Articles on the implementation of ObamaCare.
“A year ago, investors worried that WellPoint Inc. would lose more of its small business customers than it could offset by signing up individuals in the Obamacare exchanges.
The first half of those concerns were justified—and then some. Indianapolis-based WellPoint is seeing its small business customers dump their group health plans and move their workers to the Obamacare exchanges at a faster clip this year than it expected.
Already in 2014, WellPoint has watched 218,000 members of its health plans disappear because their employers have ended their group health plans. That’s a 12-percent drop in WellPoint’s overall small group membership.
As I have reported before, the Obamacare tax credits for individuals have proven quite attractive for many employers with fewer than 30 workers. That’s not to say all are taking this route. Most other health insurers have reported that small employers are ending their health plans more slowly than expected.
But WellPoint expects the trend of its small business customers ending their group health plans to play out in just two years, with roughly $400 million in annual profit disappearing.
“We think [that] will be in a more accelerated timeframe over a shorter window of time, meaning this year and next, than over a longer period of time,” said WellPoint Chief Financial Officer Wayne DeVeydt during a July 30 conference call with investors.”
“The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients’ bodies or make a host of other life-threatening mistakes.
The change, which the Centers for Medicare and Medicaid Services (CMS) denied last year that it was making, means people are out of luck if they want to search which hospitals cause high rates of problems such as air embolisms — air bubbles that can kill patients when they enter veins and hearts — or giving people the wrong blood type.
CMS removed data on eight of these avoidable “hospital acquired conditions” (HACs) on its hospital comparison site last summer but kept it on a public spreadsheet that could be accessed by quality researchers, patient-safety advocates and consumers savvy enough to translate it. As of this month, it’s gone. Now researchers have to calculate their own rates using claims data.
Before the change, the Hospital Compare website listed how often many HACs occurred at thousands of acute care hospitals in the U.S. Acute care hospitals are those where patients stay up to 25 days for severe injuries or illnesses and/or while recovering from surgery. Now, CMS is reporting the rate of occurrence for 13 conditions, including infections such as MRSA and sepsis after surgery, but dropping others.”
“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.”
“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.”
“In an oped for Politico, I explain why ObamaCare architect Jonathan Gruber’s 2012 admissions that “if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits” matter to the ongoing litigation over the Obama administration issuing those subsidies in federal Exchanges, and why Gruber’s attempts to explain his own words away are not credible. Shortly after submitting that piece, I learned Oklahoma Attorney General Scott Pruitt found Gruber’s remarks relevant enough to ask a federal court hearing one of those cases to take notice.
Gruber’s repeated remarks contradict the Obama administration’s legal argument, made in Halbig v. Burwell and three related lawsuits, that it is implausible that Congress would have conditioned those subsidies on states establishing Exchanges. His remarks likewise contradict the amicus briefs Gruber himself filed in two of those cases. (Here’s my response to those briefs.)”
“Andrew Slavitt, a former executive at the technology company tasked with “saving” HealthCare.gov and now second in command at the agency overseeing Obamacare, yesterday ran into sharp questions from a House panel about a potential conflict of interest in his new role.
Rep. Morgan Griffith, R-Va., pressed Slavitt on his previous job at OptumInsight/QSSI and that company’s continuing involvement with HealthCare.gov.
“How are you able to manage your former employer, and doesn’t this create a conflict of interest?” Griffith asked Slavitt during the new Obamacare official’s testimony before the Energy and Commerce Subcommittee on Oversight and Investigations.
Slavitt, the new principal deputy administrator at Centers for Medicare and Medicaid Services, didn’t go into specifics, but said he had limited contact with his former employer. He assured Griffith and other subcommittee members that he was taking the proper steps to maintain ethical standards and noted that he had signed an ethics pledge.
“As a public servant, I have a very clear set of rules to follow,” Slavitt said.”
“The weighted average increase for plans being sold on the Obamacare California public exchange in 2015 will be 4%. So, that means Obamacare is working really well, right?
Well, wait a minute.
Let’s consider a few things:
1.This week the California insurance commissioner reported that the average unsubsidized 2014 rate increase carriers charged going into Obamacare was between 22% and 82%. That was a pretty healthy bump to get everyone into Obamacare in the first place.
2.California voters will go to the polls this fall to vote on Proposition 45. That ballot initiative would regulate health insurance rates in California for the first time. Big rate increases on part of the carriers would do a lot to get that proposition passed and very low increases would do a lot toward defeating it.
3.The health plans competing in the Obamacare exchanges are limited to tiny losses this year because of the Obamacare reinsurance program that runs through 2016. In effect, anymore underpricing they put into their rates for 2015 is subsidized by the federal government. In fact, the Obama administration recently took the statutory caps off of how much they can pay the carriers to keep their bottom line whole.”
“The price tag for healthcare.gov, the Obamacare website, is approaching $1 billion even as key features remain incomplete, congressional auditors said.
The budget to get the site ready for the next round of enrollments, starting in November, jumped to $840 million as of March, according to the Government Accountability Office. That’s a $163 million increase since December.
Accenture Plc (ACN), the company that took over building the site that failed at its introduction this past October, is expected to be paid $175 million as of June, an $84 million increase from the estimate in January when it signed a contract. The data are part of testimony for a congressional hearing today in the Republican-led House. The GAO places blame for the site’s rising price on poor planning and supervision of contractors who built the federal health exchange.
If the management doesn’t improve “significant risks remain that upcoming open enrollment periods could encounter challenges,” William Woods, the GAO’s director of acquisition and sourcing management, is scheduled to testify according to prepared remarks released by the Energy and Commerce Committee.”
“A three-judge panel of the D.C. Circuit Court of Appeals on Tuesday ruled against a challenge to Obamacare’s individual mandate based on the origination clause of the Constitution.
The Supreme Court held in NFIB v. Sebelius (2012) that Obamacare’s individual mandate was constitutional because it was a tax. The Constitution also says tax legislation must originate in the House.
But the Obamacare individual mandate tax did not originate in the House. Senate Democrats took a House bill that provided tax credits to veterans purchasing new homes, gutted its language and “amended” it with the language that would become Obamacare.
Todd Gaziano, one of the lawyers for Matt Sissel, likened this amendment to “the complete destruction of a house and the erection of a massive skyscraper on the same street address.”
In a unanimous ruling in Tuesday’s case, Sissel v. U.S. Department of Health and Human Services, the D.C. Circuit panel held that since the individual mandate’s purpose was to require people to buy health insurance, not to raise revenue, the law did not need to comply with the origination clause.”