The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
“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.””
“In a decision with meaningful implications for the future of U.S. health reform, Swiss voters on Tuesday overwhelmingly rejected a proposal to replace their fully privatized health care system with a government-run, single-payer one. Why does this matter for Americans? Because efforts by both Democrats and Republicans to reform U.S. health care have been modeled after the Swiss system. Switzerland offers us a glimpse as to what a popular, market-oriented health-care system could look like.
Many Americans assume that all European countries have single-payer health care systems. That’s not true. They all offer universal coverage—in which health insurance is subsidized for all citizens–but only some of those countries, like the United Kingdom, actually have a system in which private insurers play no meaningful role, because the government serves as the sole insurance company (i.e., the single payer).”
“The majority of Americans who continue to oppose Obamacare should be greatly pleased to learn that the Supreme Court is likely to get a do-over on this misguided and too-often-lawlessly-implemented law. Ours is a nation of fresh starts and second chances: it is only fitting that SCOTUS be handed an opportunity to undo the convoluted, flagrantly political and highly controversial decision it made in June 2012. As eloquently detailed by fellow Forbes blogger Michael Cannon on September 30, “The U.S. District Court for the Eastern District of Oklahoma handed the Obama administration another – and a much harsher — defeat in one of four lawsuits challenging the IRS’s attempt to implement ObamaCare’s major taxing and spending provisions where the law does not authorize them.””
“A new poll finds that three-fifths of likely voters support the repeal of Obamacare. A large plurality — 44 percent — wants to see Obamacare repealed and replaced with a conservative alternative. A much smaller group —16 percent — wants to see it repealed but not replaced. Less than one in three respondents — 32 percent — would like to keep Obamacare, whether in its current form or in amended form. So, with a conservative alternative in play, 60 percent of Americans support repeal, while only 32 percent oppose it.”
“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.”
“Despite promises to the contrary by members of Congress and even the president, Americans now know that Obamacare is entangling tax dollars with coverage of elective abortion.
Last week, the Government Accountability Office released a report confirming that more than 1,000 Obamacare exchange plans cover elective abortion but remain eligible for taxpayer subsidies.
But that’s not the full story on how Obamacare funds the abortion industry.”
“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.”