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

“It’s one thing for President Obama to win an award for “Lie of the Year” for promising Americans “if you like your [health insurance] plan, you can keep it.” It must sting a bit more when a political ally like Barney Frank, the former congressman, flat out says the president “just lied to people.”
In an interview with Huffington Post, the veteran Massachusetts Democrat said he was “appalled” at the “bad” rollout of Obamacare last October.
“I don’t understand how the president could have sat there and not been checking on that on a weekly basis,” Frank said, then added:
But, frankly, he should never have said as much as he did, that if you like your current health care plan, you can keep it. That wasn’t true. And you shouldn’t lie to people. And they just lied to people.””

“Some states that expanded Medicaid under the Affordable Care Act and set up all or part of their own insurance exchanges have seen a marked drop in the number of uninsured adults.
The uninsured rates in states that opted to expand Medicaid, a health program primarily for low-income residents, and set up their own exchanges declined more in the first half of 2014 than in the states that didn’t take that approach, according to a study released Tuesday by Gallup. The survey was based on a random sample of adults through June 30.
Arkansas saw the percentage of uninsured drop from 22.5% in 2013 to 12.4% through midyear 2014, according to the survey. Kentucky followed, with its percentage of uninsured dropping from 20.4% to 11.9% during the same time span.
The other states with the largest drop in the percentage of uninsured were Delaware, Washington, Colorado, West Virginia, Oregon, California, New Mexico and Connecticut.”

“CHATTANOOGA, Tenn. — The dominion of Tennessee’s largest health insurer is reflected in its headquarters’ lofty perch above the city, atop a hill that during the Civil War was lined with Union cannons to repel Confederate troops.
BlueCross BlueShield of Tennessee has used its position to establish a similarly firm foothold in the first year of the marketplaces created by the health law. The company sold 88 percent of the plans for Tennessee individuals and families. Only one other insurer, Cigna, bothered to offer policies in Chattanooga, and the premiums were substantially higher than those offered by BlueCross.
Though insurers have been regularly vilified in debates over health care prices, BlueCross’ near monopoly here has been unusually good financially for consumers. Its cut-rate exclusive deal with one of three area health systems turned Chattanooga into one of the 10 least expensive insurance markets in the country, as judged by the lowest price mid-level, or silver, plan. The premium for a 40-year-old for that plan is $181 a month, 30 percent less than for the median cheapest silver plan nationally.”

“Last week, the House of Representatives voted to authorize Speaker John Boehner to file a lawsuit challenging President Obama’s failure to fully implement Obamacare. Specifically, the lawsuit will challenge the administration’s delay of the employer mandate—requiring many employers to provide health insurance or pay a fine—that was supposed to go into effect Jan. 1. It’s clear President Obama repeatedly has abused executive power to circumvent Congress and essentially rewrite the law, but this lawsuit still raises a host of questions.”

“Obamacare plans have shrunk payments to physicians so much that some doctors say they won’t be able to afford to accept Obamacare coverage, NPR reports.
Many of the eight million sign-ups in Obamacare exchanges nationwide already face more limited choices for physicians and hospitals than those in the private insurance market. But with low physician reimbursement rates, the problem could get even worse.
For a typical quick patient visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer would pay $100 while Medicare would pay around $80. But Obamacare plans are more likely to pay closer to $80, which Gerard says is unsustainable for his practice.
“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Dr. Gerard told NPR. ”You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”
Narrow networks have become a hallmark of many Obamacare exchange plans, as one of few options left to insurance companies that allows them to save money by lowering reimbursement rates and covering fewer providers. In the health-care law’s first year, 70 percent of all Obamacare plan networks were either narrow or ultra-narrow, according to an analysis from consulting firm McKinsey.”

“Newly hired employees who don’t sign up for health insurance on the job could have it done for them under a health law provision that may take effect as early as next year.
But the controversial provision is raising questions: Does automatic enrollment help employees help themselves, or does it force them into coverage they don’t want and may not need? A group of employers, many of them retail and hospitality businesses, want the provisions repealed, but some experts say the practice has advantages and is consistent with the aims of the health law.
By enrolling people unless they opt out, “you’re changing the default option,” says Caroline Pearson, vice president at Avalere Health, a research and consulting firm. The health law does the same thing by requiring people to have insurance or face penalties, she says.
“You’re not eliminating people’s choice or forcing people into things they don’t want,” Pearson adds.
Under the health law, companies with more than 200 full-time workers have to enroll new, full-time employees in one of the company health plans unless the employee chooses not to join. The Department of Labor said that employers aren’t required to comply until the agency issues regulations spelling out how to do so. The department delayed its initial plan to issue regulations by 2014, and at this time there’s no additional information available about when regulations will be issued, according to a DOL spokesperson. Industry experts are split on when to expect those regulations, with some believing regulations could take effect in 2015, while others say that is unlikely.”

“Francisco Velazco couldn’t wait any longer. For several years, the 35-year-old Seattle handyman had searched for an orthopedic surgeon who would reconstruct the torn ligament in his knee for a price he could afford.
Out of work because of the pain and unable to scrape together $15,000 – the cheapest option he could find in Seattle – Velazco turned to an unconventional and controversial option: an online medical auction site called Medibid, which largely operates outside the confines of traditional health insurance. The four-year-old online service links patients seeking non-emergency care with doctors and facilities that offer it, much the way Priceline unites travelers and hotels. Vetting doctors is left to prospective patients: Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.
Velazco paid $25 to post his request for knee surgery. A few days later, he had bids for the outpatient procedure from surgeons in New York, California and Virginia, including details about their expertise. After accepting the lowest bid — $7,500, a fee that covered anesthesia and related costs — he learned that his surgeon would be William T. Grant, a Charlottesville orthopedist.”

“Most voters agree with Republicans in Congress that the president does not have the right to change laws without Congress’ approval, but they doubt a House lawsuit will stop him from acting on his own.
The House voted last week to sue President Obama for exceeding his constitutional authority by making changes in the new national health care law after it had been passed by Congress. A new Rasmussen Reports national telephone survey finds that only 22% of Likely U.S. Voters believe the president should be able to change a law passed by Congress if he thinks the change will make the law work better.
Sixty-three percent (63%) think any changes in a law should be approved first by Congress. Fifteen percent (15%) are not sure. (To see survey question wording, click here.)
Forty-five percent (45%) favor the House’s decision to sue the president to stop some of his executive actions on the grounds that they exceed the powers given him by the Constitution. But just as many (44%) oppose the lawsuit. Eleven percent (11%) are undecided.
However, only 30% think it is at least somewhat likely that the lawsuit, even if it is successful, will stop the president from taking executive actions on initiatives he has proposed that Congress refuses to go along with. Fifty-six percent (56%) consider this unlikely. This includes 11% who say the lawsuit is Very Likely to stop the president from acting alone and 21% who say it is Not At All Likely to work.”

“Six months ago, a House Republican campaign official listed the top three issues that would propel the party’s candidates to victory in the midterm election: “Obamacare, Obamacare, Obamacare.”.
It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act.
But now, months removed from the political storm that resulted from the botched rollout of the law and as more Americans begin receiving healthcare under the program, many Republicans have a more nuanced view of its importance.
House Republicans are broadening their once-singular focus on the healthcare law and headed into an extended summer break without delivering on their promise to advance an alternative.”

“If being uninsured were no big deal, presumably Obamacare never would have been enacted. The whole premise of the law is that being uninsured is a bad thing, so it’s well worth wielding a few carrots and sticks to get people into coverage. Unfortunately, Obamacare has had to break more than a few eggs along the way. One of the presumably unintended consequences of this misguided law is the fashion in which it encourages some young adults to become uninsured. These are the very young people that the Exchanges need to sign up for coverage if they are to avoid a death spiral.
It may seem puzzling that a law that both hands out subsidies to encourage coverage and imposes penalties on those who do not could possibly increase the incentive to become or remain uninsured.”