Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
“The decision in the Halbig v. Burwell case this week was an unexpected legal boon to opponents of Obamacare. Spearheaded by the Cato Institute’s Michael Cannon and law professor Jonathan Adler, the case will almost certainly lead this debate about the text of the Affordable Care Act back to the Supreme Court. My colleague Sean Davis has written a comprehensive piece on the case, particularly on the nature of the supposed “drafting error” at its core.
But whatever the ultimate outcome for Halbig, the case serves as a reminder of the uneven ground on which Obama’s health care law is likely to be standing over the next two years. Whether facing challenges in the courts, or in implementation, as we saw in the GAO’s security report this week, or simply as a matter of political approval, Obamacare is going to be a subject of uncertainty in 2016, and its survival will depend on who wins the election, as I wrote here last month.
This raises an interesting question about how the presidential candidates will interact with the law. The law’s continued instability and problems will have to be answered – but the odd circumstance likely to result from the political frame of the issue is that Republicans will put forward a plan to replace Obamacare, but Democrats won’t.
One of the lazier memes of Democratic politicians and a few too many members of the media over the past several years has been the myth that Republicans have no alternative to Obamacare. This is the sort of thing that doesn’t pass even the most basic assessment of accuracy in reporting – here is a list of the health care reforms introduced by Republican House members in 2012, and here’s one for 2013. While their plans vary in scope, there are eight things Republicans generally agree about when it comes to health care reform:
•They want to end the tax bias in favor of employer-sponsored health insurance to create full portability, either through a tax credit, deductibility, or another method;
•They want to incentivize the reform of medical malpractice laws, likely through carrot incentives to the states;
•They want to allow for insurance purchases across state lines;
•They want to support state-level pre-existing condition pools;
•They want to fully block grant Medicaid;
•They want to shift Medicare to premium support;
•They want to speed up the FDA device and drug approval process; and
•They want to maximize the consumer driven health insurance model, making high deductible + health savings account plans larger and more attractive.”
“MIAMI (AP) — Linda Close was grateful to learn she qualified for a sizable subsidy to help pay for her health insurance under the new federal law. But in the process of signing up for a plan, Close said her HealthCare.gov account showed several different subsidy amounts, varying as much as $180 per month.
Close, a South Florida retail worker in her 60’s, said she got different amounts even though the personal information she entered remained the same. The Associated Press has reviewed Close’s various subsidy amounts and dates to verify the information, but she asked that her financial information and medical history not be published for privacy reasons.
“I am the kind of person the Affordable Care Act was written for: older, with a pre-existing (condition) and my previous plan was being cancelled. I need it and I’m low income,” said Close, who has spent more than six months appealing her case. “The government pledged to me that original tax credit amount. It’s crazy.”
“Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans.
Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them.
Guess what? People looked for help on the decision.
During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average. The assisters and navigators included 28,000 full-time-equivalent workers across the country, funded by federal and state governments as well as outside sources, the survey found.”
“Anger over limited choice of doctors and hospitals in Obamacare plans is prompting some states to require broader networks — and boiling up as yet another election year headache for the health law.
Americans for Prosperity is hitting on these “narrow networks” against Democrats such as Sen. Jeanne Shaheen of New Hampshire, whose GOP opponent Scott Brown has made the health law a centerpiece of his campaign to unseat her. And Republicans have highlighted access challenges as another broken promise from a president who assured Americans they could keep their doctor.
It’s not just a political problem. It’s a policy conundrum. Narrow networks help contain health care costs. If state or federal regulators — or politicians — force insurers to expand the range of providers, premiums could spike. And that could create a whole new wave of political and affordability problems that can shape perceptions of Obamacare.”
“Medicare spending growth will be slow again in 2014 relative to historical standards, and some of the usual suspects are now crediting the Affordable Care Act — Obamacare — for the good news. For instance, a recent post at Vox suggests that the slowdown in Medicare spending can be attributed, in part, to the ACA’s provision penalizing hospitals for excessive readmissions of previously treated patients.
This is nonsense.
At the time of the ACA’s enactment in March 2010, the Congressional Budget Office estimated that the readmission provision would reduce Medicare spending by $0.3 billion in 2014, and only $7.1 billion over a decade. That’s about one tenth of 1 percent of total Medicare spending over that time period. There has been no information from any source since 2010 suggesting that the savings from the readmission provision has escalated into a major cost-cutting reform. In the context of overall Medicare spending, the readmissions provision is simply inconsequential.
The same can be said for the other supposed “delivery system” reforms driven through Medicare and contained in the ACA, such as Accountable Care Organizations and efforts to promote more “bundled” payments to providers of services. These reforms were all assessed by the CBO at the time of enactment and found to be insignificant items in budgetary terms. Moreover, the early experience with these changes indicates they are unlikely to dramatically alter the way health care is delivered to Medicare patients.”
“The fear was this: The Affordable Care Act would give massive numbers of people new access to health care, creating a surge in demand for medical services and long waits to see the doctor.
But in the seven months since new insurance plans began kicking in, Puget Sound-area, Washington, primary-care providers so far seem to be keeping up with growing numbers of patients. The question now is, can they keep ahead of the demand as the formerly uninsured continue seeking care, and as baby boomers age and a sizable fraction of Washington’s physicians retire.”
“Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits.
But they’re also causing headaches in the day-to-day work of doctors and clinics. “The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,” said Dr. Charu Sawhney of Houston.
Sawhney is an internist at the Hope Clinic, a federally qualified health center in southwest Houston, in the bustling heart of the Asian immigrant community. Her patients speak 14 different languages, and many of them are immigrants or refugees from places as far flung as Burma and Bhutan. Most of her patients are uninsured, which means she is familiar with problems of access.
But the limited options of some of the HMOs sold on the marketplace surprised even her.
“I was so consumed with just getting people to sign up,” she said, “I didn’t take the next step to say ‘Oh by the way, when you sign up, make sure you sign up for the right plan.’”
Understandably, a lot of Sawhney’s patients picked lower-cost plans, “and we’re running into problems with coverage in the same way we were when they were uninsured.””
“The Affordable Care Act is the worst piece of legislation ever passed into law in the United States. It was poorly conceived, poorly written, poorly enacted, and is being poorly implemented. The thing is a mess. However, it does open up some doors that were firmly locked before—things that most free-market economists have been espousing for years without success. We should not run away from those things just because they have President Obama’s name on it.
I am not talking about the things the idiot media think are popular—the slacker mandate, open enrollment, equal premiums for men and women, and free “preventative” services. These are all terrible ideas for reasons I won’t go into here (unless you insist).
I’m talking specifically about several more important elements of the law that were not well crafted in this particular bill, but can now be used as precedents for major improvements in American health care.”
“1.) AEI’s Joseph Antos and James Capretta present “A health reform framework: Breaking out of the Medicaid model.” Here’s a peek:
The Congressional Budget Office (CBO) projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance. Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care….
2.) “Some still lack coverage under health law,” notes The Wall Street Journal:
Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don’t have coverage due to problems in enrollment systems. In states including California, Nevada and Massachusetts, which are running their own online insurance exchanges, some consumers picked a private health plan and paid their premiums only to learn recently that they aren’t insured.
3.) “Brace for the next round of Obamacare rate shock,” comments Philip Klein at The Washington Examiner:
As insurance companies begin to propose premiums for 2015, it’s time for Americans to brace themselves for the next round of rate shock in the wake of President Obama’s health care law. There are several ways in which Obamacare drives up the cost of health insurance. The primary way is that it requires insurance plans to offer a certain raft of benefits specified by the government and to cover everybody who applies, regardless of pre-existing conditions. It then limits the amount that insurers can charge older and sicker patients relative to younger and healthier patients, driving the costs up for the latter group.
4.) “Automatic Obamacare enrollment is anti-patient,” according to Diana Furchtgott-Roth:
With a new Avalere study showing that many Obamacare participants will face premium increases in the fall, the administration’s proposed rule that would automatically reenroll Americans in their existing federal health exchange plan is likely to leave many people paying higher premiums than necessary. Plus, Uncle Sam will be unable to verify correct amounts of health insurance premium subsidies. America is not yet ready for auto enrollment in Obamacare.
“Conservative criticism of the Affordable Care Act has created the impression that liberal, “big government” ideas are driving the health-care system. But plenty of ideas that conservatives like are taking hold in health care as well. To wit:
*The number of Medicare beneficiaries in private Medicare Advantage plans reached nearly 16 million this year, a record, and the Congressional Budget Office projects that it will hit 22 million by 2020. This partial privatization of Medicare is happening despite concerns that reductions in payments to private plans (what some call over-payments) would curtail enrollment.
*More than half of people on Medicaid are enrolled in managed-care plans, which are typically run by private insurers that contract with states on a capitated, or risk, basis. More than 30 million low-income Medicaid beneficiaries are in private plans. The number is growing as states move sicker and disabled populations covered by both Medicaid and Medicare to managed care and as many states expand their Medicaid programs under the ACA, putting newly covered beneficiaries into managed care.
About 50 million Americans covered by Medicare and Medicaid at some point in the year are in private insurance arrangements. Now, this is not the block grant of Medicaid or voucherization of Medicare that some conservatives ultimately seek–just as the ACA is not the single-payer system that some liberals want–but it’s a substantial privatization, and one that has occurred largely incrementally and under the radar.”