“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
“Despite over $205 million in federal taxpayer funding, Hawaii’s Obamacare exchange website will soon shut down. Since its implementation, the exchange has somehow failed to become financially viable because of lower than expected Obamacare enrollment figures. With the state legislature rejecting a $28 million bailout, the website will now be unable to operate past this year.
According to the Honolulu Star-Advertiser the Hawaii Health Connector will stop taking new enrollees on Friday and plans to begin migrating to the federally run Healthcare.gov. Outreach services will end by May 31, all technology will be transferred to the state by September 30, and its workforce will be eliminated by February 28.” - Hawaii’s $205 Million Obamacare Exchange Implodes, Americans for Tax Reform, 05/12/2015
Link to the entire story appears below:
http://www.atr.org/hawaii-s-205-million-obamacare-exchange-implodes
“The word “bipartisan” is considered by many inside the Beltway to be one of the highest honors that can be bestowed on a piece of legislation. That’s unfortunate, because too often bipartisanship means Republicans and Democrats supporting a bill that is all but certain to produce bad outcomes.
The latest example of such bipartisanship is the “Medicare Access and CHIP Reauthorization Act” (MACR). Passed Thursday by the House of Representatives, the bill would, among other things, remove the unworkable Sustainable Growth Rate (SGR) from Medicare’s payment system.
It would replace it with a payment system that is even worse.
The SGR is a formula that is supposed to help control Medicare’s costs by limiting payments to physicians. Each year the SGR sets an expenditure target for the amount Medicare spends on physicians’ fees. If the amount that Medicare actually spends exceeds the expenditure target, then physicians’ fees are supposed to be cut the following year by an amount that brings Medicare spending back into line with expenditure targets.
Physician groups have rebelled at the prospect of such cuts, telling Congress they would have a harder time treating seniors on Medicare under such a payment regime. Wary of lots of angry seniors showing up at the ballot box, Congress has suspended the SGR 17 times since 2003. But the prospect of the SGR cuts has still caused many physicians to limit the number of Medicare patients they see.” - Retooling Medicare’s Price Fixing Scheme Will Hurt Sick People, The Federalist, 03/27/2015
Link to the entire article appears below:
http://thefederalist.com/2015/03/27/retooling-medicares-price-fixing-scheme-will-hurt-sick-people/
“Thirty-six states and the District of Columbia currently limit entry or expansion of health care facilities through certificate-of-need (CON) programs.1 These programs prohibit health care providers from entering new markets or making changes to their existing capacity without first gaining the approval of state regulators. Since 1973, Florida has been among the states that restrict the supply of health care in this way, with 11 devices and services—ranging from acute hospital beds to organ transplants to psychiatric services—requiring a certificate of need from the state before the device may be purchased or the service may be offered.2
CON restrictions are in addition to the standard licensing and training requirements for medical professionals, but are neither designed nor intended to ensure public health or ensure that medical professionals have the necessary qualifications to do their jobs. Instead, CON laws are specifically designed to limit the supply of health care, and are traditionally justified with the claim that they reduce and control health care costs.3 The theory is that by restricting market entry and expansion, states might reduce overinvestment in facilities and equipment. In addition, many states—including Florida—justify CON programs as a way to cross-subsidize health care for the poor. Under these “charity care” requirements providers that receive a certificate of need are typically required to increase the amount of care they provide to the poor. In effect, these programs intend to create quid pro quo arrangements: state governments restrict competition, increasing the cost of health care for some, and in return medical providers use these contrived profits to increase the care they provide to the poor.4 “
- Certificate-of-Need Laws: Implications for Florida, Koopman and Stratmann, 03/03/2015
Link to the paper appears below:
http://mercatus.org/publication/certificate-need-laws-implications-florida?utm_source=Email&utm_medium=TWAM&utm_campaign=Newsletter
“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:
http://townhall.com/columnists/hankadler/2014/12/27/kill-the-obamacare-cadillac-tax-now-n1935676?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=
Consider these three statements regarding the legislation known as Obamacare:
'Max Baucus (D-Montana), chair of the Senate Finance Committee through which the health bill flowed, insisted that reading the law wasn't necessary. “I don’t think you want me to waste my time to read every page of the healthcare bill,” Baucus said, according to the Flathead Beacon. “You know why? It’s statutory language. ... We hire experts.”' (1)
'Tom Carper (D-Delaware), who also served on the Senate Finance Committee, insisted that the legislative language wasn't important: "I don't expect to actually read the legislative language, because reading the legislative language is among the more confusing things I've ever read in my life."' (2)
'“You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting. But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”' - Nancy Pelosi (3)
Hence legislation passed without being closely read yields many unintended consequences one of which is:
“The statute clearly states that subsidies are available only through exchanges established by a state, yet the IRS, in its interpretation, expanded the availability of subsidies to all exchanges – state and federal.
Should the D.C. Circuit decision (ruling against the IRS) be upheld, the impact would have a ripple effect on the health care law. First, only individuals purchasing coverage through a state exchange would be eligibility for federal subsidies. Those individuals in the federal exchanges would likely face costly premiums and many as a result may be exempt from the individual mandate. Second, since the employer mandate penalties are linked to the availability of the subsidies, employers would not be subject to the penalty in those states that did not establish a state exchange.”
“Aside from amending the law through normal legislative processes, one obvious quick fix would be to get more states to set up state exchanges. But that may a heavy lift. Many states opted to not establish an exchange in part because by 2015 states are required by law to fund the operating expenses of the exchanges on their own. Furthermore, grant funding that was originally included in the law to help states establish state exchanges is gone, and it is highly unlikely Congress would be willing to appropriate additional funds toward this endeavor.” - (4)
One has unread legislation, language repeatedly used specifying subsidies linked to state based exchanges, “experts” and consequential legal proceedings resulting in unintended consequences. What response does one encounter from ACA/Obamacare supporters?
“We feel very strong about the sound legal reasoning of the argument that the administration is making,” White House spokesman Josh Earnest said. “You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health-care costs regardless of whether it was state officials or federal officials who are running the marketplace.” (5)
The problem with the above argument by Mr. Earnest is dissected nicely by Peter Suderman at Reason.com:
“The reasoning for this ruling was simple: That’s what the law says. The section dealing with the creation of state exchanges and the provision of subsidies states, quite clearly, that subsidies are only available in exchanges "established by a State," which the law expressly defines as the 50 states plus the District of Columbia.
Obamacare’s defenders have responded by saying that this is obviously ridiculous. It doesn’t make any sense in the larger context of the law, and what’s more, no one who supported the law or voted for it ever talked about this. It’s a theory concocted entirely by the law’s opponents, the health law's backers argue, and never once mentioned by people who crafted or backed the law.
It’s not. One of the law’s architects—at the same time that he was a paid consultant to states deciding whether or not to build their own exchanges—was espousing exactly this interpretation as far back in early 2012, and long before the Halbig suit—the one that was decided this week against the administration—was filed. (A related suit, Pruitt v. Sebelius, had been filed earlier, but did not challenge tax credits within the federal exchanges until an amended version which was filed in late 2012.) It was also several months before the first publication of the paper by Case Western Law Professor Jonathan Adler and Cato Institute Health Policy Director Michael Cannon which detailed the case against the IRS rule.
Jonathan Gruber, a Massachusetts Institute of Technology economist who helped design the Massachusetts health law that was the model for Obamacare, was a key influence on the creation of the federal health law. He was widely quoted in the media. During the crafting of the law, the Obama administration brought him on for consultation because of his expertise. He was paid almost $400,000 to consult with the administration on the law. And he has claimed to have written part of the legislation, the section dealing with small business tax credits.”
“A video of the presentation, posted on YouTube, was unearthed tonight by Ryan Radia at the Competitive Enterprise Institute, a libertarian think tank which has participated in the legal challenge to the IRS rule allowing subsidies in federal exchanges. Here’s what Gruber says.
What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this. [emphasis added].”
“And what he says is exactly what challengers to the administration’s implementation of the law have been arguing—that if a state chooses not to establish its own exchange, then residents of those states will not be able to access Obamacare's health insurance tax credits. He says this in response to a question asking whether the federal government will step in if a state chooses not to build its own exchange. Gruber describes the possibility that states won’t enact their own exchanges as one of the potential "threats" to the law. He says this with confidence and certainty, and at no other point in the presentation does he contradict the statement in question.
In early 2013, Gruber told the liberal magazine Mother Jones that the theory advanced by the challengers in this case was "nutty." Gruber also signed an amicus brief in defense of the administration and the IRS rule. But judging by the video it is quite clear that in 2012 he accepted the essence of the interpretation advanced by the challengers.”
"Update: Earlier this week, Gruber was on MNSBC to address the Halbig ruling. He was asked if the language limiting subsidies to state-run exchanges was a typo. His response: "It is unambiguous this is a typo. Literally every single person involved in the crafting of this law has said that it's a typo, that they had no intention of excluding the federal states."
Update 2: The Cato Institute's Michael Cannon, who was instrumental in developing the arguments that laid the groundwork for the legal challenge in Halbig, responds to the video at Forbes:
I don’t mean to overstate the importance of this revelation. Gruber acknowledging this feature of the law is not direct evidence of congressional intent. But Gruber is probably the most influential private citizen/government contractor involved in that legislative process. He was in the room with the people who crafted this bill.
Update 3: Gruber says the statement in the video was "a mistake." Jonathan Cohn of The New Republic got a response from Gruber this morning. Here are a few snippets:
I honestly don’t remember why I said that. I was speaking off-the-cuff. It was just a mistake. People make mistakes. Congress made a mistake drafting the law and I made a mistake talking about it.
During this era, at this time, the federal government was trying to encourage as many states as possible to set up their exchanges. ...
At this time, there was also substantial uncertainty about whether the federal backstop would be ready on time for 2014. I might have been thinking that if the federal backstop wasn't ready by 2014, and states hadn't set up their own exchange, there was a risk that citizens couldn't get the tax credits right away. ...
But there was never any intention to literally withhold money, to withhold tax credits, from the states that didn’t take that step. That’s clear in the intent of the law and if you talk to anybody who worked on the law. My subsequent statement was just a speak-o—you know, like a typo.
Update 4: Gruber appears to have made a second "speak-o." In a separate speech, he spoke of the "threat" posed by states declining to build their own exchanges. And he once again explicitly ties the creation of state-based exchanges to the law's tax credits (its subsidies for private health insurance).” (6)
Upon further review, if one trumpets that reading legislation is a non-starter, legislative language is unimportant and that merely passing unread legislation and unimportant legislative language to see what is inside the legislation……then one should not be surprised by the never ending cascade of unintended consequences spawned by the ACA/Obamacare legislation. Political dupery and nitwitery has a price and cost.
A question to ponder regarding the never ending cascade of unintended consequences spawned by the ACA/Obamacare legislation is an old Thomas Sowell expression regarding notional propositions such as Obamacare: What next? Then what?
Updated 07/30/2014: The Flip-Flopping Architect of the ACA, Politico Magazine, 07/28/2014
http://www.politico.com/magazine/story/2014/07/jonathan-gruber-the-flip-flopping-architect-of-the-aca-109466_Page2.html#.U9jrBiUg91s
Notes:
(1) (2) Maybe Democrats Should Have Read Obamacare Before They Passed It, townhall.com, 07/25/2014
http://townhall.com/tipsheet/kevinglass/2014/07/25/obamacare-and-the-problem-with-democrats-refusing-to-read-the-bill-n1865814?utm_source=thdaily&utm_medium=email&utm_campaign=nl
(3) Nancy Pelosi: "We Have to Pass Our Bill So That You Can Find Out What Is In It", gatewaypundit.com, 03/09/2010
http://www.thegatewaypundit.com/2010/03/nancy-pelosi-we-have-to-pass-our-bill-so-that-you-can-find-out-what-is-in-it/
(4) The Obamacare Employer Mandate Could Die in Some States, dailysignal.com, 07/23/2014
http://dailysignal.com/2014/07/23/obamacare-employer-mandate-die-states/?utm_source=heritagefoundation&utm_medium=email&utm_campaign=morningbell&mkt_tok=3RkMMJWWfF9wsRonua%2FJZKXonjHpfsX56OgvWa%2BylMI%2F0ER3fOvrPUfGjI4AT8RmI%2BSLDwEYGJlv6SgFQrLBMa1ozrgOWxU%3D
(5) Federal appeals courts issue contradictory rulings on health-law subsidies, 07/22/2014
http://www.washingtonpost.com/national/health-science/federal-appeals-court-panel-deals-major-blow-to-health-law/2014/07/22/c86dd2ce-06a5-11e4-bbf1-cc51275e7f8f_story.html
(6) Watch Obamacare Architect Jonathan Gruber Admit in 2012 That Subsidies Were Limited to State-Run Exchanges (Updated With Another Admission), reason.com, 07/24/2014
http://reason.com/blog/2014/07/24/watch-obamacare-architect-jonathan-grube
The paper It All Depends: “Sticker Shock” in Health Insurance Reform, Pauly, Harrington and Leive, Wharton School, 01/04/2014 the conclusion is as follows:
Conclusion
"This analysis of the change in total expected payment for those to be covered in post-ACA exchanges tells rather different stories about "sticker shock." On the one hand, among those who previously bought individual coverage, premiums generally increase only modestly if they choose the plans with the lowest bronze or silver premiums. While bronze premiums are lower than what was paid before, however, estimated out of pocket payments are higher, so the net effect is a moderate increase in TEP. If people choose to pay the median silver premium, the increase will be larger, but (at 25-30%) is still much lower than some of the estimates from the informal literature.
The sticker shock story is much different for the previously uninsured. The low income previously uninsured will have subsidies to cover much of the higher premiums and cost sharing to which they will be subject. But the previously uninsured who will receive minimal subsidies, who constitute a sizeable fraction of the uninsured population, are estimated to experience a very large increase in financial responsibility. Not only will they have to pay significant premiums but, because of increases in total utilization because of moral hazard or greater willingness of providers to supply care, their responsibility for out of pocket payment will also increase. They will pay a slightly smaller fraction of their total cost of care than when they were uninsured, but the total cost will increase to such an extent that the financial burden will rise.
We have not provided welfare calculations for this population. Such calculations would reduce the change in TEP by an estimate of the value to them of additional care (but by something less than the cost of that care), and by a small reduction in the risk of very high levels of OOP. One reason for this large increase in TEP is the small average OOP for the non-low-income uninsured in the CPS data, and this data may have underestimated the relatively rare event of a high out of pocket payment. Even so, it seems that this is the population that will be subject to the most severe financial shock from health reform."
Note: click the link below then once upon the page which the link leads you to, click the very first link in the column of links and it will take you to the un-gated pdf version of this paper.
https://www.google.com/?gws_rd=ssl#q=%22Sticker+Shock%22+in+Individual+Insurance+under+Health+Reform+mark+pauly
A worthy point within the paper is that the previously uninsured taking the largest total expected payment (TEP) increase:
"Given our assumptions, an insurance plan can be evaluated in terms of its "Total Expected Price" (TEP), defined by:
(1) TEP* = P* + OOP*
where P* is the average premium paid by persons in a given subgroup, OOP* is the average expected amount paid out of pocket, and TEP* is the sum of the "average person’s" premium and the average person’s expected value of out of pocket payments."
"The policy exemplar of an uninsured person is one who faces the risk of paying out of pocket for all of their medical care, which means either high financial risk (if care is used) or reduced access (if it is not). But the combination of charity and bad debt care, combined with the effects of incentives to seek out free care at emergency departments of hospitals, mean that the uninsured as a group do not either face or pay the full market price paid by insured patients. Somewhat surprisingly, this use of free or subsidized care even applies to the large minority of uninsured people who have incomes high enough that they could "afford" insurance (Bundorf and Pauly, 2006). So the relevant analysis of the financial consequences (though not the welfare consequences) from health reform that results in insurance purchase for this population compares their actual out of pocket payment when uninsured with the combination of premiums and out of pocket payments they will face under bronze and silver plans after reform."
Upon further review, will the uninsured remain uninsured because they already know how the system works i.e. "combination of charity and bad debt care, combined with the effects of incentives to seek out free care at emergency departments of hospitals". It would be a rational response to a price spike to avoid the price increase and remain at zero price. Further, not only do the uninsured understand how the system works, they may feel comfortable, in that, they have learned what to obtain health-care so why bother learning a new system (if it isn't broke, don't fix it).
“Hospitals are in a state of uncertainty as to how to cover the funding gap from uninsured patients as Medicaid and Medicare are expected to decrease payments for those bills.
A new report from the Urban Institute in the most recent Health Affairs journal notes Medicare payments to help compensate for the cost of treating the uninsured in hospitals are set to drop this year as more get coverage through the Affordable Care Act (ACA). Similar payments for Medicaid will begin to fall starting in 2016, which means the healthcare providers might have to take a larger financial hit.
“Providers incur significant costs in caring for the uninsured,” the report said. “However, the bulk of their costs are compensated through a web of complex funding streams that are financed largely with public dollars.”
If those funding streams begin to dry up, it could pose major financial challenges to providers, especially in states that have not adopted Medicaid expansion or where implementation of healthcare reform has been slow, according to the report.
In 2013, providers spent almost $85 billion to pay for the uninsured, but 65 percent of that was offset by the government. Under the ACA, Medicaid compensations for such costs are expected to be cut by 50 percent, and Medicare is expected to be cut by 28 percent.” - Hospitals face O-Care uninsured funding gap, thehill.com, 05/27/2014
Link to the entire article appears below:
http://thehill.com/policy/healthcare/207286-hospitals-face-o-care-uninsured-funding-gap
“While the federal government was trumpeting the benefits of Obamacare to boost enrollment earlier this year, about 1,800 families in New Jersey were receiving letters telling them their children would be losing their health coverage last week.
The Affordable Care Act — the federal law that mandates everyone have insurance — effectively killed FamilyCare Advantage, a low-cost option for kids in New Jersey created six years ago for parents who earned too much to qualify for Medicaid and other subsidized programs but too little to buy on a policy on their own. The state program was the first of its kind in the nation.
Horizon Blue Cross Blue Shield of New Jersey was the only insurance carrier that agreed to offer the FamilyCare Advantage plan, which covered most medical, dental and vision needs for the relative bargain of $144 a month per child.
But it didn’t offer mental health treatment and several other services Obamacare requires, and that was the fatal flaw, said Sen. Joseph Vitale (D-Middlesex), who sponsored the law creating the program.
Vitale said he tried for several months to broker a deal between Horizon and the U.S. Centers for Medicare and Medicaid Services, but neither side could agree on how to make it affordable and legal. The program ended last week.
People who tried to buy a plan on the health exchange would have been hit with sticker shock, Vitale said. FamilyCare Advantage had no deductible, compared with the less generous Horizon plan on the exchange that has a minimum deductible of $1,500. And most people would not have qualified for subsidies through the exchange because they earned too much money, he said.
“This is enormously disappointing. New Jersey was always ahead of the nation on health coverage for children and parents,” said Vitale. “It was $5 for doctor visits, $1 for pharmacy and no deductible or cost sharing.”
Vitale noted the irony that the program created to extend universal health care access to all New Jersey’s uninsured children was done in by federal health care reform.” - Obamacare eclipses low-cost NJ health plan for middle-class kids, nj.com, 04/06/2014
Link to the entire article appears below:
http://www.nj.com/politics/index.ssf/2014/04/obamacare_eclipses_low-cost_nj_health_plan_for_middle-class_kids.html#comments
“Volunteer fire departments all across the U.S. could find themselves out of money and unable to operate unless Congress or the Obama Administration exempts them from the Affordable Care Act.
'I thought the kinks were worked out of Obamacare at the first of the month, Central Florida volunteer firefighter Carl Fabrizi told Sunshine State News.
'Man, oh, man, this could potentially destroy some real good companies in Florida.'
The U.S. Department of Labor takes the term 'volunteer' literally, but the IRS says volunteer firefighters are technically employees if they're on the job more than 30 hours per week, making them subject to Obamacare's employee-mandate rules.
Since the Obamacare law doesn't specifically carve out an exemption for them, fire departments where 50 or more people work – either as volunteers or officially as employees – are expected to provide health insurance for every one of them.
In towns with more than one volunteer fire department, all the staffers will likely be lumped together for tax purposes, pushing many municipalities above the 50-worker threshold.
That could cost departments of life-savers hundreds of thousands of dollars each year. Those that dump their volunteers into the federal insurance exchanges would still have to pay an annual $2,000 fine for each 'employee' after the first 30.” - ‘A Public Safety Disaster’: Obamacare Could Force Thousands of Volunteer Fire Departments to Close, foxnews.com, 12/09/2013
Link to the entire article appears below:
http://nation.foxnews.com/2013/12/10/public-safety-disaster-obamacare-could-force-thousands-volunteer-fire-departments-close
One might consider taking a moment and reading the opinion piece by David Cutler, Obama Administration advisor, regarding his claim that the ACA bent the cost curve downward for health-care:
“But the focus on insurance coverage obscures other parts of the ACA that are working well, even better than expected. It is increasingly clear that the cost curve is bending, and the ACA is a significant part of the reason.” - The health-care law’s success story: Slowing down medical costs, David Cutler, professor of economics Harvard, opinion, Washington Post, 11/08/2013
Link to the entire Article appears below:
http://www.washingtonpost.com/opinions/the-health-care-laws-success-story-slowing-down-medical-costs/2013/11/08/e08cc52a-47c1-11e3-b6f8-3782ff6cb769_story.html
Now examine Charles Blahous essay refuting Cutler’s claim:
‘One particularly egregious example is White House advisor David Cutler’s op-ed published November 8 in the Washington Post, entitled, “The health care law’s success story: slowing down medical costs.” This piece contains the following paragraph:
“Before he was criticized for his statements about insurance continuity, President Obama was lambasted for his forecasts of cost savings. In 2007, Obama asserted that his health-care reform plan would save $2,500 per family relative to the trends at the time. The criticism was harsh; I know because I helped the then-senator make this forecast. Yet events have shown him to be right. Between early 2009 and now, the Office of the Actuaries at the Centers for Medicare & Medicaid Services has lowered its forecast of medical spending in 2016 by 1 percentage point of GDP. In dollar terms, this is $2,500 for a family of four.”
To see why this is wrong, it is useful to break down this paragraph’s thesis into its component parts. Specifically, it claims that:
The President’s previous assertions that his “health-care reform plan” would “save $2,500 per family” have been “shown” “to be right,” and that;
This is proved by the fact that the CMS actuaries have lowered, between early 2009 and now, their forecast of medical spending in 2016 by $2,500 per family.
For this paragraph to be correct, the ACA must be the reason the CMS actuaries have lowered their 2016 health spending projections. That is flatly untrue.’
‘The obvious point that leaps out from this graph is that the chief CMS actuary found that the ACA would increase national health expenditures through 2016. Not content to let the tables speak for themselves on this point, CMS was explicit in the text of its memorandum that the ACA increased the near-term cost projections:
“The estimated effects of the PPACA on overall national health expenditures (NHE) are shown in table 5. In aggregate, we estimate that for calendar years 2010 through 2019, NHE would increase by $311 billion or 0.9 percent, over the updated baseline projection that was released on June 29, 2009. Year by year, the relative increases are largest in 2016, when the coverage expansions would be fully phased in…The increase in total NHE is estimated to occur primarily as a net result of the substantial expansions in coverage under the PPACA…” '
‘But no one can rightly claim that CMS has revised their near-term cost projections downward because of the ACA. That is simply false.’ - No Grounds for Claim that Obamacare Lowers Healthcare Costs, Charles Blahous, Manhattan Institute, 11/25/2013
Link to the entire article appears below:
http://www.economics21.org/commentary/no-grounds-claim-obamacare-lowers-healthcare-costs
Who is right and who is wrong? Comparing the two presentations, Cutler’s argument appears as a notional proposition whereas Blahous’s argument appears based upon empirical information that pointedly refutes Cutler.
But maybe, just maybe, one might be asking the wrong question about the two claims regarding the health-care cost curve. What question should be asked? Maybe the real question is: Why is the Obama Administration, and advisors thereof, either all-knowing or not knowing? How so?
The Obama administration, taking claim for lower health-care costs, is based upon the implicit assumption of: They knew all along, where completely abreast of the situation, were the rain maker. That is, when they claim something positive regarding Obamacare (ACA) they also claim they were well aware of the situation. The proverbial: “Told you so!”
Conversely, when something is negative e.g. web site mess, cancellation letters, narrow networks (aka "Medicaid-Plus") etc., regarding Obamacare, then in these situations, they implicitly and explicitly were unaware, never knowing and not knowing. The proverbial: “We are as surprised as you!”
How very odd for the Obama Administration and advisors thereof to be so very, very well aware of supposed positive aspects of ACA and simultaneously to be completely and totally unaware of negative aspects of ACA.
Hence one is faced with a situation in which, Obamacare, in its action phase, considering the authors and advisors thereof, is an all-knowing intentional consequence while simultaneously being a know-nothing unintentional consequence. Stated alternatively, the authors and advisors of Obamacare knew all along, where completely abreast of the situation, were the rain maker and simultaneously knew-nothing, not abreast of the situation, and not responsible.
Which leads one to think that the authors and advisors of Obamacare designed and studied Obamacare, in such a particular way, that they are either know-it-alls or know-nothings.
“President Barack Obama, who has portrayed himself as surprised by technical problems with the government's new healthcare website, was briefed earlier this year on a consultant's report that warned of possible widespread site failures, the White House said on Tuesday.
There have been weeks of questions about whether Obama understood the depth of the site's problems and let it open anyway, or simply "did not have enough awareness" of them, as the president stated at a Nov. 14 news conference.
While the government says it is improving the portal's performance every day, security experts told a Republican sponsored congressional hearing Tuesday that in their opinions, it is still not sufficiently secure to be used confidently by consumers.”
“Bits and pieces have leaked out over the past few weeks about flaws in the site's development process. Monday night, however, Republican lawmakers who oppose Obamacare released a report and recommendations prepared by McKinsey & Co. at the government's request in March 2013.
It cited, among other things, a rushed process that left insufficient time for testing and a focus by officials on getting people enrolled versus making the system work right.
The consequence, it said, could be system failures that could make enrollment slow or at times impossible for consumers, which is exactly what happened.
Questioned about the McKinsey study, White House spokesman Jay Carney said the president had been briefed on it in the spring.
But he said the president's familiarity with the report and recommendations did not contradict previous statements from the White House that described Obama as surprised by the scope of flaws in HealthCare.gov.
Obama was told that the problems identified by McKinsey were being addressed, Carney said. And Obama had never claimed to be unaware of "red flags" about the site, only of their seriousness.”
- Obama Was Briefed Last Spring on Obamacare Problems, Thomson/Reuters via newsmax.com, 11/20/2013
Link to the entire article appears below:
http://www.newsmax.com/Newsfront/obama-briefed-website-problems/2013/11/20/id/537595?ns_mail_uid=62439580&ns_mail_job=1546884_11202013&promo_code=15AD3-1
“The world-renowned Cleveland Clinic said on Wednesday it would cut jobs and slash five to six percent of its $6 billion annual budget to prepare for President Barack Obama's health reforms.
The clinic, which has treated celebrities and world leaders such as musician Lou Reed, former Italian Prime Minister Silvio Berlusconi and former Olympic gold medal skater Scott Hamilton, did not say how many of its 44,000 employees would be laid off. But a spokeswoman said that $330 million would be cut from its annual budget.
"Some of the initiatives include offering early retirement to 3,000 eligible employees, reducing operational costs, stricter review of filling vacant positions, and lastly workforce reductions," said Eileen Sheil, Executive Director of Corporate Communications for the Cleveland Clinic Foundation.
The clinic is Cleveland's largest employer and the second largest in Ohio after Wal-Mart. It is the largest provider in Ohio of Medicaid health coverage for the poor, the program that will expand to cover uninsured Americans under Obamacare.
"We know we are going to be reimbursed less," under Medicaid, Sheil said.” - Cleveland Clinic announces job cuts to prepare for Obamacare, Reuters, 09/18/2013.
Link to the entire article appears below:
http://www.reuters.com/article/2013/09/18/us-usa-health-clevelandclinic-idUSBRE98H14V20130918
"UPS and a growing list of other big companies will end health insurance coverage of employees' spouses this fall if they can get coverage elsewhere — an unwelcome result, at least in part, of Obamacare.
Increased medical costs, "combined with the costs associated with the Affordable Care Act (ACA), have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost," UPS said in a memo to employees.
A survey by consultant Towers Watson found that in 2013, 4 percent of large employers excluded spouses who also had coverage at their own workplace, and 8 percent planned to implement the restriction next year, Kaiser Health News and USA Today reported.
"When healthcare reform came on the scene a few years ago we definitely saw an uptick in companies wanting to explore a working-spouse provision," Steve Noury, national sales director for HMS Employer Solutions, told Kaiser. "We have seen [them] over the past two or three years putting those in place."
While Obamacare requires large employers to cover employees and dependent children, it does not require them to cover spouses or domestic partners.
The move by UPS will affect an estimated 15,000 working spouses at that company, which UPS estimated would save about $60 million annually.” - UPS Cutting Back Spousal Health Coverage, Blames Obamacare, Newsmax, 08/21/2013
Link to the entire article appears below:
http://www.newsmax.com/Economy/Obamacare-health-UPS-spouse/2013/08/21/id/521521?s=al&promo_code=1499D-1
Remember when President Obama famously promised that if you like your health-care plan, you'll be able to keep your health-care plan? It was a brilliantly crafted political sound bite. Turns out, the statement is untrue.
Aside from that small detail, the slightly larger problem is that the Obama administration doesn't have a health-care plan. Yes, the White House has a law with thousands of pages, but the closer we get to Oct. 1, the day government-mandated health-insurance exchanges are supposed to open, the more we see that the administration doesn't have a legitimate plan to successfully implement the law.
Unworkable. That word best describes ObamaCare. Government agencies in states across the country, whether red or blue, have spent countless hours and incalculable dollars trying to keep the ObamaCare train on its track, but the wreck is coming. And it is the American people who are going to pay the price.
Fifty-five working days before the launch of the ObamaCare health-insurance exchanges on Oct. 1, the administration published a 600-page final rule that employers, individuals and states are expected to follow in determining eligibility for millions of Americans. Rather than lending clarity to a troubled project, the guidelines only further complicated it. - Jindal and Walker: Unworkable ObamaCare, Opaque rules, big delays and rising costs: The chaos is mounting, Wall Street Journal, 07/25/2013
Link to the entire article appears below:
http://online.wsj.com/article/SB10001424127887324110404578626452647631608.html?mod=WSJ_Opinion_LEADTop
“A new study suggests President Obama’s Affordable Care Act might have yet another huge and negative unintended consequence: if low-income adults can get health insurance through Obamacare’s Medicaid expansion, they are less likely to try and get a job — or keep a job. As Public Health Insurance, Labor Supply, and Employment Lock by Craig Garthwaite, Tal Gross, and Matthew J. Notowidigdo puts it [original emphasis]:
Our results suggest a significant degree of “employment lock” – workers employed primarily in order to secure private health insurance coverage. The results also suggest that the Affordable Care Act – which similarly affects adults not traditionally eligible for public health insurance – may cause large reductions in the labor supply of low-income adults. … One must exercise considerable caution when directly applying our results to the ACA, but our results appear to indicate that the soon-to-be-enacted health care reform may cause substantial declines in aggregate employment.
Using CPS data, we estimate that between 840,000 and 1.5 million childless adults in the US currently earn less than 200 percent of the poverty line, have employer-provided insurance, and are not eligible for public health insurance.
Applying our labor supply estimates directly to this population, we predict a decline in employment of between 530,000 and 940,000 in response to this group of individuals being made newly eligible for free or heavily subsidized health insurance. This would represent a decline in the aggregate employment rate of between 0.3 and 0.6 percentage points from this single component of the ACA.” - Study: Obamacare could cause 1 million low-income Americans to move from work to welfare, 07/15/2013, AEI, James Pethokoukis
The link to the entire article appears below:
http://www.aei-ideas.org/2013/07/study-obamacare-could-cause-1-million-low-income-americans-to-move-from-work-to-welfare/
'Small business owners' fear of the effect of the new health-care reform law
on their bottom line is prompting many to hold off on hiring and even to shed
jobs in some cases, a recent poll found.
"We were startled because we know that employers were concerned about the
Affordable Care Act and the effects it would have on their business, but we
didn't realize the extent they were concerned, or that the businesses were being
proactive to make sure the effects of the ACA actually were minimized," said
attorney Steven Friedman of Littler Mendelson. His firm, which specializes in
employment law, commissioned the Gallup poll.
"If the small businesses' fears are reasonable, then it could mean that the
small business sector grows slower than what economic conditions otherwise would
indicate. And small businesses have been a growth engine in the economy,"
Friedman told CNBC.
Forty-one percent of the businesses surveyed have frozen hiring because of
the health-care law known as Obamacare. And almost
one-fifth—19 percent— answered "yes" when asked if they had "reduced the number
of employees you have in your business as a specific result of the Affordable
Care Act."
The poll was taken by 603 owners whose
businesses have under $20 million in annual sales.' - Will Obamacare Hurt Jobs? It's Already Happening, Poll Finds, CNBC 06/19/2013
Link to entire article appears below:
http://www.cnbc.com/id/100825782?__source=yahoonews&par=yahoonews
"Smokers, beware: tobacco penalties under President Obama’s Affordable Care Act could subject millions of smokers to fees costing thousands of dollars, making healthcare more expensive for them than Americans with other unhealthy habits.
The Affordable Care Act, which critics have also called “Obamacare”, could subject smokers to premiums that are 50 percent higher than usual, starting next Jan 1. Health insurers will be allowed to charge smokers penalties that overweight Americans or those with other health conditions would not be subjected to.
A 60-year-old smoker could pay penalties as high as $5,100, in addition to the premiums, the Associated Press reports. A 55-year-old smoker’s penalty could reach $4,250. The older a smoker is, the higher the penalty will be.
Nearly one in every five U.S. adults smokes, with a higher number of low-income people addicted to the unhealthy habit. Even though smokers are more likely to develop heart disease, cancer and lung problems and would therefore require more health care, the penalties might devastate those who need help the most – including retirees, older Americans, and low-income individuals.” (1)
“The law, known as the Patient Protection and Affordable Care Act, was — as its name implies — ostensibly designed to make health insurance affordable to Americans. It prohibits insurers from turning down or charging more to individuals with pre-existing conditions and even certain conditions (such as obesity) that increase the risk of health problems.
However, the one condition that the law does not protect from high insurance rates is nicotine addiction — despite the fact that smoking is associated with a number of serious health problems including heart disease and lung cancer. In fact, it specifically permits insurers to charge higher rates to older smokers than to nonsmokers or even younger smokers. Under the law, older adults in general may be charged up to triple what younger ones are charged (which could end up harming the young by hiking their rates). Smokers may, in addition, be charged up to 50 percent more than nonsmokers for their coverage, but younger smokers may be hit with a lesser penalty than older ones. Plus, the subsidies the government provides to offset the cost of insurance purchased on the individual market cannot be applied to the smoking penalty.” (2)
"Take a hypothetical 60-year-old smoker making $35,000 a year. Estimated premiums for coverage in the new private health insurance markets under Obama's law would total $10,172. That person would be eligible for a tax credit that brings the cost down to $3,325.
But the smoking penalty could add $5,086 to the cost. And since federal tax credits can't be used to offset the penalty, the smoker's total cost for health insurance would be $8,411, or 24 percent of income. That's considered unaffordable under the federal law. The numbers were estimated using the online Kaiser Health Reform Subsidy Calculator.
The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance," said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California.
In today's world, insurers can simply turn down a smoker. Under Obama's overhaul, would they actually charge the full 50 percent? After all, workplace anti-smoking programs that use penalties usually charge far less, maybe $75 or $100 a month.
Robert Laszewski, a consultant who previously worked in the insurance industry, says there's a good reason to charge the maximum.
"If you don't charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers," said Laszewski. "They are going to have to play defense." (3)
Upon further review, the ACA forbids discriminatory pricing except for those conditions ACA wants to discriminate against. Hmmm. Non-discriminatory discriminatory pricing. Very nice indeed! Load up on those Twinkies but stay away from those smokes.
Wait a minute! ACA is supposedly an attempt to insure the uninsured and predominately aimed at lower income individuals. You know, “affordable care act”. Affordable care [insurance] for those that supposedly can’t afford insurance. However, as with all intention oriented do-gooder schemes, the negative cascading unintended consequences become the results. Hence uninsured lower income James Goodsmoker suffers a 50% up-rate that will not qualify for an Obamacare subsidy. James Goodsmoker finds coverage as unaffordable under the “affordable care act” as he did prior to ACA. Go figure. (4)
A question to ponder: since sixteen million of the uninsured will be herded into Medicaid, will the federal government charge itself a 50% up-rate for the subsection of the sixteen million that smoke?
Notes:
(1) 'Obamacare' to hit smokers with huge penalties, rt.com
http://rt.com/usa/health-care-penalties-americans-769/
(2) Under ObamaCare, It’s Quit Smoking or Pay the Price — Literally, thenewamerican.com
http://www.thenewamerican.com/usnews/health-care/item/14327-under-obamacare-it%E2%80%99s-quit-smoking-or-pay-the-price-%E2%80%94-literally
(3) Obamacare to Hit Smokers with Huge Penalties, newsmax
http://www.newsmax.com/Newsfront/Obamacare-Smokers-Huge-Penalties/2013/01/26/id/487522
(4) Socioeconomic status and smoking, oxford journals.org
http://eurpub.oxfordjournals.org/content/15/3/262.full
