ACA: Navigating the Navigators

“At least 43 convicted criminals are working as Obamacare navigators in California, including three individuals with records of significant financial crimes.

Although some of the offenses are decades old, and although convicted criminals account for only 1 percent of the 3,729 certified enrollment counselors in the state, Californians still have good cause to be concerned about their privacy.”

“Limited statistics released by Covered California — the state’s new health-insurance exchange — showed that one navigator has repeat forgery offenses — one in 1982, then another in 1994, with a burglary in between. Another had two forgery convictions in 1988, in addition to a domestic-violence charge a decade later. Another committed welfare fraud in 1999 and had shoplifted on at least two prior occasions. Since 2000, individuals now working as navigators have committed crimes including child abuse, battery, petty theft, and evading a police officer. At least seven navigators have multiple convictions. The information released covered only certified enrollment counselors, one of the three types of navigators working in California.” - California’s Obamacare Scandal, NRO, 01/29/2014

Link to the entire article appears below:

　

http://www.nationalreview.com/article/369695/californias-obamacare-scandal-jillian-kay-melchior

ACA and Pre-Existing Conditions: Who Cancelled Who?

Consider for a moment the following mantra regarding pre-existing conditions:

(1) Obamacare/ACA proponents put forth that their scheme is grand and great as it takes all comers as it includes/accepts even those with pre-existing conditions,

(2) that somehow and in some way people where cancelled by insurers, in the past, due to pre-existing conditions which becomes the vilification of insurers for such practice,

(3) hence you can then acquire health insurance and never be cancelled due to pre-existing conditions.

Nice and tidy argument huh? Maybe not so much.

For a moment consider the above mantra as exactly correct (which it is not and discussed below). Now consider the above mantra again with the following in mind:

(1) if one had acquired health insurance in the past and consequently a condition manifested itself which would qualify as a pre-existing condition,

(2) yet one’s policy was cancelled or will soon be cancelled because it did not/does not conform to Obamacare/ACA guidelines,

(3) then the same group of ACA proponents have advocated and initiated, through legislation, insurers cancelling policies with pre-exiting conditions.

Oops!

If you examine the ACA proponents argument regarding insurers cancelling policies due to pre-existing conditions one actually finds the facts and mantra don’t jive. How so? The mantra is based on “rescissions”. An insurer rescission of coverage, generally speaking, is when an applicant did not divulge a pre-existing condition on the initial application then seeks treatment soon after the policy went into force for the pre-existing condition. The policy is rescinded and premium is returned to the insured [rescission].

Exactly how widespread was this "rescissions" process? One hundred thousand rescissions per year? Half a million rescissions per year? Millions? If you no longer have to worry about losing your health insurance because you are sick, and this is a major talking point regarding Obamacare, then the phenomena had to be affecting a major portion of the population. Right?

Wrong. Sorry, it’s yet another Obamacare riddle.

"According to a congressional report, there were actually fewer than 5,000 rescissions per year, and at least some of those were actual cases of fraud...." (1) (2)

Coming full circle, considering fewer than 5,000 rescissions per year supporting the mantra regarding pre-existing conditions and further considering the approximately 135,000 signing up for Obamacare directed risk pools: Is the total number of rescissions and risk pool applicants smaller than or greater than the 4.2 million policies cancelled by ACA advocates considering the subsection of the 4.2 million policies (so far) which indeed have acquired pre-existing conditions? (3) (4)

Who cancelled who?

Notes:

　

(1) Bad Medicine, Cato Institute, M.D. Tanner, page 7

(2) http://energycommerce.house.gov/Press_111/20090616/rescission_supplemental.pdf


(3) Funds run low for health insurance in state ‘high-risk pools’

http://www.washingtonpost.com/national/health-science/2013/02/15/cb9d56ac-779c-11e2-8f84-3e4b513b1a13_story.html?hpid=z1


(4) New Numbers: 4.2M Americans Dropped From Health Plans, foxnewsinsider.com

http://foxnewsinsider.com/2013/11/07/how-many-americans-have-lost-their-health-insurance-under-obamacare


　

　

　


　

Hey Buddy, Can You Spare a Ten Spot to Protect Obamacare?

"First lady Michelle Obama is seeking $10 donations to protect Obamacare, her husband's troubled health insurance system.

Just one day before he gives the annual State of the Union address, the first lady sent out a fundraising email to supporters hoping to use the speech to prompt donations to help Democrats in the midterm elections this fall." - Michelle Obama wants $10 donations to 'help protect Obamacare', Washingtonexaminer.com, 01/27/2014

Link to the entire article appears below:

http://washingtonexaminer.com/michelle-obama-wants-10-donations-to-help-protect-obamacare/article/2542925

ACA: Insurance -or- Politico Scheme of Focused Benefit/Dispersed Price?

In the book, The Basic Bond Book, which is a book for general contractors and sub-contractors to help them understand surety, the book opens with a definition of insurance. The definition is displayed to contrast insurance with the definition of surety which are two different concepts. The comparison of definitions is also displayed to end confusion between the two products. The confusion occurs because insurers offer both insurance and surety products. Being that James and Jane Goodfellow are more familiar with insurance, it follows that people will confuse surety with insurance due to the base issuer of both products.

The definition of insurance offered is as follows:

“Insurance is a two-risk party transfer mechanism whereby one party pays to have another protect it from certain well-defined risks. In purely theoretical terms, insurance is a pool created by a large number of people exposed to a common risk. Each member of the pool contributes to it and any members who suffer loss as a result of the risk assumed may be compensated for that loss by the pool.  The contribution to the pool is determined by an actuarial study of probability of loss. The probability factor determines how much will be charged to pay losses while still leaving the pool solvent.” (1)

　
One of many basic problems with ACA/Obamacare is that its proponents have based the viability of ACA on one half of the definition of insurance. That is, the “large pool” and/or law of large numbers; is one of the mantra of ACA proponents. Implicitly and explicitly they claim that a large pool of insured’s becomes self solving regarding coverage/price. The second half of the definition is discarded: “The contribution to the pool is determined by an actuarial study of probability of loss. The probability factor determines how much will be charged to pay losses while still leaving the pool solvent.”

As with all chairs with four legs, all legs support the chair. One can not discard a leg or two and expect the chair to function properly or to deliver its intended utility. So it is too with insurance. Discarding the probability of loss and consequently charging premium based on individual exposure units based upon probability of loss, is to create nitwit insurance.

Can you suddenly insure a burning house? Insurance would not be the mechanism. Fire trucks serve better. The insurance premium, if it was possible insurance could be written (which it is not), would be exactly equal to the loss sustained, plus some. If the fire causes $50,000 of loss, then the premium is $50,000 plus the price of insuring a standard exposure unit and claims administration expense.

Can you suddenly insure a burning home and non-burning homes would remain with their current premium? No. Why? The $50,000 loss, if it in fact it could be insured during a current/present fire, would require the $50,000 loss be spread across the non-burning homes as an increased price. The only way for the non-burning homes to remain with their current premium would be to charge the burning home $50,000 plus the premium associated with a standard exposure unit and claims administration expense.

Moreover, if one’s mantra is “large pool” then one needs to go one step further in insurance theory regarding an expanded definition of insurance. The theory of large numbers aka “large pool” demands the pool be populated by homogeneous exposure units, e.g. vehicles, commercial buildings, health of people, life of people, etc. Once the homogenous exposure unit is identified an average exposure unit is determined with above or below average exposure units existing in comparison to the average unit. The “actuarial study of probability of loss” is applied to average exposure, above average and below average exposure units arriving at price that varies based on the probability of loss.

The homogenous exposure unit is only “homogenous” in a very broad sense. Within the broad swath of homogeneous exists differing risk criteria. For example, regarding the homogeneous exposure unit “commercial building” one might find a commercial building built in 2004 with superior construction, a sprinkler system, central fire and burglar systems. Another homogenous exposure unit within “commercial building” might be a commercial building built in 1978, with no updates since time of construction, of frame construction, with no sprinklers nor central fire and burglar systems.

The two commercial buildings have different probability of loss. Hence price differs to insure. If one’s mantra is “large pool”, then one would want to charge differing rates given the above discussion. However, if one merely figures “large pool” is all one needs, then: Superior construction and the price inherent with such construction, safety measures such as sprinkler systems, central fire and burglar systems and the price inherent with such systems and finally age of construction are all tossed aside.

When one tosses aside differences in probability of loss, then the exposure units have disincentives to lower probability of loss. Further, any prior value associated with reducing the probability of loss is destroyed. One arrives at a price that, in the short-run becomes cross subsided and in the long-run a price exists with zero incentive to lower probability of loss.
  
Returning to the mantra of ACA proponents regarding “large pool” and/or law of large numbers: Is “large pool” an insurance concept -or- is “large pool” a politico collective action concept? Stated alternatively, was an insurance concept/term merely borrowed with no intention of deploying “insurance”? Is the intention to charge the many, for the few with no insurance mechanism intended? Is "insurance" politically-purposely used as a substitute term for "scheme"? Was the greater intention, to camouflage as it were, politico focused benefit/politico dispersed price [scheme], as a happy little insurance plan with a happy little insurance web site?

　

　

Notes:

(1) The Basic Bond Book, second edition, 2001, The Associated General Contractors of America, John J. Curtin Jr., page 1.

Moody’s Downgrades Health Insurers: ACA Major Component of Downgrade

 

“New York, January 23, 2014 -- Moody's changed the outlook for US health insurers to negative from stable, as implementation of the Affordable Care Act (ACA) continues to create uncertainty for the industry, says Moody's Investors Service in its new industry outlook "US Healthcare Insurers: Outlook Changed to Negative from Stable."

The ACA—signed into law in March 2010—seeks to increase affordability of health insurance and expand both public and private insurance coverage through a number of mechanisms including exchanges, mandates and subsidies.

"While we've had industry risks from regulatory changes on our radar for a while, the ongoing unstable and evolving environment is a key factor for our outlook change," said Stephen Zaharuk, a Moody's Senior Vice President and author of the report. "The past few months have seen new regulations and announcements that impose operational changes well after product and pricing decisions were finalized."

Uncertainty over the demographics of those enrolling in individual products through the exchanges is a key factor in Moody's outlook change, says the rating agency. Enrollment statistics show that only 24% of enrollees so far are aged 18-34, a critical group in ensuring that lower claim costs subsidize the higher claim costs of less healthy, older individuals. This is well short of the original 40% target based on the proportion of eligible people in this cohort, says Moody's.” - Moody's: Uncertain healthcare landscape leads to negative outlook for US health insurers, Global Credit Research - 23 Jan 2014, moodys.com



Link to the entire report appears below:

https://www.moodys.com/research/Moodys-Uncertain-healthcare-landscape-leads-to-negative-outlook-for-US--PR_291141


　


　

Aetna CEO: ACA Is Not Attracting Previously Uninsured

‘Aetna CEO Mark Bertolini told CNBC on Wednesday that Obamacare has failed to attract the uninsured, and he offered a scenario in which the insurance company could be forced to pull out of program.

The company will be submitting Obamacare rates for 2015 on May 15.

"Are they going to be double-digit [increases] or are we going to get beat up because they're double-digit or are we just going to have to pull out of the program?" Bertolini asked in a "Squawk Box" interview from the World Economic Forum in Davos, Switzerland. "Those questions can't be answered until we see the population we have today. And we really don't have a good view on that."

He said that so far, Obamacare has just shifted people who were insured in the individual market to the public exchanges where they could get a better deal on a subsidy for coverage. "We see only 11 percent of the population is actually people that were firmly uninsured that are now insured. So [it] didn't really eat into the uninsured population." ‘ - Aetna could be forced out of Obamacare: CEO, CNBC, 01/22/2014

Link to the entire article appears below:

http://www.cnbc.com/id/101354183

Maryland’s Health Exchange: Need Health Insurance? Call the Pottery Hot-Line!

“Critics said Saturday that the latest problem to hit Maryland's online health exchange — an incorrect help-line number that directed hundreds of callers to a Seattle-based pottery business — was another symptom of the poorly operating website.

"You can't make this stuff up, and I guess if it wasn't so serious, it could be funny," said Senate Minority Leader David R. Brinkley, a Frederick County Republican.

The website mistakenly listed a 1-800 number that sent some Marylanders attempting to pick a health insurance provider to Seattle Pottery Supply instead of Maryland's call center. The number appears under the words "State Advantage" and "call a representative." The correct number for help shows up multiple times on the site before the incorrect number appears.

A state spokeswoman said Saturday that she had no update on efforts to fix the problem. Maryland officials were unaware of the problem until contacted Friday by The Baltimore Sun.

"They really just need to get their act together. It's just a continual excuse-making," said Del. Kathy Szeliga, a Baltimore County Republican.” - Critics say wrong number is latest failure of Md. health exchange, Baltimore sun.com, 01/18/2014

Link to the entire article appears below:

http://www.baltimoresun.com/health/bs-md-health-exchange-folo-20140118,0,2367412.story

ACA Penalty/Tax: Study Reveals Even After Factoring The Subsidy It Is Cheaper For Most Young People To Forego ACA Coverage and Pay the Penalty

‘The conservative American Action Forum (AAF) released a study on Tuesday saying that the individual mandate penalty may never be substantial enough an incentive to get young adults to buy into the ObamaCare exchanges.

The study finds that after accounting for cost-sharing and subsidies in 2014, it would still be cheaper for 86 percent of young adults to forgo coverage and to pay the individual mandate instead. That percentage decreases to 71 in 2015, and 62 in 2016, as the individual mandate penalty goes up.

“Even after the mandate penalty is fully implemented, a majority of young adult households will find that it is financially advantageous for them to forgo health insurance, pay the mandate penalty, and personally cover their own health care expenses,” the study says.

While this would leave young adults vulnerable to extremely high medical bills if they endured a catastrophic illness or accident, the study highlights the challenge the Obama administration has in its push to enroll the “young invincible.”’ - Study: Young adults lack incentive to buy ObamaCare coverage, thehill.com, 01/22/2014
Link to the entire article appears below:

http://thehill.com/blogs/healthwatch/health-reform-implementation/196104-study-young-adults-lack-incentive-to-buy#ixzz2r8yBUjBc

Filomena and the ACA: New Expenses or Passing On Expenses?

“FILOMENA BUFFET NOTICE:

As of January, 1, 2014, Filomena has discontinued its Friday Lunch Buffet. We regret we had to make this decision but unfortunately we face new expenses as a result of the Healthcare reform and the Friday Buffet, though wonderful, was not profitable and required extra staff which we can no longer sustain. We regret any inconvenience and on a good note, we will continue our Saturday Buffet and invite you to try our much improved Sunday Brunch Buffet!”

“UPDATE: Filomena responds:

“In response to various inquires regarding our decision to discontinue the Friday Buffet we wish to clarify some information regarding the reasons behind it and offer some facts and hopefully clear up any misunderstandings many seem to have.”

“Filomena employed 85 employees before we stopped the Friday lunch buffet, January 3rd and as of today employee 86 employees and in fact are advertising for some new staff because our making some changes to operations to help pay for the Healthcare Reform by increasing business which has been successful so far.

Even though the Health Care Reform employer mandate of 50 or more employees had to be offered healthcare coverage was postponed one year, Filomena decided to offer that coverage, this year, 2014 and not wait until 2015 as most restaurants have done. We want to offer coverage to our employees but honestly have to find new ways to pay for it since we are so labor intense (close to 90 employees for 150 seat restaurant).

Because of the potentially large new expense of offering healthcare coverage to 90 employees, we had to look for areas of operations that were either marginal or losing money to trim expenses or losses and find new areas to increase business so that we could keep all our employees and continue to grow our business.” - Filomena Restaurant Cuts Lunch Buffet “as a result of the Healthcare reform” UPDATE: Filomena Responds, popville.com, 01/17/2014

　

Link to the entire article appears below:

http://www.popville.com/2014/01/filomena-restaurant-cuts-lunch-buffet-as-a-result-of-the-healthcare-reform/


　

　


　

Grand Valley State University Study: ACA Lead to 1000 Less Jobs and Slower Economic Growth in Western Michigan

Link to Grand Valley State University Final Summary Report, ACA Employer Survey study:

http://gvsu.edu/gvnow/files/ckfinder/userfiles/files/Priority%20Final%20Report%20B2.pdf
 

Obama Claims 6 Million Signed Up for Health Insurance Under ACA. Kessler of The Washington Post Says Don’t Believe It.

‘Don't believe President Barack Obama's claim that 6 million people have signed up for health insurance under the Affordable Care Act, warns Glenn Kessler, author of the influential Fact Checker blog in The Washington Post.

Kessler told "The Steve Malzberg Show" on Newsmax TV that the figure is based on combining a figure of 2.1 million for people who have selected plans on state and federal exchanges, and 3.9 million for Medicaid.’

‘"[It's] somewhat similar to saying you put something in your shopping cart at Amazon and that's what they're counting, all of the things that are in the shopping cart. They don't know how many people actually pushed the button and ordered the item."‘ - WashPo's Fact Checker: Don't Believe 6M People Signed Up for Obamacare, newsmax.com, 01/17/2014

Link to the entire article appears below:

http://www.newsmax.com/NewsmaxTv/obamacare-fact-checker-wrong-numbers/2014/01/17/id/547782?ns_mail_uid=11826812&ns_mail_job=1553651_01182014&promo_code=16447-1

ACA Missing Enrollment and Web Site Data vs. Exchange Information Disclosure Act

“On Monday the Department of Health and Humans Services (HHS) finally released an enrollment report on the Obamacare exchanges that not only listed the number of people who had selected a private plan or enrolled in Medicaid, but also contained data on the age and gender breakdown of enrollment and how many people qualified for a subsidy.

As yet publicly unknown: the number of people who have had difficulty enrolling in coverage, how many enrollees have paid their first premium and how many times HHS has failed to transfer crucial information to insurance companies.

The House of Representatives is set to vote today on H.R. 3362, the “Exchange Information Disclosure Act,” a bill authored by Representative Lee Terry (R-NE) that will help the Obama Administration overcome its extreme reluctance to release information on the exchanges.

H.R. 3362 requires the Administration to release data on the number of unique website visits, the number of individuals who have “created an account” on HealthCare.gov versus those who have actually enrolled in a plan and how many people are actually paying their premiums. It also mandates the release of data regarding how many people have had trouble logging on to HealthCare.gov, enrolling in coverage, or calculating their premium subsidy, and the amount of difficulty HHS has had transferring information on enrollees to insurers. The legislation also requires HHS to release such data on a weekly instead of the current monthly basis.” - It’s Time To Demand The Obamacare Exchanges’ Missing Data, the federalist.com, 01/16/2014

Link to the entire article appears below:


http://thefederalist.com/2014/01/16/its-time-to-demand-the-obamacare-exchanges-missing-data/


　

　


　

ACA/Obamacare: No Risk Based Pricing for Preexisting Conditions. Nay, nay! Think Tobacco.

ACA takes all comers as preexisting conditions have been eliminated. Further no up-charge or risk based pricing occurs for chronic illnesses such as diabetes, heart problems, obesity and an endless list of other maladies. Many chronic conditions have current and on going expensive health-care resources devoted to their maintenance however no allowance in the form of risk-based pricing is applied.

What about tobacco use? Tobacco use is not a preexisting condition in the sense it is excluded. However it is the lone condition, a condition that preexists, that is charged an up-rate and is risk based priced. Why only tobacco? Why not up-rate and risk based pricing for the other maladies that have current and on going expensive health-care resources devoted to their maintenance?

Next comes the socio-economic aspect of tobacco users. Tobacco users are skewed to the lower end of the socio-economic spectrum. Is not ACA/Obamacare, the “intention” thereof, to provide affordable coverage for the lower end of the socio-economic spectrum?

Up-charge and risk based pricing theory aside, tobacco users, when entering the ACA/Obamacare marketplace web sites can not receive their prospective insurance quote. How so? On the “Get plan information in your area” quoting screen page within the marketplace web site, in the lower right hand corner, in the fine print, the pricing screen reads:

“The prices you’ll see are for people that don’t use tobacco. You’ll get final quotes after you complete a Marketplace application.”

Some tacit and local knowledge may shed some insight:

(1) tobacco users, as well as other potential buyers, race through the screens without reading the fine print, obtain a quote, then begin the application to find a much higher quote,

(2) the differences in opening quote viewed and application quote offered becomes a discrepancy the tobacco user has to reconcile,

(3) the higher quote is due to the up-charge for tobacco use, yet one must back track and read closely that implicitly the tobacco user will pay more and that the web site user will obtain “a final quotes after you complete a Marketplace application” in relation to tobacco use. There is no explicit discussion easily accessible to the tobacco user of the mechanics of their particular pricing/quote,

(4) however, the mechanics are that any tax credit [taxpayer subsidy] associated with the original quote remains constant and no such credit is modified or expanded due to the higher premium of a tobacco user as no tax credit [subsidy] is afforded to the up-charge for tobacco use.

The tobacco user then becomes dismayed at the price, ends the application process then begins to call the marketplace or others to find out why the premium discrepancy exists between the original quote found on the “Get plan information in your area” and the quote within the application process.

Once the applicant obtains the knowledge about the up-rate and the up-rate not being subsidized, many such applicants deem the premium unaffordable and hence the application remains pended and unfinished with no final application nor submission for coverage forthcoming.

Which raises a question: Why is the ACA/Obamacare marketplace web site not transparent in its pricing? Why not publish non-tobacco and tobacco quotes so all shoppers can see price from the very beginning? Private insurers have been publishing both rates for years on their web sites and continue to publish both rates (private exchanges aka off-exchange) from the very beginning of the price/quote process.

　

　

　

Jimmy Kimmel on the ACA: Next Time Pick Up a Newspaper

ACA/Obamacare Demographics Released: Ages 55 - 64 Make Up Largest Segment.

“WASHINGTON – Insurers have raised concerns that too few young people are signing up for heath insurance through the ObamaCare exchanges after newly released statistics showed that less than a quarter of people who have enrolled are between the ages of 18 and 34.

According to the numbers released Monday by the U.S. Department of Health and Human Services, only 24 percent – or 489,460 – of the 2.2 million people who signed up for ACA were in the coveted 18-to-34 age range. That means the government has hit only 18 percent of its stated goal of registering 2.7 million adults in the 18-to-34 age range.

Experts have predicted that the program will need roughly 40 percent of enrollees to be in that prime demographic in order to be fiscally solvent. Adults ages 55 to 64 made up 33 percent of the total number of Americans who signed up, the largest group represented in the data.” - Insurers raise cost concerns after ObamaCare demographic data released, foxnews.com, 01/14/2014

Link to the entire article appears below:

http://www.foxnews.com/politics/2014/01/14/numbers-key-obamacare-demographic-group-come-in-well-below-estimates/

ACA/Obamacare,Health Insurance, and Health-Care Price Explained in One Lesson

H/T Carpe Diem

ACA Statistics and the Reported Medicaid “Eligible”

“Federal health officials announced on Wednesday that some 1.2 million people selected plans on federal or state exchanges during the months of October and November. That included 803,000 people who applied to the exchanges and were found eligible for Medicaid or a related Children’s Health Insurance Program that provide public insurance for the poor — in addition to nearly 365,000 people who chose private plans.” - Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013 (1)

　

The above is merely an example of a reference to the amount of people applying for Obamacare yet are found to be Medicaid eligible. Further, the above excerpt is somewhat correct in that: “…were found eligible for Medicaid or a related Children’s Health Insurance Program…”. That is, they were not enrolled in Medicaid, they where merely found eligible. Then again, many found “eligible” are not. Moreover, the term “eligible” is a bit misleading as the term “identified” is the correct term. (2)

Many news stories seem to implicitly assume ACA web sites determine eligibility for enrollment into Medicaid and/or the reader comes away with the impression that Medicaid enrollment is spiking. That is likely not the case. How so?

If one goes onto the Obamacare exchange aka “market place” one might very well be identified as eligible for Medicaid. The key is “identified”. The marketplace/exchange has no ability or authority to enroll those identified into any Medicaid plan. The process is to “identify” individuals that appear to be eligible then send contact information to the state of residence of such individual, specifically to the state Medicaid Department, of those identified, to determine eligibility for Medicaid.

If one lives in the states that did not expand Medicaid, via the Supreme Court ruling in their favor, then a narrative appears on the exchange web site stating your state did not expand Medicaid. Hence the number of Medicaid identified ("eligible") one sees in a news reports should be in the states that expanded Medicaid under Obamacare. (3) (4) (5)

Next one needs to consider “identified” vs. “eligible” are worlds apart. One would need to go through the eligibility paperwork [bureaucratic forms of confusing nature] and the application reconciled, reviewed, etc. by the bureaucracy. Stated alternatively, the “identified” becoming “eligible” is a long arduous process.

One must also consider the logistics of haggard state Medicaid Departments having the time to make outgoing contact with the “identified”. Such departments already have case loads and the time available to follow up is surely at a premium. Even then, is the contact follow up information correct?

Next comes the historical percentage of Medicaid eligible that actually follow through and apply for Medicaid. The national historical average of those eligible for Medicaid that actually apply for Medicaid is 61.9%. (6)

One should consider that any number of “eligible” Medicaid recipients in a news story is really the “identified” and the number reported should be discounted heavily given the “identified” vs. “eligible," the “identified” being determined eligible and the process thereof and finally the historical percentage that actually apply vs. eligible.

　


Notes:



(1) Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013.

http://www.nytimes.com/2013/12/16/opinion/medicaid-outpaces-private-plans.html?_r=0


(2) Brokers are reporting that some of their clients are in insurance limbo as they wait for the error to be corrected by HHS or their states, USA Today, 12/09/2013

http://www.usatoday.com/story/news/nation/2013/12/08/healthcaregov-medicaid-eligibility-questions/3871113/


(3) After Supreme Court ruling, Medicaid expansion faces uncertainty, Christian Science Monitor, 01/29/2013

http://www.csmonitor.com/USA/Politics/2012/0629/After-Supreme-Court-ruling-Medicaid-expansion-faces-uncertainty


　

(4) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012



http://www.forbes.com/sites/aroy/2012/07/13/why-states-have-a-huge-fiscal-incentive-to-opt-out-of-obamacares-medicaid-expansion/




(5) Why States Are So Miffed about Medicaid — Economics, Politics, and the “Woodwork Effect”, Benjamin D. Sommers, M.D., Ph.D., and Arnold M. Epstein, M.D., N Engl J Med 2011; 365:100-102 July 14, 2011 DOI: 10.1056/NEJMp1104948



http://www.nejm.org/doi/full/10.1056/NEJMp1104948


(6) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012



http://www.forbes.com/sites/aroy/2012/07/13/why-states-have-a-huge-fiscal-incentive-to-opt-out-of-obamacares-medicaid-expansion/

What Percentage of Obamacare Applicants Have Paid Their Initial Premium? Answer: 50%.

"The other challenge now is getting people to pay for coverage. I was surprised today calling around to people to find only about 50 percent have paid. That’s not a reason to panic yet. The due dates for payment have been sliding all around, so people can be confused. But it can be a mess. Some insurers are doing autocalls like politicians do the night before the election asking people to pay."- A health industry expert on ‘the fundamental problem with Obamacare', Washingtonpost.com, 01/09/2014

Link to the entire article appears below:

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/09/a-health-industry-expert-on-the-fundamental-problem-with-obamacare/

Colorado Obamacare Cancellations: When 249,000 Is Politically Inconvenient

‘At the height of controversy surrounding President Obama’s promises on the federal health care overhaul, U.S. Senator Mark Udall’s office worked assiduously to revise press accounts that 249,000 Coloradans received health care cancellation notices. Because the 249,000 figure was produced inside the Colorado Division of Insurance, Udall’s office lobbied that agency to revise the figure, or revise their definition of what qualified as a cancellation.’

‘Worth noting is the fact the original media reports of 249,000 cancellations in the state happened on or about November 6. The dispute between Udall’s office and the Department of Insurance didn’t happen more than a week later on November 14. Specifically, the issue didn’t appear to rise to importance for the Udall office until President Obama decreed citizens could keep cancelled plans.

At the time of President Obama’s decree on November 13, Senator Udall was proposing legislation that would have created a legal framework whereby citizens with cancelled plans could keep said plans for an additional two years.

In yet another email, Udall staffer Joe Britton gives away the extent to which Udall’s office was seeking complicit messaging from the Division of Insurance. ”We need to move on this ASAP – or we’ll be forced to challenge the 249K number ourselves. It is wildly off or at least very misleading and reporters keep repeating it.” Eventually, Udall’s office did take the task upon themselves, successfully garnering a telling of their story in The Denver Post with an online publishing timestamped 4:57 PM MST, November 15. Donlin later alerted several of her colleagues in the Division of Insurance about the online story, saying, “Here’s a link to [Denver Post reporter] Mike Booth’s latest article quoting ‘Sen. Udall staff.’ The online comments are very interesting.”’ - Udall’s office pushed back hard on number of health care cancellations, completecolorado.com, 01/09/2014

Link to the entire article appears below:

http://completecolorado.com/pagetwo/2014/01/09/udalls-office-pushed-back-hard-on-number-of-health-care-cancellations/

Obamacare "Subsidy Cliffs" and Other Disincentives

Abstract


Contrary to claims that Obamacare is compassionate, the new health care law further entrenches a superstructure that penalizes work and encourages dependence for a wide swathe of Americans. Obamacare also penalizes marriage, places citizens at a disadvantage compared with non-citizens, and prioritizes coverage for able-bodied adults over services and supports for the disabled. To restore the values of hard work that Americans have held dear for centuries, Congress should stop and repeal all of Obamacare.

An excerpt:

"Obamacare’s formulae for allocating federal premium and cost-sharing subsidies include several “cliffs.” At these cliffs, individuals and families will actually benefit more by working less because additional earnings could cause them to lose thousands of dollars in taxpayer-funded subsidies.
 
For example, Obamacare subsidizes insurance premiums for individuals with incomes of up to 400 percent of the federal poverty level (FPL), which is just over $62,000 for a couple in 2013. According to the Kaiser Family Foundation’s subsidy calculator, a married couple, each 50 years old, making a combined $60,000 per year would receive a taxpayer-funded insurance subsidy of up to $5,081. The couple would qualify for this subsidy because their combined income would be just below 400 percent of the FPL. However, if the couple earned an additional $2,500—raising their income just above 400 percent of the FPL—they would receive no subsidy at all. Even though they receive $2,500 more in cash compensation, the couple would actually be worse off financially because they would lose more than $5,000 in federal insurance subsidies.
 
Similar cliffs occur elsewhere in Obamacare’s subsidy structure. As income approaches 400 percent of the FPL, the percentage of income that households are expected to devote to insurance premiums rises, and the premium subsidies under Section 1401 fall. Individuals with rising income also face the loss of federal cost-sharing subsidies established under Section 1402 of the law, which reduce out-of-pocket expenses including co-payments and deductibles. These effects are particularly acute at certain cliffs established in the statute—for instance, 150 percent, 200 percent, and 250 percent of the FPL—but they also pervade the entire subsidy structure. Overall, University of Chicago economist Casey Mulligan has concluded that Obamacare will help raise effective marginal tax rates by more than 10 percentage points." - How Obamacare Undermines American Values: Penalizing Work, Marriage, Citizenship, and the Disabled, Chris Jacobs


Link to the paper appears below:

http://www.heritage.org/research/reports/2013/11/how-obamacare-undermines-american-values-penalizing-work-marriage-citizenship-and-the-disabled

Which Is Less Expensive with a Broader Provider Network: Obamacare or the Much Vilified Wal-Mart Employee Health Plan? Answer: Wal-Mart!

“New Obamacare health insurance enrollees may feel a pang of envy when they eye the coverage plans offered by Walmart to its employees.

For many years, the giant discount retailer has been the target of unions and liberal activists who have harshly criticized the company's health care plans, calling them “notorious for failing to provide health benefits” and "substandard.”

"But a Washington Examiner comparison of the two health insurance programs found that Walmart's plan is more affordable and provides significantly better access to high-quality medical care than Obamacare.”

For a monthly premium as low as roughly $40, an individual who is a Walmart HRA plan enrollee can obtain full-service coverage through a Blue Cross Blue Shield preferred provider organization. A family can get coverage for about $160 per month.

Unlike Obamacare, there are no income eligibility requirements. Age and gender do not alter premium rates. The company plan is the same for all of Walmart's 1.1 million enrolled employees and their dependents, from its cashiers to its CEO.

A Journal of the American Medical Association analysis from September showed that unsubsidized Obamacare enrollees will face monthly premiums that are five to nine times higher than Walmart premiums.

JAMA found the unsubsidized premium for a nonsmoking gouple age 60 can cost $1,365 per month versus the Walmart cost of about $134 for the same couple.

The medical journal reported a 30-year-old smoker would pay up to $428 per month, in contrast to roughly $70 each month for a Walmart employee.

A family of four could pay a $962 premium, but the same Walmart family member would pay about $160.

Low premiums are not the only distinguishing feature of the Walmart plan. The retailer's employees can use eight of the country's most prestigious medical facilities, including the Mayo Clinic, Pennsylvania's Geisinger Medical Center and the Cleveland Clinic.” - Surprise! Walmart health plan is cheaper, offers more coverage than Obamacare, Washingtonexaminer.com, 01/07/2013

Link to the entire article appears below:

http://washingtonexaminer.com/surprise-walmart-health-plan-is-cheaper-offers-more-coverage-than-obamacare/article/2541670?utm_campaign=Fox News&utm_source=foxnews.com&utm_medium=feed


　

　

　

　

　


　

Senator Ron Johnson to Sue the Obama Administration Over Lawmakers and Staffers Obamacare Subsidies.

"Sen. Ron Johnson (R-Wis.) is planning to sue the Obama administration over the federal contributions that lawmakers and their staffs get for health insurance

A provision in the Affordable Care Act forces lawmakers and aides to buy insurance plans created by the healthcare law or sold on ObamaCare exchanges.

The Office of Personnel Management (OPM) said last year that the federal government would continue to help members of Congress and staffers offset the costs of those plans, as the government does for other federal employees.

But Republicans like Johnson say that policy gives lawmakers and congressional aides special treatment unavailable to others who have to seek insurance on ObamaCare exchanges.

Johnson said last week that he believes the OPM rule broke the law, and that he thinks the lawsuit can help rein in what he sees as a pattern of executive overreach from President Obama.

“The American people have an expectation — Wisconsinites have an expectation — that members of Congress should be subjected to the letter of the law just like they’re held to the letter of the law,” Johnson said, according to the Oshkosh Northwestern." - Johnson to sue over O-Care contributions, the hill.com. 01/05/2013

Link to the entire article appears below:

http://thehill.com/blogs/healthwatch/health-reform-implementation/194450-ron-johnson-to-sue-over-obamacare


Updated 01/09/2013. No Washington Exemption, a petition web site, a project of Independent Women's Voice.

http://nowashingtonexemption.com/

And About That Healthcare.gov Contractor Screening Process…..

‘Amid the holiday season craziness, The Washington Post published an in-depth account of how a subsidiary of Canadian IT giant CGI Group won the contract to lead the design and testing of the HealthCare.gov website.

The article debunked rumors that cronyism motivated the Centers for Medicare and Medicaid Services’ (CMS) September 2011 decision to award CGI Federal the $93.7 million contract. Instead, the Post found that the main culprit was CMS, which by its own admission “dropped the ball” on evaluating the company’s background.

Specifically, what CMS contracting officials overlooked and/or downplayed was that more than 100 of CGI’s employees came from Virginia-based IT company American Management Systems (AMS), which CGI acquired in 2004. According to the Post, AMS had mishandled at least 20 government IT projects, including one particularly well-publicized fiasco involving the Federal Retirement Thrift Investment Board’s $36 million overhaul of its recordkeeping system.

AMS’s questionable past performance on government contracts should have set off alarms in 2007, when CMS awarded CGI and 15 other companies an umbrella contract allowing them to bid on future CMS projects. In fact, a former CMS official told the Post that AMS’s track record “could well have knocked [CGI Federal] out of the competition, and probably should have.”’

‘The part of the Post story that really rankled the Project On Government Oversight is contained in this passage:

While it is unclear whether agency officials examined the AMS track record, former CMS officials said it probably would not have made much difference, because past performance has long been an overlooked component of federal contracting.’

- HealthCare.gov Debacle Reveals Flaws in Contractor Screening, pogo.org, 01/03/2013

Link to the entire article appears below:

http://www.pogo.org/blog/2014/01/healthcaregov-debacle-revelas-flaws-in-contractor-screening.html



　

H/T: Crony Chronicles

Obamacare: Study Reveals Two-Thirds of Hospital Networks Offered Are Narrow or Ultra-Narrow

“To keep premium prices down for individuals and small businesses buying coverage through new online marketplaces, insurers have created smaller networks of hospitals. But consumers and policy experts have wondered, just how small?

Turns out, many are very small.

“About two-thirds of hospital networks on the exchanges are narrow or ultra-narrow,” said Paul Mango, a director at the consulting firm McKinsey & Co., at a conference of insurance industry leaders in Washington Thursday.


Based on research he says it took his team weeks to develop, Mango said the majority of the lowest-priced insurance plans sold through the new online marketplaces use very small networks of hospitals. The study did not evaluate doctor participation in those networks.

The issue of whether doctors or hospitals are in a network is often of utmost importance to consumers choosing an insurance policy. But prices also are important.

Mango said his research looked at 20 urban areas representing about 25 percent of the uninsured. To develop a definition of broad or narrow, McKinsey identified the biggest 20 hospitals by their number of beds. Insurance plan networks with 15 or more big hospitals were tagged as broad networks. Those with 7 to 14 were considered narrow, and those with 6 or fewer of the top 20 were considered ultra-narrow.” - Marketplace Plans’ Networks Are Very Small, Study Finds. Kaiser Health News, 12/12/2013

　

Link to the entire article appears below:

http://capsules.kaiserhealthnews.org/index.php/2013/12/marketplace-plans-networks-are-very-small-study-finds/?referrer=search