Articles on the implementation of ObamaCare.

“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.”

“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.””

“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.”

“SALEM, Ore. — Oracle Corp. has sued the state of Oregon in a fight over the state’s health insurance exchange, saying government officials are using the technology company’s software despite $23 million in disputed bills.
Oracle’s breach-of-contract lawsuit against Cover Oregon was filed Friday in federal court in Portland. It alleges that state officials repeatedly promised to pay the company but have not done so.
The lawsuit seeks payment of the disputed $23 million plus interest, along with other unspecified damages.
Oregon’s health-insurance enrollment website was never launched to the general public. State officials have blamed Oracle, but the company says the state’s bad management is responsible.
Gov. John Kitzhaber has called for the state to sue Oracle and recover some of the $134 million it has already paid to the Redwood City, California, company.
In June, Oregon issued legal demands for documents that could become evidence in a possible lawsuit against Oracle under the state’s False Claims Act.”

“The Affordable Care Act—also known as Obamacare—is “not an affordable product” for many people and it does not fix the underlying problems causing high health-care costs, Aetna Chairman and CEO Mark Bertolini told CNBC on Wednesday.
“If we’re going to fix health care, we’ve got to get at the delivery of care and the cost of care,” Bertolini said in a “Squawk Box” interview. “The ACA does none of that. The only person who’s really going to drive that is the consumer and the decisions they make.”
“Getting everybody insured should probably be our goal, but you have to have a more affordable system,” he added. “We have a 1950[-style] health care system in the Unites States.”
Aetna said Tuesday that its medical spending rose more than estimates in the second quarter, due in part to the higher costs of covering patients who bought insurance under Obamacare for the first time. But the third-largest U.S. health insurer also reported better-than-expected earnings and revenue in the second quarter and raised full-year guidance.”

“More Americans are enrolled in individual health insurance plans. In part, though, that’s because under Obamacare fewer are enrolled in group plans. And one health care analyst says this may be the beginning of a trend.
WellPoint Inc., the Indianapolis-based health insurance giant, reported in its latest quarterly earnings that its small-group business fell more than expected.
WellPoint said it ended 218,000 (or 12 percent) of those plans because employers dropped their group health coverage, and cited Obamacare’s tax credits as a reason for the shift, J.K. Wall wrote in the Indianapolis Business Journal.
Edmund Haislmaier, senior research fellow in health policy studies at The Heritage Foundation, told The Daily Signal that the drop in WellPoint’s employer group coverage “is in line with what we were seeing in the first quarter” for the insurance industry — a decrease in group plans but an increase in individual plans.
Haislmaier said many smaller businesses have dropped group coverage plans in instances where they have a higher number of low-income workers who would qualify for subsidies to buy insurance on Obamacare’s federal and state-run exchanges.”

“With the Nov. 15 kick-off for this year’s health law enrollment season fast approaching, the need for more training for the people who help consumers navigate the health insurance marketplace is growing increasingly clear.
For example, 92 percent of health insurance marketplace assister programs say they want more preparation than they received last year, according to survey findings released last month by the Kaiser Family Foundation.
This figure, highlighted during an Aug. 5 briefing, came out of a larger survey conducted after the first open enrollment period concluded last spring. The survey polled people who supervised assistance efforts by navigators, in-person assisters, certified application counselors, federally qualified health centers and federal enrollment assistance programs which were promoting federal and state-based health care exchanges.”

“Mixups on a health plan bought through the state’s insurance exchange have left a Las Vegas family facing more than $1 million in medical bills.
For Kynell and Amber Smith and their five children, the Nevada Health Link has been a six-month nightmare with no end in sight.
“I have spent countless hours on the phone trying to get this resolved,” said Kynell Smith, an aircraft parts salesman. “I have contacted and pleaded with elected officials to help and was told I may have to sue to get this resolved. What kind of answer is that?”
The family’s troubles began in February, when Amber Smith delivered daughter Kinsley five weeks prematurely. Kinsley spent 10 days in Summerlin Hospital’s neonatal intensive care unit, and Amber’s 40-day hospital stay included two surgeries.
The Smiths bought insurance from Anthem Blue Cross through Nevada Health Link in October and made two premium payments in January. Yet the claims are being denied because Amber’s birth year is listed incorrectly on the family’s insurance identification cards, Smith said. It’s one year off — written as 1978, when it should be 1979.
Nor has Smith been able to get baby Kinsley added to the family’s insurance, despite “dozens of calls” to Nevada Health Link and Anthem. So despite never missing a $1,300 premium payment, the Smiths are on the hook for all of Kinsley’s follow-up care. What’s more, some of Amber’s specialists have unexpectedly abandoned provider networks, leaving the family with unexpected out-of-pocket expenses, he said.
The family’s grand total? Roughly $1.2 million.”