Friday, April 17, 2015

ACA/Obamacare: When Politically Supplanting One Entitlement with Another Entitlement Doesn’t Balance the Books

‘Earlier this month, the Obama administration reversed course on spending cuts to the popular Medicare Advantage program. Instead of a nearly 1% cut in payments, private health insurers that offer Advantage plans to seniors would get a 1.25% boost.

The turnabout hardly made news, which isn't surprising since it was the third year in a row that the administration said it was planning to cut payments only to reverse course.

It is, however, emblematic of the fiscal trouble ObamaCare has planted in the federal budget.

When ObamaCare was being debated, opponents said it relied on unsustainable spending cuts in Medicare, tax hikes that wouldn't work as expected, and other political land mines designed only so President Obama could claim when he signed the law in 2010 that: "It is paid for. It is fiscally responsible."

Recent events are proving opponents right.

Nearly half of ObamaCare's costs, for example, are supposed to be "paid for" by spending cuts to Medicare, including $136 billion from Medicare Advantage in the first 10 years.

But since the law took effect, the administration has tried to minimize the cuts to the increasingly popular Advantage program, which lets seniors choose from a wide range of subsidized private plans, and now accounts for a third of Medicare enrollees.

Medicare's Third Rail

The administration effectively canceled the first two years' Medicare Advantage cuts with $8 billion in bonuses paid out as part of a "demonstration project" widely derided as phony. It also delayed rules changes that would have led to further cuts.’

‘The other big chunk of Medicare savings — nearly $200 billion — is supposed to come from payment cuts to doctors and hospitals. But when the Centers for Medicare & Medicaid Services' chief actuarylooked at this provision, he said such cuts were "unsustainable" because 15% of Medicare Part A providers would operate in the red by 2018.

By 2040, "half of hospitals, two-thirds of skilled nursing facilities, and 90% of home health agencies" would be losing money. Congress just permanently repealed a payment cut plan for Medicare doctors, which Congress had repeatedly delayed since it was enacted in 1997.

Even the little-known "Medicare Improvement Fund" has proved troublesome. ObamaCare eliminated this fund for a one-time $20.7 billion savings. But in 2014, Obama signed a law that recreated the fund and put more than $200 million back into it.’ - ObamaCare's Financial Crisis Is Fast Approaching, IBD, 04/15/2015

Link to the entire article appears below:

Wednesday, April 8, 2015

ACA/Obamacare: Penalty/Tax Reaches New Zeniths Regarding Uninsured Status in 2015

NEW YORK (MainStreet) — The fee for not having health insurance coverage in 2015 will increase to 2% of your annual household income or up to $975 per family, $325 per adult and $162.50 for each child under the age of 18 years, whichever is higher. That's twice as much as the maximum penalty in 2014, when the fee was 1% of your annual household income, or $95.00 per adult and $47.50 per child under the age of 18 years.

The maximum penalty per family in 2014 looks like a bargain now at $285, a hike of nearly 250%. The fee will continue to get stiffer in 2016 when it will cost families 2.5% of their annual household income or $695 per adult and $347.50 per child under age 18, the federal government's way of incentivizing uninsured Americans to get health care coverage.

Whether through the incentive to avoid the penalties or the need to get health care coverage to protect their personal finances and have access to doctors and hospitals, as of February 22, 2015, nearly 11.7 million consumers had signed up for health insurance coverage in the government’s marketplace, according to a report released by the U.S. Department of Health and Human Services. More than half (55%) paid monthly premiums of $100 or less after tax credits, totaling $1,200 a year or less for coverage.

Despite the relative affordability of health insurance and a requirement to pay a stiff penalty for not having coverage, many Americans eschew Obamacare. According to a new analysis by Avalere Health, many Americans are still opting to go without health insurance coverage.” - The Penalty for Going Without Obamacare Soars Nearly 250% Over 2014 Fee, MSN Money, 04/08/2015

Link to the entire article appears below:

Saturday, April 4, 2015

The Barking Cat Visits the Medicare Price Fixing Scheme

“The word “bipartisan” is considered by many inside the Beltway to be one of the highest honors that can be bestowed on a piece of legislation. That’s unfortunate, because too often bipartisanship means Republicans and Democrats supporting a bill that is all but certain to produce bad outcomes.

The latest example of such bipartisanship is the “Medicare Access and CHIP Reauthorization Act” (MACR). Passed Thursday by the House of Representatives, the bill would, among other things, remove the unworkable Sustainable Growth Rate (SGR) from Medicare’s payment system.

It would replace it with a payment system that is even worse.

The SGR is a formula that is supposed to help control Medicare’s costs by limiting payments to physicians. Each year the SGR sets an expenditure target for the amount Medicare spends on physicians’ fees. If the amount that Medicare actually spends exceeds the expenditure target, then physicians’ fees are supposed to be cut the following year by an amount that brings Medicare spending back into line with expenditure targets.

Physician groups have rebelled at the prospect of such cuts, telling Congress they would have a harder time treating seniors on Medicare under such a payment regime. Wary of lots of angry seniors showing up at the ballot box, Congress has suspended the SGR 17 times since 2003. But the prospect of the SGR cuts has still caused many physicians to limit the number of Medicare patients they see.” - Retooling Medicare’s Price Fixing Scheme Will Hurt Sick People, The Federalist, 03/27/2015

Link to the entire article appears below:



Friday, April 3, 2015

ACA/Obamacare and the Medicaid Expansion Component

“Medicaid enrollment has surged 19% nationally since ObamaCare’s expansion—50% in New Mexico, 65% in Oregon, 81% in Kentucky—and spending is exploding. So taxpayers ought to be grateful that the Supreme Court declined 5-4 on Tuesday to convert this entitlement—and all the others—into a private right.

Medicaid, the joint state-federal program originally meant for the poor and disabled, sets price controls for all health-care services. And in the law that created the program, Congress instructed the states to “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” equal to those available to the general population. In Armstrong v. Exceptional Child Center, a group of in-home care companies sued Idaho for setting reimbursement rates too low, thus purportedly violating this amorphous standard.”

“Medicaid’s fire-sale reimbursement rates often result in inferior care and distort markets, but they might be more generous if the program was limited to its original purpose of helping the poor. Also recall that Medicaid is an entitlement for providers as much as beneficiaries, and they don’t have to participate.

Armstrong was a backdoor bid to reflate the judicial rate-setting that providers have long sought but the Court rebuked in 2002 in Gonzaga v. Doe, holding that spending programs do not create judicially enforceable rights like those in the Constitution. So mark this one down as a victory for judicial and fiscal restraint.” - Close Encounters of the Medicaid Kind, WSJ, 04/01/2015

Link to the article appears below:

Wednesday, April 1, 2015

Despite ACA/Obamacare Claims, Health Insurance Premium Increases March On

“It’s been five years since the Affordable Care Act became law, but only two since most of its provisions went into effect. As its detractors predicted, the ACA’s implementation led to a large, immediate rise in health insurance premiums. This is hardly surprising: The law required that a broad swath of treatments be fully insured, thus deepening the moral hazard problems that have long plagued the American health insurance system.

Heritage Foundation microsimulation analysis of the 2015 health insurance offerings on the ACA exchanges found that the sharp 2014 price spike was not reversed. The average health insurance premium rose by 5% this year, much higher than the rate of inflation. But that increase is modest compared to the massive increase in non-group health insurance rates in 2014, which was around 50% on average, with some consumers facing much worse rate jumps.“ - ACA Has Pushed Insurance Premiums to New Heights, WSJ, 03/30/2015

Link to the entire article appears below:

Sunday, March 29, 2015

ACA/Obamacare Subsidy Debit or Credit and Penalty/Tax: Time to Pony-Up

“Understand the new health-care provisions. Under the Affordable Care Act, filers this year must check a box on Line 61 on the 1040 form if they had approved health-care coverage for all of 2014, or possibly pay a penalty if they didn’t. The instructions for Form 8965 explain how to calculate the penalty.

Employers aren’t required to provide evidence of ACA-approved insurance to employees until the 2015 tax year.

Last year, several million people received an upfront tax credit to help them buy insurance, and they could owe more tax now if their income was larger than expected or less if it was smaller than expected. According to estimates by the Kaiser Family Foundation, about half of tax-credit recipients will need to make a repayment that averages $794 for 2014, while about 45% will get back an average of $773. The average refund for all taxpayers is currently $2,893.

In February, the Department of Health and Human Services said it sent erroneous forms to about 800,000 tax-credit recipients living in 37 states. People who already had filed returns using the erroneous information were given a free pass by the IRS, but the rest have been told to wait for corrected forms before filing.

Millions of people also qualify for exemptions from required ACA coverage. They need to attach a Form 8965 to this year’s return.” - Last-Minute Tax Moves,, 03/27/2015.

Link to the article appears below:




Another ACA/Obamacare Supreme Court Case?

In 2009, the American Recovery & Reinvestment Act (ARRA) offered states stimulus funds if they agreed to a maintenance-of-effort (“MOE”) provision that required them to maintain Medicaid-eligibility standards at July 2008 levels through December 2010. MaineCare, Maine’s Medicaid program, accepted those funds and the accompanying MOE provision. In relevant part, MaineCare covered low-income individuals ages 18 to 20 in 2008 — even though Medicaid doesn’t require states to include non-pregnant, non-disabled 18- to 20-year olds — so that MOE provision required Maine to continue to do so through 2010. Then the Affordable Care Act came along and added its own MOE provision, which required states to “freeze” eligibility levels until 2019 or risk losing all federal Medicaid funding.

When the ACA took effect on March 23, 2010, Maine was still bound by the ARRA’s MOE requirements, and thus had to continue to cover 18- to 20-year olds for an additional nine years. In August 2012, however, the Maine DHHS sought to drop this coverage. The federal Center for Medicare and Medicaid Services (CMS) rejected Maine’s position regarding alleged inconsistencies between the MOE provisions.

On appeal, Maine argued that the ACA’s MOE provision is unconstitutionally coercive under the Spending Clause, that it unconstitutionally applies retroactively to ARRA MOE provisions, and that it violates Maine’s right to equal sovereignty. Nevertheless, the U.S. Court of Appeals for the First Circuit affirmed the CMS decision, so Maine now seeks Supreme Court review.

Cato has filed a brief supporting that petition. We outline the significance of the case and reiterate concerns over the executive branch’s interpretations of NFIB v. Sebelius (the previous Obamacare case at the Supreme Court). The issues presented here need to be resolved so states can decide whether to establish exchanges — regardless of how King v. Burwell is decided — or expand their Medicaid programs. In enforcing the eligibility freeze, the ACA creates inequality among states in administering their Medicaid programs and threatens state sovereignty. - The Next Big Obamacare Case?, 03/28/2015

Link to the entire article appears below: