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

“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.”

“TOPEKA — Remember that headline-grabbing report last week that said Kansas was the only state in the nation to see a significant increase in its uninsured rate?
Well, it’s looking more and more suspect.
Some officials were immediately skeptical when the Gallup-Healthways Well-Being Index survey results were released, showing that the adult uninsured rate in Kansas had increased by 5.1 percentage points, jumping from 12.5 percent in 2013 to 17.6 percent by mid-year 2014.
Kansas Insurance Commissioner Sandy Praeger was among the doubters. She said the number appeared to be “an anomaly” because a spike of that magnitude from one year to the next “would be unprecedented.”
But others seized on the numbers to score political points. Some said Kansas’ decision to join 23 other states in not expanding Medicaid contributed to the increase. Others said the number was evidence that the Affordable Care Act was failing to achieve its primary goal of reducing the number of uninsured – if only in Kansas.
But upon closer inspection, neither contention appears to be the case.”

“If consumers thought logging on to HealthCare.gov was a headache, sorting through complex forms ahead of tax deadline day 2015 is their next big Obamacare challenge.
The health care law’s benefits are rolling out, but its major math problems start next year as the IRS tries to ensure that millions of Americans are correctly calculating their benefits and that those who don’t have coverage are penalized unless they qualify for an exemption.
That means much new paper-shuffling between now and April 15, which could be especially confusing for low- and middle-income Americans unaccustomed to lots of reporting to the IRS. The insurance exchanges and employers must send consumers details about their health plan and benefits or exemptions in time for them to file a tax return. If any of that information is delayed or wrong, tax refunds could be delayed.
“We’re having some trepidation,” said Judy Solomon, vice president for health policy at the liberal Center for Budget and Policy Priorities. “This is going to be another new thing just like the roll out of HealthCare.gov.””

“If consumers thought logging on to HealthCare.gov was a headache, sorting through complex forms ahead of tax deadline day 2015 is their next big Obamacare challenge.
The health care law’s benefits are rolling out, but its major math problems start next year as the IRS tries to ensure that millions of Americans are correctly calculating their benefits and that those who don’t have coverage are penalized unless they qualify for an exemption.
That means much new paper-shuffling between now and April 15, which could be especially confusing for low- and middle-income Americans unaccustomed to lots of reporting to the IRS. The insurance exchanges and employers must send consumers details about their health plan and benefits or exemptions in time for them to file a tax return. If any of that information is delayed or wrong, tax refunds could be delayed.
“We’re having some trepidation,” said Judy Solomon, vice president for health policy at the liberal Center for Budget and Policy Priorities. “This is going to be another new thing just like the roll out of HealthCare.gov.””

“Medicaid expansion continues to be a hot-button issue in the 38th District Virginia Senate race, as candidates try to define their positions on a subject that has divided the district — and the state — since the seat was vacated unexpectedly earlier this year.
The June resignation of former Sen. Phillip Puckett, D-Russell County, threw the balanced Senate into Republican control and affected the Senate vote on whether to expand Medicaid. When he resigned, Puckett said it was because of family reasons — his daughter sought to be a judge and the Senate makes the appointments — but others said it was to accept a job with the Virginia Tobacco Commission, which did not happen.
The resignation came just days before the General Assembly voted to pass the budget without Medicaid expansion. Expansion would extend Medicaid coverage to more people who make too much for Medicaid currently, but not enough to pay for coverage — some 400,000 Virginians.
Now, as three candidates vie for Puckett’s seat in the Aug. 19 special election, the Medicaid expansion issue is still on the table.
The stakes are high and the race is being closely watched across the state and beyond.
The candidates are Ben Chafin, R-Hansonville, currently a junior member of the House of Delegates; Mike Hymes, a Democrat from Tazewell who is on the county’s board of supervisors; and Rick Mullins, an independent candidate who is waging his first campaign.”

“BOSTON — Massachusetts officials overseeing the state’s hobbled health care exchange decided Friday to stick with new software designed to upgrade the website rather than switching over to the federal government’s health insurance market.
For the past several months the state has adopted a “dual-track” approach that called for buying software that has powered insurance marketplaces in other states while also laying the groundwork for a switchover to the federal marketplace if necessary.
On Friday, Massachusetts Health Connector officials announced that Massachusetts will remain a state-based marketplace.
In a letter to head of the Centers for Medicare and Medicaid Services, Gov. Deval Patrick said officials will be rigorously testing the new system.
“We are poised to offer consumers a streamlined, single-point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment,” Patrick said in the letter to CMS administrator Marilyn Tavenner.
Earlier site problems dramatically slowed the state’s transition to the federal Affordable Care Act from its own first-in-the-nation universal health insurance law that provided a model for President Barack Obama’s plan.”