“CO-OP enrollment for the first-quarter of 2015 was 869,677 compared to 478,152 for the fourth-quarter of 2014,” said Kaminski. “This increase in enrollment on future financial performance is significant, because it demonstrates that interest is growing, along with a better understanding of how these CO-Ops operate. Additionally, for the smaller plans, the increase has allowed them to build up some scale, which is crucial for their viability going forward. However, the CO-Ops are challenged with operating efficiencies that are below par, having combined ratios as a group of over 110%. ”
Two leading Republican presidential candidates, Scott Walker and Marco Rubio, recently released concept papers that promise to provide “all Americans” with government-subsidized access to health insurance. This is a monumental development for both the campaign and for the conservative movement, one that breathes Ronald Reagan’s soul into the Republican nomination fight.
In the wake of the Supreme Court’s decision in King v. Burwell, President Obama has claimed that Obamacare is working and here to stay.
In truth, the actual effect of the Supreme Court’s decision leaves Obamacare unchanged, and the law is certainly not working well.
Not only will Obamacare’s current political and operational problems continue, but new ones will crop up as more provisions of the law take effect.
One of the key questions surrounding Obamacare is just how many people have been newly insured under the law. The answer is clouded by the fact that the White House and others have changed some rules of math for making these assessments.
For example, several years ago, the Obama Administration fiddled with Census Bureau’s definition of what it means to be “uninsured.” The new parameters, which were looser than the old factors, make it hard to construct comparisons between today’s figures for the total number of uninsured and the historical trends.
The Obama team also abruptly started to exclude uninsured illegal immigrants from the national tally on total number of uninsured Americans. Before Obamacare, these individuals were counted in that reporting, inflating the numbers. After Obamacare, these individuals didn’t get insurance, but suddenly didn’t get counted any more.
Now, a new analysis from the highly regarded managed care analyst at Goldman Sachs, Matthew Borsch, and his team, cast uncertainty on some of the recent data releases from the White House, and its network of academicians. In particular, the Goldman breakdown conflicts in some key ways with a recent analysis from RAND that was published in the journal Health Affairs and widely cited by the media.
The Centers for Disease Control and Prevention (CDC) has released early estimates of health insurance and access to health care for January through September 2014. The National Health Insurance Survey (NHIS) is (in my opinion) the most effective survey of health insurance, because it asks people three different but important questions: Are they uninsured at the time of the survey? Have they been uninsured for at least part of the year? Have they been uninsured for more than a year?
As shown in Figure 2, the proportion of long-term uninsured is about the same as it was circa 2000. The proportion of short-term uninsured has shrink a little in Obamacare’s first year.
On Monday, the Supreme Court denied certiorari in Coons v. Lew, a constitutional challenge to provisions in the Affordable Care Act (ACA) creating the Independent Payment Advisory Board (IPAB), an independent federal agency charged with responsibility for controlling the growth of health-care costs by constraining the growth of Medicare.
IPAB is controversial, and potentially unconstitutional (as even fervent ACA advocates admit). Nonetheless, the denial of certiorari was to be expected. IPAB is not yet operational, so (as the U.S. Court of Appeals for the Ninth Circuit concluded) a challenge of this sort isn’t ripe. If and when the IPAB is up and running — and begins making changes to Medicare that affect providers or beneficiaries — there will be ample time to consider the constitutionality of Congress’s creation.
Alternatively, Congress could repeal or reform IPAB itself, as some have suggested. Given that the text of the ACA expressly limits Congress’s ability to amend these portions of the law, such legislative action could itself prompt litigation and perhaps even High Court review.
The Court’s denial of certiorari in the Coons case does not mean the justices won’t revisit the ACA next term. Another cert petition is pending in Mayhew v. Burwell, Maine’s challenge to the constitutionality of the ACA’s maintenance of eligibility requirements for Medicaid. According to Maine (and supporting amici), the federal government’s threat to withhold all Medicaid funding should Maine restrict Medicaid eligibility below pre-existing levels is unconstitutionally coercive and violates the Medicaid holding of NFIB v. Sebelius.
If, as oral argument in King v. Burwell suggested, some of the justices are interested in revisiting federalism concerns about the ACA, Mayhew is a potential vehicle. Indeed, although the U.S. Court of Appeals for the First Circuit found Maine’s arguments unconvincing, Maine’s position would get a boost should the the federal government prevail in King on federalism grounds.
Six Democratic senators and one independent have asked the Department of Health and Human Services to a delay a new rule that would likely force small businesses to pay more for employee health insurance under the Affordable Care Act, aka Obamacare. The senators warn that if the administration goes ahead with the change it would be “particularly harmful and disruptive” to small businesses.
Starting in 2016, the Obamacare change will require businesses that employ between 51-100 people to purchase insurance in what the government defines as the “small group market,” rather than the market for large group plans. The senators warn that the change will inflate health care costs for those businesses.
“[T]hey could experience higher premiums, less flexibility, and new barriers to coverage. We therefore encourage you to delay the effective date in the definition change for two years so the market can more smoothly transition to the new rules,” the senators wrote in the March 12 letter to HHS Secretary Sylvia Burwell.
During a 2014 Valentine’s Day meet-up with House Democrats, President Obama thanked them for their unstinting support of the Patient Protection and Affordable Care Act. “I think,” he said, “10 years, five years from now, we’re going to look back and say this was a monumental achievement.”
Well, the president’s health care law marks its fifth anniversary this week. And most Americans are not, in fact, looking back and saying the law enacted in 2010 – with not one Republican vote in either the House or Senate – was a monumental achievement.
Indeed, in an NBC News/Wall Street Journal poll this month, a 44-34 plurality of respondents thought Obamacare a “bad idea.” And a 62-22 percent majority said that what they had seen, read or heard in recent weeks about the Affordable Care Act had made them “less confident” about the law.
Some suggest the public’s misgivings about Obamacare are almost entirely attributable to GOP opposition to the law. In a statement Monday, Democratic National Committee Chairwoman Debbie Wasserman Schultz noted that “Republicans have voted more than 50 times to repeal or undermine this critical law.”
What Were the Top 5 Fails from 5 Years ofACA?
Here are some of the top actual practices of the ACA thatdiverge from what we were promised:
1. PolitiFact “Lie of the Year”: “If you like your health care plan, you can keep it.”
The Obama Administration and many Democratic members of Congress repeatedly assured Americans that “If you like your health care plan, you can keep it.” PolitiFact rated this the “Lie of the Year for 2013” after cancellation notices went out to 4 million people. (PolitiFact)
2. “If you like the doctor you have, you can keep your doctor, too.” Not.
In June 2009, President Obama said, “If you like the doctor you have, you can keep your doctor, too.” But nearly five years later, the president admitted that Americans might lose their doctors after all. (WebMD Exclusive Interview). This is a broken promise that many ObamaCare enrollees will face, given that 70 percent of ObamaCare plans are narrow or ultra-narrow network plans, compared to 23 percent of employer-sponsored plans. (Washington Post)
The Congressional Budget Office’s new report shows updated cost projections for the insurance coverage expansion in the Affordable Care Act. With the debate over the ACA remaining so intensely polarized, advocates moved aggressively to spin this routine update as reflecting favorably on the law. A front-page article in the Washington Post referred to the new findings as showing “savings,” quoting a supporter as saying, “I can’t see how people can continue to say . . . that Obamacare had no cost containment in it.” Such comments in the wake of CBO’s update are flawed interpretations of the new estimates and what they signify. The following explains what CBO has actually projected: basically that the ACA will do less to expand coverage than previously estimated.