Thursday, February 27, 2014

ACA/Obamacare: For Whom the Pixie Dust Tolls

‘"I can't afford to go out and buy insurance while trying to start a business," said Willmus, of Colorado Springs, Colo. "Obamacare will allow me to be more comfortable at risking what I own." ’

‘Craig Mason, 59, said he has felt tied to his job as an engineer at a large defense contractor because he and his wife needed health insurance. A diabetic, he couldn't get affordable coverage on the individual market.

Now, however, he's thinking of leaving his employer in a few years to focus more on his side job, repairing and building guitars and other string instruments. He also wants to spend more time with his three grandchildren.

"I want to try something different," said Mason, a Germantown, Md., resident. "I don't want to be tied to a large corporation. The Affordable Care Act may be just the vehicle to bridge the gap until I'm eligible for Medicare." ’ - I'm quitting my job. Thanks Obamacare!, 02/25/2014

Apparently Ms. Willmus and Mr. Mason attribute their good fortune to Obamacare or The Affordable Care Act. Ostensibly the entity by the name Obamacare or Affordable Care Act is an exogenous entity that bestows low cost health insurance by its own means. Yes, the proverbial pixie dust generator!

Ms. Willmus and Mr. Mason have forgotten that other taxpayers are the means. That exogenous taxpayers are coercively made to cause the good fortune of a recipient class which Ms. Willmus and Mr. Mason have chosen to join. How very nice indeed!

Link to the Yahoo article appears below:



Obama Administration Estimates ACA to Accelerate Small Business Health Insurance Premiums: When Promised Premium Decreases Become Premium Increases

“Nearly two-thirds of small businesses that currently offer health insurance to their workers will pay more for coverage as a result of new rules in the health care law, as will millions of small-business employees and their family members, according to new estimates released by the Obama administration.

The Centers for Medicare and Medicaid Services, which has spearheaded the implementation of the law, has acknowledged that new rules requiring insurers to offer guaranteed coverage and renewal options to small employers will likely drive up the price of insurance for some companies. So will rules banning insurance companies from varying their rates based on factors like a company’s industry or the age of its employees.

On the other hand, some firms with exceptionally sick or at-risk workers will benefit from those provisions and see their premiums come down under the new rules, which took effect this year.

What we didn’t know was how many small businesses would see their rates rise and how many would see them fall. Now, it’s becoming clear.

“We are estimating that 65 percent of the small firms are expected to experience increases in their premium rates while the remaining 35 percent are anticipated to have rate reductions,” CMS’ Office of the Actuary wrote in a new report. Conversely, “the effect on large employers is expected to be negligible,” because most large companies run their health insurance programs in house.”

“If accurate, it would continue a steady climb in insurance costs for many small businesses. Ninety-six percent of small businesses say their premiums have increased in the past five years, with the average monthly insurance cost soaring from $590 per employee in 2009 to $1,121 in 2014, according to poll released earlier this month by the National Small Business Association.” - Obama administration: Health law’s new rules will increase costs for most small businesses,, 02/24/2014


Link to the article appears below:

Wednesday, February 26, 2014

Sebelius and the ACA: When Seven Million Enrollees Means Not Seven Million Enrollees

‘Secretary of Health and Human Services Kathleen Sebelius distanced the Obama administration from its unofficial goal of 7 million Affordable Care Act signups by the end of March.

In a Tuesday appearance on HuffPost Live to discuss outreach to African American communities, Marc Lamont Hill asked Sebelius about Vice President Joe Biden's acknowledgement that the administration may not reach the 7-million mark, but may see 5 to 6 million Americans enrolling by the end of next month.

"First of all, 7 million was not the administration," Sebelius said. "That was a CBO, Congressional Budget Office, prediction when the bill was first signed. I'm not sure where they even got their numbers. Their numbers are all over the board. The vice president has looked and said it may be closer to 5 to 6."‘ - Kathleen Sebelius Distances Obama Administration From Lofty Obamacare Signup Goal,, 02/25/2014

‘The comments appear to contradict what she told NBC News the day before the launch of the troubled healthcare site last fall when she said that "success," in her opinion, would be having 7 million Americans enrolled in the Obamacare exchanges by the end of March.

"I think success looks like at least 7 million people having signed up by the end of March 2014," Sebelius told NBC's Nancy Snyderman on Sept. 30.

Last June Sebelius
also volunteered the figure, telling reporters, "We're hopeful that 7 million is a realistic target."

Syndicated columnist Charles Krauthammer blasted Sebelius in an interview Tuesday on Fox News' "
Special Report with Bret Baier."

"Of course, she was the one that said it, among others," he said. "You know, it's an old rule, 'say the truth, it's easier to memorize." ' 
 - Sebelius Denies 7 Million Was Obamacare's Target,, 02/26/2014

Links to both articles appear below:



ACA: Lawyers, Funds and Money.... ‘Cause My Vote Just Hit The Fan

"Democrat Congressman Gary Peters is running for US Senate in Michigan, where he's facing a strong Republican opponent in former Secretary of State Terri Lynn Land. Like other Democrats across the America, Peters is worried sick about the political impact Obamacare -- a law for which Peters voted in 2010. Unlike many others, however, he's taken the extraordinary step of dispatching a team of lawyers to bully Michigan broadcasters into refusing to air a television ad that's critical of the healthcare overhaul. The spot is being run by Americans for Prosperity and features a cancer patient who was among the millions whose previous health plans were dropped as a result of Obamacare. The mother who's battling leukemia says politicians broke their word about the law, and that she's hurting because of it." - Dem Senate Candidate Sics Lawyers to Silence Cancer Patient in Anti-Obamacare Ads,, 02/24/2014

Link to the entire article appears below:

Saturday, February 22, 2014

ACA: Beyond the “Penalty” [Tax] Lies the “Annual Fee” [Tax]

‘The "annual fee" tax on health insurers will result in a premium increase of $60 to $160 per person in 2014, rising to $100-$300 by 2018, for the average insured individual -- and over $260 per family in 2014, rising to over $450 in 2018, for families with employer-sponsored, fully-insured coverage.’

Note: Click chart to the right to enlarge.

‘The logic behind this tax is that insurance companies will make money from increased enrollment due to the ACA, and therefore should pay more to the federal government. However, in order to remain in business, as well as to meet state and federal solvency and actuarial requirements, insurers will have to pass most of this tax along to policyholders in the form of higher premiums, or possibly higher average out-of-pocket costs or reduced benefits.

The form this tax takes makes it easy for the government to forecast its revenue. However, it is difficult or impossible for businesses to calculate the tax they will owe until well after the tax liability is incurred, in part because each insurer's tax liability depends not only on their own revenue, but on that of every other covered insurer in the country. In addition, certain types of health insurers are exempt from the tax.’

‘However, there is another effect not widely recognized. Most people enrolling through exchanges will receive a premium subsidy based on the difference between a specified percentage of their income, and a standard insurance plan (the second-lowest-priced silver plan available in their location for their family size). If the premiums are increased to pay the health insurance tax, the subsidies will automatically increase by the same amount – in effect, the federal government will be paying the tax to itself in the case of subsidized exchange customers.

This effect will partially apply in the case of those with fully insured employer-sponsored health plans. Because the premiums for employer-sponsored insurance are a form of compensation not counted as taxable income (regardless of whether they are allocated to the employer or the employee), the federal government will not collect personal income tax or FICA (payroll) tax on this amount. When the premiums increase to pay the health insurance tax, collections of income and payroll taxes will be reduced, on average, by the amount of the health insurance tax times the marginal tax rate of affected workers. This means that the federal government will be paying a portion of this tax (ranging from about 15 percent to about 40 percent, depending on the worker's income) to itself, though not the full amount as in the case of subsidized exchange enrollees.

In the case of Medicaid, CMS regulations[17] require that states pay premiums to Medicaid Managed Care Organizations (MCOs) that are “actuarially sound.” Because taxes and fees are necessary costs incurred by MCOs, they must be included in the determination of actuarially sound rates. As a result, MCOs will be fully reimbursed by the state and federal governments for the cost of this tax.[18]

In short, a substantial portion of this tax is simply transferred from the insured customer to the government, and back to the insured customer – and in the case of Medicaid, from government to government – with the insurance company serving as an intermediary in both directions. However, even in cases where there is no direct tax or budgetary impact, there will be administrative costs associated with the tax borne by both the government and the insurance companies. These particular administrative costs represent complete and unambiguous waste, as they benefit neither patients, providers, insurers, other taxpayers, nor the government.

The “annual fee” tax will, however, have its full impact on exchange enrollees without subsidies. This includes those not eligible for exchange subsidies – either because their employer offers individual coverage only,[19] or because their income exceeds four times the federal poverty level for their family size.’ - Impact of the Health Insurance “Annual Fee” Tax, Executive Summary, Robert A. Book, 02/20/2014

Link to the executive summary appears below:







Friday, February 21, 2014

ACA: The Shrinking-Shrinking Sign Up Projection

‘Late summer before the federal health exchanges launched, Health and Human Services Secretary Kathleen Sebelius said the Obama administration had a goal of getting 7 million people fully enrolled in Obamacare by March 2014.

"I think success looks like at least 7 million people having signed up by the end of March 2014,"Sebelius said during an interview with NBC News.

The White House has been slowly backing away from that number as health exchanges around the country continue to fail and as few people show interest in the program. Now, Vice President Joe Biden is admitting the White House probably won't be meeting its goal of 7 million people enrolled by March.’

‘"We may not get to seven million, we may get to five or six, but that's a hell of a start," Biden said, according to a pool report of his meeting.

The Obama administration said last week that 3.3 million people have enrolled in private Obamacare health plans between October 1 and Feb 1.’

‘Keep in mind the definition of enrolled is a broad one. The federal government counts people putting Obamacare plans in their online shopping carts as "enrolled" before they pay for the plan or check out.’ - Biden: That 7 Million Obamacare Enrollee Goal is Probably Not Going to Happen,, 02/20/2014 and Biden: 'We may not get to 7 million' by Obamacare deadline, Reuters, 02/19/2014

Link to the complete articles appear below:

Tuesday, February 18, 2014

ACA: Colorado Health Exchange Director Indicted

"State health care exchange officials said they had thoroughly vetted Christa Ann McClure, the Connect for Health Colorado director they placed on paid administrative leave Tuesday after learning she had been indicted for stealing from her last employer.

McClure, 51, pleaded not guilty Feb. 6 in federal District Court in Montana to eight counts of theft and fraud from a nonprofit housing agency in Billings.

She was indicted Jan. 16 and notified her current Denver employer, the state-sponsored health exchange, on Monday, a few days after the story broke in Montana media, Connect for Health spokesman Ben Davis said in a telephone interview.
Connect for Health performed a criminal background check and checked references before hiring McClure in March, Davis said.
"She was completely clean," he said. Her position as executive director of Housing Montana of Billings, he said, made her well-qualified for her post as Connect for Health's director of partner engagement — she was liaison with state and federal partners, such as Medicaid officials. The job pays $130,000 a year." - Colorado health exchange officials say indicted director was vetted,, 02/12/2014

Link to the entire article appears below:

Sunday, February 16, 2014

Obamacare: There Is No Crying In Baseball…..But There Is Crying In The ACA

“About 50,000 health insurance applications, many filed by low-income Massachusetts residents, have yet to be processed by the state’s troubled insurance marketplace, officials disclosed Thursday, and it may take months to get all these people enrolled in subsidized plans.”

“For several months, residents have been encouraged to file old-fashioned paper applications because the state’s insurance website has been hobbled by error messages and has crashed frequently since it was revamped in October to comply with the more complex requirements of the federal health care law.

Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the Connector board how demoralized her staff is.” - 50,000 filings for health coverage in limbo, Boston, 02/14/2014

Link to the entire article appears below:

Saturday, February 15, 2014

ACA: The Most Healthy and Least Wealthy Subsidize The Least Healthy and Most Wealthy.

Consider these excerpts from an article recently appearing in the Wall Street Journal:


‘In all, 25% of the people enrolling in private plans through the online portals since their launch in October were between the ages of 18 and 34, according to the data. Through the end of December, that proportion was 24%, according to a previous report from the federal government.

That is well short of the percentage of young people who might have registered in the exchanges. Insurers say they need strong enrollment from younger people. who are likely to be healthier, to balance out the likely higher costs racked up by older, sicker people.

Kaiser Family Foundation, a health-policy think tank, has said census data suggest that about 40% of people for whom the exchanges were intended are in the 18-34 age group.’


‘The Congressional Budget Office initially estimated that 7 million people would use exchanges in 2014; the nonpartisan agency has since revised that number downward to 6 million to take into account the technical problems that stopped many from signing up in the first weeks of the exchanges' launch.

Actuaries have warned that if the participants in the exchange end up incurring bigger medical claims than they had anticipated, insurance premiums will jump in future years. Older people and women typically have higher costs, though not always, they say.

The key question is how costs will compare to expectations," said Ross Winkelman, a fellow of the Society of Actuaries. "Age is a useful, but imperfect predictor of costs. Enrollment at the oldest ages seems to be outpacing expectations, which will clearly raise some concerns."

Administration officials declined Wednesday to discuss concerns about the balance of risk in the new insurance marketplaces.’


‘Other supporters of the law have said they are banking on getting young people in as the deadline for getting coverage this year nears.

"We are doing everything we can in the next six weeks to make sure young people know they can get free or reduced-cost coverage," said Aaron Smith, the executive director of the advocacy organization Young Invincibles.

The group has planned more than 100 events around the country for the coming Presidents Day weekend, including an enrollment event in Miami and a pub-crawl in Austin, Texas.’ - Young Remain Slow to Sign Up On New Exchanges [print edition] 02/13/2014 (appearing in the on-line edition as: Health Exchanges Hit 3.3 Million Enrollees Through January) (1)


One might want to further examine the position of Aaron Smith, executive director of the advocacy organization Young Invincibles, regarding: "We are doing everything we can in the next six weeks to make sure young people know they can get free or reduced-cost coverage."

The first concern a young person might examine is the following from the web site:

“People under 30 and people with hardship exemptions may buy a "catastrophic" health plan. This type of plan mainly protects you from very high medical costs.”

“If you buy a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or lower out-of-pocket costs based on your income. Regardless of your income, you pay the standard price for the catastrophic plan.” (2)

Therefore, if you are young, age 29 or under, you can purchase a catastrophic plan but you do not qualify for a subsidy. Hence someone picked winners and losers in the subsidy game and young people wanting the lower cost catastrophic plan are the losers. Very nice indeed!

An additional concern a young person might want to examine is the price of the catastrophic plan. Similar plans were roughly 25% less expensive before 01/01/2014 and ACA pricing. The increased price is subsidizing older insured’s. Hence the young indirectly or directly subsidize non-catastrophic coverage purchasers (those over 30) yet themselves can not qualify for a catastrophic plan subsidy. The subsidizer can’t obtain a subsidy. A one-way subsidy street. Sweet! (3)


(1) Young Remain Slow to Sign Up On New Exchanges [Health Exchanges Hit 3.3 Million Enrollees Through January], WSJ, and, 02/13/2014 and 02/12/2014, respectively.

(2) Can I buy a “catastrophic” plan?,

(3) Where's The Outrage From Young Americans About Obama's Health Reforms?,, 07/31/2012











ACA: One Branch Government and a Chart of Its Unilateral Path

Thursday, February 13, 2014

Obamacare Strikes Again! National Youth Enrollment Day Being the Same Day the ACA Web Site is Down for Extended Maintenance. No Way! Way!

“Did you know that this Saturday is National Youth Enrollment Day? Don’t worry, few people do. It’s another gimmick and last-minute effort to get young healthy, people to sign up for ObamaCare.

However, someone forgot to tell the folks over at Health and Human Services. They announced that will be down this weekend for scheduled maintenance. Perfect timing!

Those most surprised about the scheduling snafu are youth advocacy groups hosting bar crawls and attending festivals trying to get young people to enroll. Once again, because of incompetence the Administration is shooting itself in the foot –and that is to the good of young people who are being sold a bad deal with ObamaCare.

Buzzfeed reports:

Saturday is National Youth Enrollment Day for Obamacare, a day designed to help make up for youth recruitment time lost while was down last year. It will be marked by a broad array of events, from Head Start information sessions to pub crawls.

The day will also feature a outage that came as a surprise to the White House allies who have been planning Feb. 15 enrollment activities for weeks.

The Obamacare website outage begins at 3 p.m. ET and carries on through Tuesday at 5 a.m. ET. While the Social Security system is down for maintenance, users will not be able to formally send in an application for health insurance, though they will be able to browse plans and, the enrollment groups say, calculate what insurance will cost for their family.

A functioning website has always been pitched by the administration and its allies as key to securing youth enrollment in health care. It’s not the most important thing, they say — affordability information is the key to getting youth enrollment. But a working website is a key piece to the puzzle.” - Obamacare Youth Blunder, Independent Women’s Forum, 02/13/2014

Link to the entire article appears below:

Wednesday, February 12, 2014

Obamacare Bailout or Risk Adjustment? First Insurer Comes Forward Requesting $250 to $450 Million

"There’s been a lot of discussion about whether the risk adjustment tools embedded in ObamaCare amount to a bailout for the insurance companies, or are a reasonable feature of the law. There’s been far less information about how much money the insurers stand to gain from these measures, to offset their expected losses.

Now we have some hard numbers. Humana announced that it expects to tap the three risk adjustment mechanisms in ObamaCare for between $250 and $450 million in 2014. This amounts to about 25 percent of the insurer’s expected exchange revenue. This money is needed to offset losses that the insurer will take as a result of slower enrollment in its ObamaCare plans, and a skewed risk pool that weighs more heavily toward older and less healthy members than it originally budgeted.

More than half of the money will come from the $25 billion reinsurance pool that ObamaCare provides (collected through a tax on employer-sponsored health plans). The other half will come mostly from the risk corridors. Humana is expected to book the money as revenue to offset shortfalls between what it collects in exchange premiums and pays out in medical claims.

The company blamed the Obama Administration’s decision late last year to extend grandfathering of individual market plans for the overall deterioration in the risk pool. That means that Humana (like other insurers) was counting on people from the individual market being forced to transition into ObamaCare plans. It’s widely perceived that the Obama Administration counted on that migration as well. But Humana’s statement was a very clear expression of this expectation." - Obamacare 'Bailout' For One Insurer Will Cost Up To $450 Million In 2014,, 02/06/2014

Link to the entire article appears below:


ACA Enrollment Collapses: They Came, They Saw, They Did Not Pay.

“With less than seven weeks of open enrollment to go, ObamaCare enrollment — and payments — have slowed to a near-crawl in some states.

Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.

But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.

As of Feb. 1, Nevada had just 14,999 paid enrollees — vs. the state's March 31 goal of 115,000.

Washington state, meanwhile, was slightly more than halfway to its goal of 340,000 signups — but only 88,071 had paid as of Feb. 1.

The January data available from a handful of states raise new doubts about whether ObamaCare's downgraded first-year prospects are still too optimistic.

Further, a spotty payment rate (50% in Washington and 66% in Nevada) creates a risk that the demographics of the paid exchange population may be older — and possibly sicker — than even the national signup data have signaled.”

“No state has provided as much detail about its enrollment through Feb. 1 as Minnesota, and the details are somewhat concerning. (The state counts people who have completed their application and chosen a payment method.)

Only 21% of signups were in the key 18-34 demographic vs. 35% ages 55 to 64. Minnesota officials have been taken by surprise at the share of people signing up for ObamaCare's richest "platinum" coverage, which reimburses 90% of the covered group's qualifying expenses.

Fully 29% have signed up for low-deductible platinum policies — compared to a projection of 5%. Such policies would tend to be favored by people who want to guard against high medical expenses, while someone expecting minimal costs might go for a high-deductible bronze plan.”
- ObamaCare Enrollment Slows To Crawl, State Data Show,, 02/10/2014

Link to the entire article appears below:

Tuesday, February 11, 2014

ACA: Another Day, Another Delay. Employer Mandate Delayed for Employers With 50 to 99 Full-time Workers.

“Most employers won't face a fine next year if they fail to offer workers health insurance, the Obama administration said Monday, in the latest big delay of the health-law rollout.

The Treasury Department, in regulations outlining the Affordable Care Act, said employers with 50 to 99 full-time workers won't have to comply with the law's requirement to provide insurance or pay a fee until 2016. Companies with more workers could avoid some penalties in 2015 if they showed they were offering coverage to at least 70% of full-time workers.

The move came after employers pressured the Obama administration to peel back the law's insurance requirements. Some firms had trimmed workers' hours to below 30 hours a week to avoid paying a penalty if they didn't offer insurance.

A senior administration official said the shift was a response to businesses' concerns, though the official said no one reason was behind the change.

Under the original 2010 health law, employers with the equivalent of at least 50 full-time workers had to offer coverage or pay a penalty starting at $2,000 a worker beginning in 2014. Last year, the administration delayed the requirement for the first time by moving it to 2015.

The new rules for companies with 50 to 99 workers would cover about 2% of all U.S. businesses, which include 7% of workers, or 7.9 million people, according to 2011 Census figures compiled by the Small Business Administration. The rules for companies with 100 or more workers affect another 2% of businesses, which employ more than 74 million people.”

“The new regulations are likely to help employers who currently don't provide health coverage to certain employee groups by allowing them to temporarily continue that practice for at least some workers, said Paul Hamburger, a health-care attorney at Proskauer Rose in Washington.

But employers remain subject to a $3,000 penalty each time one of those workers buys coverage on a state health-care exchange and qualifies for subsidized premiums, he said, after a preliminary review of the new regulations.”
- Health-Law Mandate Put Off Again, WSJ, 02/11/2014

Link to the entire article appears below:


Obama Rewrites ObamaCare. Another day, another lawless exemption, once again for business, WSJ, 02/11/2014

Obama validates the conservative case against the employer mandate, AEI, 02/11/2014

Sunday, February 9, 2014

ACA: The Informed and Web Savvy Consumer Purchases Health Insurance?

The Affordable Care Act was supposedly aimed at insuring the previously uninsured. Unfortunately a woefully low percentage of previous uninsured are attracted to ACA whereas the vast majority of applicants are the previously insured merely looking for a tax credit to lower rates [subsidy]. (1)

Moreover, regarding the uninsured or the previous insured seeking subsidy, an implicit assumption by the central planners of ACA is that potential health insurance consumers are web savvy and informed consumers of health insurance. Maybe not so much regarding the uninsured which is the supposed target market of ACA.

Lower middle income and lower income people, making up a large segment of the previously uninsured, are not exactly the segment of the population with computers, computer skills and web savvy. Hence the central plan designers of the ACA have designed a delivery system known as the market place exchange web site that does not match the target market’s access point and skill set.

The same population that makes up the uninsured market, if they manage to find a computer, acquire computer skills and navigate the web site, are further assumed to be informed consumers by the central planners. Would an uninsured person or an insured person be more informed regarding health insurance? Would a person consistently uninsured in the realm of health insurance over long periods, in the main, be familiar and informed regarding health insurance?

One ends with a mismatched delivery system regarding its target market with the target market being additionally populated with uninformed market participants. Central planning at its zenith!

What are the results? Abysmal. However, highlighting two of the uninformed results may be of interest:

(a) when comparing seemingly like-kind insurance plans on the ACA web site the consumer defaults to lower price. Unfortunately the lower price many times means the consumer has purchased the ultra-narrow or narrow provider network. Hence when the time comes to use the insurance the consumer finds few takers. One might call this procedure being “informed” the hard way, (2)

(b) the supposed informed consumer will realize, without any doubt, that once his or her policy is issued they will need to request a HIPPA Release Authorization Form from their insurer, sign such form, and return it post-haste. Huh? Without the form only the named insured can access insurance information, claims paid or pending information, etc. A single person without a HIPPA Release Authorization Form filed will find no outside person can help. If a spouse is involved, sorry no information unless the form is on hand. Yes, one spouse is considered the named insured and the other spouse can only gain access if the named insured submits the HIPPA Release Authorization Form. Of course the model informed consumer of the central planner surely knows this information without a second thought. (3) (4) (5)

The plans differ; the planners are all alike... - Frédéric Bastiat



(1) Aetna could be forced out of Obamacare: CEO, CNBC, 01/22/2014


(2) Marketplace Plans’ Networks Are Very Small, Study Finds. Kaiser Health News, 12/12/2013

(3) Authorization Use and Disclosure FAQs

(4) HIPAA Release Form

(5) HIPPA Release Authorization Form

Saturday, February 8, 2014

ACA: When the Provider Network is Not the Provider Network

'After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor's office.

A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.

Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.

Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.

But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.

"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."

To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.

Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.

"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."‘ - Obamacare enrollees hit snags at doctor's offices, Los Angeles Times, 02/04/2014

Link to the entire article appears below:,0,1675336,full.story#axzz2sgbPiNeG


Wednesday, February 5, 2014

ACA Error Resolution: The No Fix-Fix

“Tens of thousands of people who discovered that made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors.

Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.

For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health-care marketplace directly — are told that’s computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation." - can’t handle appeals of enrollment errors, Washington 02/02/2014

Link to the entire article appears below:

Sunday, February 2, 2014

Obamacare Bailout of Health Insurers

“House Republicans floated the idea Friday of demanding that the White House agree to end programs designed to assist insurance companies selling policies as part of the new health-care law in exchange for raising the debt ceiling for one year, according to a GOP lawmaker and senior leadership aides.”

“Under one scenario discussed Friday morning at the House GOP's annual policy retreat held on Maryland's Eastern shore, Republicans would agree to extend the debt limit for one year, but demand that there be "no bailouts for insurance companies under Obamacare," the lawmaker and aides said. House Majority Leader Eric I. Cantor (R-Va.) and House Budget Committee Chairman Paul Ryan (R-Wis.) described to colleagues how this scenario could play out and conservative lawmakers in the room seemed supportive of the idea, including Rep. Michele Bachmann (R-Minn.), who spoke up in support and offered to help whip up support for the plan among Republicans.”

“Concerns about a so-called "Obamacare bailout" have emerged in recent days, especially on conservative op-ed pages. The term is generally used to describe three programs in the health-care law — two temporary and one permanent — that make it less financially risky for health insurance plans to sell on the new exchanges. The term also is sometimes used to refer to one specific program in the health-care law known as "risk corridors" that limit both the amount of money that a health insurance plan can make and lose during the first three years it is sold on the new health-care exchanges established by the law.” - House Republicans might propose canceling ‘Obamacare bailouts’ to raise debt limit, Washington Post, 01/31/2014

Link to the entire article appears below: