ObamaCare’s impact on health costs.

“Who’s up for the latest batch of bad Obamacare-related news?
(1) Consumers brace for the second full year of Obamacare implementation, as the average individual market premium hike clocks in at eight percent — with some rates spiking by as much as 30 percent.
(2) “Wide swings in prices,” with some experiencing “double digit increases.”(Remember what we were promised):
Insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last. One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases…”

“One year ago, every network, every member of Congress and certainly HHS and CMS watched or tried to log into HealthCare.gov. It proved to be a long, long wait. The collective frustration at the end of the day was the site did not work.
Despite repeatedly assuring both Congressional committees and the American public that the new marketplace and this bold new experiment on shopping for government controlled health insurance was to be smooth as silk and easy as pie, the rollout was a colossal failure for the HHS Secretary and her team. Ultimately, she admitted being responsible for the ‘debacle’ but not much has been done to eliminate the problems and clean up the process. HealthCare.gov is still broken.
The rollout was a failure, but my hope is the bureaucracy has learned some lessons. Here are five things I hope we can file away as lessons learned.”

“Thousands of Americans will see their health plans cancelled before the November elections in a development that could boost critics of ObamaCare.
The Morning Consult, a Washington-based policy publication, reported that nearly 50,000 people will lose their current health coverage in the coming weeks.
The figure encompasses cancellations announced by insurance departments and providers in Kentucky, Alaska, Tennessee, New Mexico, North Carolina, Maine and Colorado.
The possible political consequences are clear in states like Kentucky, where Senate Minority Leader and leading ObamaCare critic Mitch McConnell (R-Ky.) is defending his seat against Democrat Alison Lundergan Grimes.”

“During the Patient Protection and Affordable Care Act’s first period of open enrollment October 2013 – March 2014, an estimated fourteen million people enrolled for health coverage through the new private insurance Marketplaces (8 million) and through Medicaid (6 million). To facilitate this substantial volume of enrollment and enrollment-related activities, approximately 4,400 Marketplace Assister Programs employing more than 28,000 full time-equivalent staff and volunteers served consumers nationwide. All Assister Programs were expected to help consumers understand their coverage options, apply for financial assistance, and enroll (see Appendix 1). Additional functions undertaken by many assisters included outreach and education; help with post-enrollment questions and problems; assistance with appeals of eligibility determinations; and help applying for other public benefits and services.
The emergence of Marketplace Assister Programs around the country is a significant health policy innovation. The majority of programs that were operational in 2013-14 needed to organize, launch and scale up quickly to be ready for the ACA’s first open enrollment period. Because so many programs were new or substantially expanded their scope during this first year, this period was also characterized by both the need and opportunity for widespread “learning by doing.” Several surveys conducted during or just at the close of 2013-14 Open Enrollment have already begun to assemble valuable data about: consumers’ experiences with assisters; assisters’ self-reported experiences; and best practices and lessons emerging from specific states or assister-related initiatives.1”

“The big story in the Medicare world these days is the slowdown in program spending. Based on our comparison of CBO’s August 2010 and August 2014 baselines, Medicare spending this year will be about $1,200 lower1 per person than was expected in 2010, soon after passage of the Affordable Care Act (ACA), which included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aimed to improve efficiency and reduce costs. By 2019, Medicare spending per person is projected to be more than $2,400 lower per person than was expected following passage of the ACA. Medicare spending projections in CBO’s August 2010 and subsequent baselines take into account the anticipated effects of the ACA, along with other factors that are expected to affect future Medicare spending. So it seems that the ACA may be having a bigger than expected effect, but something else may be going on here too.”

“Here unedited is what I posted on September 29, 2013:
The Affordable Health Care Act’s Launch On October 1st––So How Did it Go?
Unavoidably, that will be the big question come Tuesday.
But there will be much more to it than that.
A 180-Day Open Enrollment––Not a One-Day Open Enrollment
What happens on the first day, for good or bad, will constitute only a tiny percentage of the open enrollment period. Consumers will likely visit the new websites many times before they make any decisions, and that is exactly as it should be.
Many of the health plans touted as being low-cost plans are going to be very limited access plans. It won’t be easy for consumers to compare one plan’s provider network to the other. In the best of circumstances, consumers will be confused by what is being offered for some time and will have to make a major effort to make sense of it for themselves.”

“Former HHS insurance oversight chief Jay Angoff has filed a lawsuit against the department for not making 2015 rate filings public, arguing the administration is not abiding by its own regulations on disclosing the information.
Responding to the lawsuit, an HHS official said the agency will publish the rate information prior to the beginning of open enrollment. HHS Spokesperson Ben Wakana told Inside Health Policy late Wednesday (Oct. 1): “We are readying the rate change information. The department is committed to providing consumers accurate information so they can make informed decisions, and therefore, before the beginning of Open Enrollment, the agency will publish final insurance rates for all 50 states.””

“Consumer Reports has published an article demanding that we get “mad about the outrageous cost of health care.”
Hey, I’m all for that. The article goes through the usual list of suspects, e.g. $37.50 for a single Tylenol, having two or three MRI scans when one will do, et cetera. The article also asserts that “health care works nothing like other market transactions. As a consumer, you are a bystander to the real action…” I could not agree more. However, I was a taken aback by a statement from George Halvorson, the former Chairman of Kaiser Permanente:
“There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is.”

“Legal challenges to various aspects of Obamacare (aka the Affordable Care Act) keep traveling on a rollercoaster. Today’s episode of the law’s continuing courtroom soap opera involves a ruling by a federal district court in Oklahoma, which overturned a 2012 IRS rule authorizing premium assistance tax credits in federal exchanges (since rebranded as “federally facilitated marketplaces”). The decision improves the likelihood that the Supreme Court ultimately will consider this issue on appeal; either in the spring of 2015 or during its next 2015-2016 term.
Judge Ronald White ruled in State of Oklahoma v. Burwell that the IRS rule is “arbitrary, capricious, an abuse of discretion not in accordance with law, pursuant to 5 U.S.C. section 706(2)(A), in excess of statutory jurisdiction, authority, or limitations, or short of statutory right, pursuant to 5 U.S.C. section 706(2)(C), or otherwise is an invalid implementation of the ACA, and is hereby vacated.”
In other words, it was not just a “bad idea,” but an illegal one, too.”

“The second Obamacare enrollment season could go negative — but not because of the health care law’s critics.
Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don’t get covered. It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year.
There are several challenges: The 2015 enrollment period is shorter, the most motivated Americans are probably already enrolled and the law is still politically unpopular. That means that even if HealthCare.gov works well — and it couldn’t be worse than last October’s meltdown — proponents are confronting a tough messaging landscape.”