Thursday, June 23, 2016

ACA/Obamacare: When the Price Isn’t The Price Because The Price Is a Political Price

“Amid reports that consumers could be hit with Obamacare health insurance premium hikes of 10 percent or more, the administration is providing state insurance regulators with $22 million to encourage them to beef up their reviews of requests for rate hikes from the health insurance industry.

The decision announced on Wednesday to provide states with additional resources to evaluate and challenge rate increases, in addition to undertaking other activities related to Obamacare, appears to be as much a political maneuver as another attempt to bend the health care cost curve.

A new Kaiser Family Foundation analysis of Obamacare insurance markets in roughly a third of major metropolitan areas projects that premiums on the most popular silver plans will increase by an average of 10 percent to 11 percent next year, twice the rate of increase approved last fall. And that doesn’t include almost certain increases in co-payments or other out-of-pocket costs to consumers.

Obama administration officials reportedly are wary of the political impact of a rash of double-digit premium increases so close to the election, despite warnings from major insurance providers they will need higher revenues in order to remain in Obamacare. Millions of Americans are likely to get their first notice of Obamacare premium rate increases for 2017 shortly before the November election.” - White House Is Spending Millions to Battle Obamacare Rate Hikes,, 06/17/2016

Link to the entire article appears below:




Friday, June 10, 2016

ACA/Obamacare: If Markets Fail, Governments Fail too

“One of the worst developments has been the failure of many of the online exchanges that were supposed to be a one-stop, one-size-fits-all marketplace where insurances policies could be purchased cheaply and easily. In a lot of places that hasn't turned out to be the case. In Massachusetts, for example, the administration of Democratic Gov. Deval Patrick took a functioning website created as part of Romneycare, spent a lot of money on so-called improvements and promptly broke it.

By far the worst example is Oregon, where the website for the state exchange was declared completely dysfunctional, but only after more than $300 million – according to best estimates – was spent trying to figure out how to make it work.

The politicians back in Oregon, at least one of whom has lost his job in part over the "Cover Oregon" scandal, have tried all along to blame the companies and contractors they hired to build the website. The official term of art for that is "buck passing." The House Committee on Oversight and Government Reform has been investigating what went wrong and, in a report just issued, has concluded – no surprise – it was the politicians playing politics who are to blame.

Here, in brief, is what the committee found:

State law clearly established Cover Oregon as an independent entity. The governor and his political advisers' involvement in Cover Oregon was inconsistent with Oregon law.

Campaign funds were used to assist the governor in his official capacity while handling Cover Oregon.
Cover Oregon became closely tied with all campaign activities, from polling to meetings.

The governor's political operatives – none had technological experience – micromanaged many of the decisions that needed to be made regarding Cover Oregon.
Junking Cover Oregon and moving to was viewed as a way to "let the steam out of so much of the attacks."

The Cover Oregon board was told the cost of moving to was $4-6 million. A slide showing moving the Medicaid system would cost $36 million was deleted.

After the governor complained about the "free independent expenditure campaign" his political opponent was receiving because of Cover Oregon, his political advisers drafted letters asking the attorney general to sue. The letter was sent days later.

In sum, the committee says, "Cover Oregon failed for two main reasons: The state acted as their own system integrator (like, and the state tried to revamp its entire health care system, not just build an exchange."

All in all it's a pretty damning indictment. As a result, in what may be the first allegations of criminal misconduct related to Obamacare, the committee wants United States Attorney General Loretta Lynch to launch a criminal probe and for Oregon's attorney general to appoint a special prosecutor with a mandate to uncover what happened with Cover Oregon.” - 'Cover Oregon' Cover-Up, US News and World Report, 06/08/2016

Link to the entire article appears below:




Thursday, June 2, 2016

ACA/Obamacare: Oh No, Way to Go, Ohio…….

“Ohio's Obamacare plan has closed up shop, making 13 out of 23 consumer-oriented-and-operated plans to shutter.

InHealth Mutual in Ohio will shut down and will force more than 20,000 people to choose new plans. They will have 60 days to find a new plan. Ohio's insurance regulator said Thursday that it had to take control of the co-op because of major losses.

The Ohio co-op is the first one this year to close. Last year, 12 of the 23 taxpayer-funded plans shut down due to mounting financial losses and a lack of federal funding.

Including InHealth, the federal government has spent $1.3 billion to set up the co-ops, which were created to offer more competition on Obamacare's exchanges.” - Ohio Obamacare co-op collapses, Washington Examiner, 05/26/2016

Link to the entire article appears below:

Sunday, May 22, 2016

ACA/Obamacare: Big Loses, Risk Corridors and Lawsuits

“May 19--Highmark could soon be in good company in suing the federal government over Affordable Care Act reimbursement.

Other insurers have contacted Highmark since the Pittsburgh carrier filed a lawsuit Tuesday over reimbursement for losses incurred in providing coverage under the ACA, president and CEO David Holmberg said Wednesday. The companies are weighing their options to recoup billions of dollars they say are owed, he said.

"The losses were pretty significant," Mr. Holmberg said. "We ended up with the other companies standing here holding the bag. We saw no path forward."

Highmark, the fourth-largest Blues company and dominant provider of ACA coverage in Pennsylvania, Delaware and West Virginia, sued the federal government in the U.S. Court of Federal Claims for $223 million in losses sustained in 2014. In addition, Highmark says it will be owed another $500 million for losses on member claims by July when a government accounting is due.

Through a risk-sharing tool called risk corridors, the government had promised to pick up a share of the losses during the early years of the Affordable Care Act because insurers had little information about setting appropriate rates for a new population.

Instead, insurers received payment for only about 12.6 percent of the amount claimed -- $362 million for $2.87 billion in losses claimed by the carriers, according to Ursula Taylor, partner at the Chicago law firm of Butler Rubin Saltarelli & Boyd LLP.

"It is a holy mess," Ms. Taylor said. "This is a nationwide issue and it affects plans everywhere. Litigators are just beginning to pay attention to this."

Highmark's lawsuit is among a handful that have been filed nationwide over risk corridor reimbursement, but among only a few asserting that the government breached a contract with insurers. Other challenges have focused on the wording of the ACA, which was enacted in 2010.” - Highmark Lawsuit Could Prompt Other Insurers To Recoup ACA Losses, [via Pittsburgh Post-Gazette], 05/19/2016

Link to the entire article appears below:

Friday, May 13, 2016

ACA/Obamacare: Oops! Unauthorized Subsidies of the Made-up Political Authority Kind

‘A federal district court in Washington, D.C., ruled Thursday in favor of the U.S. House of Representatives’ challenge to the Obama administration’s implementation of part of the Patient Protection and Affordable Care Act, also known as Obamacare.

The act has been “revised” dozens of times by the administration since its passage in March 2010, leading the House to sue over the administration’s payment out of the U.S. Treasury of subsidies to insurance providers for providing cost-sharing reductions to certain policyholders, even though Congress explicitly refused to appropriate funds for these subsidies.

As D.C. District Court Judge Rosemary Collyer explained in an opinion last fall, Section 1402 of the law “requires insurers to reduce the cost of insurance to certain, eligible statutory beneficiaries,” and the “federal government then offsets the added costs to insurance companies by reimbursing them with funds from the Treasury.”

This section stated that cost-sharing offsets must be funded by annual appropriations. But the House has never appropriated funds for Section 1402, so it argued that the administration violated Article I, Section 9, Clause 7 of the Constitution, which provides that “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.’

‘Collyer was not concerned by the “cascading series of nonsensical and undesirable results” that the administration claimed would flow from failing to recognize a permanent appropriation for Section 1402: “Higher premiums, more federal debt, and decreased enrollment are not consequences of the [Affordable Care Act’s] text or structure,” Collyer explained, but rather those “would flow … from Congress’ continuing refusal to appropriate funds.” She concluded, “That is Congress’s prerogative; the Court cannot override it by rewriting [the statute].”

Collyer granted summary judgment to the House of Representatives, enjoining any “further reimbursements [to insurance companies] under Section 1402 until a valid appropriation is in place.” However, she stayed her injunction pending an appeal.’ - Obama Administration Loses Key Obamacare Case,, 05/12/2016

Link to the entire article appears below:


Federal judge rules Obamacare is being funded unconstitutionally, Los Angeles Times, 05/13/2016



Friday, May 6, 2016

ACA/Obamacare: Another Large Insurer, Humana, Might Leave the ACA Exchanges (see a pattern, huh?)

“Humana became the latest health insurer to serve notice that it might leave some Affordable Care Act exchanges next year, creating more uncertainty for customers ahead of this fall's enrollment window and presidential campaign, during which the law is sure to remain a hot debate topic.

The insurer, which is being acquired by rival Aetna, said Wednesday that it expects to make a number of changes to its business for 2017, and that may include leaving some markets both on and off the exchanges or changing prices. Humana Inc. sold coverage in 15 states this year.

"We do not take these changes lightly," spokesman Tom Noland said in an email. "We are striving to avoid unnecessary coverage disruption wherever possible."

Several insurers say they have struggled with sicker-than-expected customers and had a hard time attracting younger, healthy people to the coverage they sell on the ACA's state-based public insurance exchanges, which opened for enrollment in the fall of 2013. Some also have been hurt by temporary government support programs that haven't delivered as they were initially advertised.

UnitedHealth Group Inc., the nation's biggest insurer, said last month that it was chopping its participation in the exchanges down to only a handful of states in 2017 after expanding to 34 for this year. Aetna Inc. has said it lost more than $100 million last year on its exchange business, but it still sees potential in the new market.” - Humana Might Leave Some ACA Exchanges Next Year,, 05/04/2016

Link to the entire article appears below: