Sunday, December 28, 2014

The ACA Cadillac Tax Rabbit Hole

“The Cadillac Tax is supposed to raise $80 billion over ten years to finance the expansion of health coverage.”

“The $80 billion of tax revenues will never appear. Companies as well as government entities will limit their medical insurance plans to the "predetermined thresholds". It is difficult to imagine virtually any entity continuing with any plan that results in an Obamacare Cadillac Tax.” - Kill the Obamacare Cadillac Tax Now, Hank Adler, 12/27/2014

-Upon Further Review-

If the $80 billion in tax revenue never occurs through tax avoidance, and the tax revenue was a component of the financing of ACA, then either a deficit occurs, government supplied items of another variety are reduced, revenue must be raised from another source (the other revenue source can only come from another set of taxpayers) -or- a combination of increased deficit, reduced government supplied items of another variety and increased tax upon some taxpayer group.

Not only does the tax revenue not appear due to tax avoidance, the Cadillac plans scrapped mean those individuals currently with the Cadillac plan must now have less-than a Cadillac plan (a less generous plan to avoid the tax) meaning those individuals absorb more health-care expense than under any previous Cadillac plan they were enrolled in.

The final result being zero tax revenue raised for ACA and more health-care expense for the individual. Judging intentions is always a mistake. Judging this particular lose-lose result might be more enlightening.

Link to the entire article appears below:


Obamacare: Re-enrollment vs. Automatic Renewals

Opinions Regarding Obamacare Remain Negative

“Most voters continue to hold a negative opinion of Obamacare and remain committed to the belief that consumers should have choices when it comes to health insurance. They also still strongly belief employers and individuals should be able to buy health insurance across state lines.

A new Rasmussen Reports national telephone survey finds that 42% of Likely U.S. Voters now have at least a somewhat favorable opinion of the national health care law, while 53% view it unfavorably. These findings are generally consistent with surveys since early 2013 and include 17% with a Very Favorable opinion and 38% with a Very Unfavorable one. (To see survey question wording, click here.)” - Voters Remain Strongly Pro-Choice When It Comes To Health Insurance, Rasmussen Reports, 12/22/2014

Link to the entire article appears below:

Tuesday, December 23, 2014

How Many Really Did Sign Up for Obamacare in the Initial Open Enrollment of 2013-2014? Answer: Less Than Advertised.

“The Obama administration said it erroneously calculated the number of people with health coverage under the Affordable Care Act, incorrectly adding 380,000 dental subscribers to raise the total above 7 million.

The accurate number with full health-care plans is 6.7 million as of Oct. 15, a spokesman for the U.S. Department of Health and Human Services confirmed today, saying the U.S. won’t include dental plans in future reports.”

“The error was brought to light by Republican investigators for the House Oversight and Government Reform Committee, using data they obtained from the U.S. Centers for Medicare and Medicaid Services.

“A mistake was made in calculating the number of individuals with effectuated Marketplace enrollments,” said Kevin Griffis, a spokesman for the U.S. Health and Human Services Department. “Individuals who had both Marketplace medical and dental coverage were erroneously counted in our recent announcements,” he said in an e-mail.

The new count puts enrollment short of a 2013 estimate by the Congressional Budget Office, adopted last year as a goal by the Obama administration, that 7 million people would be enrolled this year. Federal officials said in September they had 7.3 million people enrolled in coverage through new government-run insurance exchanges. They didn’t distinguish between medical and dental plans, breaking from previous practice without notice.”

“Blending dental and medical plans let the administration assert that enrollment was more than 7 million. The move also partly obscured the attrition of more than 1 million in the number of people enrolled in medical insurance.

The administration had supplied information about dental plans separately in earlier disclosures. In May, the government reported that 8 million were signed up for health plans and 1.1 million were in dental coverage.

Then in September, the numbers became less transparent. The Medicare agency’s administrator, Marilyn Tavenner, released a new enrollment figure, obtained from insurance companies participating in the exchanges: 7.3 million people were “enrolled in the health insurance marketplace coverage,” she said at a hearing by the Republican-led Oversight committee.”

‘“After touting 8 million initial sign-ups for medical plans, four months later they engaged in a concerted effort to obscure a heavy drop-out rate of perhaps a million or more enrollees by quietly adding in dental plan sign-ups to exchange numbers,” Republican Darrell Issa of California, chairman of the Oversight committee, said in an e-mail from a spokeswoman.’ - Obamacare Sign-Ups Were Inflated With Dental Plans, Bloomberg, 11/20/2014

Link to the entire article appears below:








Monday, December 22, 2014

American Health Care and the Fortress Mentality

“For decades America’s health care debate has pitted Left against Right, federal against state, public against private. All sides, however, have shared a similar, inhibiting mindset—an excessive aversion to risk and deference to medical insiders—instead of stressing the ideal goal of better health care for more people at lower cost on a continuous basis.

A new study published by the Mercatus Center at George Mason University shows how this “Fortress”-like mentality has limited innovation in health care, constraining medical advances and raising costs. Shifting to a “Frontier” approach—one that tolerates risk and opens the field to other participants and disciplines—would bring to health care the kinds of creativity seen in many other fields, such as information technology.

The study illustrates these ideas in part through a set of unconventional characters, including a Hollywood actress who figured out how to stop Nazis from jamming American torpedo controls, a small-town doctor who pioneered stem-cell therapy, an injured carpenter and a puppet-maker who saw $40,000 prosthetic hands and produced a workable alternative that costs less than $50, a dying rodeo enthusiast who successfully battled the Food and Drug Administration (FDA), and—on the other side of the coin—a well-meaning educator who helped destroy African-American medical education.” - Fortress and Frontier in American Health Care, Robert Grabayes, George Mason University

Link to the summary:

Link to the entire paper:





Wednesday, December 3, 2014

Regarding Proponents of ACA and the Bumper Sticker Sized Slogan: “Bending the Cost Curve”. Maybe Not so Much.

“The American middle class has absorbed a steep increase in the cost of health care and other necessities as incomes have stagnated over the past half decade, a squeeze that has forced families to cut back spending on everything from clothing to restaurants.

Health-care spending by middle-income Americans rose 24% between 2007 and 2013, driven by an even larger rise in the cost of buying health insurance, according to a Wall Street Journal analysis of detailed consumer-spending data from the Bureau of Labor Statistics.

That hit has been accompanied by increases in spending on other necessities, including food eaten at home, rent and education, as well as the soaring cost of staying connected digitally via cellphones and home Internet service.

With income growth sluggish, discretionary spending on things like clothing and movies, live shows and amusement parks has given way.” - Basic Costs Squeeze Families, Wall Street Journal, 12/01/2014

Link to the entire story appears below:

Tuesday, December 2, 2014

Why Isn’t Big Business Complaining About ACA? Answer: Self-Insurance

"Have you ever wondered why the largest companies almost never criticize the Affordable Care Act? That may be because they are getting a deal that the rest of us aren’t getting.

The mandate to provide health insurance to employees kicks in for large employers on January 1st and applies to smaller companies the following year. Surprisingly, firms that are large enough to self-insure (and pay employees’ medical expenses directly) can satisfy the mandate without covering hospitalization. They can also avoid paying for mental health care, the services of specialist doctors and even emergency room visits.

In a nutshell, the largest firms can offer the skimpiest plans.

Perhaps aware of the embarrassing implications of these loopholes, the Obama administration made an election eve announcement that there would be limits on the ability of firms to exploit them going forward. On Election Day, a Treasury Department notice alerted employers that any health plans not already finalized will have to cover hospitalization and doctor services—but not other benefits that are required of small-employer plans and plans purchased by individuals.

The timing of these announcements suggests that the administration wanted absolutely no media attention for them. Who is going to pore over changes to Obamacare technicalities when exciting election results are coming in? There are two issues here that the administration doesn’t want discussed: Why does the law have a huge gaping loophole for the largest companies? And how is the Obama administration able (once again) to re-write the law without any act of Congress?

If you work for a self-insured company and have an above-average income, you probably don’t have much to worry about. Employers are going to provide higher-income employees reasonably good health insurance in the future, just as they have in the past. But if your income is below-average, you could end up with worse coverage than you had before." - Obamacare’s Gift to Big Business: The Largest Firms Can Offer the Skimpiest Health Plans, The Independent Institute, 11/25/2014

Link to the entire article appears below:



Wednesday, November 26, 2014

Narrow Networks and the 2015 Version of ACA

"More directly, Obamacare is eliminating access to many of the best specialists and best hospitals for middle-income Americans. To meet the law's requirements, major insurers all across the country are declining to participate in the exchanges, or only offering plans that exclude many of America's best doctors and hospitals. McKinsey reported 68% of Obamacare insurance options only cover narrow or very narrow provider networks, double that of one year ago." -If you like choice in health care, look to Republicans, Scott Atlas, CNN

Atlas is correct, the vast majority of the choices on the ACA exchange are that of narrow networks regarding the 2015 offerings (effective 01/01/2015).

Last year, James and Jane Goodfellow would have had a tough time discerning what was a broad or narrow network of providers as insurers used their pet names regarding what was broad or narrow. This go around, after the insurers pet name appears, regarding PPO's (preferred provider organizations), there is inserted the term "board network" or "limited network" as a clarification for consumers.

However, once you get outside the PPO, the HMO (health maintenance organization) offerings do not explain or add a clarification what an HMO is and how it functions. One might say the HMO was/is the original narrow network (only those inside the HMO are one’s providers).

CMS and 1600 Pennsylvania Avenue are stating that one can keep one’s premium level (current ACA policyholders) or with a slight increase by switching insurers i.e. buy one of the new offerings. They fail to point out the particulars of their claim of level or slightly increased price. By switching to a more narrow network or from old insurer narrow network to new insurer narrow network, one might keep premium increases modest. However a secondary and as important phenomena is at work regarding the claim of modest price increase by switching insurers: anti-selection. How so?

Consider 10/01/2013 and the initial availability of ACA with effective date 01/01/2014. Crowded at the starting line, like a group of marathon runners awaiting the starting pistol, were hundreds of thousands of chronically ill people. This group, the existence thereof caused by a variety of reasons, wanted to obtain coverage immediately and so they did. Hence the initial group of insurers that appeared on the ACA exchange for the 2014 offering ended up with large numbers of chronically ill insured’s. Stated alternatively, rather than attracting a wide variety of homogeneous exposure units spread over a wide geographic area they attracted an inordinate number of chronically ill exposure units.

The initial group of insurers offering ACA products, attracting the chronically ill, suffered losses that that drove up loss ratios and hence premium increases were called for to offset losses.

Now comes the 2015 offerings and a new set of insurers appear. The new insurers have the knowledge that anti-selection has already occurred regarding the initial insurers. They also know that the chronically ill are less apt to change insurers for a lower price but healthy insured’s, face with a price increase yet having made no claims are very apt to change insurers based on price. The new insurers offer a slightly lower premium rate to attract the healthy away from the initial insurers. Hence the new insurers attract the healthy exposure units while the initial insurers, in the main, lose the healthy but retain the chronic.

The entire process ends with the initial insurer faced with few new entrants into their plan due to spiraling price increases and an ever increasing exodus of healthy insured’s must close the book of business regarding the offered plan and transition the remaining insured’s to a new plan or merely exit ACA.

Friday, November 21, 2014

ACA/Obamacare: Spending Figures Released on the Medicaid Component of Obamacare

‘WASHINGTON (Reuters) - One part of the Affordable Care Act is going according to plan, with U.S. states receiving and spending more money on the Medicaid health insurance program, a report released by the National Association of State Budget Officers on Thursday showed.’

‘"The large increase in federal funds to states in fiscal 2014 was almost solely due to additional Medicaid dollars, mainly resulting from the expansion of Medicaid in a majority of states under the Affordable Care Act," the association found. "While federal Medicaid funds to states increased $41.8 billion in fiscal 2014, all other federal funds to states are estimated to have declined $3.4 billion."‘

‘Medicaid spending rose the most of all states' budget areas, increasing 11.3 percent in fiscal 2014, but the federal government shouldered most of the burden. Federal funding for Medicaid increased 17.8 percent, and state dollars directed to the program only grew 2.7 percent, according to NASBO.’ - U.S. states get more, spend more on Medicaid under Obamacare: report, 11/20/2014, yahoo

Link to the entire article appears below:

Thursday, November 20, 2014

ACA/Obamacare: Revisiting Interstate Commerce and Buying Health Insurance Across State Lines

“The second open enrollment period for health insurance under the Affordable Care Act is underway, and the law is more unpopular than ever. According to Gallup, a record-high 56 percent of Americans now disapprove of the 2010 law.”

“Republicans in Congress — less inclined than some deep thinkers to sneer at "the stupidity of the American people" — unanimously opposed the Affordable Care Act when it was enacted, and were rewarded in the 2010 midterms for their steadfastness. In the ensuing four years, Republicans repeatedly called for replacing Obamacare with alternatives expanding choice, competition, and market reforms — and the voters just rewarded them again.

Of course, even with their new majorities in Congress Republicans will have to contend with President Obama's veto pen. So a bill "repealing every last vestige of Obamacare," as Senator Rand Paul of Kentucky exuberantly proposed on Election Night, isn't in the cards anytime soon. But that doesn't mean there is nothing to be done, particularly since the Supreme Court has agreed to hear a new challenge to the law, one that could potentially cause Obamacare to topple under its own weight.”

“One way or another, changes in the law are coming. Not all of them have to be bitterly controversial, or provoke cries of Republican overreaching. Here's a suggestion: Allow individuals to buy health insurance from out of state.

In an age when consumers can purchase almost anything from vendors almost anywhere, government policies protecting insurance companies from interstate competition are indefensible. Lawmakers would be laughed out of office, rightly, if they insisted that the only CDs, cellphones, or ceramics their constituents could buy were those manufactured in the state where they lived. All sorts of financial products are routinely acquired without to state borders proving an impenetrable barrier: life insurance, service warranties, stocks and bonds, bank accounts, credit cards. Why should a medical plan be any different?

There is no good reason to deny freedom of choice to Americans when it comes to buying health insurance. Yet licensing rules in virtually every state effectively prevent individual residents from shopping for health plans in any other state. Consequently, there is no national market for health insurance. There are only autonomous state markets, many dominated by near-monopolies that can get away with offering lower quality insurance at ever-higher premiums.

As Michael Cannon of the Cato Institute points out, it isn't only insurance companies that are sheltered from the rigors of competition. Insurance regulators are insulated too. State governments, inveigled by special interests, can burden health insurance policies with more and more mandatory benefits, driving up premiums to cover services that many consumers would never willingly choose.

In Massachusetts, for instance, health insurance policies must cover at least 49 specifiedtreatments and types of providers, among them midwives, infertility treatments, hair prostheses, and chiropractors. But what if all you want is a plain-vanilla health plan akin to those sold by insurers in New Hampshire (only 38 state-required health-care mandates) or, better yet, in Michigan (24) or Idaho (13)? Tough luck. That's what it means when interstate commerce in health insurance is blocked.” - Buy Your Health Insurance Out of State, Jeff Jacoby, 11/19/2014,

Link to the entire article appears below:

Wednesday, November 19, 2014

ACA/Obamacare: To Gruber Or Not To Gruber, That is the Question…..

“Grubergate: The lies are getting pretty thick these days. The president claims that he never misled anyone about ObamaCare and that Jonathan Gruber was just "some adviser." In fact, Gruber was a key player in the deception.

When Fox News' Ed Henry asked Obama on Sunday if he'd misled the American people "in order to get the bill passed," Obama's answer was "No, I did not." Space prohibits listing all the ways Obama did, in fact, mislead the public.”

“Actually, Gruber played a central role in a coordinated campaign to deceive the public — a campaign that arguably proved instrumental in getting ObamaCare enacted. To see how he did it, let's turn the clock back to Nov. 4, 2009.

At the time, the White House was in a frantic push to get ObamaCare through the Senate before the year was up. Democrats, who held 60 seats at the time, could not afford to lose a single vote against unified GOP opposition. And they were rightly worried that a January special election in Massachusetts would deny them their filibuster-proof majority if voters elected Republican Scott Brown.

That day, the White House touted a research paper that Gruber had issued, describing it as an "objective analysis" that showed how "reform will help small businesses (and) lower premiums for American families." Later that month, Nancy-Ann DeParle — director of the White House Office of Health Reform — said that another Gruber study "confirms" that the "Senate health reform bill reduces costs and improves coverage."

“In fact, the existence of Gruber's fat $400,000 contract didn't emerge until after the Senate passed ObamaCare — when a blogger for the left-wing website Daily Kos posted a link in early January 2010 complaining about Gruber's "sole source" contract for "technical assistance in evaluating options for national healthcare reform." The contract claimed that Gruber was the "only one responsible source" available for such help.” - Gruber Was Key to Getting ObamaCare Passed, Investors Business Daily, 11/17/2014

Link to the entire article appears below:

Monday, November 17, 2014

ACA/Obamacare: ACA is Creating More or Less Relative Health-Care Cost Savings? Answer: Less.

"1) Slower growth in health care costs is reducing the projected cost of the ACA’s coverage expansion (good). On this, we have the numbers: CBO provides them. For example, in 2012 CBO had projected that by 2021, the gross cost of these coverage provisions would be $242 billion annually. By 2014, however, CBO had lowered that estimate for 2021 to $208 billion.

2) Slower growth in health care costs is reducing the savings projected from the ACA’s cost-containment provisions (bad). We don’t have post-2012 CBO numbers on this effect; SBC estimates that these provisions will save $132 billion less through 2024 than previously estimated. SBC’s qualitative conclusion is clearly correct even if the precise number is unknowable. Basically, the less health spending there otherwise would have been, the less credit the ACA can get for cutting costs. Accounting for this effect is necessary for consistency; since the ACA is credited for its coverage expansion provisions costing less as health care inflation comes down, we must also recognize that its cost-cutting provisions will save less.

I will elaborate on this point because there appears to be some dispute about it. Paul Van de Water, an analyst I respect, has argued that the SBC results are wrong because they are “assuming that health reform had nothing whatsoever to do with the substantial slowdown in health care cost growth in the past few years.” In effect he argues that the ACA should be credited with additional savings based on the assumption that it is at least partially responsible for the cost slowdown.

I disagree with that criticism for a couple of reasons. First, it doesn’t square with CBO’s methodology, which is what the SBC study is intended to reflect. CBO is explicit that when general health inflation slows, less relative savings can be attributed to the ACA. For example, in 2012 CBO explained how recent changes in health spending assumptions affected its re-scoring of a proposal to repeal the ACA:

“CBO’s current projections of Medicare spending are lower than those in the January 2011 baseline. In aggregate, therefore, the projected increase in spending from repealing the Medicare provisions of the ACA is also smaller.”

This is another way of saying that the ACA’s Medicare growth cuts are saving less money than previously projected. As this graph shows, when health spending projections were lowered from 2011 to 2012, the ACA’s Medicare/Medicaid savings dropped by $63 billion over 2013-21 (notably, $59 billion of this reduction was in the last five years of 2017-21, a roughly $12 billion change per year).

Health spending projections have continued to come down since 2012, so we’d expect CBO’s estimates of cost savings due to the ACA to continue to decline as well. SBC’s estimate that the further savings reduction would equal $132 billion from 2015-2024 is reasonable, as it amounts to an adjustment of $13 billion a year.

The second reason we can’t assign the ACA extra credit for the national health spending slowdown is that the evidence is mounting pretty conclusively that the ACA has little if anything to do with it. A striking graph (Figure 4-1) in the White House’s Economic Report of the President shows that the cost slowdown began well before the ACA was passed. Another compelling graph shows that the slowdown occurred throughout all OECD nations, and thus can’t be attributed to US legislation. Finally, the CMS Medicare actuary’s office has found that the ACA’s net effect so far has been to increase costs rather than decrease them.

3) Also, many of the ACA’s cost-savings provisions are not being enforced as originally assumed (bad). Examples include the ACA’s individual/employer mandate penalties, scheduled Medicare Advantage cuts that have been rolled back, and others. If this continues it will further worsen the ACA’s fiscal effects; the SBC analysis did not even take this into account.

4) CBO has since found that various ACA provisions (including its health insurance subsidies, Medicaid expansion, and new taxes) will significantly reduce labor force participation (bad). CBO sees the ACA removing the equivalent of 2 million full-time workers from the workforce by 2017, resulting in slower economic growth and smaller federal tax revenues. CBO writes that “CBO has now incorporated into its analysis additional channels through which the ACA will affect labor supply, reviewed new research about those effects, and revised upward its estimates of the responsiveness of labor supply to changes in tax rates.” In other words, the 2010 analysis that appeared to show the ACA reducing the deficit failed to take into account what CBO now believes about its adverse effect on employment. SBC projects on the basis of CBO information that this effect will lower federal tax revenues by roughly $280 billion through 2024; Van de Water argues that the effect will be less, noting that wages and salaries represent only 70 percent of adjusted gross income. But either methodology should show enough of a revenue loss in combination with other updated information to find the ACA worsening federal deficits."
- Budget Committee Report Confirms the ACA Worsens the Deficit, The Manhattan Institute, 11/03/2014
Link to the entire article appears below:

Sunday, November 16, 2014

ACA/Obamacare: And Then There Is Jonathan Gruber

‘WASHINGTON — Three years ago, as President Obama fought for re-election, his team was more than happy to have Jonathan Gruber, a well-known Massachusetts Institute of Technology professor, mouthing off.

Mr. Gruber, a health care expert who helped develop Mitt Romney’s health care plan in Massachusetts and later was a consultant for Mr. Obama’s Affordable Care Act, was no stranger to the pundit circuit, and repeatedly called attention to the similarities between the two plans — a politically helpful fact for the Obama 2012 campaign.

“They’re the same bill,” Mr. Gruber declared once, adding an expletive before the word “bill.”

But now, Mr. Gruber’s bluntness is clearly less appreciated by those in the West Wing, thanks to the emergence of a series of videos that show Mr. Gruber calling the American public “stupid” and suggesting that the president’s health care law passed by fooling Americans about how it works.

“This bill was written in a tortured way to make sure C.B.O. did not score the mandate as taxes,” Mr. Gruber said in October 2013, referring to the Congressional Budget Office. “Lack of transparency is a huge political advantage. And basically, call it the ‘stupidity of the American voter’ or whatever, but basically that was really, really critical to getting the thing to pass.”’

‘White House officials rejected the idea that Mr. Gruber was the “architect” of the Affordable Care Act. They noted he was never employed by the White House or any federal agency, though he was paid close to $400,000 as a consultant to the Department of Health and Human Services during 2009 and 2010.

But Mr. Gruber had become a high-profile booster of the president’s signature domestic achievement and participated in its development. During the contentious debate in Congress, top Democrats frequently cited his analysis of the law’s impacts. An invitation to a different October 2013 panel discussion listed him as: “a key architect of the A.C.A., Dr. Jonathan Gruber.”’ - Affordable Care Act Supporter Ignites Fury With a Word: ‘Stupid’, New York Times, 11/14/2014

Link to the entire article appears below:




Thursday, November 13, 2014

ACA/Obamacare: The Low Hanging Fruit is Gone

“WASHINGTON—Millions fewer people will enroll in private health plans under the Affordable Care Act next year than the Congressional Budget Office had predicted, the Obama administration said Monday.

The developments are the latest sign that the law, which Democrats passed in 2010 to provide near-universal health insurance, is struggling to reach that goal quickly. Attracting new enrollees to the health law’s insurance exchanges has proven more difficult than advocates had predicted, and a slice of those who do sign up for plans haven’t kept up with premiums.

Health and Human Services Secretary Sylvia Mathews Burwell said the administration was aiming for 9.1 million paid-up enrollees by the end of 2015, though the range could extend to 9.9 million, according to a new analysis conducted by her agency.

The exchanges, which reopen Saturday for the law’s second year of insurance enrollment, were expected to have 13 million people enrolled in private health plans under the law in 2015, according to an April 2014 projection by the nonpartisan CBO.

Around 7.1 million Americans currently have private coverage through the law’s exchanges, the administration said Monday. That is down from the 8 million the administration said had picked plans as of this spring, and from a figure of 7.3 million paid-up enrollees in mid-August.”

“Mike Perry, a pollster who conducts research for supporters of the law, said recent focus groups with people who were uninsured after the first year of sign-ups made clear they were a “harder group to reach” now. “They know their budget, and their budget has no room,” he said.”

“HHS officials also released new figures on their efforts to clear up data problems from the first sign-up period. They said they had cut off tax credits for December for 120,000 households that hadn’t responded to requests for more information about their income.

Another 112,000 people have had their coverage terminated because the federal government couldn’t confirm they were legally residing in the U.S., they said. That number is down slightly from an earlier announcement that the government was cutting off 116,000 people over immigration and citizenship status issues.” - Health-Law Enrollment in 2015 Won’t Meet Forecast, WSJ, 11/11/2014

Link to the entire article appears below:





Sunday, November 9, 2014

ACA/Obamacare: So Obamacare Wasn’t an Election Issue? Tell that Tale to the Missing U.S. Senators that Voted for ACA.

“On Dec. 24, 2009, the Democratic-controlled Senate passed President Obama’s healthcare law with a filibuster-proof 60-vote majority, triggering a massive backlash that propelled Republicans to control of the House the following year. On the Senate side, going into Tuesday’s elections, 25 senators who voted for Obamacare were already out or not going be part of the new Senate being sworn in on January.

To be sure, it isn’t fair to attribute all of the turnover in the chamber to Obamacare. Many senators voted for Obamacare and lost re-election battles in which they were hit hard for their support for the law, and other Democrats were forced to retire because they had no hope of getting re-elected given their support for the law. But in some cases — such as John Kerry leaving his seat to become secretary of state, or Robert Byrd passing away — Obamacare clearly had nothing to do with it.

Additionally, some outgoing pro-Obamacare votes were replaced by new Democratic senators.

That having been said, as of this writing, 15 Senators who voted for Obamacare either failed to win reelection or declined to run for reelection and had their seats turned over to Republicans. That number is likely to grow once the results are in from the Senate runoff in Louisiana, which Mary Landrieu is expected to lose.” - 29 senators who voted for Obamacare and won't be part of new Senate, 11/06/2014,


Note: The link below is to the entire article that produces the exact breakdown of the missing Senators.

Saturday, November 1, 2014

ACA/Obamacare: When Political Constituency Building Schemes Backfire

‘Most Americans don’t want to get rid of Obamacare. They just don’t share its fundamental goal of universal coverage anymore.

And not only did the political benefits that Democrats thought the 2010 law would eventually bring them not materialize, opposition has only grown, according to an analysis of multiple polls taken between 2010 and last month.

“There have been backlashes, but never like this,” said Robert Blendon, a professor at the Harvard School of Public Health and co-author of the analysis released Wednesday by the New England Journal of Medicine.

That backlash doesn’t appear directed at the mechanics of the law but at its underlying core principle.

Only 47 percent of Americans agree that it’s the government’s job to make sure everyone has health coverage, down from 69 percent in 2006, the analysis found. That shift is particularly pronounced among likely voters. Of those who are most likely to show up at the polls on Nov. 4, one in four believe in this principle.

The study includes a new poll of likely voters by the Harvard School of Public Health showing that while only 31 percent want to see Obamacare repealed, 23 percent want it scaled back. This coalition of Republicans and independents could represent a mandate for congressional efforts to diminish the sweeping overhaul four years after it was enacted — and with millions of people now covered under its provisions.

The debate is now “about whether or not you believe you want to get everybody covered,” Blendon said. “Something happened on the way to the forum here that made that a much more controversial value.”’ - Obamacare brings Democrats backlash, not benefits,, 10/29/2014

Link to the entire article appears below:

Friday, October 24, 2014

ACA/Obamacare: Same Zebra with the Same Stripes?

‘If there is one thing Republicans and Democrats agree on it’s this: Obamacare represents a radical change in the US health care system. Soon after its passage, some on the left declared that we had created a right to health care for the first time in our history. Some on the right predicted death panels and a march toward socialized medicine.

But what if they are all wrong?

Is it possible that we could spend $2 trillion over the next ten years, create hardship and anxiety for millions of families who already had health insurance they liked, cause buyer’s remorse for millions of newly insured, cause almost every business in America to change its employee benefits and at the end of the day accomplish not much of anything?

Yes that’s possible.

What brings this to mind is a new report by the inspector general at the Department of Health and Human Services. As summarized in The New York Times:

“… the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards….”

“The report … says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.” ‘

‘The same problem arose under Romney Care. When he was governor, Mitt Romney told me that once people were insured, they would go to physicians’ offices rather than hospital emergency rooms. They would get less expensive care and more appropriate care as a result, he said.

There were two problems with that prediction. First, Romney Care didn’t create any new physicians’ offices. Second, the newly subsidized private insurance didn’t pay that much more than Medicaid. Bottom line: patients in Massachusetts are largely going to the same places they went before Romney Care. Emergency room traffic is higher than ever. The traffic to community health centers has changed very little. For reasons I don’t understand, those with newly subsidized private insurance have more difficulty seeing a doctor than patients on Medicaid. And waiting times in Massachusetts are the highest in the country. In Boston, the wait to see a new doctor is about two months!

Under Obamacare, things are likely to be even worse. Not only does the health reform law not create any new doctors, it will shrink the supply of doctor services as more physicians retire early (discouraged by a new raft of rules and regulations) and more of them become hospital employees (where they work nine to five and play golf on the weekends). At the same time the law will greatly expand the demand for care by the relatively healthy. Millions of senior citizens are now entitled to an annual wellness visit (of no medical value according to almost every expert) and everyone with private insurance will be entitled to a long list of preventive procedures (almost all of questionable medical value), with no copayment or deductible.

Giving preventive care to healthy patients is time consuming and it crowds out access by those who have genuine medical problems. In fact a Duke University study estimated that fulfilling the promise of preventive care to all Americans would consume almost the totality of the average doctor’s day.’ - What if Obamacare Doesn't Change Much Of Anything?, Forbes, 10/06/2014

Link to the entire article appears below:

Wednesday, October 22, 2014

ACA/Obamacare: Cancellations and Confusion in Colorado

“DENVER—The Colorado Division of Insurance announced Friday a surge in health-care policy cancellations in the wake of Obamacare, just what Democratic candidates in high-profile races didn’t need less than three weeks before Election Day.

In a letter to state Senate Republicans, Colorado insurance commissioner Marguerite Salazar said that more than 22,000 Coloradans received cancellation notices in the last month, and that 192,942 Coloradans will lose their policies at the end of 2015.

That would bring the total number of cancellations in Colorado to more than 550,000 by the time the Affordable Care Act has been fully implemented and non-compliant plans have been phased out. Ten Colorado carriers have opted to continue offering non-compliant plans through 2015, Ms. Salazar said.”

“A RAND Corporation report issued earlier this week found that there was “significant confusion and little understanding about Medicaid and private insurance subsidies through Connect for Health Colorado,” the state-run exchange.

Barriers to enrollment included “mistrust” of the system and “unfavorable attitudes toward the individual mandates,” despite the exchange’s $21 million marketing effort.” - Health care cancellation avalanche hits Colo. Democrats weeks before election, The Washington Times, 10/17/2014

Link to the entire article appears below:

Tuesday, October 14, 2014

ACA/Obamacare: The Affordable Care Act and the New Economics of Part-Time Work by Casey Mulligan

“Starting this year, the United States’ working population will face three major employment disincentives resulting from the very benefits the Affordable Care Act (ACA) provides: (1) an explicit tax on full-time work, (2) an implicit tax on full-time work for those who are ineligible for the ACA’s health insurance subsidies, and (3) an implicit tax that links the amount of available subsidies to workers’ incomes.

A new study published by the Mercatus Center at George Mason University advances the understanding of how much these ACA taxes will reduce overall employment, and why. It concludes that the reduction will be nearly double that projected by previous analyses. Labor markets ultimately will reduce weekly employment per person by about 3 percent—translating to roughly 4 million fewer full-time-equivalent workers.” - Mercatus Center, George Mason University, 10/07/2014

Link to the working paper by Casey Mulligan:

ACA/Obamacare: Covered California’s No-Bid Contracts

“California's health insurance exchange has awarded $184 million in contracts without the competitive bidding and oversight that is standard practice across state government, including deals that sent millions of dollars to a firm whose employees have long-standing ties to the agency's executive director.

Covered California's no-bid contracts were for a variety of services, ranging from public relations to paying for ergonomic adjustments to work stations, according to an Associated Press review of contracting records obtained through the state Public Records Act.

Several of those contracts worth a total of $4.2 million went to a consulting firm, The Tori Group, whose founder has strong professional ties to agency Executive Director Peter Lee, while others were awarded to a subsidiary of a health care company he once headed.”

“The founder of The Tori Group, Leesa Tori, worked under Lee when she was a senior executive at Pacific Health Advantage, a small business insurance exchange that failed in 2006. Lee was a longtime chief executive of Pacific Business Group on Health, which managed Pacific Health Advantage, and Tori also worked with him at the parent company.

Long before it opened its doors to the public last fall, Covered California awarded a small contract to Tori for her advice on designing a program to sell insurance to small companies. The $4,900 agreement in late 2011 was executed without rival bids.

The deal would mark the beginning of a lucrative and far-reaching partnership between the agency and the company Tori formed about two years ago, just as national health care reform took root across the U.S. An initial $150,000 contract with The Tori Group in March 2013 was executed by Lee, but later amendments that increased its value to $4.2 million were approved by Covered California's board, an agency statement indicated.

Nearly three years after her first, small contract went into effect, she and employees at her firm hold senior-level positions and work on issues ranging from enrollment to health plan design at Covered California.

At least five other people who are contracted to work at Covered California have ties to the now-defunct Pacific Health Advantage, four of them at The Tori Group, whose employees are paid through the consulting contracts. In all, nine people listed on the group's website, in addition to Tori, work at the exchange.

Yolanda Richardson, Covered California's chief deputy executive director who reports directly to Lee, was a vice president at Pacific Health Advantage. Before she was hired on staff, she received a 10-month, $176,500 no-bid consulting contract from the agency in 2011, about a month before Lee came on board, according to the records.” - AP Exclusive: California Gives No-Bid Health Pacts, 10/12/2014

Link to the entire article appears below:







Saturday, October 11, 2014

ACA/Obamacare: Schemes Tend to be Complicated and to Become More Complicate as Time Passes

Assume for a moment you are one of the many millions that have already procured an on-exchange health insurance policy through Yes, assume for a moment you were one of the persistent people that had the patience to pass through seventy six web-based pages of data collection on a highly glitch prone web site and acquired a health insurance policy. One would assume you weathered the storm, made a gallant effort and now there is nothing but blue skies ahead. Congratulations are in order, right? Maybe not so much. How so?

Now it’s renewal time and the yellow brick road forks. Here are several items one will encounter at the fork in the road known as open enrollment renewal:

(a) as one approaches open enrollment renewal, the directional sign is blank at the fork in the road . One will not be able to know plan prices or plan availability until 11/15/2014 which is the first day of open enrollment (and a politically convenient date falling after the mid-term elections), (1)

(b) one’s current plan selected on-exchange at, for a multitude of reasons, may no longer be available. Yes, do not pass go, do not collect two hundred dollars and merely start all over again by searching for a plan, (2)

(c) your plan may still be available but the price has risen in a substantial manner. If the price rise is extreme, merely start all over again by searching for a plan, (3)

(d) if one was/is receiving a subsidy then income must be projected again in regards to subsidy eligibility. One must further consider the change in price of the second lowest silver plan price now available upon the exchange, which is a determinant of subsidy, and then considerer the new price of the second lowest silver plan in relation to the plan one considers selecting, (4)

(e) one might do nothing. Huh? That’s right, if you already have an on-exchange health insurance policy through, and if the plan is continued, and you do nothing you are automatically re-enrolled. Sweet! An easy way out! Nada. The plan may continue and yes one is re-enrolled, but the price has likely changed upward. If one is receiving a subsidy and since one did nothing, one’s income was not re-projected and the new price of the second lowest silver plan in relation to the new price of the old plan you selected (automatically re-enrolled) still holds as a determinant, so your subsidy likely remains the same while your plan’s price rises substantially and one ends this zero effort exercise with a nasty premium increase, (5)

(f) meanwhile the process outlined above needs initiated between 11/15/2014 and 12/15/2014. Renewal open enrollment is a thirty day window and is not the same as the open enrollment period for new comers which is 11/15/2014 to 02/15/2015. (6)

Happy holidays! One might consider that holiday shopping after 12/15/2014 and don’t be late for Thanksgiving dinner!



(1) Next edition of is unveiled,, 10/08/2014



(2) ACA/Obamacare: Why Your Old Plan Got Cancelled and Why Your New Plan Is Likely to be Cancelled Too.



(3) (4) How Automatic Renewal Could Cost Obamacare Enrollees, WJS, 07/02/2014


(5) (6) Next edition of is unveiled,, 10/08/2014









Thursday, October 9, 2014

ACA/Obamacare: California Proposition 45

"Californians are split over a high-profile voter initiative that opponents say could complicate the future of President Barack Obama ’s health-care law in one of the states that has gone furthest to embrace it.

Proposition 45 would grant California’s insurance commissioner new powers to veto health-insurance premium increases for individual and small-group policies, a popular sentiment in a state that has seen large rate jumps in the past, though they have recently moderated.

Some prominent Democrats, including Sens. Dianne Feinstein and Barbara Boxer, have endorsed the measure, which would also grant citizens and outside groups the power to delay health-insurance rate increases by requesting a government review.

The measure is strongly opposed by health insurers, who have donated tens of millions of dollars to defeat it. Opponents say the measure could hamper efforts to further implement the health-care law in California, which spent more time and money than any other state building its insurance exchange, Covered California. They say Covered California’s power to negotiate with insurers on behalf of consumers would be weakened, and that federal subsidies could be hard to price for many of the low-income people who dominate the exchange.

“It starts to raise very serious questions about the certainty of what Covered California will be able to negotiate with the insurance companies…and even whether some plans will be available,” said Rep. George Miller (D., Calif.), one of the Affordable Care Act’s co-authors. “The problem is Prop 45 was written before we got to the final stages here” of the ACA.

Prop 45 was originally drafted for the 2012 election, but the measure failed to qualify for the ballot in time. Since then, Covered California has become the most robust exchange in the country, signing up 1.4 million people during the last enrollment period.

The new powers under Prop 45 would broadly enhance the influence of Dave Jones, the Democratic state insurance commissioner. Since taking office in 2011, he has said that a missing piece of the health law was the lack of authority to reject insurance rate increases."

- Californians Split Over Letting Official Veto Insurers’ Rate Boosts, WSJ, 10/09/2014
Link to the entire article appears below: