ACA/Obamacare: The Cadillac Tax, the Forty Percent Excise Tax, Delayed for Two Years

"The omnibus spending bill recently passed by Congress and signed into law by President Obama delays the onset of the Affordable Care Act (ACA)’s so-called “Cadillac plan tax” for two years. The new law also weakens the effect of the tax (assuming it’s ever collected) by making it deductible, as noted by my Mercatus Center colleague Brian Blase. I agree with former OMB director Peter Orszag’s observation that the delay may simply be a first instance of a “rolling permanent deferral” of the Cadillac plan tax.

The tax has long been on shaky political ground and the new law considerably reduces the chances of its ever taking effect. It is worth understanding what caused the unraveling of the tax, and what lessons can be drawn from this.

The Cadillac plan tax is (was) a 40% excise tax on the amount by which health insurance plan costs exceeded annual thresholds of $10,200 (individuals) or $27,500 (families), starting in 2018. These thresholds were indexed to grow more slowly than historical health cost growth, so that over time more and more plans would be subject to the tax, producing escalating federal revenues necessary to help fund the ACA’s ambitious health entitlement expansion. A key policy intent of the tax was to offset the damaging effects of the longstanding federal tax preference for employer-sponsored insurance (ESI), one of which is to drive excess health cost inflation.

Lesson #1: Save before you spend.

Lesson #2: Don’t assume a favorable future political alignment.

Lesson #3: Be transparent.

Lesson #4: Partisan victories can be short-lived.

Lesson #5: Don’t campaign against necessary policy steps."

　

- Five Lessons of the Cadillac Plan Tax Failure, Economics 21, Manhattan Institute, 12/22/2015
　

Link to the entire article appears below:

http://economics21.org/commentary/cadillac-tax-obamacare-charles-blahous-12-23-15


　

　

　

　




　

ACA/Obamacare: 2016 Premiums are Up an Average of 10%

“Obamacare enrollees will pay more next year, as new data found a roughly 10 percent increase on all types of marketplace plans.

The Robert Wood Johnson Foundation released datasets on average premiums for 2015 and 2016 on Wednesday. The data showed that every tier of Obamacare plans — bronze, silver and gold — raised average premiums by about 10 percent in 2016 from 2015.

Gold plans had the largest increase with 11 percent, while bronze came in with 10 percent and silver with just under 10 percent, the foundation data shows.” - Obamacare enrollees face higher premiums next year, Washington Examiner, 12/16/2015

Link to the entire article appears below:

http://www.washingtonexaminer.com/obamacare-enrollees-face-higher-premiums-next-year/article/2578518


　

　


　

U.S. Healthcare Delivery System: We Have Met Canada and We are Them

“Americans like to think that our health care system is very different from “socialized medicine” in Canada. In fact, the two health care systems are far more similar than they are different. In Canada, when people go to the doctor the visit is free. In America, it’s almost free.

On the average, every time Americans spend a dollar at a doctor’s office only 10 cents is coming out of our own pockets. The rest is paid by an employer, an insurance company or government. Like the Canadians, we do not primarily pay for health care with money. We pay with time.

According to a Merritt Hawkins survey:
The average wait time to see a primary care doctor in the United States is almost three weeks.
In Boston (where we are told there was universal coverage even before there was Obamacare), the average wait is more than two months.

Compare that with how long you have to wait to get your cellphone repaired.

Waiting in the US is becoming more like waiting in Canada and in some cases it can be worse.” - What Everyone Should Know About Rationing By Waiting, Forbes, 11/09/2015

Link the entire article appears below:

http://www.forbes.com/sites/johngoodman/2015/11/09/what-everyone-should-know-about-rationing-by-waiting/

ACA/Obamacare: Largest US Private Health Insurer Has Second Thoughts About On-Exchange Offerings

‘According to enrollment data, more than 500,000 Americans using the exchanges purchased plans from UnitedHealthcare. Those consumers will have to purchase new plans in 2017 should the insurance company leave the exchanges, Ed Haislmaier, a health policy expert at The Heritage Foundation, told The Daily Signal.

“What we’re seeing is that insurers are re-evaluating whether this is a good market to go into,” he said. “Some are expanding; others are having problems, and they pulled back. Over time, what you’ll probably see is fewer insurers offering coverage in the exchanges. We’re already seeing that, even though United expanded in 2015 and 2016, insurers offering coverage is down. It’s going to take a few years to play out.”

Compared to its competitors, UnitedHealthcare was slow to offer products on the exchange when Obamacare first went into effect in October 2013 and sold plans in just four states—Colorado, Maryland, Nevada, and New York—in 2014, according to the state-run exchanges and federal exchange, HealthCare.gov.

However, the insurer expanded its exchange coverage substantially in 2015 and 2016, selling plans in 22 states during the 2015 open enrollment period and 34 states during this year’s open enrollment period.

Competitors Aetna and Humana, by comparison, are offering coverage on the exchanges in 15 states.

Haislmaier said that insurers like UnitedHealthcare may not have prepared for how much plans sold on the exchanges would cost them.

“What you’re seeing is the market itself, and this is attributable to Obamacare, is turning out to be a market that’s predominately low-income individuals between 100 to 200 percent of the poverty line,” Haislmaier said. “They’re buying coverage, getting a substantial subsidy, but gravitating toward the low cost-sharing plans where they get extra subsidies. The enrollees have more of an incentive to use more health care, and that makes those plans more expensive [for the insurer].”

For insurers to profit from the coverage offered on the exchanges, Haislmaier said, they must narrow networks or raise prices, both of which impact consumers.

“The ones who have not narrowed the networks or have been behind the curve on pricing are having losses and reevaluating participation,” he said.’ - How Obamacare Could Limit Insurance Options for Americans in These 34 States, daily signal.com, 11/25/2015

ACA/Obamacare: Failed Co-Ops and Unpaid Doctor/Hospital Bills

‘NEW YORK (AP) — The sudden collapse of the largest nonprofit insurance cooperative created by President Barack Obama's health care law is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan's patients.

More than 200,000 people insured through Health Republic Insurance of New York have until Monday to sign up with another company if they want to maintain coverage in December.

State regulators ordered the insurer to shut down at the end of the month because of severe financial problems. They are also investigating what they say were inaccurate financial filings by the company.

The closure - part of a wave of failures of the new co-ops nationwide - has been a big hassle for Health Republic policyholders, who have had to shop around quickly for alternative coverage.

The situation may be worse, though, for doctors, hospitals and other clinicians. They are legally obligated to continue treating Health Republic patients through the end of the month but have been given no assurances they will ever be paid for that care.

"I'm aware of at least two physicians who have gotten checks from Health Republic, and those checks have bounced," said Dr. Joseph Maldonado, president of the Medical Society of the State of New York.

Two groups that represent hospitals, the Health Care Association of New York State and the Greater New York Hospital Association, said their member facilities are already owed at least $150 million, not including care provided in much of November.

Medical practices are likely owed millions of dollars more. A survey of 800 doctors by the medical society found that 43 percent were owed money by the company. Nearly 8 percent reported being owed $25,000 or more. One practice of 22 physicians reported being owed more than $5 million, the society said.’ - Health Co-Op Failure Leaves Doctors Owed Millions, insurancenewsnet.com, 11/24/2015

Link to the entire article appears below:

https://insurancenewsnet.com/oarticle/2015/11/24/health-co-op-failure-leaves-doctors-owed-millions.html


　


　

ACA/Obamacare: When Insurance Theory Becomes Reality Theater

‘UnitedHealth Group, the largest insurance company in the U.S., on Thursday slashed its earnings outlook, citing new problems related to Obamacare, and told investors it may exit the program's exchanges.

"In recent weeks, growth expectations for individual exchange participation have tempered industrywide, co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated," Stephen J. Hemsley, chief executive officer of UnitedHealth Group, said in a press release.

The release added that, "UnitedHealthcare has pulled back on its marketing efforts for individual exchange products in 2016. The company is evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017."

In a conference call with investors, Hemsley offered a sober assessment of the exchanges' future viability. He said that claims data have been getting worse as time has gone on, and there's no evidence pointing toward improvement.

Asked about whether the company could sustain losses past 2016, he was blunt: "No. We cannot sustain these losses. We can't really subsidize a marketplace that doesn't appear at the moment to be sustaining itself."

The year 2017 is significant for insurers, because that's the year when several programs designed to mitigate risk for insurers through federal backstops go away. The hope was that those programs would act as training wheels for Obamacare in its first few years of implementation, but after that, the insurers were supposed to be able to thrive on their own. UnitedHealth's statement suggests otherwise.’ - Nation's largest insurer may exit Obamacare due to losses, Washington Examiner, 11/19/2015

　

Link to the entire story appears below:

http://www.washingtonexaminer.com/article/2576726

ACA/Obamacare: Church and State

‘The latest objection to the Affordable Care Act before the U.S. Supreme Court won't derail President Barack Obama's federal health care law but could carve out an exception for religious nonprofits, attorneys and legal experts said.

The court said Friday it will hear challenges by the Catholic Dioceses of Pittsburgh and Erie and Geneva College, a Beaver Falls school affiliated with the Reformed Presbyterian Church, along with six other lawsuits from religious organizations around the country objecting to provisions in the federal health care law mandating the church and its affiliate agencies provide coverage for birth control or file a form opting out.

"This has nothing to do with the particulars of the issue, and that's why the court took it," said Bruce Ledewitz, a Duquesne University professor who studies religion and law.

"This isn't about abortion. It isn't about conception. It's not about Obamacare, either."

The court will instead consider whether the government has the right to dictate what religious nonprofits can and can't do, Ledewitz said.

Bishop David Zubik of the Pittsburgh diocese said the issue is one of religious freedom.

"The insurance mandate, which is one small provision of the Affordable Care Act, would require us to facilitate access to contraceptives, sterilization and abortifacients contrary to our teaching," Zubik said in a statement Friday. "We are encouraged that the Supreme Court will hear our case and are hopeful that they will rule to protect not only our religious liberty but that of all Americans."‘ - Supreme Court Agrees To Hear Church Groups’ ACA Challenge, insurancenewsnet.com, 11/07/2015

Link to entire article appears below:

https://insurancenewsnet.com/oarticle/2015/11/07/u-s-supreme-court-agrees-to-hear-western-pennsylvania-catholic-challenges-to-obamacare.html


　

　

　


　

ACA/Obamacare: Trouble in Paradise -or- The Disconnect Between Hawaii Health Connector and Healthcare.gov

‘Hawaii residents are taking over an hour on average -- and as long as four hours for non-English speaking people -- to apply for Obamacare health coverage via the federal marketplace, healthcare.gov.

On Sunday, Obamacare coverage in Hawaii switched to the federal marketplace from the Hawaii Health Connector, the state-based exchange that is ending operations completely in 2016. The Connector is contracted by the state to assist people signing up for insurance under the Affordable Care Act, or Obamacare, but didn't have enrollment numbers as of Friday. A spokesman for the Centers for Medicare & Medicaid Services, which oversees the federal exchange, said the government agency is not releasing enrollment figures at this time.

"Hawaii is at risk of being unable to process all re-enrollments. We are having significant challenges getting people enrolled on healthcare.gov," Jeff Kissel, the Connector's executive director, told board members at a meeting Friday. "Even if we put all the people we have on it we're not going to get done by Jan. 31. We told CMS we've got to have a contingency plan."

All of the roughly 40,000 Hawaii residents who got health insurance through the Connector must re-enroll on healthcare.gov as policies will not be automatically rolled over to the federal exchange. If a policyholder does not re-enroll, coverage will end Dec. 31. The 2016 enrollment period closes Jan. 31.

One of the major problems hindering enrollment is that automated identity verification is not working on healthcare.gov, Kissel said.’

Average enrollment time for individuals is taking about one hour and 15 minutes, while the time for those signing up over the phone through the federal call center is in excess of two hours, he said. - Hawaii Residents Face Long Delays In Applying For Health Coverage, insurancenewsnet.com, 11/07/2015

Link to the entire article appears below:

https://insurancenewsnet.com/oarticle/2015/11/07/hawaii-residents-face-long-delays-in-applying-for-obamacare-coverage.html

ACA/Obamacare: No Cadillac Plan for You! Tax for You! Maybe Not So Much…..

“Reid and Pelosi have been talking since the spring with President Obama about repealing the “Cadillac tax” on employer healthcare benefits, a senior Democratic aide confirmed on Friday.”

“Both Reid and Pelosi have remained relatively quiet on the tax since the bill's passage in 2010. Even as dozens of Democrats signed onto bills in their respective chambers to repeal it, Reid and Pelosi stayed in the background, refraining from public statements on the efforts.

Powerful labor groups such as the AFL-CIO and the American Federation of Teachers vehemently opposed the Cadillac tax from the start. They say repeal needs to happen soon, before employers begin trimming back healthcare benefits.

Aside from the question of how to pay for repeal, the Democrats' biggest roadblock is the Obama administration.” - Reid, Pelosi pushing for repeal of ObamaCare's 'Cadillac tax', the hill.com, 11/06/2015

Link to the entire article appears below:

http://thehill.com/policy/healthcare/259429-reid-pelosi-pushing-repeal-of-cadillac-tax

ACA/Obamacare: Sticker Shock

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ACA/Obamacare: When the Narrow Network Becomes the Narrowest

“WASHINGTON - Many health plans sold through Affordable Care Act marketplaces in 2015 are so limited that they don't offer patients access to some medical specialists such as endocrinologists, rheumatologists and psychiatrists, a study suggests.

That may be forcing some patients to pay thousands of dollars out of pocket for any care provided by these specialists.

"This translates into huge cost burdens for patients," said Stephen Dorner, lead author of the study, which was published by the Journal of the American Medical Association.”

“To test the extent of narrow networks, researchers at the Harvard T.H. Chan School of Public Health looked at provider directories in a sampling of 135 Silver health plans being sold in the 34 states that relied on the federal HealthCare.gov marketplace in 2015.

They expected to find plans with only a handful of physicians in some specialties. Instead, they discovered that nearly 15 percent of the plans did not include a single in-network physician for at least one specialty.” - Some ACA Plans May Exclude Specialists, Study Finds, 10/28/2015, insurancenewsnet.com

Link to the entire article appears below:

https://insurancenewsnet.com/oarticle/2015/10/28/some-obamacare-plans-may-exclude-specialists-study-finds.html

ACA/Obamacare: Broken Obamacare Promises Web Site

A new web site has been developed where one can share stories regarding: loss of a trusted doctor, rate increases, lost access to a reasonably priced prescription, cancellations i.e. if you like your plan you can keep your plan.

The web site is sponsored by “ Independent Women’s Voice is a 501(c)(4) nonpartisan, nonprofit organization for mainstream women, men and families. IWV is the sister organization of the Independent Women’s Forum.”

The web site address is:

http://www.brokenobamacarepromises.com/

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:

http://news.yahoo.com/ninth-cooperative-formed-under-affordable-care-act-closing-214059601.html

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!

 

Notes:

 

(1) http://www.theblaze.com/contributions/obamacare-proof-that-democrats-will-tax-the-middle-class/

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:

https://insurancenewsnet.com/oarticle/2015/10/19/bigger-bite-for-health-law-penalty-on-uninsured.html


　

　


　

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:

http://www.thefiscaltimes.com/2015/10/18/Obamacare-Falls-Short-Sign-Ups-While-Co-Op-System-Crumbles

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:

http://www.forbes.com/sites/theapothecary/2015/10/15/flatlined-white-house-says-obamacare-exchange-enrollment-growth-to-collapse-in-2016/

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:

https://insurancenewsnet.com/oarticle/2015/10/09/kentucky-health-cooperative-going-out-of-business-51000-insurance-customers-affected.html


　

　

　


　

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:

https://insurancenewsnet.com/oarticle/2015/10/14/employers-offer-cash-incentives-to-shop-around-for-health-care.html


　


　

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:

http://dailysignal.com/2015/09/25/lawsuit-obamacare-legs/?utm_source=heritagefoundation&utm_medium=email&utm_campaign=saturday&mkt_tok=3RkMMJWWfF9wsRouuqjNZKXonjHpfsX56OgvWa%2BylMI%2F0ER3fOvrPUfGjI4ATcRmNK%2BTFAwTG5toziV8R7jHKM1t0sEQWBHm

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:

http://www.msn.com/en-us/news/money/obamacare-is-actually-not-so-affordable-unless-youre-broke/ar-AAf0EKn?li=AAa0dzB

ACA/Obamacare: Big Foot, The Loch Ness Monster and Other Sightings of That $2,500 Obama Promised Heath Insurance Annual Premium Savings.

‘Employer-based health insurance premiums climbed 4.2% this year for family plans, according to an annual Kaiser Family Foundation report. That's up from 3% the year before.

Since 2008, average family premiums have climbed a total of $4,865.

The White House cheered the news, saying it was a sign of continued slow growth in premium costs.

That much is true. Since 2006, the average annual increase for family plans at work has been 4.9%, down from around 10% a year from 1999-2005.

Slightly less higher premiums aren't what President Obama promised Americans when he ran for office touting his medical overhaul. He specifically said his plan would cut premiums.

"We will start," Obama said back in 2008, "by reducing premiums by as much as $2,500 per family."

That $2,500 figure was Obama's mantra on health care. You can watch the video if you don't believe it.

And Obama wasn't talking about government subsidized insurance or expanding Medicaid or anything like that. He specifically focused on employer provided health care.

For "people who already have insurance, and the employers who are providing it," he said at one campaign event, "we will work to lower your premiums by up to $2,500 per family."‘ - Health Premiums Have Climbed $4,865 Since Obama Promised to Cut Them $2,500, IBD, 09/23/2015

Link to the entire article appears below:

http://news.investors.com/blogs-capital-hill/092315-772384-premiums-have-steadily-climbed-despite-obama-promise-to-cut-them.htm

Fires Are Down Fifty Percent in the Last Thirty Years But Paid Firefighters Are Up Fifty Percent? No Way. Way!

“If you want to chat with a firefighter or see a fire truck up close, you can go down to the local firehouse at any time of day. The crew will probably be there, lifting weights or washing down the already gleaming red engines. Career firefighters usually live at the firehouse for a day or two, then take as many as three days off. Between eating and sleeping at the station, they mop floors, clean toilets and landscape the yard - with a few hours set aside daily for training and drills. Mid-morning, you'll find several of them at the local supermarket doing the day's grocery shopping.

In other words, being a firefighter these days doesn't involve a lot of fighting fire.

Rapid improvements in fire safety have caused a dramatic drop in the number of blazes, according to the National Fire Protection Association. Buildings are constructed with fire-resistant materials; clothing and curtains are made of flame-retardant fabrics; and municipal laws mandate sprinkler systems and smoke detectors. The striking results: On highways, vehicle fires declined 64 percent from 1980 to 2013. Building fires fell 54 percent during that time.

But oddly, as the number of fires has dropped, the ranks of firefighters have continued to grow - significantly. There are half as many fires as there were 30 years ago, but about 50 percent more people are paid to fight them.” - Fewer fires, so why are there far more firefighters? Washington Post, 09/04/2015

Link to the entire article appears below:

https://www.washingtonpost.com/opinions/2015/09/04/05316abe-517c-11e5-933e-7d06c647a395_story.html

ACA/Obamacare: Other people, spending other people’s money, on other people

ACA/Obamacare: So You’ll Save $2,500 Per Year? Maybe Not So Much

“Insurers have asked for double-digit rate increases for nearly 1 out of every 3 Obamacare plans that will be sold on HealthCare.gov for 2016 coverage, according to a new analysis.

And in three states—Delaware, South Dakota and West Virginia—every plan sold on HealthCare.gov is asking for 10 percent or more hikes in the prices of their premiums for next year, AgileHealthInsurance.com said in its report.”

“Existing Obamacare customers in six other states on that federally run marketplace, which serves two-thirds of the United States, could also be in for a rude awakening come November when open enrollment resumes.

In those other six states, a majority of plans are requesting double-digit hikes, ranging from Montana, where 86 percent of the plans have asked for such increases, down to North Dakota, where 67 percent of the plans are doing so.

"The natural reaction [for those customers] is: They're going to be surprised," said Sam Gibbs, executive director of AgileHealthInsurance.com.

"In some of these states, there's going to be a strong reaction to it," said Gibbs.

AgileHealthInsurance's analysis found that 7 percent of the Obamacare plans sold on HealthCare.gov are asking for rate hikes of at least 30 percent, while 14 percent of such plans are asking for increases of at least 20 percent. “ - Obamacare's many double-digit price hikes for next year, CNBC, 09/05/2015

Link to the entire article appears below:

http://www.cnbc.com/2015/09/04/obamacares-many-double-digit-price-hikes-for-next-year.html


　

　


　

Independent Women's Forum: Meet Beth

ACA/Obamacare: Nevada Health Co-Op Closes, Third of Twenty Three Co-Ops to Close

‘A Nevada health insurance provider that received more than $65 million in taxpayer-funded loans from the federal government announced last week that it is discontinuing operations at the end of the year.

The Nevada Health Co-Op will close its doors beginning Jan. 1 because of “challenging market conditions.” The co-op will be the third of the 23 consumer-oriented and operated plans created under Obamacare to shutter.’

‘The 23 co-ops received $2.5 billion in loans from the Centers for Medicare and Medicaid Services to help get off the ground and remain solvent. The federal government awarded the Nevada Health Co-Op $65.9 million in startup loans. It’s unclear whether the co-op will be able to repay the loans.

According to the Nevada Health Co-Op, it enrolled 14,000 consumers in 2014. However, the nonprofit insurer projected it would enroll 33,748, according to a July audit of co-ops from the Department of Health and Human Services inspector general.’

‘The analysis from the Department of Health and Human Services also found that the Nevada Health Co-Op projected that it would make $371,000 in 2014. However, it lost more than $15 million.’ - This Obamacare Co-Op Was Supposed to Make Money. Instead, It Lost Over $15 Million, 08/31/2015, dailysignal.com

Link to the entire article appears below:

http://dailysignal.com/2015/08/31/this-obamacare-co-op-was-supposed-to-make-money-instead-it-lost-over-15-million/?utm_source=heritagefoundation&utm_medium=email&utm_campaign=morningbell&mkt_tok=3RkMMJWWfF9wsRohvq3OZKXonjHpfsX56OgvWa%2BylMI%2F0ER3fOvrPUfGjI4ATMpnMK%2BTFAwTG5toziV8R7jHKM1t0sEQWBHm


　


　

ACA/Obamacare: Keep your Doctor? Not So Much. Narrow Network is the Order of the Day

“If you bought Obamacare in Georgia or Florida you most likely don't have a lot of options for choosing doctors or hospitals, according to a new study showing that some enrollees may have less choice than others.

A report released Monday found that those two states had the highest amount of Obamacare plans in narrow networks, which limit the number of physicians who are covered. The report concludes that insurers are using narrow networks as a way to keep costs down and remain competitive.

Georgia was the top state for having these narrow networks. The report from the nonprofit Robert Wood Johnson Foundation said 83 percent of Georgia's networks were narrow. Florida came in second at 79 percent, followed by Oklahoma (78 percent), California (75 percent) and Arizona (73 percent).” Obamacare's latest problem: Narrow doctor networks, Washington Examiner, 08/24/2015

Link to the entire article appears below:

http://www.washingtonexaminer.com/obamacares-latest-problem-narrow-doctor-networks/article/2570723

ACA/Obamacare: And About the Supposed Reduction in Health-care Price.....

“Just in time for the next presidential election, health care spending is starting to take off again. Through 2024, health care spending is projected to grow by 5.8% annually, on average, according to CMS. While this isn’t unexpected—health economists across the political spectrum expected health care costs to start growing again (and growth rates are expected to still be lower than the long-run average)—the window for addressing health care costs in a less painful way is closing. Without better cost controls in the private sector, and without immediate reforms to Medicare, the health care sector is set to gobble up a full fifth of the U.S. economy in just 10 years.

So the Obama Administration is going to have to put some corks back into their champagne bottles. Obamacare has not slain the health care cost dragon. Back to the drawing board.”

“Despite media rhetoric about soaring drug prices, absent a one-off jump in drug spending from expensive, life-saving Hepatitis C drugs, drug spending as a share of U.S. health care spending is expected to remain largely flat: from 9.9% in 2014 to 10.4% in 2024.

Less than 1% growth is hardly a cost explosion.

The big drivers of spending growth will, unsurprisingly, will be Medicaid and Medicare. Even as per-capita costs in these programs grow relatively slowly—averaging just around 4% through 2024—greater enrollment in the two programs will drive spending: 7% for Medicare, thanks to a retiring cohort of baby boomers, and around 6 percent for Medicaid, mainly due to the ACA’s Medicaid expansion.” - America's Health Care-Cost Slowdown Goes Kaput, Forbes, 08/22/2015

Link to the entire article appears below:

http://www.forbes.com/sites/theapothecary/2015/08/22/americas-health-care-cost-slowdown-goes-kaput-what-should-republicans-say-and-do-about-it/

ACA/Obamacare: Qualifying the Non-qualified

‘Some people who signed up for healthcare through ObamaCare may not have been qualified for the benefits they received, according to a government audit released Monday.

For several months after the rollout of HealthCare.gov, the government’s website was unable to verify important parts of a customer’s application, such as household income, citizenship status and family size.

The audit, which was completed by the Department of Health and Human Services’s inspector general, tracked sample applicants to determine weaknesses with the system's internal controls.’

‘“The Federal marketplace did not always maintain applicant data that were complete, accurate, and up to date in the eligibility and enrollment system and did not always maintain documentation supporting resolution of inconsistencies,” the 50-page report said.’ - Audit: Not all healthcare customers fully vetted by HealthCare.gov, the hill.com, 08/10/2015

Link to the entire article appears below:

http://thehill.com/policy/healthcare/250736-audit-not-all-healthcare-customers-fully-vetted-by-healthcaregov

ACA/Obamacare: Health Insurance Is Not Health-care

‘Low- and middle-income consumers who use the marketplaces often are able to qualify for tax subsidies to offset the cost of monthly premiums and help them afford care. But while the Department of Health and Human Services has touted low premiums averaging $100 a month for the majority of Americans who use exchanges, that message only tells part of the story, leaving out details about copays, deductibles and provider costs that may be out of reach.

"There is a lot of evidence to suggest consumers are learning as they go, and I'm sure it's not without a lot of painful experiences," says Paul Lambdin, insurance exchanges and retail practice leader for health plans at Deloitte Consulting. The Deloitte Center for Health Solutions, a research arm of Deloitte, has been polling consumer attitudes about health insurance and the health care system since 2008.

For this report, researchers surveyed 3,887 people, 406 of whom used online marketplaces to buy health insurance. The analysis did not distinguish between people who used state exchanges and those who used the federal website, HealthCare.gov.

Despite having insurance coverage that some may not have had before, the survey revealed costs are still a major concern for exchange customers. Results showed only 24 percent felt they could get affordable care when they needed it, and just 16 percent felt financially prepared to handle future health care costs. And 1 in 3 reported they had difficulty paying for out-of-pocket expenses when enrolled in a marketplace plan for a full year.’ - Obamacare Exchange Customers: Health Care Still Costs Too Much, US News and World Report, 08/03/2015

Link to the entire article appears below:

http://www.usnews.com/news/blogs/data-mine/2015/08/03/obamacare-exchange-customers-health-care-still-costs-too-much