Articles on the implementation of ObamaCare.

“Congressional Republicans investigating last fall’s botched launch of HealthCare.gov revealed Friday that a top Obamacare official had asked her spokeswoman to delete an email from a senior White House advisor that discussed problems with customer service calls about that website.
Those Republicans now want Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner to explain that deletion request, and to reveal if she has asked staff to “delete or otherwise destroy emails, communications or any other documents relating to HealthCare.gov.” The Republicans said the Obama administration has a “pattern” of being unable to preserve records.
Tavenner’s email asking the subordinate to delete an email was turned over to the House Energy and Commerce Committee last week, just a day after her staff told the committee that some copies of her email communications might have been lost.”

“New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board.
One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions. For example, the data could reflect an oncologist partnering with a biopharmaceutical company to lead a clinical trial on an innovative cancer treatment or a family practice physician’s attendance at an industry-sponsored speaking event led by a peer to further her education about geriatric care. However, if the data released includes only names and numbers, the public is likely to be confused and the information is left subject to misinterpretation.
Additionally, many physicians are not aware about the Sunshine Act, what it means for them and their ability to be part of this collaborative process. It is important for CMS to provide physicians with more information about their ability to register and review data reported on them.
To compound this lack of information, physicians also face a confusing registration process with a very short timeline. Given how instrumental relationships between companies and physicians are to driving future innovation, we want to ensure that both groups can provide input on the process of Sunshine Act reporting.”

“In 2010, President Obama signed into law the Patient Protection and Affordable Care Act, also known as the “Affordable Care Act,” the “ACA,” or “Obamacare.” The ACA will reduce the number of Americans without health insurance— an important goal—but it will do so by increasing the cost of U.S. health coverage. Increasing the cost of health coverage, in turn, will worsen two of the nation’s most important policy problems.
The first of those problems is the increasing unaffordability of private health insurance, a problem that is straining the budgets of middle-income Americans, and hampering social mobility. The second problem is the nation’s grave long-term fiscal instability, a problem primarily driven by government spending on health insurance and health care.
Indeed, the ACA will especially drive up the cost of private health insurance that individuals purchase directly. The law will dramatically expand Medicaid, a program with the poorest health outcomes of any health insurance system in the industrialized world. And the ACA, despite spending over $2 trillion over the next decade, will leave 23 million lawful U.S. residents without health insurance, according to estimates from the Congressional Budget Office (CBO).
In other words, the U.S. health care system remains in need of substantial reform, in ways that address the ACA’s deficiencies as well as the system’s preexisting flaws.”

“This tax season will be a messy one for most of Obamacare’s 8 million enrollees.
Individuals and families who bought subsidized coverage have been receiving tax credits based on whatever amount they thought they would earn this year. Upon filing taxes, the IRS will reconcile the amount of subsidy received, based on expected income, with the person’s actual income.
That’s where things can get ugly.
If the person underestimated their income for the year — and got a higher subsidy than they actually deserved — they’ll owe the government the difference. But if they overestimated their income, and received too small a subsidy, they’ll see a bigger tax return.”

“State officials offered assurances Wednesday that software fixes to the flawed MNsure health insurance exchange are happening as planned, and that the system should be in good working order by the Nov. 15 start of open enrollment.
Still grappling with consumer fallout and political pressure over last year’s troubled rollout, MNsure officials said changes are being made to the system that will allow more time for testing and that sufficient backup plans are in development if things go wrong.
MNsure is preparing for the “worst case, if that comes about,” interim Chief Operating Officer Wes Kooistra told the agency’s board of directors, but he added that all hands are on deck to ensure an “improved user experience for 2015.”
IBM installed its final software upgrades over the weekend, officials said, a move that should resolve one of several major logjams that have prevented consumers from seamlessly logging onto the MNsure website and enrolling in health insurance coverage.”

“Backers of the health-care law say they are rushing to make sure tens of thousands of people provide more documents to prove they are in the U.S. legally and therefore entitled to the coverage they obtained through HealthCare.gov.
Immigrant advocates say they felt the Obama administration moved hastily in announcing Tuesday it would cut off health insurance for up to 310,000 people who signed up for plans through online exchanges run by the federal government if they don’t send additional information in the next few weeks showing they are U.S. citizens or legal residents.
The federal government is taking the steps to comply with a requirement in the health law that bars unauthorized immigrants from using the online exchanges to shop for coverage, as well as from receiving federal tax credits to offset the cost of premiums.”

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The law’s supporters inserted the provision to try to tamp down controversy over the prospect that it could help people who aren’t legally in the U.S.

“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 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.”

“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.”

“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.”