Friday, April 29, 2016

ACA/Obamacare: Total Uninsured Remains at 11.9% -or- Sound and Fury Signify Nothing

“In 2014, after accounting for attrition after the end of the first open-enrollment period (March 31, 2014), 6.7 million individuals had enrolled by December 31. In 2015, 2.6 million additional individuals enrolled (and remained on their plans), raising the total to 9.3 million people enrolled on December 31. If similar trends hold, total enrollment on the ACA exchanges will hit 10 million on December 31, 2016.

Overall, ACA-exchange enrollment has been lower than expected; in 2016, the gap between actual and forecasted enrollment is likely to widen further. For instance, in 2014, the ACA exchanges’ first year, enrollment (6.7 million) exceeded the CBO’s February 2014 forecast (6 million). But in 2015, total enrollment (9.3 million) lagged behind the CBO’s March 2015 forecast (11 million). And if current trends hold, total enrollment in 2016 (about 10 million) will be dramatically less than the CBO’s March 2015 forecast (21 million).

Are these lower-than-anticipated ACA-exchange enrollment figures the result of uninsured individuals securing coverage by other means — such as by enrolling in employer-sponsored coverage or Medicaid? Start with the former. As the Department of Health and Human Services has noted, in a growing economy, employer-sponsored coverage typically rises as more people acquire jobs. Instead, from the fourth quarter of 2013 to the fourth quarter of 2015, employer-sponsored coverage in the U.S. declined.

Or take Medicaid. Enrollment in this government-insurance program for the poor expanded during the aforementioned period; but such expansion largely matched the CBO forecast — and, therefore, was also incorporated into the CBO forecast for ACA-exchange enrollment. Indeed, if the ACA exchanges’ meager enrollment numbers were caused by a rise in coverage obtained elsewhere, America’s overall uninsured rate would have declined in 2015. Instead, it barely budged, hovering around 11.9 percent.” - Why Obamacare Is Failing at "Universal Coverage", foundation for economic education, 04/17/2016

Link to the entire essay appears below:




Tuesday, April 26, 2016

ACA/Obamacare: Without a Bail Out, Health Insurers Sing a Different Tune

“With Congress limiting the bailouts of insurance companies for two years in a row, business is not looking good for the industry that lobbied for Obamacare. The latest casualty is United Healthcare, which announced that it is withdrawing from most of its 34 Obamacare exchanges next year.

Announcing the decision during a first quarter earnings conference call, UnitedHealthcare CEO Stephen Hemsley said, “The smaller overall market size and shorter-term, higher-risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis."

Due to congressional limits on insurance company bailouts, in October the Department of Health and Human Services transferred $362 million to loss-making insurance companies, rather than the $2.9 billion that they requested.

The Health Insurance Association of America, under the leadership of Karen Ignagni, lobbied heavily in favor of the Affordable Care Act. But now the pool of insured is smaller and sicker than they anticipated.”

“If Congress holds its ground during the appropriations process and refuses to bail out the insurance companies for fiscal 2017, it is likely that more of them will withdraw from the exchanges, raising prices for existing customers. Premiums rose in some markets by 20 percent in 2016, leading to more healthy young people dropping out of plans or not enrolling, accelerating the financial imbalance.

Look at UnitedHealthcare as the canary in the coal mine, and expect more withdrawal announcements in the future.” - UnitedHealthcare’s Exit Augurs Badly for Obamacare,, 04/19/2016

Link to the entire article appears below:




Saturday, April 16, 2016

ACA/Obamacare: Section 1332 and Some Universal Health-Care For You

“As Republican policymakers nationwide continue debating ways to replace Obamacare with patient-centered solutions, a Colorado group has landed a plan implementing a single-payer model of health care on November’s ballot. Coloradans are already bracing for its impact.

In the general election, Colorado residents will not only head to the polls to cast their votes for president, but they’ll also weigh in on a controversial ballot measure: Amendment 69, which would create a government-run health care plan in the Centennial State.

The plan, formally known as ColoradoCare, is the first in the country that would replace Obamacare, action made possible by Section 1332 of the Affordable Care Act, which allows states to receive a waiver from the health care law if their own plan provides residents with “access to high quality, affordable health insurance while retaining the basic protections of” the health care law.

In Obamacare’s place: universal health care.” - Beyond Obamacare: Colorado Considers Single-Payer Model, daily, 04/14/2016

Link to the entire article appears below:

Monday, March 28, 2016

ACA/Obamacare: What Was The Total Price of

“Obamacare’s implementation in October 2013 came with the launch of, the federal health insurance exchange.

Just six people successfully signed up for health insurance on on Oct. 1, 2013, because of massive glitches and failures with the site. In the months that followed the disastrous launch, the Republican-led House of Representatives held numerous hearings to determine why the Obama administration decided to launch the website.

The Department of Health and Human Services fired CGI Federal, which was originally tasked with building, after the website’s launch and signed a new contract with Accenture to rebuild the exchange.

Though the Obama administration hasn’t formally said how much cost the taxpayers, Department of Health and Human Services Secretary Sylvia Mathews Burwell said last May that the website cost $834 million. Similarly, a report from the Department of Health and Human Services Inspector General put the cost of the exchange at $800 million.

An analysis by Bloomberg Government, though, put the total cost at $2.1 billion. Bloomberg Government took into account budgetary costs for the Internal Revenue Service and other government agencies, as well as contracts reworked to pay for the website.” - In 5 Charts, How Obamacare Has Worked the Past 6 Years, daily, 03/23/2016

Link to the entire article appears below:



Thursday, March 24, 2016

Unpaid Patient Healthcare Bills Mount: The Seen and the Unseen

“NASHVILLE — Hospitals and medical practices share a growing problem with those they treat: Patients aren’t paying their bills.

Working people are on the hook for an increasingly large portion of the cost of their care, as insurance policies pay for less. It’s a trend that is not reversing — and it’s causing financial distress for families and CEOs alike.”

“In health care, the billing process is called revenue cycle management. It’s a complex system of diagnostic codes, services, insurance benefit analysis, billing departments and software.

Hospitals and providers, historically, received 90% of the reimbursement from insurers, according to The Advisory Board. The patient portion was more of an afterthought.”

“For every patient dollar being billed, hospitals have historically failed to collect 65 cents.”

"The hospital operator is not alone, and the problem is not simple.

Billing practices are not designed to collect small, incremental payments from hundreds or thousands of patients. They are designed to bill a handful of large entities — insurance companies — not individuals who walk in the door.”

“Streamlining billing into a single itemized list is essential to helping turn patients into bill-paying customers.

One might not go back to a restaurant that gave you a bill for the appetizer then a bill for the bread then individual bills for the entrée and drink.

But that’s how health care is presently billed. An open heart surgery could bring individual bills from the cardiologist, the surgeon, the lab, the anesthesiologist, a consulting doctor who helped read charts and more.” -
Why more than half of hospital bills don’t get paid,, 03/09/2016


The Seen and Unseen

The above excerpts, from the above mentioned report, do manage to explain the “seen”, but what about the “unseen”? How so?

The above statements are based on the assumption that insurance historically paid the vast majority of bills, which it did not. As recent as 1960 patients paid 90% of the bills and third party payers 10%. Stated alternatively, as recently as 1960 the percentages paid by third parties and the patients were exactly opposite of today i.e. today third party providers pay 90% and patients pay 10%, whereas 1960 third party providers paid 10% and patient 90%.

Somehow patients managed to pay 90% of bills as recent as 1960 and those bills were somehow manageable to be paid from a household budget. Conversely, somehow patients in 2016 can’t manage to pay 10% of bills and those bills are not manageable to be paid from a household budget.

With the 10% patient responsibility existing in 2016, the report mentions: “Hospitals and providers, historically, received 90% of the reimbursement from insurers, according to The Advisory Board. The patient portion was more of an afterthought”, “hospitals have historically failed to collect 65 cents” and “Billing practices are not designed to collect small, incremental payments from hundreds or thousands of patients. They are designed to bill a handful of large entities — insurance companies — not individuals who walk in the door.” Suppose one could look at the above statements many ways. One way is to state: The customer is not the customer, rather the customer is the third party payer.

Moreover, if the third party payer is indeed the indirect or direct consumer from the point of view of the healthcare provider as the report indeed suggests, then as such, it confirms the oft mention non-price signal discussion in healthcare. That is, the statement confirms the regularly discussed scenario that healthcare in conjunction with health insurance is akin to buying “grocery insurance” and paying a monthly premium. As the scenario goes, one arrives at the grocery store to shop where no prices are posted (price is not a signal). When checking out with the cashier one never knows the single item price nor total price as the bill goes to the “grocery insurance company”. One merely laments their monthly grocery insurance premium along with complaints and moans about their ever escalating monthly “grocery insurance” premium.

One can also make a grand argument that the unpaid patient bills are directly related to the process of non-price purchases. If price is not a signal at the point of exchange and only a signal after exchange, are the unpaid patient bills merely an adjustment to mutual exchange, after the fact, in that the patient doesn’t pay the bill to adjust for mutual exchange? Stated alternatively, had price been a signal many exchanges would have never occurred as the patient would have been unwilling to pay such price at the point of exchange (transaction rejected as a non-mutual exchange). As an extension to the argument: Are the unpaid patient bills merely part of the process, a process of non-price signal, a process self-produced by healthcare providers, and hence not a surprise but rather a known-known of such a process?

A final point one might consider involves the following observations from the article: “Streamlining billing into a single itemized list is essential to helping turn patients into bill-paying customers“, “One might not go back to a restaurant that gave you a bill for the appetizer then a bill for the bread then individual bills for the entrée and drink“, and “But that’s how health care is presently billed. An open heart surgery could bring individual bills from the cardiologist, the surgeon, the lab, the anesthesiologist, a consulting doctor who helped read charts and more.”. Why all the bills?

What about the “why” concerning the several and many bills received by patients? The “why” is related to the non-competitive nature of much healthcare (CON [Certificate Of Need] legislation and other related legislation protecting the incumbent healthcare provider) and the consequential failure to reach scale in healthcare.

The several and many bills are not going to change as it is part of a conscious process. Nay, nay there is absolutely no reason to wring one’s hands over the flood of bills received by the patient as it is by design, not by error. Many and varied healthcare providers, in a self-produced and politically [legislation] protected non-scale environment, send many bills by design. Nope, no Wal-Mart or Southwest Airlines of healthcare in this supply, just a gazillion little shops sending non-price signal bills….and expecting to be paid.

Yep, one might think twice about the supply-side of healthcare.

Tuesday, March 15, 2016

ACA/Obamacare: ObamaCare Cooperatives, A Story of Epic Failure

‘The dozen failed ObamaCare cooperatives have not repaid any of the $1.2 billion in federal loans they received and still owe more than $1 billion in additional liabilities, according to recent financial statements cited Thursday at a congressional hearing.

“We shouldn’t hold our breath on repayment,” Sen. Rob Portman, R-Ohio, chairman of the Senate Permanent Subcommittee on Investigations, said in his opening statement at the hearing.

“In some states, these losses will be absorbed by other insurance companies—which means, by the policyholders of other insurance companies who have to pay increased … premiums,” he said. “In other states, doctors, hospitals and individual patients stand to suffer large out-of-pocket losses due to the co-op failures—as our report details.”

Portman’s statement, first obtained by Fox News, refers to an investigation by the committee’s majority staff.

It claims the most recent balance sheets provided to the subcommittee show the failed cooperatives owe more than $700 million to doctors and hospitals for plan year 2015.

The failed cooperatives lost $376 million and exceeded the projected worst-case-scenario losses outlined in their loan applications by more than $260 million in 2014. They lost an additional billion dollars in 2015, according to the report.

“Once the co-ops got going in 2014, things went south in a hurry—both in terms of financial losses and enrollment figures that wildly deviated from the co-ops’ own projections,” Portman said. “Despite getting regular reports that the co-ops were hemorrhaging cash, HHS [the Department of Health and Human Services] took essentially no corrective action for over a year.”’ - Failed ObamaCare co-ops have not repaid $1.2B in federal loans, docs say,, 03/10/2016

Link to the entire article appears below:


Thursday, March 10, 2016

ACA/Obamacare: The Independent Payment Advisory Board

“The Independent Payment Advisory Board, or IPAB, is one of the more notorious provisions of the Affordable Care Act because it is the perfect embodiment of belief in technocratic expertise. The IPAB’s 15 “expert” members would have great power and little accountability.”

“The IPAB is fundamentally flawed concept for two reasons:

It tramples on Congress’ power to write laws. The IPAB would have the authority to rewrite any aspect of Medicare’s payment policies -- everything from hospital payments, to physician fees, and even how Part D prescription drug plans pay for covered medications -- to achieve additional savings. Congress has the constitutional power to write new legislation for a reason; voters can hold their elected representatives accountable for the kinds of laws they pass. Not so with the IPAB. IPAB members will get six-year terms and will be allowed to be reappointed once. Removing them from their positions will be extremely difficult.

It emphasizes payment reductions at the expense of real Medicare reform. The constraints placed on what the IPAB can recommend were not accidental. The authors of the ACA support restraining Medicare spending, but only with government-imposed payment restrictions, not financial incentives. So the IPAB can impose blunt payment cuts on physicians and hospitals -- and for the HMOs serving Medicare Advantage patients -- but it cannot recommend structural changes, like giving participants in the program incentives for selecting low-cost, high-value care. If payments are reduced too much, the network of willing providers of medical services becomes very constrained, and the participants in the program begin to have trouble securing access to the care they need. Congress could easily find itself undoing payment cuts it previously approved, much like it did for years with the “doc fixes” aimed at undoing the Sustainable Growth Rate formula for physician fees.” - Don't Forget about the IPAB, Real Clear Health, James Capretta, 03/08/2016

Link to the entire article appears below: