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

“As the image above shows, reporters and pundits–including some of the most respected ones I know–have different takes on the importance of Obamacare as an election issue now that implementation of the law is moving forward and some of the controversy around it has cooled. Observers are split: Some emphasize the law’s decline as a hot political issue, others its staying power as a rallying cry for the right, and a few suggest that the ACA may emerge as an issue Democrats want to run on.
Each of these positions may be at least partly right. Obamacare has cooled as an issue now that there isn’t an obvious controversy, such as last fall’s website debacle, to occupy the front pages. But the law, now a more conventional Republican talking point than an outsize rallying cry, is still useful to some Republican candidates as a tool to motivate their anti-Obama base. Less clear is whether many Democrats will choose to run on some of the ACA’s most popular provisions, such as its protections for people with pre-existing medical conditions. This was the consensus of an event Tuesday the Kaiser Family Foundation and the Cook Political Report held in Washington about the ACA and the midterm elections; it featured people from both organizations and journalists covering tight Senate races for the Des Moines Register and the Charlotte Observer.”

“Dan wrote up yesterday’s Washington Post/ABC News poll, which was jammed with crooked numbers for President Obama. Most striking was the (30/55) majority deeming Obama’s presidency “a failure,” along with the prevailing opinion that he’s divided the country, and his unsightly leadership score. The survey also included a dreadful (38/56) presidential approval rating on the implementation of Obamacare; support for the law itself was also underwater, with an outright majority opposed, despite this polling series’ silly question wording that omits any mention of ‘Obamacare’ or the ‘Affordable Care Act.’ A new Kaiser Family Foundation poll produces similar findings, with support for the president’s signature domestic accomplishment swamped by opposition. It’s been this way for years, across hundreds of national surveys.
One major reason for the enduring opposition is that the law has violated virtually every major promise erected in dishonest ideologues’ sales pitch. Another is that an ongoing parade of unpleasant developments continues to make headlines, including the recent revelation that Healthcare.gov was hacked last month. Apologists can cherry-pick useful data points to try to convince the public that Obamacare is reducing premium costs and driving down costs, but that’s simply not the case. Individual market premiums exploded in 2014, and are expected to grow by roughly eight percent in 2015 (with many consumers confronting double-digit spikes) — to say nothing of high out-of-pocket costs and narrow coverage networks. Overall health spending continues an upward climb. The law was billed as a dramatic premium reducer that would also bend down the so-called “cost curve.””

Dan wrote up yesterday’s Washington Post/ABC News poll, which was jammed with crooked numbers for President Obama. Most striking was the (30/55) majority deeming Obama’s presidency “a failure,” along with the prevailing opinion that he’s divided the country, and his unsightly leadership score. The survey also included a dreadful (38/56) presidential approval rating on the implementation of Obamacare; support for the law itself was also underwater, with an outright majority opposed, despite this polling series’ silly question wording that omits any mention of ‘Obamacare’ or the ‘Affordable Care Act.’ A new Kaiser Family Foundation poll produces similar findings, with support for the president’s signature domestic accomplishment swamped by opposition. It’s been this way for years, across hundreds of national surveys.
One major reason for the enduring opposition is that the law has violated virtually every major promise erected in dishonest ideologues’ sales pitch. Another is that an ongoing parade of unpleasant developments continues to make headlines, including the recent revelation that Healthcare.gov was hacked last month. Apologists can cherry-pick useful data points to try to convince the public that Obamacare is reducing premium costs and driving down costs, but that’s simply not the case. Individual market premiums exploded in 2014, and are expected to grow by roughly eight percent in 2015 (with many consumers confronting double-digit spikes) — to say nothing of high out-of-pocket costs and narrow coverage networks. Overall health spending continues an upward climb. The law was billed as a dramatic premium reducer that would also bend down the so-called “cost curve.”

“The ACA imposes several burdensome regulations that could potentially harm job and wage growth, including the employer mandate and requirements on the generosity of coverage. Under the ACA, employers with 50 or more full-time employees are required to provide health insurance for their workers or pay a fine. In addition, the ACA enforces rules that govern the type of insurance plans they can provide and restricts their options in choosing low-cost coverage. When employers are required to provide health insurance and their low-cost options are limited, costs will naturally rise and companies will be more responsive to changes in insurance premiums. As a result, employees are less insulated from insurance premium growth, and if premiums rise considerably under the ACA, then employers could be more likely to offset those costs by cutting jobs or wages.
Today, the central difficulty in analyzing the labor market implications of ACA regulations is that most significant rules have only been recently implemented. For instance, the employer mandate was scheduled for January 1, 2014, but the White House delayed the mandate to January 1, 2015, and then delayed it again to January 1, 2016 for businesses with 50 to 99 employees.”

“Obamacare is taking a toll on small businesses, according to a new analysis of the effects of the health-care reform law, which found billions of dollars in reduced pay and hundreds of thousands fewer jobs.
Take-home pay at small businesses was trimmed by some $22.6 billion annually because of the Affordable Care Act and related insurance premium hikes, researchers at the American Action Forum, a center-right think tank headed by former Congressional Budget Office director Douglas Holtz-Eakin, found in a report released Tuesday.
Individual year-round employees at businesses with 50 to 99 workers lost $935 annually, while those at firms with 20 to 49 workers are out an average of $827.50 per person in take-home pay, the report found.”

“The federal government will wait until January to roll out its five-star rating system meant to help consumers compare quality at dialysis centers across the country.
Use of the system on the CMS’ dialysis centers compare website had been scheduled for October, but was met with angst by dialysis providers who questioned the methodology and said the program was likely to be more confusing than helpful.
In response, the federal agency announced Wednesday that it has moved the date by about three months.
The CMS began using the rating program on nursing homes in December 2008 and earlier this year applied a similar rubric to physician groups. In July, the agency announced plans to extend the program to dialysis facilities starting Oct. 9.”

“Welcome back from the summer.
It’s been pretty quiet lately on the Obamacare front.
So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time.
Wishful thinking.
Obamacare has largely been out of the news cycle for a couple of months but that is about to change.
A few thoughts.
The 2015 rate increases have been largely modest. Does that prove Obamacare is sustainable? No. You might recall that on this blog months ago my 2015 rate increase prediction was for increases of 9.9%.
You might also recall my reason for predicting such a modest increase. With almost no valid claims data yet and the “3Rs” Obamacare reinsurance program, insurers have little if any useful information yet on which to base 2015 rates and the reinsurance program virtually protects the carrier from losing any money through 2016. I’ve actually had reports of actuarial consultants going around to the plans that failed to gain substantial market share suggesting they lower their rates in order to grab market share because they have nothing to lose with the now unlimited (the administration took the lid on payments off this summer) Obamacare reinsurance program covering their losses.”

“Obamacare’s defenders are busy declaring victory again. Ezra Klein is touting a new survey of Obamacare benchmark premiums in some regions of the country as evidence that the law is defying the predictions of critics and working to cut costs rather than increase them.
But, as Bob Laszewski notes, the truth about Obamacare implementation is far less rosy than the latest round of cheerleading would indicate.
For starters, the federal and state websites remain largely a dysfunctional mess, although the media isn’t really covering the story anymore. The supposed “fix” that allowed millions of consumers to sign up with plans on the exchanges from December through April really wasn’t much of a fix after all. It was a workaround, allowing consumers to access large federal subsidies with minimal verification.”

“DETROIT– A lawsuit has been filed on behalf of potentially thousands of immigrants who have been rejected for full Medicaid coverage in Michigan because of computer problems.
The lawsuit in Detroit federal court says the state has known about the problem for weeks but is moving too slowly to fix it. Attorneys are asking a judge to issue an injunction to get things moving.
The Center for Civil Justice in Flint says many immigrants are approved only for emergency services. The group says federal law typically grants full health coverage under Medicaid to low-income refugees and poor lawful permanent residents.”

“Robert Laszewski, health policy wonk, blogger, and president of Health Policy and Strategy Associates, tells Inside Health Insurance Exchanges:
The Obama administration has no idea how many people are currently enrolled [in exchanges] but they keep cutting checks for hundreds of millions of dollars a month for insurance subsidies for people who may or may not have paid their premium, continued their insurance, or are even legal residents.
And if you think they’re doing those “enrollees” a favor, remember that if it turns out a recipient wasn’t eligible for the subsidy, he or she has to pay the money back.
Surprised? Don’t be. This is part of a deliberate, consistent strategy by the Obama administration to throw money at individual voters and key health care industry groups—lawfully or not—to buy support for this consistently unpopular law.”