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

The number of uninsured people declined by nearly eight million during the first nine months of 2014, reducing their ranks to 37.2 million, according to an analysis of data released late last week by the National Center for Health Statistics (NCHS).

Healthcare expenses appear to have climbed at a brisk pace, backing previous calculations that the healthcare industry remains a force even during an otherwise lackluster quarter.

The U.S. Commerce Department’s Bureau of Economic Analysis released its second estimate of first-quarter economic growth, finding that healthcare spending climbed 5.4% annually when adjusted for inflation.

The GOP’s months-long debate over when and how to send a repeal of Obamacare to the president’s desk now appears to have an answer.

They can’t do it all at once.

Repealing the law “root and branch” is probably out of the question, the chamber’s parliamentarian is hinting, because some parts of Obamacare don’t affect the federal budget. That’s a must in order to use the obscure procedure known in Senate parlance as reconciliation, which allows lawmakers to avoid the 60-vote filibuster hurdle and pass bills on a simple majority vote.

That’s not the GOP’s only problem. Under those rules any Obamacare repeal has to reduce — not increase — the deficit. So Republicans will have to pick and choose which parts of the Affordable Care Act they most want to ditch.
Obama will, of course, veto any bill that significantly damages his signature domestic policy achievement. But the entire process has the makings of a difficult political exercise that will reveal something about the GOP’s priorities when it comes to the reviled law, forcing the party to go beyond the pile-on repeal rhetoric and say specifically what it would do and how it would pay for it.

The HSA Council’s study is designed to address the uncertainty surrounding Cadillac Tax liability by providing a relational
tool employers can use to compare the cost of their plan against average plan data compiled by AHIP and KFF, the
industry benchmarks. Some employers are currently contracting for healthcare plan designs through 2018. Since
industry data is not consistent and there are considerable state-by-state variations in average premiums, employers and
brokers are looking for affordable plan designs that allow them to avoid the Cadillac Tax. HSA-qualified plans can be
that solution.

Democrats and Republicans are sitting on the edge of their seats, waiting to see what the Supreme Court will decide in King v. Burwell, the looming decision about the Affordable Care Act, or Obamacare, as it has come to be known.

If the Supreme Court agrees with the challenge, an estimated 13 million people will lose their federal health insurance subsidies. The plaintiffs have argued that based on the literal reading of the legislation, the government is only supposed to provide citizens with subsidies in states that set up their own health care exchanges (a total of 16 states). The sentence in the law upon which their claim is based, The New York Times reported, was based on a sloppy error made during the drafting process. Regardless, the plaintiffs argue that in states where residents rely on federal subsidies (34 altogether), the law does not provide for subsidies.

If the Supreme Court ruling takes away their subsidies, a substantial number of the citizens in those states will not be able to pay for their health care. Many younger and healthier Americans will take the risk and decide that they won’t purchase insurance, a trend which would send prices skyrocketing. An ever-growing cycle would be devastating.

Senate Republicans want to create a top watchdog to dig into ObamaCare.

GOP Sens. Pat Roberts (Kansas) and Rob Portman (Ohio) have introduced legislation that would create an Office of the Special Inspector General for Monitoring the Affordable Care Act (SIGMA).

The Department of Health and Human Services (HHS) already has an inspector general, but Roberts said he wanted to create a position that could investigate ObamaCare across the federal government.

“While all of the federal agencies charged with implementing Obamacare have their own Offices of the Inspector General, they are all investigating this law in their own silos,” Roberts said in a statement. “The Health and Human Services Inspector General isn’t talking to the Treasury IG, or the Department of Labor IG, or the Homeland Security IG.”

The legislation would give SIGMA the authority to “conduct, supervise, and coordinate audits and investigations of the implementation and administration of programs and activities established under, and payment system changes made by, the Affordable Care Act,” according to the legislation.

Under Obamacare, doctors have been strained by costly new regulations, intricate payment “reforms” that tie their Medicare reimbursement to complex federal reporting requirements, and mandates that they install and make “meaningful” use of electronic health records.

Add a new burden to the mix: The proportion of patients they see are rapidly shifting away from commercial health plans and toward Medicaid, which sometimes pays doctors pennies on the dollar that they were previously reimbursed under private insurance.

The data comes from ACAview, a product of athenahealth that aims to measure the impact of Obamacare on medical practices. The project, jointly funded with the Robert Wood Johnson Foundation, is the first large-scale examination of data derived directly from outpatient medical practices belonging to more than 60,000 providers. It gives a unique insight into how the Affordable Care Act is impacting patients at the point of care.

About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked with a smile.

“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”

I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.

The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”

New research about implementation of the Affordable Care Act finds that Obama administration regulations are allowing taxpayer subsidized health insurance for some people earning less than the statutory income floor and also for unlawful immigrants.

A new study by Andy S. Grewal, an associate professor at the University of Iowa College of Law, explains that the ACA provides tax credits to U.S. citizens with incomes between 100 and 400% of the Federal Poverty Level (FPL). However, IRS regulations were written to extend credits to citizens below 100% FPL in some cases.

Also, Section 36B of the ACA grants credits to some non-citizens with low-incomes only if they are themselves lawfully present in the U.S. and cannot obtain Medicaid coverage. IRS regulations, however, contradict the statute and allow subsidies if “the taxpayer or a member of the taxpayer’s family is lawfully present in the United States,” and “the lawfully present taxpayer or family member is not eligible for the Medicaid program.”

Employer groups and insurers are pushing to keep businesses with 51 to 100 workers exempt from a provision of the federal health law that they say could significantly increase their costs.

For these midsize employers, the Affordable Care Act’s requirements for what health plans must cover—and how they are priced—are set to take effect on Jan. 1, 2016.

Already the law requires insurers to sell individual and “small group” plans to everyone at the same price, regardless of their health. Those rules, which kicked in Jan 1, 2014 for businesses with 50 or fewer workers, also set standards for what health-benefits packages must cover.