Tuesday, October 27, 2015

ACA/Obamacare: Number Nine Shuttered….The Incredible Shrinking Co-Op Offerings

'A South Carolina health insurer has become the ninth insurance cooperative formed nationwide under the Affordable Care Act to fold.

Consumers' Choice Health Insurance Co. said Thursday that it will not sell policies in 2016, a decision that will leave 67,000 individuals and business customers looking for new coverage.

Ray Farmer, director of the South Carolina Department of Insurance, said Consumers' Choice and state regulators reached a mutual decision to shut down the company's business. He said the company was in a "financially hazardous condition."

"I did not have the confidence that this company would be a viable entity throughout the entire year of 2016," Farmer said.”' - Ninth cooperative formed under Affordable Care Act closing, AP, 10/22/2015

Link to the entire article appears below:


Saturday, October 24, 2015

ACA/Obamacare: Drug Companies, Drug Prices and Generic to Over-the-Counter

What if the politico mantra of vilification of drug prices ends as no more than standard political dupery and nitwitery? How so?

"Several of these middle-class tax changes impact tax-free accounts called Health Savings Accounts and Flexible Spending Accounts. Prior to the Affordable Care Act, Americans could use HSAs or FSAs to pay for over-the-counter drugs tax-free. The ACA
prohibits the use of these accounts for over-the-counter drugs, which is effectively a tax increase." - Obamacare: Proof That Democrats Will Tax the Middle Class, Hadley Heath, 10/16/2015 (1)

Heath is correct. However she is entering the argument in the middle. How so? Ponder the following:

(1) although the development of new drugs is full of dead ends and a highly expensive endeavor, particular politicos and their ilk vilify drug makers,

(1a) the vilification side steps the high price tag regarding drug development and merely concentrates on the "high price" as a debate point,

(2) the politico manta associated with #1 and #1a above leads to an argument string wanting drugs to quickly go generic as the price will be lower and hence fits well into the debate line of particular politicos vilifying drug makers,

(3) to mitigate the trumpeted "high prices" legislation is enacted regarding flexible spending accounts and health savings accounts (tax qualified and tax free vehicles that can be used to buy drugs among other health-care purchases to reduce price to the consumer),

(4) from time to time, not always, an initially full price prescription drug runs the gambit in that it goes generic and finally becomes an over-the-counter offering e.g. Zantac, Mylanta, Claritin,

(4a) when a once prescription drug, vilified as too high in price, runs the gambit to over-the-counter, the price has been reduced to its lowest level which one would perceive to be to the liking of, and hence the ultimate rosy outcome of, those debaters making "high price" as a debate point/argument point,

(5) Nay, nay! Now that the price has fallen to its lowest point (over-the-counter) those riding the charging stallion of "high price" and dispensing their beneficence far and wide.....deploy political dupery and nitwitery and raise the price of the now lowest price point by withdrawing the tax qualified and tax free vehicles in relation to over-the-counter purchases.
Hence the "price is too high" mantra regarding drugs is only too high when its not too low. Pure political dupery and nitwitery. Sweet!

Thursday, October 22, 2015

ACA/Obamacare: Your New “Penalty” aka “Tax” for 2016 -Or- When the Carrot Becomes the Stick

‘The math is harsh: The federal penalty for having no health insurance is set to jump to $695, and the Obama administration is being urged to highlight that cold fact to help drive its new pitch for health law sign-ups.

That means the 2016 sign-up season starting Nov. 1 could see penalties become a bigger focus to motivate millions of people who have remained eligible for coverage, but uninsured. They're said to be more skeptical about the value of health insurance.

Until now, health overhaul supporters have stressed the benefits of getting covered: taxpayer subsidies that pay roughly 70 percent of the monthly premium, financial protection against sudden illness or an accident, and access to regular preventive and follow-up medical care.

But in 2016, the penalty for being uninsured will rise to the greater of either — $695 or 2.5 percent of taxable income — for someone who goes without coverage for a full 12 months. This year the comparable numbers are $325 or 2 percent of income. While the increase isn't good news, it does create a marketing opportunity.

The numbers are pretty clear. With subsidized customers now putting in an average of about $100 a month of their own money, a consumer would be able to get six months or more of coverage for $695, instead of owing that amount to the IRS as a tax penalty. Backers of the law are urging the administration to hammer that home.

"Given that the penalty is larger, it does make sense to bring it up more frequently," said Ron Pollack, executive director of Families USA, a liberal advocacy group. "It's an increasing factor in people's decisions about whether or not to get enrolled."‘ - Penalty For Being Uninsured Will Jump, insurancenewsnet.com, 10/19/2015

Link to the entire article appears below:





Monday, October 19, 2015

ACA/Obamacare: Are They Co-Ops or Opt-Outs? Two More Co-Ops Shuttered

“Two nonprofit health insurance co-ops that were established under the ACA announced on Friday that they were going out of business for financial reasons. The two organizations in Colorado and Oregon are the latest in a string of eight such coops that have closed their doors in recent months, according to The Hill. That means that only 15 of the original 23 co-ops will remain in business next year – unless of course more decide to fold in the coming weeks.

We should know fairly soon whether other co-ops will fold because the sign-up period for next year’s Affordable Care Act coverage begins November 1 and the remaining co-ops must decide whether to stay in business.

Amy Goldstein of TheWashington Post first reported on the full extent of the co-ops financial crisis last week. The non-profit health plans were conceived of as a “consumer-friendly counterweight” to traditional for-profit insurers – and as a way to encourage more competition and greater consumer choice, according to the report.

The federal government provided billions of dollars in loans to help get these co-ops off the ground. But many of them had ragged startups and were troubled by highly flawed enrollment and business models.

Alarmed by these serious shortcomings, the Centers for Medicare and Medicaid Services (CMS), which oversees Obamacare, issued warning letters to 11 of the co-ops, placing them under special scrutiny and requiring that they produce a plan of “corrective action.”

Instead of finding a way out of the morass, many of the co-ops simply threw in the towel. It began in February when a program that served residents of Iowa and Nebraska announced it was folding. That was followed in July by the shuttering of a co-op in Louisiana, according to The Post.” - Obamacare Falls Short on Sign-Ups While Co-Op System Crumbles, thefiscaltimes.com, 10/18/2015

Link to the entire article appears below:


Saturday, October 17, 2015

ACA/Obamacare: Enrollments Decreasing at an Increasing Rate

“Today, the Obama administration announced that it projected dramatically lower enrollment growth for Obamacare’s exchanges in 2016: only 1.3 million, compared to a prediction of 8 million when the law was passed five years ago.

The problem is fairly easy to understand. Obamacare imposed thousands of pages of new federal regulations on the market for private-sector health insurance purchased by individuals. These regulations mandated that all plans had to pay for a wide range of services, even if policyholders didn’t want them. They forced young people to pay double, and sometimes triple, what they had been paying before for coverage. And plans were required to provide higher financial payouts than they previously had to.

All of these bells and whistles cost money. And so, in 2014 alone, in the average U.S. county, Obamacare drove up the price of individually-purchased health insurance by 49 percent. In 2015 and 2016, additional double-digit rate hikes have been common throughout the country.

ACA enthusiasts disputed the significance of this problem, arguing that taxpayer-funded subsidies would compensate for the higher premiums. But there were always several flaws with that argument. First, subsidies don’t fall from the sky; they’re paid for by imposing additional costs on taxpayers. Second, the subsidies are only large enough for people whose incomes are near the poverty line. Those in the lower-middle class and above don’t receive subsidies that are large enough to compensate for Obamacare-induced rate shock.

In March, Caroline Pearson of Avalere Health published an analysis examining Obamacare enrollment relative to the number of people actually eligible for the law’s insurance subsidies. In a report entitled “Exchanges Struggle to Enroll Consumers as Income Increases,” she observed what should have been obvious in 2010: that those who are more exposed to Obamacare’s rate hikes—by being eligible for fewer subsidies—were not signing up.” - Flatlined: White House Says Obamacare Exchange Enrollment Growth To Collapse In 2016, Forbes, 10/15/2015

Link to the entire article appears below:


Friday, October 16, 2015

ACA/Obamacare: Yet Another Co-Op Bites the Dust -or- Your Tax Dollars Down An Endless Rabbit Hole

“The largest private provider of health insurance policies on Kynect, Kentucky's health insurance exchange, is going out of business.

The Louisville-based Kentucky Health Cooperative Inc. announced Friday that it will end current memberships on Dec. 31 and will not add new members because of financial problems. It will not offer health insurance plans on Kynect when open enrollment for 2016 coverage starts on Nov. 1.

The cooperative has about 51,000 members in all 120 Kentucky counties.”

“Glenn Jennings, the interim chief executive officer of Kentucky Health Cooperative, said the decision to shut down was a result of not receiving adequate federal funding "on which the organization had relied."

The co-op, financed by loans under the reform law, lost $50 million last year after selling 75 percent of the private insurance policies purchased on Kynect in its first year. That was far more than the 30,000 customers it was projected to lure.

Many of those members did not previously have health insurance, which led to "a lot of people with pent up medical needs," Jennings said. "When they suddenly had health insurance ... they began using their benefits."

Jennings said the co-op had reversed a trend of significant financial losses, but needed further support under a temporary program meant to keep prices lower by sharing losses between insurance plans and the federal government.

The company's losses had slowed to $4 million by the end of the first half of 2015, he said.

"We were on track to reverse direction and begin operating in the black, and we expected this to come about in 2016," Jennings said.

But the federal government announced last week that it would provide just 12.6 percent of the money requested by insurance providers through the assistance program.

Kentucky had hoped to get $77 million but got $9.7 million, he said.” - Kentucky Health Cooperative Going Out Of Business, 10/09/2015, insurancenewsnet.com

Link to the entire article appears below:






Thursday, October 15, 2015

Incentives Matter When Shopping Health-Care Supply

“Paula Bennett pockets about $3,000 a year from her employer mainly for driving around 80 miles roundtrip for a deal on doses of her Chrohn's disease treatment Remicade.

The extra income comes through SmartShopper, a program offered by some employers to provide cash to workers who choose quality health care options with lower prices.

"I absolutely love the program," said Bennett, 43, a fiscal specialist with New Hampshire's Division for Children, Youth and Families.

SmartShopper represents a twist in how corporate America is dealing with rising health care expenses. It's part of a push by employers to heap more responsibility for costs onto the people who are covered by their health care plans.

Companies for years have raised deductibles, or the amount employees pay before most of their coverage begins. They've also given workers online tools to help them shop for the best deals on things like imaging exams and bloodwork. Now, some are using cash to nudge employees toward those deals.

"We're in the process of changing habits," said Mitch Rothschild, founder of the health care data firm Vitals, which created SmartShopper. "And frankly there's nothing better for changing habits than to give somebody money."

SmartShopper works by offering financial incentives for about 40 categories, from lab tests to some surgeries. It steers clear of areas like cancer care, though, because Rothschild says "you don't want to hear from us on an economic incentive when your life is at stake." - Employers Offer Cash To Shop Around, 10/14/2015, insurancenewsnet.com

Link to the entire article appears below:




Saturday, October 3, 2015

ACA/Obamacare: Another Lawsuit But This Time Around it’s the Entire U.S. House of Representatives v. The Obama Administration. No Way?!? Way!

‘For those who thought that the lawsuits challenging the Patient Protection and Affordable Care Act (Obamacare) were at an end, think again. On September 9, Judge Rosemary Collyer of the federal district court for the District of Columbia refused to dismiss a lawsuit filed by the entire U.S. House of Representatives against the Obama administration over its funding of certain aspects of Obamacare.

This is a historic lawsuit and a historic decision. In the past, individual members of Congress have filed a number of (unsuccessful) lawsuits against sitting administrations. But this is one of the few occasions when such a suit has been pursued by the entire House of Representatives as an institution.

Adopted on July 30, 2014, House Resolution 676 authorized the speaker to file suit. On January 6, 2015, the House in the new 114th Congress adopted HR 5, authorizing itself to succeed the 113thHouse as a plaintiff in the lawsuit.

The challenge by the House makes two claims against the Obama administration and specifically Sylvia Burwell, the secretary of the Department of Health and Human Services, and Jacob Lew, the secretary of the Treasury. First, that the administration has spent “billions of unappropriated dollars to support” Obamacare. Second, that the administration “effectively amended the Affordable Care Act’s employer mandate by delaying its effect and narrowing its scope.”

According to Judge Collyer, Section 1402 of Obamacare “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.” While certain other credits in Obamacare are paid through a permanent appropriation in the Internal Revenue Code, these “Section 1402 Cost-Sharing Offsets must be funded and re-funded by annual, current appropriations.”

The House claims it has never appropriated any funds for §1402, yet the administration “nonetheless drew and spent public monies on that program beginning in January 2014.” This violates Article I, Section 9, Clause 7 of the U.S. Constitution, which states that “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.”’ - This New Lawsuit Against Obamacare Has Legs, Daily Signal, 09/25/2015

Link to the entire article appears below:


Friday, October 2, 2015

ACA/Obamacare: When the Affordable is Unaffordable

‘"Many of the non-poor formerly uninsured are estimated to be worse off," than without insurance, according to a September-dated working paper from the National Bureau of Economic Research titled "The Price of Responsibility: The Impact Of Health Reform On Non-Poor Uninsured."

How so? The subsidies are not large enough to offset the cost of the insurance premiums and the fact that many previously uninsured will now have to pay part of the cost to see a doctor, the report explains. The authors reached that conclusion after reviewing data for the uninsured prior to Obamacare, including age, gender, earnings and location. Then, they married that information with health-care expenditures for the group and used it to make estimates of out-of-pocket costs before and after the law went into effect.

The group of people whom the authors highlight are the non-poor, or those ineligible for Medicaid but who maybe eligible for various subsidies for premiums or cost-sharing, depending on their income level. It turns out that the more someone earns the worse off they'll be.’ - Obamacare is actually not so affordable -- unless you're broke. MSN news, 10/01/2015

Link to the entire article appears below: