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

“With the second open enrollment period of the health insurance marketplaces approaching, this analysis provides an initial look at premium changes for marketplace plans for individuals in 15 states and the District of Columbia that have publicly released comprehensive data on rates or rate filings for all insurers.
The analysis examines premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. The findings show that in general, individuals will pay slightly less to enroll in the second-lowest cost plan in 2015 than they did in 2014, prior to the application of tax credits.
Although premium changes vary substantially across and within states, premium changes for 2015 in general are modest when looking at the low-cost insurers in the marketplaces, where enrollment is concentrated. While the analysis provides an early look at how competitive dynamics may be influencing health insurance premiums, it is important to bear in mind that the overall picture may change as comprehensive data across all fifty states becomes available.”

“Last week, the Obama Administration announced the appointment of a new chief executive officer (CEO) for the federal health insurance marketplace under the Affordable Care Act (ACA). Kevin Counihan—who headed up Connecticut’s health insurance exchange, which worked quite well—will fill the newly created position.
Calling this position a CEO represents semantic gymnastics of a sort. That’s because CEOs generally have near-total autonomy to manage an organization, reporting only to a board of directors. Nothing like that really exists in government, short of the president. In this case, the new CEO reports to the administrator of the Centers for Medicare and Medicaid Services, so he is firmly ensconced in the normal federal agency bureaucracy. That may be a positive, because it respects the traditional lines of authority and accountability that help the government function.”

“In 2002, in a modification of the primary healthcare information privacy rule under the Health Insurance Portability and Accountability Act, HHS removed patient consent as a requirement for the release and disclosure of patient information for most common uses. In so doing, HHS gave a regulatory green light to electronic health data disclosures.
Twelve years later, it looks as if Apple is laying down a big bet in the opposite direction by placing consent-management restrictions on developers who plan to use its HealthKit mobile application platform, which is expected to be part of its new operating system to be released later this month, according to published reports.
According to the Guardian, which quotes as its primary source an article in the Financial Times, Apple has informed developers that they “’must not sell an end-user’s health information collected through the HealthKit APIs to advertising platforms, data brokers or information resellers.””

“Obamacare created a new entitlement through its exchange subsidies and vastly expanded another one, Medicaid. The Congressional Budget Office expects these two pieces of the law to cost over $1.8 trillion over the next decade.
To offset some of this new spending, the law includes 18 new or increased taxes and fees that are estimated to bring in nearly $800 billion in new revenue from 2013-2022. Many of Obamacare’s taxes fall directly on the middle class, breaking the president’s promise to the contrary, while others will affect taxpayers indirectly through increased costs for goods, higher insurance premiums or lost wages.”

“A research network funded with millions by the Affordable Care Act will begin conducting vast studies next year to compare standard medical treatments. But what about the 100 million patients in the network — do they have a choice in the matter?
Will researchers get permission from each of those patients? And if patients are told about the studies, what, exactly, will they be told? These questions have bioethicists, scientists and health care officials debating how to bring the question of patient informed consent into the 21st century.
Obamacare is best known for extending health coverage to more Americans. But the health care law has many provisions aimed at improving health care outcomes and safety while lowering costs. One element is “comparative effectiveness” research: not just finding out whether a drug or treatment is safe and effective but comparing drugs head to head to find out which is better, for everyone or certain populations.
And with electronic medical records and vast pools of data, some of these studies have the potential to make lightning-fast, dramatic discoveries. But informed consent issues have the potential to slow such studies and make them too expensive.”

“Dive Brief:
•In an effort to reduce the backlog of contested Medicare claims, the Centers for Medicare and Medicaid Services has offered to pay hospitals 68% of what they say they are owed for short-term inpatient stays.
•The system of hearings on challenged claims has been on hold since December, when the HHS Office of Medicare Hearings and Appeals temporarily suspended most new requests for administrative law judge hearings on payment denials by recovery audit contractors.
•Hospitals will have 60 days to decide whether to accept CMS’ offer, which does not apply to any short-term hospital admission that occurred after October 1, 2013.”

“Josiah Citrin’s Melisse and Suzanne Goin’s Lucques, The Larder restaurants, Tavern and the new AOC are just the latest in a group of Los Angeles restaurants implementing a 3% employee benefit surcharge to all guest checks..
Goin, along with Citrin and Rustic Canyon’s Josh Loeb and Zoe Nathan all made the announcement to add the surcharge in recent newsletters to customers. The surcharge started showing up on guest checks Monday.
“To us, when we rolled it out, we thought people would want to support places that are supporting their staff,” Loeb told The Times. “I would do that. If I knew a place was supporting their staff, I’d want to go there.”
According to Loeb, the decision to add a surcharge rather than increase menu prices was twofold.
“We wanted to have our menu prices be an accurate reflection of ingredient costs, and we also wanted give customers a little bit of control and power,” said Loeb. “If we were to call out every ingredient price increase, how do you designate where the line is drawn?””

“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.
“I called them three or four times and each time it would take a minimum of 15 to 20 minutes to get through to a human being, only to be given the runaround,” Weaver said.
One time the wait dragged on for so long, Weaver ended the call, worried she was racking up too many minutes on her family’s cellphone plan.”

“It’s not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That’s the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act.
Consider:
37% of enrollees don’t know the amount of their deductible. The deductibles in the plans sold on the exchanges are large; on average $2,300 for single coverage in the most popular plan, a Silver plan. For many people their deductible will be as important to their family budgets and their ability to get health care as the premium they pay, especially if they get a premium subsidy as most do in the exchanges. If people don’t understand their deductibles and copays they may pick a plan based solely on the premium and be in for a nasty surprise when they begin to use care and their deductible hits. It can also be important to know if services such as some physician visits and tests or generic drugs are exempt from the deductible.
Speaking of the subsidies, 46% of enrollees in the new insurance marketplaces say they’re getting a subsidy, when official numbers indicate about 85% actually get them. And even among those who know they’re receiving a subsidy, 47% don’t know the amount of the subsidy. A political implication is that many people getting help from the ACA don’t know it.
Many enrollees also don’t grasp basic insurance terms. A study of people eligible to enroll in the marketplaces showed that many were not confident in their understanding of a premium (36%), deductible (31%), copayment (28%), coinsurance (48%), maximum annual out-of-pocket spending (38%), provider network (36%), covered services (35%), annual limits on services (39%) or excluded services (40%).”

“The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear (PDF) the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance exchanges. Oral arguments will begin Dec. 17.
The court’s decision to rehear the case en banc, which experts said is rare for the D.C. appellate court, vacates the judgment issued earlier this summer. On July 22, a three-judge panel ruled 2-1 in Halbig v. Burwell that the Patient Protection and Affordable Care Act forbade people with lower incomes from receiving tax subsidies from insurance marketplaces run by the federal government, effectively making those subsidies illegal in 36 states.
Opponents of the Affordable Care Act greeted the D.C. court’s initial ruling with praise, saying the judges upheld the text of the law. The law’s supporters, however, argued the court read the text too narrowly and applied an unreasonable and inaccurate interpretation of exchange subsidies.
The July ruling dealt a fresh blow to President Barack Obama’s healthcare law, which relies on the insurance subsidies to make coverage more affordable for millions of people. However, the Obama administration vowed at the time to petition for a full court review of the decision.”