“In an action with major implications for health reform in Michigan, the state House has voted to turn down — at least for now — nearly $10 million in federal funds to create a statewide health exchange by 2014 to sell more affordable, standardized health insurance to consumers and small businesses.”
“With many states unwilling or unable to get insurance exchanges operational by the health law deadline of Jan. 1, 2014, pressure is growing on the federal government to do the job for them.
But health care experts are starting to ask whether the fallback federal exchange called for in the 2010 health law will be operational by the deadline in states that will not have their own exchanges ready.”
“Congress made a serious drafting error in the health-overhaul law when it said that subsidies could be delivered through state exchanges but not through any federal fallback exchanges… The Obama administration has been trying an end-run around the problem by ordering the IRS to simply say in its proposed regulations that the subsidies can be delivered through either type of exchange. This is a big issue because a growing number of states are refusing to create exchanges. If they don’t, the feds can come in and set one up, but these will be relatively useless if they can’t deliver subsidies.”
“The Patient Protection and Affordable Care Act (ACA) — the new health reform law — contains financial incentives for the states to establish health insurance exchanges where qualifying individuals and small businesses can purchase subsidized, individual health insurance, starting in 2014.
The structure of the exchange subsidies will encourage low-income workers to congregate in companies that do not provide insurance and high-income employees to work for firms that do provide it.”
“Even if ObamaCare survives Supreme Court scrutiny next spring, its trials will be far from over. That’s because the law has a major glitch that threatens its basic functioning. It’s so problematic, in fact, that the Obama administration is now brazenly trying to rewrite the law without involving Congress.”
“The federal insurance subsidies and tax credits are among the few popular features of the law. But they won’t remain that way as Americans learn more about them. ObamaCare provides subsidies to those whose incomes fall between 133 and 400 percent of the federal poverty level, and who do not have access to federally defined “affordable” coverage through their employer. All other Americans — including those in the exact same income bracket — will not be eligible to receive subsidies.”
“Some of the federal healthcare law’s requirements related to insurance exchanges threaten the autonomy of U.S. states, which need more support in establishing the marketplaces, state governors said in a letter released on Thursday. ‘The decision to implement health insurance exchanges requires a number of complex policy decisions amid aggressive timelines,’ wrote the National Governors Association in a letter to U.S. Health Secretary Kathleen Sebelius dated Nov. 2.”
“ObamaCare’s rate review regulations are premised on the notion that rising health insurance premiums are somehow caused by excess profits and wasteful spending. But insurer profits are actually quite small. The Congressional Research Service reports that in 2009, health insurers’ average profit margin was just 2.6%. The cost of insurance is rising because the cost of health care has increased dramatically. True health reform would’ve addressed this underlying problem.”
“Last Thursday, the Institute of Medicine finally released its long-awaited set of recommendations for how the Secretary of Health and Human Services should accomplish the impossible–determining the ‘essential health benefits’ for tens of millions of Americans under the to-be-implemented Affordable Care Act. Early reviews indicate that, not surprisingly, there is no way to please everyone, or perhaps even anyone, in this highly political exercise. The countervailing pressures ‘essentially’ are that one side wants to ensure that benefits are more comprehensive and generous to ensure that everyone either gets what they want, or what other interests and experts think they must get anyway. “
“In other words, Sebelius’ dilemma is whether or not to take away a perfectly good option—catastrophic coverage—that the market currently offers patients. And the expert advice is that she should not. I’m not sure whether to applaud this dawn of wisdom or weep that the Obama administration needed a panel to tell it the obvious. What’s next? An expert panel advising the administration that GM should, after all, keep its wheels round?”