ObamaCare’s impact on health costs.

“Welcome back from the summer.
It’s been pretty quiet lately on the Obamacare front.
So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time.
Wishful thinking.
Obamacare has largely been out of the news cycle for a couple of months but that is about to change.
A few thoughts.
The 2015 rate increases have been largely modest. Does that prove Obamacare is sustainable? No. You might recall that on this blog months ago my 2015 rate increase prediction was for increases of 9.9%.
You might also recall my reason for predicting such a modest increase. With almost no valid claims data yet and the “3Rs” Obamacare reinsurance program, insurers have little if any useful information yet on which to base 2015 rates and the reinsurance program virtually protects the carrier from losing any money through 2016. I’ve actually had reports of actuarial consultants going around to the plans that failed to gain substantial market share suggesting they lower their rates in order to grab market share because they have nothing to lose with the now unlimited (the administration took the lid on payments off this summer) Obamacare reinsurance program covering their losses.”

“Obamacare’s defenders are busy declaring victory again. Ezra Klein is touting a new survey of Obamacare benchmark premiums in some regions of the country as evidence that the law is defying the predictions of critics and working to cut costs rather than increase them.
But, as Bob Laszewski notes, the truth about Obamacare implementation is far less rosy than the latest round of cheerleading would indicate.
For starters, the federal and state websites remain largely a dysfunctional mess, although the media isn’t really covering the story anymore. The supposed “fix” that allowed millions of consumers to sign up with plans on the exchanges from December through April really wasn’t much of a fix after all. It was a workaround, allowing consumers to access large federal subsidies with minimal verification.”

“Robert Laszewski, health policy wonk, blogger, and president of Health Policy and Strategy Associates, tells Inside Health Insurance Exchanges:
The Obama administration has no idea how many people are currently enrolled [in exchanges] but they keep cutting checks for hundreds of millions of dollars a month for insurance subsidies for people who may or may not have paid their premium, continued their insurance, or are even legal residents.
And if you think they’re doing those “enrollees” a favor, remember that if it turns out a recipient wasn’t eligible for the subsidy, he or she has to pay the money back.
Surprised? Don’t be. This is part of a deliberate, consistent strategy by the Obama administration to throw money at individual voters and key health care industry groups—lawfully or not—to buy support for this consistently unpopular law.”

“Having access to health insurance is slowing the rate of young adults who head to the emergency department for care, a new study suggests. Relative use of the ED decreased among 19- to-25-year-olds after the healthcare reform law allowed them to stay on their parents’ policies. The authors say the results show insurance can reduce ED overuse by removing the economic barriers to preventive care.
“It’s possible that when people have healthcare insurance they are less worried about the financial costs of care,” said Tina Hernandez-Boussard, assistant professor of surgery and biomedical informatics at Stanford University and lead author of a study published Monday in the journal Health Affairs. “They might seek appropriate care elsewhere and take care of conditions earlier. This could lead to a reduction in utilization of the emergency department.””

“The Affordable Care Act attempts to help low- and middle-income families avoid some of the tough sacrifices that would be necessary to purchase health insurance without assistance. But no program can change the fundamental reality that society itself has to make sacrifices in order to deliver health care to more people. Workers and therefore production have to be taken away from other industries to beef up health care, or the workforce itself has to get bigger, or somehow people have to work more productively. Although the ACA helps specific populations by giving them a bigger slice of the economic pie, the law diminishes the pie itself. It reduces the amount that Americans work, and it makes their work less productive. This slows growth in both personal income and gross domestic product.”

“Allowing young adults to stay on their parents’ health plans is one of the most popular elements of the president’s health-care law, but a pair of new studies out today raises questions about the overall impact of the coverage expansion to an estimated 3 million people.
The provision, which allows young adults to stay on their parents’ health insurance plans until their 26th birthday, was one of the earliest parts of the law to take effect, in 2010, and researchers are now starting to report on the effects of that expansion. As expected, it increased the rate of health insurance among young adults, who historically had the highest uninsured rates of any age group. But the provision didn’t change whether the age group perceived themselves as healthier or whether they thought health care was any more affordable, according to a new study in JAMA Pediatrics.”

“Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.
Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”
Distance is one problem: Residents have to travel farther to get face-to-face assistance from the so-called navigators and assisters hired to help consumers figure out the process. And Internet access is sometimes spotty, discouraging online enrollment.
But the most significant barriers may stem directly from state decisions about whether to expand Medicaid eligibility — more than 20 states chose not to — and whether to operate their own health exchanges. States that embraced those parts of the law generally had more federal resources as well as funds generated by their online marketplaces for outreach efforts to boost enrollment, including those aimed at consumers in less accessible areas, and more coverage options, through Medicaid, for which these consumers might be eligible.”

“Large businesses expect to pay between 4 and 5 percent more for health-care benefits for their employees in 2015 after making adjustments to their plans, according to employer surveys conducted this summer.
Few employers plan to stop providing benefits with the advent of federal health insurance mandates, as some once feared, but a third say they are considering cutting or reducing subsidies for employee family members, and the data suggest that employees are paying more each year in out-of-pocket health care expenses.
The figures come from separate electronic surveys given to thousands of mid- to large-size firms across the country by Towers Watson, the National Business Group on Health and PriceWaterhouseCoopers, consulting groups that engage with businesses on health insurance issues.
Bracing themselves for an excise tax on high-cost plans coming in 2018 under the Affordable Care Act, 81 percent of employers surveyed by Towers Watson said they plan to moderately or significantly alter health-care benefits to reduce their costs.”

“When Congress returns this week, action in both chambers will mostly be a show for the voters back home ahead of the midterm election. In the House, that will include a vote on a bill to allow insurance companies to continue offering any plan that was sold in the group market in 2013.
Noticeably absent from congressional politicking in the next few weeks is the Affordable Care Act’s risk corridor program, which was, as recently as a few months ago, a major Republican criticism of the law. But that doesn’t mean the “insurer bailout” fight is dead. Republicans in both chambers are quietly working to challenge the legality and projected cost of the program. And that could tee up the issue to become a bargaining chip in the budget fights to come at the end of this year, regardless of who wins the Senate.
The Affordable Care Act’s risk corridor program runs from 2014 through 2016, and was established to encourage insurers to take a chance on covering an unknown population — the Americans who would be purchasing insurance on state and federal exchanges. The program collects funds from qualified health plans that bring in more money than they paid for medical claims, and then pays that money to plans with claims that cost more than they brought it from consumers.
But what happens if there isn’t enough money from well-performing insurers to pay all of the insurers that missed the mark? The federal government is on the hook, but where they find the money to pay those insurers is a question being debated throughout Washington. That’s because the law did not give the federal government a clear appropriation to spend money to make up for losses. And Republicans are, of course, very unlikely to give them one.”

“MADISON, Wis. — Nearly 26,000 adults who lost Medicaid coverage through Wisconsin’s BadgerCare Plus program after being kicked off earlier this year will have more time to sign up for private subsidized insurance, the federal government announced Thursday.
The U.S. Centers for Medicare and Medicaid Services said it was establishing a special enrollment period through Nov. 2 for those people to sign up under the federal exchange created under the health overhaul law.
The Wisconsin Department of Health Services estimates that about 25,800 out of 63,000 adults who lost that coverage had yet to sign up for subsidized insurance plans under the federal law.
They lost coverage after Gov. Scott Walker and the Republican-controlled Legislature tightened income eligibility for the state’s Medicaid coverage from 200 percent of poverty to 100 percent. That made the income cutoff for coverage $11,670 for an individual and $23,850 for a family of four.”