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

“Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered.
Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program.”

“A federal appeals court threw out a lawsuit over the delay of ObamaCare’s employer mandate, a sign that a similar challenge in the works by House Republicans might not fare well.
The 7th Circuit Court of Appeals said the plaintiffs did not have standing to sue, and only parties “seeking to advance the interests” of the mandate could mount a “plausible” case against its delay.”

“President Obama’s claim last spring that 8 million people had enrolled in ObamaCare recently got a significant downgrade from the head of the agency overseeing the plan.
Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, told a congressional committee that “as of August 15, this year, we have 7.3 million Americans enrolled in Health Insurance Marketplace coverage and these are individuals who paid their premiums.””

“The launch of the Affordable Care Act has focused attention on the idea of a health insurance exchange, or marketplace. Separate from the ACA, private exchanges have also started to emerge as an option for employers providing coverage to their workers. This report identifies the different types of private exchanges as well as projects the potential size of the private exchange market, which has the potential to reshape the employer-sponsored health insurance landscape, in the coming years.
Through interviews with representatives of more than fifteen private health insurance enrollment platforms as well as several employers and health plans moving in this direction, this report examines important implications in this quickly-growing landscape, including the potential for cost stability to employers and more choice among health plans for consumers.”

“CMS Administrator Marilyn Tavenner on Thursday (Sept. 18) pledged the agency would conduct full “end-to-end” testing of healthcare.gov prior to the launch of open enrollment in November, likely either by the end of this month or early October. Tavenner also told members of Congress that the site will see continued improvement but will not be perfect in year two.
The comments came during a sometimes fiery House oversight committee hearing that focused on the security of the exchange website, which took place shortly after the Government Accountability Office released a report finding that healthcare.gov continues to be vulnerable to breaches. On Wednesday, Chair Darrell Issa (R-CA) released a scathing report on the run-up to the launch of the site that highlighted staff concerns about security, attempts to cover-up the reasons behind the failed launch, and a disconnect between HHS and CMS staff.”

“This week’s double-barreled release of government statistics on health insurance coverage leaves us with only one question: How many Americans are insured because of Obamacare? Remarkably, the two highly regarded government surveys released this week do not even agree whether the number of uninsured increased or decreased. The survey that received a great deal of attention said there were 3.8 million fewer uninsured. The other, which was hardly noticed, found that there were 1.3 million more uninsured.
The Centers for Disease Control (CDC) reported preliminary results on the expansion of health insurance coverage. Its National Health Interview Survey (NHIS) interviewed 27,000 people in the first three months of this year. The survey estimates that the number of uninsured dropped by 3.8 million since 2013. That represents a 1.3 percentage point decline in the uninsured rate, from 14.4 percent last year to 13.1 percent early this year.”

“Voters continue to give lackluster reviews to the U.S. health care system despite positive opinions of their own insurance coverage and care. Half still think the system will get worse under the new health care law.
A new Rasmussen Reports national telephone survey finds that only 32% of Likely U.S. Voters rate the nation’s health care system as good or excellent. Just as many (32%) give it poor marks, up from 29% in August but still below the 35% who felt that way in June.”

“States have developed various ways to avoid paying their fair share of Medicaid expenses over the years, in some cases costing the federal government hundreds of millions of dollars in extra funding for the program.
The Department of Health and Human Services, which runs Medicaid through its Centers for Medicare and Medicaid Services (CMS), has known about the issue for more than a decade, but states still find ways to game the system. The agency’s inspector general this year listed the issue among 25 key problems the agency needs to address.”

“Employer groups are ramping up their efforts to revise the ACA’s 30-hour full-time employee definition in hopes of getting it changed before the employer mandate kicks in for some large employers next year. The initiative, titled “More Time for Full-Time,” was announced Friday (Sept. 19) and is the latest tactic by employers to change the standard so that it defines a full-time employee as one who works 40 hours per week.
Groups involved in the initiative include the National Restaurant Association, the National Retail Federation, the U.S. Chamber of Commerce, the National Grocers Association and the International Franchise Association.
“As all Americans have known for decades, 40 hours represents the widely-accepted definition of a full-time work week. Unless there is a statutory change to the definition of a full-time employee in the ACA, there will be fewer full-time jobs, more part-time workers and fewer overall hours available for Americans to work,” International Franchise Association President and CEO Steve Caldeira said in a statement.”

“A major innovation in health insurance plan design over the past several years has been the rapid growth of “narrow network” plans. Such plans either limit enrollee choices of providers, or place providers in differential cost tiers whereby individuals face higher cost in selecting some providers relative to others. This movement harkens back to the restrictions put in place during the U.S. initial infatuation with managed care in the mid-1990s. That episode ended badly for the limited choice model, as the “HMO backlash” induced regulatory restrictions on plans which handicapped choice limitations within the HMO model.
The latest growth of narrow network plans has been hastened by the introduction of health insurance exchanges under the Affordable Care Act (ACA). State exchanges have fostered strong insurer competition through both organizing the marketplace and through tying low income health insurance tax credits to the second-lowest cost plan in the silver tier. Insurers have responded to these competitive incentives in many ways, but perhaps the most notable is the expansion of narrow network insurance products. Such products are widespread on exchanges and appear to be growing rapidly.”