowhere in the Western world has the governmentalization of health care been so incompetently introduced and required protection by such a phalanx of lies.

Obamacare is not a left/right issue; it's a fraud issue.

[Ritty77]

Maybe Pain Will Teach You Millenials Not To Vote For Your Own Serfdom
Kurt Schlichter
11/4/2013

You Millenials voted for Obama by a margin of 28 percent, which will make it a lot easier for me to accept the benefits you will be paying for. We warned you that liberalism was a scam designed to take the fruits of your labor and transfer it to us, the older, established generation. Oh, and also to the couch-dwelling, Democrat-voting losers who live off of food stamps and order junk from QVC with their Obamaphones.

You didn’t listen to us. Maybe you’ll listen to pain.

I have been told that being hard on you Millennials will turn you against conservatism, that I should offer you a positive, hopeful message that avoids the touchy problem of your manifest stupidity.

No. There’s no sugar-coating it – your votes for Democrats have ensured that you are the first generation in American history that will fail to exceed what their parents attained. Embracing liberalism was a stupid thing to do, done for the stupidest of reasons, and I will now let you subsidize my affluent lifestyle without a shred of guilt.

I’m a 48 year old trial lawyer living on the coast in California – I should have “Hope and Change” tattooed on my glutes. I’d have an excuse to be lib-curious, but you Millennials? Why do you support an ideology that pillages you to pay-off Democrat constituencies? Your time in the indoctrination factories of academia trained you in a form of “critical thinking” that is neither. Somehow, you came to embrace the bizarre notion that conservatives are psychotic Jesus freaks who want to Footloosisze America into a land of mandatory Sunday school and no dancing.

But liberals, in contrast, are nice. Obama is cool. You chose petty fascism with a smile. Not a lot of thought went into it. Facts, evidence – these were mere distractions from the feelings-based validation that came from rejecting us wicked conservatives.

What did you get? The chance to be forced to buy health insurance you don’t want at inflated rates so my rates can be lower. You get to pay more out of your monthly barista take – liberalism ensured that the tanked job market foreclosed a real career – so that I get to pay less out of my lawyer checks. Thanks, suckers.

You fume that conservatives want to spy on you in your bedrooms. Leaving aside the fact that that your tacky boudoir fumblings are the last thing conservatives care about, have you noticed how your precious Big Brother spies on your doings everywhere else? But who cares about that – Mumford & Sons totally digs Obama!

Don’t even get me started on your crappy music.

Enjoy your student loans, Millennials! We tried to tell you that it was a Democrat scam designed to subsidize liberal academia by allowing you to go into decades of crushing debt to pay for a bachelors in Ancient Guatemalan Gender Identity Issues.

Good plan. Now fetch my latte – I’m in a hurry to get to my corner office. And I’ll leave you a tip – next time you decide to vote for a liberal, first be born in 1964.

Don’t think that I’m happy about this. I came to Los Angeles after the Gulf War. I had a car and a few bucks I had saved in the desert which went right into paying for Loyola Law School. I had no contacts and no money, but I knew I had endless opportunity.

I worked hard. I could start a business. I could get credit. I could – and did – build my own future.

But can you? Liberalism, with its impoverishing redistribution, crippling regulations and the debt it suckered you into undertaking, has ensured that most of you can’t.

You live with your parents, and Obamacare encourages sponging until you are 26 years old. At 26, I was leading Americans in a war, not begging mommy to pay my bills. The liberals want you to be eternal man-children, wearing cargo shorts and passively pumping money into their socialized medicine nightmare in return for “Brosurance” you don’t want or need.

It breaks my heart to see the young lawyers I hire hobbled by six figures of debt. But hey, your desperation works fine for us established folks. I got 297 applications for a junior associate position. Let me say that again – 297. Most of them weren’t even practicing law – they were brewing coffee, not writing briefs. Now, I understand that most of you learned nothing but liberal clichés in college, but take a guess: As an employer, are the salaries I pay generally more or less when I have 297 people competing for each job?

So feel free to keep voting for the liberals who keep you in chains. I’ll take my cheaper insurance, my future Social Security checks, and the other benefits that come from being established without guilt. The guys who you squander your votes upon certainly won’t change that equation. You’ll tread water in life, but hey, at least those conservatives won’t be in charge!

Thanks again, suckers. Now get off my lawn.

townhall.com/columnists/kurtschlichter/2013/11/04/maybe-pain-will-teach-you-millenials-not-to-vote-for-your-own-serfdom-n1733722#

[Ritty77]

Beyond HealthCare.gov, Obamacare’s other challenges
By Jon Kingsdale, Published: November 8

Jon Kingsdale, who oversaw the Massachusetts health insurance exchange from 2006 to 2010, is a managing director of the Wakely Consulting Group. Wakely has provided actuarial and other technical assistance for the Obama administration’s Affordable Care Act.

“The Affordable Care Act is not just a Web site. It’s much more,” President Obama said last month. This focus beyond short-term technical problems is meant to bolster the faith of those, like me, who support the Affordable Care Act. However, it will succeed only if the administration does much more than fix the Web site.

As HealthCare.gov — the main door to insurance shopping for 13 million of the 17 million uninsured who are eligible for subsidies — gets patched up in the coming weeks, the government must also prepare the world’s largest insurance store to meet two equally daunting challenges.

The first is to get enrollment, billing and premium collections working smoothly. In 2006, when we launched the Massachusetts Health Connector, which became the prototype for insurance exchanges under the ACA, my team encountered start-up problems. Tracking billing and collections was a much bigger challenge than getting our Web site to work.

Here’s why: Enrollees are not covered until their first month’s premium is received. In the individual insurance market, premium billing and collection is difficult to track. Folks frequently pay late or in weekly installments, or send too little or even too much. And when they stop paying, they often do not notify the insurer; the company must determine whether it is an intentional termination, an oversight, or a lost or late payment. Unlike most of today’s 15 million direct enrollees, who pay premiums on their own, an estimated 27 percent of those who will be eligible for tax credits under the ACA do not have checking accounts. So they must use cash, money orders or prepaid debit cards to pay their share of monthly premiums.

Under the health-care law, premium billing and tracking will be even tougher. There are hundreds of prices across each of the thousands of plans in the federal marketplace. Having enrollees pay partial premiums, and the IRS issue tax credits for the rest, means twice as much billing. Calculating subsidies based on personal income tax filings also creates security issues: In addition to the problems with verifying consumers’ identities online, which have created delays on HealthCare.gov, tens of thousands of unlicensed “navigators” are fanning out across the country to help folks enroll. Many of these people don’t have to submit to thorough background checks, although they will gain access to personal financial information. And consumer protections for low-income enrollees who miss payments require complex notifications over 90 days before an insurer can end coverage.

Even when the Web site is fixed, these challenges will remain.

In Massachusetts, we received about 100 visits to the site for every one enrollment. If the tens of millions of hits for the federal exchange in October eventually translate into millions of customers, the accuracy of the enrollment data — and insurers’ ability to correctly split premium billing between millions of enrollees and the IRS; track premium remittances; and chase, reconcile and report on accounts receivable — will be tested under the pressure of high volume. If insurers cannot track and collect premium dollars each month, the extra work of doubling back with customers and insurers will frustrate consumers and delay coverage. And a mounting backlog could eventually compromise the fiscal integrity of the exchange.

What Obama points to with justifiable pride are good prices for good coverage. But there lies the second potential pitfall, with even greater political peril for the ACA. Comparing prices in 2014 to those in 2013 is an “apples to oranges” exercise because the health plans on the exchange are new, and many of them differ considerably from older ones. The president is correct in pointing to the substandard quality of much of the individual coverage that is being phased out. We did that in Massachusetts as well, replacing an estimated 150,000 individual and group insurance policies that lacked prescription drug coverage and other basic elements.

Because the exchange makes it easy for consumers to compare premiums and other features of one health plan against those of another, by next autumn they will be able to see premium increases, state by state and congressional district by district. The insurance shopping season is scheduled to open on Oct. 15, 2014 — 20 days before the midterm elections.

Why is this an immediate challenge? Because the hundreds of insurers offering plans on the federal exchange will begin pricing for 2015 in just a few months. Their chief financial officers should be sweating bullets about the obstacles that HealthCare.gov’s glitches have put in the path of enrollees. Fortunately, October was an early shopping month, mainly for browsing and for those who are sick and highly motivated to get coverage. It wasn’t an important month for enrolling the “young invincibles” — uninsured young people who don’t think they need health care — who will subsidize older, sicker enrollees. But the longer HealthCare.gov remains clogged, the more young invincibles will be discouraged from joining. If that happens, enrollment in the 36 states using the federal exchange will resemble small, high-risk insurance pools composed mainly of the sick — potentially causing premiums to soar in 2015.

Insurers must set rates for 2015 in some states by the end of February, and in most states before June. They can’t raise their rates on plans in the federal exchange now; their prices are locked in for next year. Nor can most carriers recoup any 2014 losses by raising premiums for 2015: Unless most competitors do the same, hiking premiums will chase away any healthy customers they have. But that is the imminent danger — a general rise in rates among health plans on the federal exchange.

The administration can try to head off the problem, or it can blame insurers after the fact. To convince skeptical CFOs that October 2014 will be very different from today, first the Web site and the information systems behind it must work. Additionally, the administration has to prove that it can effectively manage the world’s largest commercial health insurance store. And the president has only a few months to do so.

Health reform is a marathon, not a sprint. The Congressional Budget Office projects that public exchanges will build enrollment gradually — to 7 million in 2014, 13 million in 2015 and 22 million in 2016. A shortfall in 2014 can be made up in 2015.

Except that 2015 is essentially here already. In Massachusetts, we begin planning for open enrollment nine months ahead — and that’s just one state. Even while it struggles with its start-up, Covered California is already planning for 2015.

A health insurance exchange is more than a Web site. It is an insurance store, and to manage it well requires insurance experience, technical know-how, and savvy marketing and sales tactics. The administration has a few months to put together a management team with these skills, dedicated exclusively to running the world’s largest store for private insurance. The Centers for Medicare and Medicaid Services have talented staff, and Jeffrey Zients, a former budget official who’s been called up to help fix the federal exchange’s online enrollment, may be just the guy to corral wayward technology vendors. But selling insurance is not what policy analysts and turnaround specialists do. I had 45 employees dedicated to operating the Massachusetts Health Connector; California has budgeted more than 300. Who’s minding the federal store?

If the administration fails to convince hundreds of insurers that the federal exchange will do a superb job marketing their products next fall, what then?

Premiums will jump, Democrats will blame “greedy” insurers, regulators will review rates and push for price controls. And Republicans can credibly crow: “We told you so.

© The Washington Post Company

www.washingtonpost.com/opinions/beyond-healthcaregov-obamacares-other-challenges/2013/11/08/26cd7e3c-4702-11e3-bf0c-cebf37c6f484_story.html

[Ritty77]

Today's Numbers: The Good, the Bad, and Ugly
By Patrick Brennan
November 13, 2013 7:33 PM

HHS released the enrollment numbers for the federally run health-care exchange and most of the state-run exchanges today, the first comprehensive set of data that had been released so far. Bearing in mind that it’s the first month of enrollment, and we still don’t know much about the customers, here are a few thoughts on what they show us:

80 percent (or more) of the people who’ve gotten insurance so far have done so through Medicaid: About 400,000 people who’ve entered the exchanges have been determined eligible for Medicaid, while about 100,000 have selected an insurance plan for which they’re eligible (obviously these two statistics are not strictly comparable, but HHS juxtaposed them and Nancy Pelosi added them together). Hundreds of thousands of more people are set to enroll in Medicaid beyond the 400,000 group, too, because a number of states are rolling the beneficiaries of their existing free or heavily subsidized insurance programs for low-income individuals onto the Medicaid-expansion rolls — meaning the proportion is, currently, much higher even than 80 percent. This matters because, in short, Medicaid is a poorly run single-payer plan that does very little to improve health-care outcomes, but does lots of damage to government budgets. There’s a reason why House Democrats didn’t propose expanding it to much higher income levels than the law eventually did, and it looks like much more of Obamacare will be the Medicaid expansion than we thought.

120,000 of those determined eligible for Medicaid come from states that haven’t agreed to help run the ACA expansion of the program; rather, they were already eligible under the existing federal system, and for some reason didn’t enroll until the current push for people to sign up. This is called the “woodwork problem,” referring to enrollees “coming out of the woodwork” — it’s a problem because, unlike the Medicaid expansion, which (for now) the federal government will pay for almost entirely, somewhere between 30 and 50 percent of the cost of these new enrollees will fall on the states, who are compensated at normal Medicaid rates, not the juiced expansion rates. Medicaid is now one of the two biggest problems on almost every state’s budget (along with pensions); even a few thousand more enrollees in Medicaid can be quite costly.

Three in ten people were eligible for subsidies, out of the 1.08 million who filled out enough information on an exchange to see what plans they can get and at what price were eligible for. Just 23 percent of people on the state-run exchanges have been found eligible for subsidies, while 34 percent of people in states using the federal exchange were. After one caveat — some people, by HHS’s definition, have been determined eligible for marketplace plans but their subsidy eligibility is pending — this is interesting: The CBO predicted that just 1 million out of the 7 million people who would enroll on the exchanges would be ineligible for subsidies. That’s one-seventh, when five-sevenths of those who’ve currently checked out plans, if they all sign up, will be unsubsidized. This can only be because the incomes of those who’ve applied are much higher than the CBO expected the eventual makeup of the risk pool to be — why might that be?

Half of Americans make low-enough incomes to qualify for subsidies, and uninsured Americans are, of course, disproportionately uninsured, which is why the CBO predicted so many of the enrollees will be subsidized. This means the program may not be doing a very good job reaching out to the poor (an issue Representative Bill Cassidy, a doctor from Louisiana, raised when he visited NR a couple weeks ago — Obamacare isn’t well designed to reach the uninsured), though that could get better as time passes. It also may mean the pool is older than expected — older people make a lot more money than young people. Neither would be great for Obamacare: The former means it’s not substantially reducing the ranks of the uninsured, but simply absorbing existing individual-insurance market customers (or people who could afford insurance but couldn’t get it because of preexisting conditions), and the latter means the pool will be older and sicker than expected, so the rates haven’t been set high enough.

That said, higher-income people, holding the age distribution constant, do tend to be healthier, which means the exchanges will work better. And if the CBO’s subsidized-unsubsidized estimate turns out to be off, the law will actually cost a lot less than expected. People also could be generally overstating their income — either because they’re making a mistake, or because they want to avoid being undercharged for insurance (if your income ends up higher than you tell the exchange, you’ll owe the IRS the undeserved subsidies, on your tax bill at the end of the year).


www.nationalreview.com/corner/363897/todays-numbers-good-bad-and-ugly-patrick-brennan

[Ritty77]

DETAILS: Summary of Republican Study Committee’s alternative to Obamacare
By Caroline May
09/18/2013

The Republican Study Committee will roll out their alternative to Obamacare, the “American Health Care Reform Act,” on Wednesday. RSC Chairman Steve Scalise, RSC health care working group chairman Phil Roe, and other RSC members will unveil the new legislation at a Wednesday afternoon press conference. Below is a bill summary courtesy of the RSC.

Bill Summary

Title I – Repeal of Obamacare

This legislation fully repeals the Patient Protection and Affordable Care Act and health care- related provisions in the Health Care and Education Reconciliation Act of 2010.

Title II – Increasing Access to Portable, Affordable Health Insurance

This legislation will level the playing field between those who receive insurance from an employer and those purchasing it in the individual market. It does so by replacing 1) the current uncapped tax benefit for employer-sponsored health insurance and 2) the self-employed tax deduction with an above-the-line standard deduction for health insurance (SDHI). Those with a qualifying health plan will receive an SDHI of $7,500 (individuals) or $20,000 (families) which will apply to income and payroll taxes, and will increase at CPI-U. The SDHI eliminates the current incentive to choose increasingly expensive plans by providing the full value of the deduction regardless of how expensive the plan is. For example, a family with a $15,000 plan would receive an additional $5,000 tax deduction. Based upon Kaiser Family Foundation data, the vast majority of Americans will receive a tax cut under this plan.

This tax benefit will be portable, will provide payroll tax relief to the working poor, and will give families the flexibility to choose a plan that best fits their needs.

In addition, this bill will expand access to and allowable expenses for health savings accounts (HSAs), increase the maximum allowable contribution into HSAs, and allow employers to offer a larger benefit for successful completion of a wellness program than is currently permitted.

Title III – Improving Access to Insurance for Vulnerable Americans

This legislation will expand federal support for state high risk pools to $25 billion over 10 years, providing a federalist solution to address a segment of the population that has been unable to obtain affordable insurance. Premiums in these state high risk pools will be capped at 200% of the average premium in the state.

The bill also guarantees that individuals with pre-existing conditions can move between the large group, small group, and individual health insurance markets, so long as they maintain continuous coverage. Under current law, individuals purchasing insurance in the individualmarket are protected from pre-existing condition exclusions only if they have not had a substantial break in coverage, their previous coverage was through an employer, and they fully exhaust COBRA coverage. This provision would allow individuals to receive those same protections regardless of the source of their prior coverage and without requiring them to exhaust COBRA coverage, which is often very expensive for both employees and employers.

Title IV – Encouraging a More Competitive Health Care Market

Our bill would take steps toward creating a competitive health care marketplace. This legislation would take steps to address this problem by, most notably, allowing Americans to purchase health insurance products across state lines and by permitting small businesses to pool together to negotiate better rates.

Other pro-patient reforms include amending the McCarran-Ferguson Act to ensure that federal anti-trust law applies to health insurance, making Medicare claims and payment data publicly available so that patients and taxpayers alike can better understand what they are being charged, helping states develop transparency portals with useful information on insurance plans, and stopping the federal government from denying coverage for health care services based upon comparative effectiveness data.

Title V – Reforming Medical Liability Law

This bill attempts to address the medical liability crisis that has played a role in the escalating cost of health care by implementing meaningful legal reforms that include caps on non- economic damages and limits to attorneys’ fees. These provisions set no caps on economic damages, which are often the largest component of liability awards, thus patients will continue to have their rights to economic damages protected.

Title VI – Respecting Human Life

Provides that nothing in this act requires health plans to provide coverage of abortion services, or permits any government official to require coverage of abortion. Prohibits federal funds authorized or appropriated by this act from covering abortion, except in the case of rape, incest, or when the life of the mother is jeopardized. Ensures that no state pro-life or conscience protection laws will be preempted.

dailycaller.com/2013/09/18/republican-study-committee-to-release-obamacare-alternative/

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The Affordable Care Act Briefing Book

www.bankruptingamerica.org/book/affordable-care-act-briefing-book/#.UqD_Dyd5_pc