Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.

“The federal government will wait until January to roll out its five-star rating system meant to help consumers compare quality at dialysis centers across the country.
Use of the system on the CMS’ dialysis centers compare website had been scheduled for October, but was met with angst by dialysis providers who questioned the methodology and said the program was likely to be more confusing than helpful.
In response, the federal agency announced Wednesday that it has moved the date by about three months.
The CMS began using the rating program on nursing homes in December 2008 and earlier this year applied a similar rubric to physician groups. In July, the agency announced plans to extend the program to dialysis facilities starting Oct. 9.”

“Obamacare’s defenders are busy declaring victory again. Ezra Klein is touting a new survey of Obamacare benchmark premiums in some regions of the country as evidence that the law is defying the predictions of critics and working to cut costs rather than increase them.
But, as Bob Laszewski notes, the truth about Obamacare implementation is far less rosy than the latest round of cheerleading would indicate.
For starters, the federal and state websites remain largely a dysfunctional mess, although the media isn’t really covering the story anymore. The supposed “fix” that allowed millions of consumers to sign up with plans on the exchanges from December through April really wasn’t much of a fix after all. It was a workaround, allowing consumers to access large federal subsidies with minimal verification.”

“Two Planned Parenthood chapters, two United Way organizations, a food bank association and a Catholic hospital system are among 90 nonprofit groups that will receive a total of $60 million to help people sign up for health insurance, the Department of Health and Human Services announced today.
The money will help people in 34 states that rely on the federal government fully or in part for their Affordable Care Act insurance exchanges, where individuals can buy Obamacare policies. States with their own exchanges have separate funding to help consumers get assistance.”

“Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.
Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”
Distance is one problem: Residents have to travel farther to get face-to-face assistance from the so-called navigators and assisters hired to help consumers figure out the process. And Internet access is sometimes spotty, discouraging online enrollment.
But the most significant barriers may stem directly from state decisions about whether to expand Medicaid eligibility — more than 20 states chose not to — and whether to operate their own health exchanges. States that embraced those parts of the law generally had more federal resources as well as funds generated by their online marketplaces for outreach efforts to boost enrollment, including those aimed at consumers in less accessible areas, and more coverage options, through Medicaid, for which these consumers might be eligible.”

“Large businesses expect to pay between 4 and 5 percent more for health-care benefits for their employees in 2015 after making adjustments to their plans, according to employer surveys conducted this summer.
Few employers plan to stop providing benefits with the advent of federal health insurance mandates, as some once feared, but a third say they are considering cutting or reducing subsidies for employee family members, and the data suggest that employees are paying more each year in out-of-pocket health care expenses.
The figures come from separate electronic surveys given to thousands of mid- to large-size firms across the country by Towers Watson, the National Business Group on Health and PriceWaterhouseCoopers, consulting groups that engage with businesses on health insurance issues.
Bracing themselves for an excise tax on high-cost plans coming in 2018 under the Affordable Care Act, 81 percent of employers surveyed by Towers Watson said they plan to moderately or significantly alter health-care benefits to reduce their costs.”

“In the shrub steppe of Grand Coulee on the banks of the Columbia River, Wash., the town’s two family doctors practice at an unrelenting pace, working on call every other night and every other weekend.
In the coastal town of Port Angeles, the doctor shortage is so acute that a clinic is turning away 250 callers a week seeking a physician.
George and Lynne Rudesill are two of those people. Since learning earlier this summer that their primary-care doctor in Sequim was retiring, the couple have scrambled to find a replacement. Their calls are being met with waiting lists hundreds of people long or advice to call again in a month.
“I’m going to have to drive all the way to Silverdale or Bremerton to see a doctor,” George Rudesill said, citing cities that are about 70 or more miles away from home. “This area is in a medical crisis right now.”
Rural areas have long been strapped for doctors, but now the Affordable Care Act (ACA) is further straining those limited resources. More people with insurance means more people will want to connect with a doctor — just as aging baby boomers require more care and the doctors are retiring.”

“Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.
Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve. Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014. The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014. Then in March, the administration said it would extend the transitional policy for two more years, meaning that some people will be able to hang onto their non-compliant plans through 2017.”

“Last week, the Obama Administration announced the appointment of a new chief executive officer (CEO) for the federal health insurance marketplace under the Affordable Care Act (ACA). Kevin Counihan—who headed up Connecticut’s health insurance exchange, which worked quite well—will fill the newly created position.
Calling this position a CEO represents semantic gymnastics of a sort. That’s because CEOs generally have near-total autonomy to manage an organization, reporting only to a board of directors. Nothing like that really exists in government, short of the president. In this case, the new CEO reports to the administrator of the Centers for Medicare and Medicaid Services, so he is firmly ensconced in the normal federal agency bureaucracy. That may be a positive, because it respects the traditional lines of authority and accountability that help the government function.”

“A research network funded with millions by the Affordable Care Act will begin conducting vast studies next year to compare standard medical treatments. But what about the 100 million patients in the network — do they have a choice in the matter?
Will researchers get permission from each of those patients? And if patients are told about the studies, what, exactly, will they be told? These questions have bioethicists, scientists and health care officials debating how to bring the question of patient informed consent into the 21st century.
Obamacare is best known for extending health coverage to more Americans. But the health care law has many provisions aimed at improving health care outcomes and safety while lowering costs. One element is “comparative effectiveness” research: not just finding out whether a drug or treatment is safe and effective but comparing drugs head to head to find out which is better, for everyone or certain populations.
And with electronic medical records and vast pools of data, some of these studies have the potential to make lightning-fast, dramatic discoveries. But informed consent issues have the potential to slow such studies and make them too expensive.”

“Over the past few weeks, the American Medical Association has complained publicly and privately to the Centers for Medicare and Medicaid Services over its so-called Open Payments database, which will display what drug and device makers pay physicians. The system was created in response to concerns that medical practice and research may be unduly influenced by industry. But the database has been plagued by delays and technical glitches. The AMA is concerned that physicians lack the needed time to ensure correct data is displayed and that the public will understood what they see. The database is expected to go live on Sept. 30, but the AMA wants a six-month postponement to compensate for the problems. So far, CMS says no. We spoke with AMA president Robert Wah about the frustrations. This is an edited version.”