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

“The nation’s largest health insurer expects to play a much bigger role in the health care overhaul next year, as the federal law shifts from raising giant questions for the sector to offering growth opportunities.
UnitedHealth Group said Thursday that it will participate in as many as 24 of the law’s individual health insurance exchanges in 2015, up from only four this year.
These state-based exchanges debuted last fall as a way for customers to buy individual health insurance, many with help from income-based tax credits. They played a key role in helping roughly 8 million people gain coverage for 2014.
But UnitedHealth and other insurers approached them cautiously, in part because they had little information about the health of the people who would sign up. That uncertainty was compounded by a provision in the overhaul that prevents them from rejecting applicants based on health.
Now, some of that uncertainty is starting to dissipate, which gives insurers ‘‘a little more confidence to try to tap into some of the opportunities,’’ said Jennifer Lynch, an analyst who covers the sector for BMO Capital Markets.”

“Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage.
Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don’t understand how health insurance works, that could hurt their ability to use their benefits — or to keep their coverage altogether.
Community organizations are scrambling to keep up with the larger-than-anticipated demand, but they are stretched thin. A federal program to help consumers has also run out of money.
“We are hearing this in probably every state that we work in,” said Christine Barber, a senior policy analyst with Community Catalyst, a Boston-based advocacy organization that works with community groups in more than 40 states. “ ‘Okay, I have my card. What do I do now?’ ””

“WASHINGTON — Efforts by congressional Republicans to rein in what they say are the legislative and political excesses of the Obama administration played out in simultaneous hearings on Wednesday, further highlighting how election-year politics are overtaking business on Capitol Hill.
The first hearing, by the House Committee on Oversight and Government Reform, was quickly adjourned after the administration refused to allow testimony from David Simas, the White House political director, who had been called under a Republican subpoena to answer questions about Democratic campaign activities.
The second, a debate in the House Rules Committee on the merits of a lawsuit that Speaker John A. Boehner plans to file against President Obama, exposed simmering partisan tensions as Democrats used the occasion to ridicule the speaker’s move as a hollow ruse.
“We have seen subpoena after subpoena after subpoena, witch hunt after witch hunt,” Representative Jim McGovern, Democrat of Massachusetts, said. “The American people should sue the House leadership for emotional pain and suffering.””

“The fear was this: The Affordable Care Act would give massive numbers of people new access to health care, creating a surge in demand for medical services and long waits to see the doctor.
But in the seven months since new insurance plans began kicking in, Puget Sound-area, Washington, primary-care providers so far seem to be keeping up with growing numbers of patients. The question now is, can they keep ahead of the demand as the formerly uninsured continue seeking care, and as baby boomers age and a sizable fraction of Washington’s physicians retire.”

“Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits.
But they’re also causing headaches in the day-to-day work of doctors and clinics. “The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,” said Dr. Charu Sawhney of Houston.
Sawhney is an internist at the Hope Clinic, a federally qualified health center in southwest Houston, in the bustling heart of the Asian immigrant community. Her patients speak 14 different languages, and many of them are immigrants or refugees from places as far flung as Burma and Bhutan. Most of her patients are uninsured, which means she is familiar with problems of access.
But the limited options of some of the HMOs sold on the marketplace surprised even her.
“I was so consumed with just getting people to sign up,” she said, “I didn’t take the next step to say ‘Oh by the way, when you sign up, make sure you sign up for the right plan.’”
Understandably, a lot of Sawhney’s patients picked lower-cost plans, “and we’re running into problems with coverage in the same way we were when they were uninsured.””

“Looking for a place where Obamacare doesn’t exist? Try moving to the U.S. Territories, where the Obama administration just provided a pretty big waiver from the law’s major coverage provisions.
The Affordable Care Act’s design dealt a pretty big problem to the territories. It required insurers there to comply with the law’s major market reforms — guaranteed coverage, mandated benefits, limits on profits, etc. — without requiring residents to get coverage or providing subsidies to help them afford coverage. The territories — Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam and the Northern Mariana Islands — have been warning for years that would destroy their insurance markets. The individual mandate and the subsidies are the major ways the ACA tries to bring healthy people into the individual insurance market to balance out sick patients who can no longer be denied coverage.
That was until Wednesday, when the Obama administration told the territories that the coverage requirements actually don’t apply to them. The exemption was posted on a Health and Human Services Web site on Thursday.
It’s an apparent reversal from last July, when a HHS official told the territories there was nothing HHS could do to help them out.”

“During the open enrollment period for the state and federal health care exchanges, each staff member and volunteer worked with an average of 1.8 people per day, according to a survey of assister programs released by the Kaiser Family Foundation. Kaiser calculated the number of people receiving aid between October 1, 2013 and the end of April, 2014:
More than 4,400 Assister Programs, employing more than 28,000 full-time-equivalent staff and volunteers, helped an estimated 10.6 million people during the first Open Enrollment period.
If you do the math, 28,000 individuals assisting 10.6 million people over 210 days breaks down to 1.8 people per day per service representative. While the individualized guidance was time consuming, the study revealed that the assister programs should have been able to help more people in the span of a full workday. The questionnaire answers indicated that 64 percent of the programs spent an average of 1-2 hours with each person, 18 percent took 2-3 hours, and just five percent exceeded three hours.
The assister programs faced a myriad of other issues too. From the New York Times (buried deep in the second to last paragraph):
About four in 10 of the programs could not help everyone who approached them, the survey found, and 12 percent said the demand for help far exceeded their capacity to provide it. Nine of 10 programs said clients had already returned to them with post-enrollment problems.”

“Most of the momentum in fights over birth control and abortion has been in the direction of opponents of late. But you wouldn’t know that by watching the U.S. Senate.
Democrats who control the chamber have scheduled a vote for Wednesday on a bill that would effectively reverse the Supreme Court’s Hobby Lobby ruling regarding contraceptive requirements in the Affordable Care Act. And on Tuesday the Judiciary Committee heard testimony on a separate, sweeping measure that would invalidate many state abortion restrictions.”

“RALEIGH, N.C. — North Carolinians came out in droves for Obamacare enrollment, signing up at a rate that beat nearly every other red state. But that doesn’t mean they’re going to come out for the law — or the Democratic senator who supported it — at the voting booth in November.
More than any other state, North Carolina may represent the huge disconnect between Obamacare’s success in getting people health insurance and its failure to help the Democratic politicians who voted for the law.
The Tar Heel State signed up more than 357,000 people — one-third of those eligible for the new health insurance exchange. Yet President Barack Obama’s health law remains a major liability for Sen. Kay Hagan, who faces one of the toughest reelection races for any Senate Democrat this year, a true toss-up fight against North Carolina House Speaker Thom Tillis. He misses no chance to tie her to Obama and the Affordable Care Act, forcing her to calibrate both how to defend a law she voted for and how to distance herself from it.”

“The Affordable Care Act is the worst piece of legislation ever passed into law in the United States. It was poorly conceived, poorly written, poorly enacted, and is being poorly implemented. The thing is a mess. However, it does open up some doors that were firmly locked before—things that most free-market economists have been espousing for years without success. We should not run away from those things just because they have President Obama’s name on it.
I am not talking about the things the idiot media think are popular—the slacker mandate, open enrollment, equal premiums for men and women, and free “preventative” services. These are all terrible ideas for reasons I won’t go into here (unless you insist).
I’m talking specifically about several more important elements of the law that were not well crafted in this particular bill, but can now be used as precedents for major improvements in American health care.”