The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

“BOSTON — When it comes to the president’s health care law, there’s very little that Republicans and Democrats agree on—but one idea that seems to unite analysts, experts and lawmakers across the political spectrum is that Obamacare has done very little to actually improve health care.
“The U.S. healthcare system was always dysfunctional. The Affordable Care Act has just provided more access to that dysfunctional system,” iVantage chief Donald Bialek said during an ACA debate at The Economist’s health care forum in Boston on Wednesday. Bialek, for his part, was on the side defending the health care law.”

“A day after Maryland committed to a gradual launch of its health exchange, state officials are still working out some key details — including where the opening day sign-up will be held — but experts say it could be a way to avoid a repeat of last year’s botched rollout.
Several health experts said the approach that limits enrollment in the first few days could allow Maryland to “kick the tires” on its new website.
“It’s a controlled way to open enrollment,” said Karen Pollitz, senior fellow at the Kaiser Family Foundation. “They can work with a controlled number of people for the first couple of days to see how this works in practice. I’m assuming there is some plan at the end of the day when people gather in a room and compare notes and say we need to fix this or that.””

“Lawmakers told officials with the Department of Health and Hospitals on Wednesday they needed to provide more complete information going forward about Bayou Health, Gov. Bobby Jindal’s Medicaid privatization program.
The Legislative Audit Advisory Council heard testimony from DHH and the Legislative Auditor’s Office about an audit that raised a number of questions about the program. Auditors testified 74 percent of the transparency report was based on self-reported data with no corroborating documentation.”

“RICHMOND — Republican leaders of Virginia’s House of Delegates, who have staunchly opposed Medicaid expansion all year, plan to put the question to a floor vote as early as Thursday in a special legislative session.
The GOP-dominated chamber is widely expected to shoot down the proposed $2 billion-a-year expansion, although a few conservative legislators have expressed fears that the measure might defy expectations and pass — just as a then-record tax hike did when Democrat Mark R. Warner was governor a decade ago.”

“Enrolling in Missouri’s Medicaid program has not been easy.
Many applicants have experienced a barrage of problems when trying to sign up for the program, including long delays until coverage kicks in, lost paperwork and a lack of one-on-one interaction with caseworkers. State officials have blamed a new computer system used to process Medicaid applications.
But there is another reason why some Missourians struggle to get help.
When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636. When she called, Weaver endured long waits and received no guidance.”

“Very few industries in bed with Obamacare come off smelling like a rose. But if one had to pick a bad actor above all others, it would probably be Big Health Insurance.
America’s largest and most influential health insurance companies actively supported passage of Obamacare in Congress, and continue to do so today. That’s not surprising, since the heart of Obamacare is a mandate on Americans to purchase the product the health insurance companies are selling (the individual mandate). The “essential minimum coverage” on “qualified health insurance plans” as dictated by the Department of Health and Human Services tend to emphasize first dollar insurance coverage whenever possible, which increases insurance company profits. Worst of all, insurance companies are the beneficiaries of a giant taxpayer bailout that makes their Obamacare participation a “heads they win, tails taxpayers lose” kind of scenario.”

“Just days before the security of the Obamacare website is the subject of a new report by an independent government agency, a watchdog group today released documents showing federal health officials knew about security vulnerabilities in the run-up to the site’s shaky launch last fall.
Judicial Watch said it obtained 94 pages of government documents detailing HealthCare.gov’s “massive” security risks.
The documents, the watchdog said, show that officials at the Department of Health and Human Services and a subordinate agency, the Centers for Medicare and Medicaid Services, decided to roll out the online insurance exchange despite knowledge of the security flaws.”

“Obamacare—or at least the version of it that the president and his advisers currently think they can get away with putting into place—has been upending arrangements and reshuffling the deck in the health system since the beginning of the year. That’s when the new insurance rules, subsidies, and optional state Medicaid expansions went into effect. The law’s defenders say the changes that have been set in motion are irreversible, in large part because several million people are now covered by insurance plans sold through the exchanges, and a few million more are enrolled in Medicaid as a result of Obamacare. President Obama has stated repeatedly that these developments should effectively shut the door on further debate over the matter.
Of course, the president does not get to decide when public debates begin or end, and the public seems to be in no mood to declare the Obamacare case closed. Polling has consistently shown that more Americans oppose the law than support it, and that the opposition is far more intense than the support. The law is built on a foundation of dramatically expanded government power over the nation’s health system, which strikes many voters as a dangerous step toward more bureaucracy, less choice, higher costs, and lower quality care. The beginning of the law’s implementation does not appear to have eased these fears, and in some cases has exacerbated them.”

“The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are. Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.
The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect. It found that rates remained statistically unchanged at just over 7 percent for both time periods.”

“Since the Affordable Care Act’s (ACA) passage, a number of lawsuits have been filed challenging various provisions of the law. The Supreme Court has decided cases about the constitutionality of the ACA’s individual mandate and Medicaid expansion as well as the applicability of the contraceptive coverage requirement to closely held for-profit corporations with religious objections. In addition, several cases challenging the availability of premium subsidies in the Federally-Facilitated Marketplace (FFM) are currently progressing through the federal courts. All of this litigation has altered, or has the potential to alter, the way in which the ACA is implemented and consequently could affect the achievement of the law’s policy goals. This issue brief examines the federal courts’ role to date in interpreting and affecting implementation of the ACA, with a focus on the provisions that seek to expand access to affordable coverage.
Court decisions about how to interpret the ACA will continue to affect the number of people who ultimately obtain affordable coverage. At present, access to Medicaid up to 138% FPL is dependent upon where people live because the Supreme Court held that implementation of the ACA’s Medicaid expansion is effectively a state option. This has resulted in a coverage gap for just over 4.5 million people with incomes too high to qualify for Medicaid but too low to qualify for Marketplace subsidies in the states that have not implemented the ACA’s Medicaid expansion to date.”