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

“AUSTIN — A legislative committee is examining market-based alternatives to providing low-income Texans with health care since the state has rejected the expansion of Medicaid under the federal Affordable Care Act.
Members of the state Senate Health and Human Services committee plan Thursday to discuss alternatives to the law critics call “Obamacare.”
Some ideas include expanding Medicaid block grants and waivers. Lawmakers are seeking to hold health costs in-check while improving access to care.”

“California is coming face to face with the reality of one of its biggest Obamacare successes: the explosion in Medi-Cal enrollment.
The numbers — 2.2 million enrollees since January — surprised health care experts and created unforeseen challenges for state officials. Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state’s population.
That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state’s health care system, and it has raised concerns about California’s ability to meet the increased demand for health care.
Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past.”

“Health Tracking Poll: Exploring the Public’s Views on the Affordable Care Act (ACA) … “

“The Affordable Care Act is like a patient who is feeling worse when key clinical indicators say he is doing better.
Obamacare recovered from its Web site fiasco last October and went on to exceed enrollment projections in March. Despite predictions of “rate shock,” early indications are that premiums in the new insurance marketplaces are increasing modestly in most states that have made 2015 information public and more slowly than the non-group market has grown in the past. While critics said that the Affordable Care Act was having no impact on the uninsured, the share of the population that is uninsured is down significantly. Adding to the more upbeat news, health costs are rising at historically moderate rates, although the ACA has played only a supporting role in that so far. Still, opinion about the ACA has not moved significantly in any direction since 2010, when the law passed, and remains decidedly more negative than positive.
The best explanation can be seen in the chart below, which shows partisan views of the Affordable Care Act since 2010: Republicans have intensely disliked the health-care law from the start; Democrats have favored it; and independents are in the middle.”

“What happens in November will play a major role in shaping President Obama’s final two years in office.
No, it’s not just the 2014 midterm elections that have the White House on edge, but also the return of open enrollment in Obamacare.
After the disastrous rollout of the president’s signature domestic initiative in 2013, the administration needs to avoid the problems that diminished public confidence in the most significant overhaul to the health care system since the creation of Medicare.
The White House believes the technical problems that crashed healthcare.gov will become a distant memory. However, team Obama must worry about much more than just a website.
Here are the top five potential Obamacare headaches looming in November:”

“The Obama administration’s effort to end one political crisis during the 2014 Obamacare rollout may have sown the seeds of another controversy: potential double-digit rate hikes in 2015.
If insurers have their way, some residents in politically key states like Florida, North Carolina and Iowa would face hikes of 11 percent to nearly 18 percent — far beyond the average 7.5 percent increase in proposed rates for much of the country.
Major carriers there in part blame such increases on the administration’s response to the furor that erupted when millions of Americans received notice last fall that their health policies would be canceled because they fell short of Obamacare requirements.
Facing a barrage of criticism from Republicans and some Democrats, who accused him of breaking his promise that people could keep plans they liked, President Barack Obama relented. He told insurers they could continue offering those plans if states agreed. About two-thirds of the states took him up on the offer.
But the president’s decision is now having an impact on upcoming rates, insurers say. Many younger, healthier Americans — the category companies had counted on enrolling when they set their initial prices — stuck with their existing coverage. In states with the biggest numbers of these “transitional” policyholders, their absence from the Obamacare market is pushing premiums higher.”

“The latest somersaults and contortions over Obamacare last month spread from courtrooms to the blogosphere, with another round of regulatory “adjustments” not far away. The common principle followed by the health law’s most energetic advocates appears to be the whatever-it-takes motto of the late Oakland Raiders owner Al Davis, “Just win, baby!”
A pair of federal appellate court decisions on July 21 (Halbig v. Burwell and King v Burwell) sent Obamacare backers cycling through at least the first three stages of grief (anger, denial, and bargaining) over the potential loss of tax credit subsidies for states with federal-run health exchanges, along with the likelihood of further unraveling of the health law’s interrelated scheme of coverage mandates and tighter insurance regulation. A 2-1 majority ruling in Halbig delivered the latest blow to the Affordable Care Act, by deciding to vacate a 2012 Internal Revenue Service rule that attempted to authorize such subsidies.
The loudest voices among the flock of pro-ACA court watchers had previously declared such a judicial decision all but “inconceivable.” For example, Henry Aaron of the Brookings Institution termed these legal challenges to Obamacare as absurd, crazy, and wacky in an April 1, 2014 New England Journal of Medicine article. Jonathan Gruber of MIT and a key architect of both Massachusetts-based Romneycare and its cloned twin Obamacare called the tax credit theory behind the cases “screwy,” “nutty,” “stupid,” “unprecedented,” and “desperate” (but that depends on which version of Gruber one chooses to sample).
Tim Jost of the Washington and Lee University School of Law and a frequent blogger on this issue at Health Affairs, continues to be often wrong, but never in doubt—at least until later events require some modest repositioning. In July 2012, he flatly asserted that “these claims are simply false” regarding contentions that final IRS rules to enable premium tax credits through federal exchanges are unauthorized by law. Jost further opined that the only viable challengers with legal standing to contest the IRS rule would be employers failing to offer their employees insurance (or at least affordable or adequate coverage), but that any such challenges would be barred by the Tax Anti-Injunction Act until probably sometime in 2015.”

“Media coverage of the two Supreme Court cases challenging Obamacare’s HHS mandate for employers to provide workers with “free” coverage of abortion-inducing drugs largely focused on Hobby Lobby, the arts and crafts chain founded by the Greens, an evangelical Christian family.
The case of another family-owned business also was heard by the high court, though — that of Conestoga Wood Specialties and the Hahns, Mennonite Christians from East Earl, Pa. The Hahns established their business — the manufacture of custom wood kitchen cabinets and parts — on Christian values and say they’re committed to applying those values in the workplace.
Why did they go to court, represented by the Alliance Defending Freedom? Regulations drawn up by the Department of Health and Human Services to implement the Affordable Care Act, or Obamacare, included the HHS rule mandating that employee insurance plans cover 20 forms of contraception, four of which are considered seen by many to be potentially life-ending.”

“Republicans plan to hold a series of votes on repealing ObamaCare if they win control of the Senate in November, according to a report.
The votes would set the tone for a new, GOP-led Congress and create a showdown with President Obama, who would almost certainly veto any legislation rolling back parts of the healthcare law.
“If we won, I think you would see a vote for repeal, and I would vote to repeal the whole thing,” Sen. Rand Paul (R-Ky.), an expected GOP presidential candidate, told The New York Times.
“I have a feeling he won’t sign that,” Paul said of Obama. “Then you start trying to see what he will sign.”
The Senate will change hands if Republicans score a net gain of six seats in the election — a goal that is difficult, but doable, given the number of incumbent Democrats who are vulnerable this year.
Republicans would also be expected to send legislation to Obama repealing the law’s tax on medical devices and changing the law’s definition of full-time work to 40 hours per week.”

“Premiums on ObamaCare’s health insurance exchanges will rise by an average of 7.5 percent next year, according to a new analysis.
Data compiled by the Health Research Institute (HRI) at PricewaterhouseCoopers found modest changes in premiums for 27 states and the District of Columbia, with the increases mostly falling short of dire predictions for ObamaCare’s second year.
The average national increase of 7.5 percent is “well below the double-digit increases many feared,” HRI Managing Director Ceci Connolly wrote in an email.
The highest proposed rate increase so far came in Nevada, where consumers with Time Insurance Co. might see their insurance premiums rise by 36 percent. Some consumers in Arizona, on the other hand, could see rates drop by 23 percent.
Overall, the highest average price increases under ObamaCare so far have come in Indiana, where some consumers will see prices rise by 15.4 percent. The biggest average savings were found in Oregon, where premiums will drop an average of 2.5 percent in 2015.”