Thursday, May 29, 2014

ACA/Obamacare: Nevada Closes Exchange, Total Price Tag for Exchanges Now Stands at $4.9 Billion

‘Nevada has become the latest state to announce it will concede Obamacare exchange enrollment responsibilities to the federal government via’

‘Nevada received $91 million in grants and, as of April 19, had enrolled 45,390 people, for a federal taxpayer cost of $2,005 per enrollee. Cover Oregon, the exchange that was never able to successfully enroll one person online from start to finish, got $305 million in federal grants and had 68,308 enrollees, so its cost was about $4,465 per enrollee. Massachusetts’s per-enrollee cost was $5,648. Hawaii received $205 million in grant money and enrolled only 8,592 people, for an astonishing per-enrollee cost of $23,859.

Worse yet, in Nevada, the federal government is now spending even more money to transition their exchange to the federal exchange.

According to Nevada’s announcement:

“The federal government will pay all costs associated with transitioning from the BOS [Xerox’s health insurance enrollment system] to Nevada will not be required to pay a monthly per -member per-month fee to for its use. The federal government will pay 90 percent of any costs incurred to disconnect Nevada’s Medicaid system from the BOS and to connect Nevada’s Medicaid system to The initial high estimates of this cost ranges between $15 – $20 million, of which Nevada must pay 10 percent.”- Nevada Gives Up on $91 Million Obamacare Exchange,, 05/28/2014

Link to the entire article appears below:








Sunday, May 25, 2014

ACA/Obamacare: Renewal Premium Announcement Dates State-by-State

“States are nailing down dates to release 2015 premium costs under ObamaCare, and their decisions will guarantee a drumbeat of news about rate hikes all the way to the November midterm elections.

Democrats are bracing for grim headlines that could put the unpopular law back at the forefront of voters’ minds.

Premiums are expected to go up in a majority of states, as they do every year, but the size of the increases could go a long way toward determining how much political damage ObamaCare inflicts on vulnerable Democratic lawmakers.

A survey by The Hill of state insurance commissioners found that news about ObamaCare premiums will hit nearly every week this summer (see list below), providing ample opportunity for Republicans to attack any significant premium hikes.”


The following is a list of responses from states on when they plan to release insurance premium rates. Dates are subject to change. Sixteen states did not respond or did not specify a date.


Montana (May 27 or later)

Maine (May 30)

Connecticut (May 31)

Ohio (by May 31)


Rhode Island

Kansas (June 1 and available via records request)

North Dakota (June 6)

Michigan (June 9)

Delaware (June 13)

South Dakota (June 15)

Louisiana (June 27)

Florida (end of the month, or early August)

Nevada (Aug. 1)

Nebraska (mid-month)

Wisconsin (late in the month)

Massachusetts (Aug. 15)

North Carolina (no earlier than Aug. 15)


West Virginia (available via records request)

Arkansas (Sept. 10)

New Jersey (Nov. 15)

January 2015
New Hampshire (Jan. 1)

Will not release rates




No response,
or no month given









New Mexico

New York




South Carolina

Texas (will release rates that rise by more than 10 percent via public records request, no month or date given)


Already released,
in full or in part






Washington” - Premium hike drumbeat before elections, The Hill, 05/22/2014

Link to the entire article appears below:

Wednesday, May 21, 2014

ACA/Obamacare: The First Day of Full Operation of Exactly One Enrollment Was Processed. No Way! Way!

“(Washington, DC) – Judicial Watch today released a 106-page document obtained on May 1 from the U.S. Department of Health and Human Services (HHS), revealing that on its first full day of operation, October 1, 2013, Obamacare’s received only one enrollment. The document, obtained in response to a November 25, 2013, Freedom of Information Act (FOIA) lawsuit against HHS, also reveals that on the second day of operation, 48% of registrations failed (Judicial Watch v. U.S. Department of Health and Human Services (No. 1:13-cv-01855)).

The FOIA lawsuit was filed after HHS failed to respond to an October 7, 2013, Judicial Watch FOIA request seeking the following information:

Any and all records concerning, regarding, or related to the number of individuals that purchased health insurance through between October 1, 2013, and October 4, 2013.

The Affordable Health Care Act website, which officially launched on the Tuesday, October 1, immediately encountered substantial problems typical of those reported by the Chicago Tribune: “Consumers seeking more information on their new options under the Affordable Care Act were met with long delays, error messages and a largely non-working federal insurance exchange and call center Tuesday morning.” Pressed for an explanation in a conference call with reporters Tuesday afternoon, Marilyn Tavenner, head of the HHS Centers for Medicare and Medicaid Services, refused to disclose the number of people who had purchased insurance through the site saying, “We have just decided not to release that yet.”

The full extent of the failure, however, is reflected in the details provided by the Judicial Watch FOIA document revelations. They include:

*On October 1, there were 43,208 accounts created and 1 enrollment.

*As of October 31, 2013, there were 1,319,425 accounts created nationwide – but only 30,512 actual enrollments in Obamacare.

*On October 1, 2013, at the end of the first day (4:30), the Senior Advisor at Center forConsumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Brigid M. Russell, sent out an email to her staff with a subject line celebrating “2 enrollments!” The body copy of the email read: “We have our second official FFM enrollment! The first two Form 834s sent out are to: 1) CareSource in Ohio, 2) BCBS of North Carolina.

*Official figures contained in the HHS report provide conflicting figures as to the number of enrollments. FFM [Federally Facilitated Marketplace] statistics show 23,259 cumulative to-date applications submitted as of 10/2/13 and 286 completed plan selections. Earlier numbers show 356 enrollments created as of 7pm on 10/2/13 that were completed with Form 834s sent.

*An October 2, 2013, email from HHS Special Assistant Marianne Bowen indicated serious problems with congressional enrollments: “The Congressional issue (68 attempts for Direct enrollment) was an issue stemming from incomplete applications being sent through (started, not finished, sent anyway) and the way the issuers are assigning unique numbers. Turns out there were only 4 complete Direct Enrollment applications that went through, the other 64 were not complete.” [The U.S. Congress has approximately 24,000 professional staffers.]

*On October 2, 2013, the Obamacare website had 70 million page views but only 5 million were unique visitors, and 48% of registrations failed. The large number of page views may have been the result of visitors repeatedly hitting the “refresh” button due to long waiting times.” - Judicial Watch Obtains 106-Page HHS Document Revealing Scope of Obamacare Rollout Disaster, Judicial Watch, 05/19/2014

Link to entire press release appears below:





Saturday, May 17, 2014

ACA/Obamacare: Math Quest Subsidies

“The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.

The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show.

The government has identified these discrepancies but is stuck at the moment. Under federal rules, consumers are notified if there is a problem with their application and asked to upload or mail in pay stubs or other proof of their income. Only a fraction have done so, according to the documents. And, even when they have, the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.

So piles of unprocessed “proof” documents are sitting in a federal contractor’s Kentucky office, and the government continues to pay insurance subsidies that may be too generous or too meager. Administration officials do not yet know what proportion are overpayments or underpayments. Under current rules, people receiving unwarranted subsidies will be required to return the excess next year.

The inability to make certain the government is paying correct subsidies is a legacy of computer troubles that crippled last fall’s launch of and the initial months of the first sign-up period for insurance under the Affordable Care Act. Federal officials and contractors raced to correct most of the technical problems hindering consumers’ ability to choose a health plan. But behind the scenes, important aspects of the Web site remain defective — or simply unfinished.”

“Because the computer capability does not yet exist, the work will start by hand, according to two people familiar with the plans. It will focus at first not on income questions, but on another roughly 1 million cases in which people enrolled — or tried to enroll — in health plans and ran into questions about their citizenship status. Throughout the sign-up period that ended earlier this spring , flaws in blocked many naturalized citizens or permanent legal residents, requiring them to submit immigration documents that are, like the income information, caught in a backlog.

The work of sorting out inaccurate incomes — and inaccurate subsidies, as a result — will likely begin sometime this summer, two individuals familiar with the plans said.”

“Of the various technical problems that remain with, the difficulty in straightening out discrepancies affects an especially large number of consumers. Of the roughly 8 million Americans who signed up for coverage this year under the health-care law, about 5.5 million are in the federal insurance exchange. And according to the internal documents, more than half of them — about 3 million people — have an application containing at least one kind of inconsistency. These inconsistencies have arisen as the information listed on their applications has been cross-checked, via a newly built federal data hub, with the Social Security Administration and other federal agencies, as well as incarceration, IRS and immigration records.

The income information is significant because the government for the first time is providing subsidies to help working-class and middle-class Americans buy private health plans. Under the federal rules, an application is “flagged” for special checking if the income someone says that they expect this year is at least 10 percent above or below the most recent income in their IRS tax returns.”

“The federal rules say that consumers have 90 days after applying to try to prove that their information is correct and, if an inconsistency is not resolved by then, whatever the federal records show is assumed to be correct. By now, about one-third of people with inconsistencies have passed their 90-day window. But because of the trouble verifying incomes, the government has not lowered or raised anyone’s subsidies.

Making sure that incomes — and subsidies — were accurate became a prominent issue during budget negotiations last year, as House and Senate Republican opponents of the health-care law warned of potential fraud. Health and Human Services Secretary Kathleen Sebelius promised to thoroughly vet the salary information that people submitted as part of their health insurance applications.” - Federal health-care subsidies may be too high or too low for more than 1 million Americans, Washington Post, 05/16/2014

Upon further review, consider for a moment and the segue to the pricing page. The questions asked on the website, just prior to finding pricing is: “What is your household's expected income for 2014?” If one asks a question about "expected" income, one might find some interesting answers.

Link to the entire Washington Post article appears below:

Update 05/21/2014: Yes, Some People Will Have to Pay Back Their Obamacare Subsidies,




Wednesday, May 14, 2014

VA Hospitals Appointment Wait Times: 14 Days is 14 Days Except When It Isn’t 14 Days.

'A Veterans Affairs employee at the VA Medical Center in Cheyenne, Wyoming, has been placed on administrative leave after CBS News obtained an email showing an employee directing his staff on how to game the appointments system to make it appear as though veterans were being seen within the VA's 14-day directive.

The email, written by Telehealth Coordinator David Newman, a registered nurse, describes how patients at the Cheyenne VA Medical Center are always listed getting appointments within a 14-day window, no matter when the appointment was first requested, and no matter how long the patient actually waited.

The memo admitted, "Yes, this is gaming the system a bit..." because "when we exceed the 14 day measure, the front office gets very upset, which doesn't help us."

The employee further instructs staff on how to "get off the bad boys list" by "cancelling the visit (by clinic) and then rescheduling it with a desired date within that 14 day window."' - Email reveals deliberate effort by VA hospital to hide long patient waits, CBS News, 05/09/201

Link to entire story appears below:



Monday, May 12, 2014

ACA/Obamacare: The Rise and Fall of State-Based Obamacare Web Sites ($474 Million Loss and Counting)

“Nearly half a billion dollars in federal money has been spent developing four state Obamacare exchanges that are now in shambles — and the final price tag for salvaging them may go sharply higher.

Each of the states — Massachusetts, Oregon, Nevada and Maryland — embraced Obamacare, and each underperformed. All have come under scathing criticism and now face months of uncertainty as they rush to rebuild their systems or transition to the federal exchange.

The federal government is caught between writing still more exorbitant checks to give them a second chance at creating viable exchanges of their own or, for a lesser although not inexpensive sum, adding still more states to The federal system is already serving 36 states, far more than originally anticipated.”

“The $474 million spent by these four states includes the cost that officials have publicly detailed to date. It climbs further if states like Minnesota and Hawaii, which have suffered similarly dysfunctional exchanges, are added.

Their totals are just a fraction of the $4.698 billion that the nonpartisan Kaiser Family Foundation calculates the federal government has approved for states since 2011 to help them determine whether to create their own exchanges and to assist in doing so. Still, the amount of money that now appears wasted is prompting calls for far greater accountability.” - $474M for 4 failed Obamacare exchanges, Politico, 05/11/2014

Link to the entire article appears below:


Friday, May 9, 2014

ACA/Obamacare and the Twin Subsidy “Silver” Plan

“May 02--Some 8 million people, including 151,352 Tennesseans, have enrolled in insurance plans through the Affordable Care Act marketplace, the government said Thursday.

That's just shy of half of the 305,628 Tennesseans the U.S. Department of Health and Human Services determined are eligible to enroll -- 169,740 of them with financial assistance

As in the U.S. overall, females made up slightly more than half of Tennessee enrollees, 55 percent. All but 20 percent of Tennesseans who enrolled were eligible for financial assistance to pay for their insurance plans. Most enrollees -- 72 percent -- opted for the midlevel "silver" coverage, with 18 percent getting a more basic "bronze" plan, and 6 percent and 3 percent, respectively, buying "gold" and "platinum" plans. One percent of Tennesseans chose catastrophic coverage available to certain people.” (1)

Upon further review, one needs to take note of the trend/pattern regarding the inordinate percentage applying for the “silver” coverage. The silver plan affords twin subsidies for those eligible. Twin subsidies? How so?

Depending upon income, number of proposed insured(s) applying regarding the policy, ages of the proposed insured and dependents in the household one can receive a taxpayer subsidy against total premium and a reduction in major medical deductible, reduction in the maximum out-of-pocket under major medical co-insurance and a reduction in doctor office co-pay.

The “silver” plan, via word of mouth, became very, very popular among ACA/Obamacare applicants. Stated alternatively, at the point sale, applicants had already predetermined “silver” as their plan choice by word of mouth referral from prior applicants. Applicants were well aware of the possibility of the twin subsidy regarding the “silver plan” and were seeking the twin subsidy.


(1) ACA enrollment ends with 151,000 Tennesseans signed up, 05/01/2014,


Tuesday, May 6, 2014

Another ACA Web Site Bites the Dust: Massachusetts Scraps ACA Site. Price? $100 Million!

“Massachusetts plans to scrap the state’s dysfunctional online health insurance website, after deciding it would be too expensive and time-consuming to fix, and replace it with a system used by several other states to enroll residents in plans.

Simultaneously, the state is preparing to temporarily join the federal insurance marketplace in case the replacement system is not ready by the fall.

The strategy announced Monday will still cost an estimated $100 million, and it creates many uncertainties, especially for insurance companies and consumers. Some customers might eventually need to change insurance plans.” - Mass. scrapping flawed health insurance website. Next steps have uncertainties for users, insurers -, 05/05/2014

Link to the entire article appears below:

Saturday, May 3, 2014

ACA/Obamacare: Then Comes The Regulations and Regulators

“In my 23 years as a practicing physician, I've learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.”

“So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?

The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are "meaningful use" criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?”

“I don't know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?” - A Doctor's Declaration of Independence, It's time to defy health-care mandates issued by bureaucrats not in the healing profession, WSJ, 04/28/2014

Link to entire article appears below: