“In an oped for Politico, I explain why ObamaCare architect Jonathan Gruber’s 2012 admissions that “if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits” matter to the ongoing litigation over the Obama administration issuing those subsidies in federal Exchanges, and why Gruber’s attempts to explain his own words away are not credible. Shortly after submitting that piece, I learned Oklahoma Attorney General Scott Pruitt found Gruber’s remarks relevant enough to ask a federal court hearing one of those cases to take notice.
Gruber’s repeated remarks contradict the Obama administration’s legal argument, made in Halbig v. Burwell and three related lawsuits, that it is implausible that Congress would have conditioned those subsidies on states establishing Exchanges. His remarks likewise contradict the amicus briefs Gruber himself filed in two of those cases. (Here’s my response to those briefs.)”
“The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.
The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in July, the highest level since the law was passed in 2010. It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.) The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.
Support for the law in July remained about the same as in June, with 37 percent supporting it. The change came from the number of people who had previously told pollsters they did not know or refused to discuss their opinions: while 16 percent fell into that group in June, only 11 percent did in July.
The poll did not provide any definitive answers for the change but noted that people reported that their informal chatter with friends and family was more than four times as likely to be negative as supportive toward the law.
Public opinion was evenly divided on the Supreme Court’s decision that closely held companies such as the Hobby Lobby craft stores could refuse to provide workers with birth control through their insurance because it violated the religious beliefs of the company. Women and men also saw things pretty much the same. Seven of 10 Republicans hailed the decision, and Democrats disliked it just as strongly. The public was split about whether the decision will make it harder for women to get prescription birth control. Few people said the court’s action would make them more likely to vote in the fall mid-term elections.”
“Florida Blue, the state’s largest health insurer, is increasing premiums by an average of 17.6 percent for its Affordable Care Act exchange plans next year, company officials say.
The nonprofit Blue Cross and Blue Shield affiliate blames higher health costs as a result of attracting older adults this year who previously lacked coverage and are using more services than expected.
Florida insurance regulators plan to release rate information for all companies next week. The exchange plans cover individuals who aren’t covered by employer-based policies.
Florida Blue offers many plans. The 40 percent of its individual policyholders who chose “narrow network” plans called BlueSelect that limit coverage to fewer doctors and hospitals will see rates rise by an average of 13 percent.
Critics of the health law have predicted big rate hikes in the second year of the online marketplaces. Florida Blue CEO Patrick Geraghty noted that premiums in the individual market have been going up for years. “In the individual market, this type of average rate increase is typical,” he told Kaiser Health News. “It’s is not aberrant.””
“The annual report from the Social Security and Medicare trustees predicted that Medicare will be solvent until 2030, four years later than the trustees predicted last year. That’s thanks to the recent slowdown in Medicare spending and a stronger economy that yields higher revenue through payroll tax contributions to the Medicare trust fund.
The administration and congressional Democrats are taking credit for elements of the Affordable Care Act that have helped to slow the growth in Medicare spending, and they warn against changes to Medicare that they fear would shift costs to seniors and undermine the program.
Republicans, however, see little good in the trustees’ report. “Don’t be fooled by the news that Medicare has a few more years of solvency,” Rep. Kevin Brady, chairman of the House Ways and Means subcommittee on health, said in a statement. More fundamental changes to Medicare are needed, many Republicans argue, such as transforming the program to a premium-support or voucher model.
Here are three points that might have been lost in the back and forth over the report by those on the left and the right:”
“Andrew Slavitt, a former executive at the technology company tasked with “saving” HealthCare.gov and now second in command at the agency overseeing Obamacare, yesterday ran into sharp questions from a House panel about a potential conflict of interest in his new role.
Rep. Morgan Griffith, R-Va., pressed Slavitt on his previous job at OptumInsight/QSSI and that company’s continuing involvement with HealthCare.gov.
“How are you able to manage your former employer, and doesn’t this create a conflict of interest?” Griffith asked Slavitt during the new Obamacare official’s testimony before the Energy and Commerce Subcommittee on Oversight and Investigations.
Slavitt, the new principal deputy administrator at Centers for Medicare and Medicaid Services, didn’t go into specifics, but said he had limited contact with his former employer. He assured Griffith and other subcommittee members that he was taking the proper steps to maintain ethical standards and noted that he had signed an ethics pledge.
“As a public servant, I have a very clear set of rules to follow,” Slavitt said.”
“The weighted average increase for plans being sold on the Obamacare California public exchange in 2015 will be 4%. So, that means Obamacare is working really well, right?
Well, wait a minute.
Let’s consider a few things:
1.This week the California insurance commissioner reported that the average unsubsidized 2014 rate increase carriers charged going into Obamacare was between 22% and 82%. That was a pretty healthy bump to get everyone into Obamacare in the first place.
2.California voters will go to the polls this fall to vote on Proposition 45. That ballot initiative would regulate health insurance rates in California for the first time. Big rate increases on part of the carriers would do a lot to get that proposition passed and very low increases would do a lot toward defeating it.
3.The health plans competing in the Obamacare exchanges are limited to tiny losses this year because of the Obamacare reinsurance program that runs through 2016. In effect, anymore underpricing they put into their rates for 2015 is subsidized by the federal government. In fact, the Obama administration recently took the statutory caps off of how much they can pay the carriers to keep their bottom line whole.”
“The Affordable Care Act may be the law of the land, but some states are still doing their best to avoid it. Nearly half the states have refused to participate in the law’s expansion of Medicaid. Some describe this reluctance as tantamount to a moral crime—see Virginia Governor Terry McAuliffe’s recent statement that expansion’s opponents are “prevent[ing] their own constituents from getting access to health care.”
As a doctor, I know this isn’t true. Medicaid is sold to the public as a magic pill that will solve the poor’s inadequate access to medical care. But reality isn’t so simple.
Simply put, Medicaid gives patients terrible access to medical care. A recent study found that nearly a third of doctors no longer accept new Medicaid patients. In some states, as many as 60 percent don’t. Why not? Because Medicaid operates in a world without economic logic.
Bureaucrats in Washington dictate how much money doctors receive for the treatments and services they provide. Unfortunately, on average they reimburse at less than the actual cost—the average Medicaid reimbursement is 40 percent less than the reimbursement from private insurance.
Medicaid payments don’t even match the reimbursement rates for Medicare. Primary care receives 59 cents for every Medicare dollar. Obstetric care receives 78 cents. Overall, Medicaid receives 66 cents for every Medicare dollar—a one third cut for the exact same service.”
“The price tag for healthcare.gov, the Obamacare website, is approaching $1 billion even as key features remain incomplete, congressional auditors said.
The budget to get the site ready for the next round of enrollments, starting in November, jumped to $840 million as of March, according to the Government Accountability Office. That’s a $163 million increase since December.
Accenture Plc (ACN), the company that took over building the site that failed at its introduction this past October, is expected to be paid $175 million as of June, an $84 million increase from the estimate in January when it signed a contract. The data are part of testimony for a congressional hearing today in the Republican-led House. The GAO places blame for the site’s rising price on poor planning and supervision of contractors who built the federal health exchange.
If the management doesn’t improve “significant risks remain that upcoming open enrollment periods could encounter challenges,” William Woods, the GAO’s director of acquisition and sourcing management, is scheduled to testify according to prepared remarks released by the Energy and Commerce Committee.”
“A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected.
The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress.
Released Tuesday, the report for the Institute of Medicine called for more accountability for the funds, two-thirds of which are provided by Medicare. It also called for an end to providing the money directly to the teaching hospitals and to dramatically alter the way the funds are paid.
The funding in question is for graduate medical education (GME), the post-medical school training of interns and residents required before doctors can be licensed to practice in any state.”
“The recent decision of a three-judge panel in the Halbig case, if it prevails, would have a direct effect on the availability of subsidies under the Affordable Care Act (ACA). People buying coverage on their own in insurance exchanges run by the federal government would be ineligible for income-based subsidies. Depending on how you count, that would take premium subsidies away from 4.6 million people in 34 states, or 4.7 million people in 36 states if you count New Mexico and Idaho (which have signaled their intention to operate their own exchanges but are still using the federal marketplace).
Many more people are eligible for subsidies but haven’t yet signed up. We estimate (using the approach described here that a total of 9.5 million uninsured people are eligible for subsidies in federal marketplace states (or, 9.7 million people if you include New Mexico and Idaho).
Since many low and moderate income people would have difficulty affording insurance without the subsidies, this would no doubt alter the extent to which the ACA is reducing the number of Americans who are uninsured, which recent surveys peg at about 8 to 10 million.
But, there would also be two important side effects of the Halbig case.”