‘A federal district court in Washington, D.C., ruled Thursday in favor of the U.S. House of Representatives’ challenge to the Obama administration’s implementation of part of the Patient Protection and Affordable Care Act, also known as Obamacare.
The act has been “revised” dozens of times by the administration since its passage in March 2010, leading the House to sue over the administration’s payment out of the U.S. Treasury of subsidies to insurance providers for providing cost-sharing reductions to certain policyholders, even though Congress explicitly refused to appropriate funds for these subsidies.
As D.C. District Court Judge Rosemary Collyer explained in an opinion last fall, Section 1402 of the law “requires insurers to reduce the cost of insurance to certain, eligible statutory beneficiaries,” and the “federal government then offsets the added costs to insurance companies by reimbursing them with funds from the Treasury.”
This section stated that cost-sharing offsets must be funded by annual appropriations. But the House has never appropriated funds for Section 1402, so it argued that the administration violated Article I, Section 9, Clause 7 of the Constitution, which provides that “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.’
‘Collyer was not concerned by the “cascading series of nonsensical and undesirable results” that the administration claimed would flow from failing to recognize a permanent appropriation for Section 1402: “Higher premiums, more federal debt, and decreased enrollment are not consequences of the [Affordable Care Act’s] text or structure,” Collyer explained, but rather those “would flow … from Congress’ continuing refusal to appropriate funds.” She concluded, “That is Congress’s prerogative; the Court cannot override it by rewriting [the statute].”
Collyer granted summary judgment to the House of Representatives, enjoining any “further reimbursements [to insurance companies] under Section 1402 until a valid appropriation is in place.” However, she stayed her injunction pending an appeal.’ - Obama Administration Loses Key Obamacare Case, dailysignal.com, 05/12/2016
Link to the entire article appears below:
http://dailysignal.com/2016/05/12/obama-administration-loses-key-obamacare-case/?utm_source=TDS_Email&utm_medium=email&utm_campaign=MorningBell&mkt_tok=eyJpIjoiTWpka05XVmpZalEzT0RnMiIsInQiOiJiMGhZK0o2K0dOY1Q3aXBKNWtCZGdjd3hJd0s0UEk2K0tJYVJTQ3plaVd0RzFPMXcwVFpLWDdxNDBMYnZ0dHNhbzVNWkcybGNuV0lDTTN6Rmp3WEtHclFUS2d0ajB2Q29GYzFyaDNpeFdtND0ifQ%3D%3D
Updated:
Federal judge rules Obamacare is being funded unconstitutionally, Los Angeles Times, 05/13/2016
“Humana became the latest health insurer to serve notice that it might leave some Affordable Care Act exchanges next year, creating more uncertainty for customers ahead of this fall's enrollment window and presidential campaign, during which the law is sure to remain a hot debate topic.
The insurer, which is being acquired by rival Aetna, said Wednesday that it expects to make a number of changes to its business for 2017, and that may include leaving some markets both on and off the exchanges or changing prices. Humana Inc. sold coverage in 15 states this year.
"We do not take these changes lightly," spokesman Tom Noland said in an email. "We are striving to avoid unnecessary coverage disruption wherever possible."
Several insurers say they have struggled with sicker-than-expected customers and had a hard time attracting younger, healthy people to the coverage they sell on the ACA's state-based public insurance exchanges, which opened for enrollment in the fall of 2013. Some also have been hurt by temporary government support programs that haven't delivered as they were initially advertised.
UnitedHealth Group Inc., the nation's biggest insurer, said last month that it was chopping its participation in the exchanges down to only a handful of states in 2017 after expanding to 34 for this year. Aetna Inc. has said it lost more than $100 million last year on its exchange business, but it still sees potential in the new market.” - Humana Might Leave Some ACA Exchanges Next Year, insurancenewsnet.com, 05/04/2016
Link to the entire article appears below:
http://insurancenewsnet.com/oarticle/change-is-in-the-works-for-humana-aca-exchange-participation
“In 2014, after accounting for attrition after the end of the first open-enrollment period (March 31, 2014), 6.7 million individuals had enrolled by December 31. In 2015, 2.6 million additional individuals enrolled (and remained on their plans), raising the total to 9.3 million people enrolled on December 31. If similar trends hold, total enrollment on the ACA exchanges will hit 10 million on December 31, 2016.
Overall, ACA-exchange enrollment has been lower than expected; in 2016, the gap between actual and forecasted enrollment is likely to widen further. For instance, in 2014, the ACA exchanges’ first year, enrollment (6.7 million) exceeded the CBO’s February 2014 forecast (6 million). But in 2015, total enrollment (9.3 million) lagged behind the CBO’s March 2015 forecast (11 million). And if current trends hold, total enrollment in 2016 (about 10 million) will be dramatically less than the CBO’s March 2015 forecast (21 million).
Are these lower-than-anticipated ACA-exchange enrollment figures the result of uninsured individuals securing coverage by other means — such as by enrolling in employer-sponsored coverage or Medicaid? Start with the former. As the Department of Health and Human Services has noted, in a growing economy, employer-sponsored coverage typically rises as more people acquire jobs. Instead, from the fourth quarter of 2013 to the fourth quarter of 2015, employer-sponsored coverage in the U.S. declined.
Or take Medicaid. Enrollment in this government-insurance program for the poor expanded during the aforementioned period; but such expansion largely matched the CBO forecast — and, therefore, was also incorporated into the CBO forecast for ACA-exchange enrollment. Indeed, if the ACA exchanges’ meager enrollment numbers were caused by a rise in coverage obtained elsewhere, America’s overall uninsured rate would have declined in 2015. Instead, it barely budged, hovering around 11.9 percent.” - Why Obamacare Is Failing at "Universal Coverage", foundation for economic education, 04/17/2016
Link to the entire essay appears below:
https://fee.org/articles/why-obamacare-is-failing-at-universal-coverage/
“With Congress limiting the bailouts of insurance companies for two years in a row, business is not looking good for the industry that lobbied for Obamacare. The latest casualty is United Healthcare, which announced that it is withdrawing from most of its 34 Obamacare exchanges next year.
Announcing the decision during a first quarter earnings conference call, UnitedHealthcare CEO Stephen Hemsley said, “The smaller overall market size and shorter-term, higher-risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis."
Due to congressional limits on insurance company bailouts, in October the Department of Health and Human Services transferred $362 million to loss-making insurance companies, rather than the $2.9 billion that they requested.
The Health Insurance Association of America, under the leadership of Karen Ignagni, lobbied heavily in favor of the Affordable Care Act. But now the pool of insured is smaller and sicker than they anticipated.”
“If Congress holds its ground during the appropriations process and refuses to bail out the insurance companies for fiscal 2017, it is likely that more of them will withdraw from the exchanges, raising prices for existing customers. Premiums rose in some markets by 20 percent in 2016, leading to more healthy young people dropping out of plans or not enrolling, accelerating the financial imbalance.
Look at UnitedHealthcare as the canary in the coal mine, and expect more withdrawal announcements in the future.” - UnitedHealthcare’s Exit Augurs Badly for Obamacare, economics21.org, 04/19/2016
Link to the entire article appears below:
http://www.economics21.org/html/unitedhealthcare%E2%80%99s-exit-augurs-badly-obamacare-1765.html
“As Republican policymakers nationwide continue debating ways to replace Obamacare with patient-centered solutions, a Colorado group has landed a plan implementing a single-payer model of health care on November’s ballot. Coloradans are already bracing for its impact.
In the general election, Colorado residents will not only head to the polls to cast their votes for president, but they’ll also weigh in on a controversial ballot measure: Amendment 69, which would create a government-run health care plan in the Centennial State.
The plan, formally known as ColoradoCare, is the first in the country that would replace Obamacare, action made possible by Section 1332 of the Affordable Care Act, which allows states to receive a waiver from the health care law if their own plan provides residents with “access to high quality, affordable health insurance while retaining the basic protections of” the health care law.
In Obamacare’s place: universal health care.” - Beyond Obamacare: Colorado Considers Single-Payer Model, daily signal.com, 04/14/2016
Link to the entire article appears below:
http://dailysignal.com/2016/04/14/beyond-obamacare-colorado-considers-single-payer-model/?utm_source=TDS_Email&utm_medium=email&utm_campaign=MorningBell&mkt_tok=eyJpIjoiWlRGbFltUTROR1JpTW1ZMyIsInQiOiJ2TXpCOFpOdXpTUmR1SEk4MUphT0pvYWVrRG16WGM5b2hzdURNZjB5WWgzSGphZ2tKcE12R2RwMHNpVVwvM3BEeUFNWjd0ZEloV1pwOWR2V0IyYzRVWXVwZEZ4OEhcLzhMXC9RQnQrR1FRZVNMND0ifQ%3D%3D
“Obamacare’s implementation in October 2013 came with the launch of HealthCare.gov, the federal health insurance exchange.
Just six people successfully signed up for health insurance on HealthCare.gov on Oct. 1, 2013, because of massive glitches and failures with the site. In the months that followed the disastrous launch, the Republican-led House of Representatives held numerous hearings to determine why the Obama administration decided to launch the website.
The Department of Health and Human Services fired CGI Federal, which was originally tasked with building HealthCare.gov, after the website’s launch and signed a new contract with Accenture to rebuild the exchange.
Though the Obama administration hasn’t formally said how much HealthCare.gov cost the taxpayers, Department of Health and Human Services Secretary Sylvia Mathews Burwell said last May that the website cost $834 million. Similarly, a report from the Department of Health and Human Services Inspector General put the cost of the exchange at $800 million.
An analysis by Bloomberg Government, though, put the total cost at $2.1 billion. Bloomberg Government took into account budgetary costs for the Internal Revenue Service and other government agencies, as well as contracts reworked to pay for the website.” - In 5 Charts, How Obamacare Has Worked the Past 6 Years, daily signal.com, 03/23/2016
Link to the entire article appears below:
http://dailysignal.com/2016/03/23/in-five-charts-how-obamacare-has-worked-past-six-years/?utm_source=heritagefoundation&utm_medium=email&utm_campaign=saturday&mkt_tok=3RkMMJWWfF9wsRonu6rPdO%2FhmjTEU5z16u8pW6e%2Bhokz2EFye%2BLIHETpodcMTcRhNL3YDBceEJhqyQJxPr3NLtQN191pRhLiDA%3D%3D
“NASHVILLE — Hospitals and medical practices share a growing problem with those they treat: Patients aren’t paying their bills.
Working people are on the hook for an increasingly large portion of the cost of their care, as insurance policies pay for less. It’s a trend that is not reversing — and it’s causing financial distress for families and CEOs alike.”
“In health care, the billing process is called revenue cycle management. It’s a complex system of diagnostic codes, services, insurance benefit analysis, billing departments and software.
Hospitals and providers, historically, received 90% of the reimbursement from insurers, according to The Advisory Board. The patient portion was more of an afterthought.”
“For every patient dollar being billed, hospitals have historically failed to collect 65 cents.”
"The hospital operator is not alone, and the problem is not simple.
Billing practices are not designed to collect small, incremental payments from hundreds or thousands of patients. They are designed to bill a handful of large entities — insurance companies — not individuals who walk in the door.”
“Streamlining billing into a single itemized list is essential to helping turn patients into bill-paying customers.
One might not go back to a restaurant that gave you a bill for the appetizer then a bill for the bread then individual bills for the entrée and drink.
But that’s how health care is presently billed. An open heart surgery could bring individual bills from the cardiologist, the surgeon, the lab, the anesthesiologist, a consulting doctor who helped read charts and more.” - Why more than half of hospital bills don’t get paid, usatoday.com, 03/09/2016
The Seen and Unseen
The above excerpts, from the above mentioned report, do manage to explain the “seen”, but what about the “unseen”? How so?
The above statements are based on the assumption that insurance historically paid the vast majority of bills, which it did not. As recent as 1960 patients paid 90% of the bills and third party payers 10%. Stated alternatively, as recently as 1960 the percentages paid by third parties and the patients were exactly opposite of today i.e. today third party providers pay 90% and patients pay 10%, whereas 1960 third party providers paid 10% and patient 90%.
Somehow patients managed to pay 90% of bills as recent as 1960 and those bills were somehow manageable to be paid from a household budget. Conversely, somehow patients in 2016 can’t manage to pay 10% of bills and those bills are not manageable to be paid from a household budget.
With the 10% patient responsibility existing in 2016, the report mentions: “Hospitals and providers, historically, received 90% of the reimbursement from insurers, according to The Advisory Board. The patient portion was more of an afterthought”, “hospitals have historically failed to collect 65 cents” and “Billing practices are not designed to collect small, incremental payments from hundreds or thousands of patients. They are designed to bill a handful of large entities — insurance companies — not individuals who walk in the door.” Suppose one could look at the above statements many ways. One way is to state: The customer is not the customer, rather the customer is the third party payer.
Moreover, if the third party payer is indeed the indirect or direct consumer from the point of view of the healthcare provider as the report indeed suggests, then as such, it confirms the oft mention non-price signal discussion in healthcare. That is, the statement confirms the regularly discussed scenario that healthcare in conjunction with health insurance is akin to buying “grocery insurance” and paying a monthly premium. As the scenario goes, one arrives at the grocery store to shop where no prices are posted (price is not a signal). When checking out with the cashier one never knows the single item price nor total price as the bill goes to the “grocery insurance company”. One merely laments their monthly grocery insurance premium along with complaints and moans about their ever escalating monthly “grocery insurance” premium.
One can also make a grand argument that the unpaid patient bills are directly related to the process of non-price purchases. If price is not a signal at the point of exchange and only a signal after exchange, are the unpaid patient bills merely an adjustment to mutual exchange, after the fact, in that the patient doesn’t pay the bill to adjust for mutual exchange? Stated alternatively, had price been a signal many exchanges would have never occurred as the patient would have been unwilling to pay such price at the point of exchange (transaction rejected as a non-mutual exchange). As an extension to the argument: Are the unpaid patient bills merely part of the process, a process of non-price signal, a process self-produced by healthcare providers, and hence not a surprise but rather a known-known of such a process?
A final point one might consider involves the following observations from the article: “Streamlining billing into a single itemized list is essential to helping turn patients into bill-paying customers“, “One might not go back to a restaurant that gave you a bill for the appetizer then a bill for the bread then individual bills for the entrée and drink“, and “But that’s how health care is presently billed. An open heart surgery could bring individual bills from the cardiologist, the surgeon, the lab, the anesthesiologist, a consulting doctor who helped read charts and more.”. Why all the bills?
What about the “why” concerning the several and many bills received by patients? The “why” is related to the non-competitive nature of much healthcare (CON [Certificate Of Need] legislation and other related legislation protecting the incumbent healthcare provider) and the consequential failure to reach scale in healthcare.
The several and many bills are not going to change as it is part of a conscious process. Nay, nay there is absolutely no reason to wring one’s hands over the flood of bills received by the patient as it is by design, not by error. Many and varied healthcare providers, in a self-produced and politically [legislation] protected non-scale environment, send many bills by design. Nope, no Wal-Mart or Southwest Airlines of healthcare in this supply, just a gazillion little shops sending non-price signal bills….and expecting to be paid.
Yep, one might think twice about the supply-side of healthcare.
