ObamaCare’s impact on health costs.
“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.”
“Medicare’s true cost is the biggest problem in Washington and the one most ignored.
The long-awaited 2014 Medicare Trustees report is out, and the “spinning “ is well underway. But the media is not yet reporting another big finding – this one by the Medicare Actuary and revealed on the same day: Taxpayers face a Medicare unfunded liability ranging from $28 trillion to $35 trillion, depending on the most realistic assumptions about the future. In other words, Washington politicians have promised seniors that over the next 75 years (the so-called long-term “actuarial window”) they will receive tens of trillions of dollars of Medicare benefits that are not paid for. It is Washington’s biggest, most expensive and most difficult federal entitlement problem. And it is one most politicians—with a few noble exceptions—continue to ignore.”
“Luis Martinez of Hialeah survived two heart attacks during the more than 10 years that he went without health insurance.
So he was relieved to finally find coverage on the Affordable Care Act’s insurance exchange in March, two weeks before the enrollment deadline.
But four months after he and his wife signed up for a subsidized, bronze-level health plan with Coventry, Martinez, 51, said he feels as though he has fallen into a black hole of government bureaucracy while trying to prove his income and his wife’s citizenship in order to keep their coverage, part of a national effort to verify policyholders’ eligibility.
Martinez, who has stents implanted in his coronary arteries, said he has tried repeatedly for more than a month to comply with the government’s requests for additional documentation to resolve inconsistencies in his personal information — or risk losing his $457 monthly subsidy, and health insurance for him and his wife, Rocio Balbin, 46.
So far, officials with the U.S. Department of Health and Human Services are not satisfied with his response.”
“Better access to data about real world patient experience holds enormous potential to help achieve many of the goals of health reform, including improving the quality and delivery of medical care, reducing costs, and improving safety and outcomes by accelerating the knowledge base upon which the development of new treatments and cures relies.
Capturing data about the actual experience of patients outside of the carefully controlled clinical trial setting – Real World Data – can help fill the knowledge gap between clinical trials and clinical practice. RWD offers a treasure-trove of information that could allow providers, innovators, health plans, researchers, and others in the scientific and medical communities to make faster, more efficient, and less costly advances in medical research and clinical treatment. Life sciences companies can use this data to explore the benefits and risks of treatment options including their effectiveness in patient subpopulations, expedite enrollment in clinical trials, identify new targets for research and development, and transform the value equation in medical care.”
“The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight healthcare fraud.
U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote “significant time” to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing “complex and egregious” cases.
“My advice to the medical community is to stay away from gray areas or outright fraud that wastes tax dollars, because we will be watching,” Johnson told the Sioux Falls Argus Leader. “The end result in many of these cases will be that the taxpayers get their money back with interest and penalties, and the medical professional loses their license.”
Johnson’s office recently settled an alleged fraud case involving two doctors at Dakotas-based Sanford Health. Court documents show that Sanford paid $625,000 to settle the lawsuit, in which the doctors and the hospital did not admit wrongdoing. Cindy Morrison, Sanford’s executive vice president for marketing and public policy, said the hospital settled to avoid distraction.
“For us, it’s the issue of time and expense,” she said.”