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

“States and the federal government will have to work hard to make sure that new insurance exchanges in President Obama’s healthcare law actually create more competition, a new study says… The Health Affairs study says people in those areas generally pay higher out-of-pocket costs than people in more populated areas with greater competition. ‘If experience with the federal benefits program is an indication of how much competition can be expected in the exchanges, then people obtaining coverage from exchanges will not benefit much from competition unless the exchanges are at least modestly assertive in setting conditions of participation for qualifying health plans,’ the authors wrote.”

“Some colleges are dropping student health-insurance plans for the coming academic year and others are telling students to expect sharp premium increases because of a provision in the federal health law requiring plans to beef up coverage. The demise of low-cost, low-benefit health plans for students is a consequence of the 2010 health-care overhaul.”

“Medical specialists are urging regulators to slow implementation of an initiative funded by the 2010 healthcare law that aims to streamline care for some low-income elderly and disabled patients. “

“This case thus illustrates a serious danger latent in the “comparative effectiveness research” approach taken by the Patient Protection and Affordable Care Act: mass studies of how different treatments affect large swaths of people are not likely to pick up the subtleties and nuances in treatment effectiveness that can vary from person to person based on a whole range factors that determine each individual’s unique biochemistry.”

“[T]he only sure way that we’re going to
bend the cost curve is by coming up with fundamentally new ways to deliver
healthcare services that improve efficiencies and enable us to get more medical care
for each dollar we spend. These ideas are going to come forward the same way
better ideas have always arisen – from start-ups backed by entrepreneurs,
supported by investment capital, coming together in search of profits. Yet PPACA
contains provisions that I fear tilt against these kinds of innovations. The legislation
relies instead on arrangements that could serve to entrench existing players.”

“At issue is a new payment scheme that pays renal doctors a lump sum, or ‘bundled payment,’ for taking care of dialysis patients. Under the program, the doctors mostly get one fixed payment regardless of how much time they spend with patients, or how many drugs and procedures they use in caring for these folks. These ‘bundled payments’ are a key feature of the Obama health plan. That legislation uses various forms of capitation to shift financial risk onto providers in a bid to cut down on the use of costly, and some argue wasteful, medical services.”

“The health reform law changes that: It raises Medicaid rates for primary care to match those of Medicare for 2013 and 2014. That, the Obama administration hopes, will lure doctors to accept Medicaid patients — and also prevent some costly emergency room visits down the line. But there’s a problem: The payment boost runs out at the end of 2014. While the federal government estimates that it will spend $11 billion raising provider rates for 2013 and 2014, no additional federal funds are appropriated beyond that. There’s already some thinking, among the health-care provider community, that a fierce lobbying battle could play out as doctors look to turn a short-term pay boost into a permanent one.”

“CMS’ goal here is to cut down on the number of procedures. The same device has been approved in Europe for almost 5 years and has gained widespread use by patients who want to forgo very invasive open-heart surgeries—for good reason. The minimally invasive approach poses a lot less hardship on patients. This ruling will force people to get open-heart surgeries that might have been avoidable. These decisions used to be left to patients and doctors. Now it’s clear that for costly procedures, Washington will be making more of these choices for us.”

“The Patient Protection and Affordable Care Act of 2010 (PPACA) – regardless of the view one has of the legislation – has created enormous disruption. And with disruption comes enormous opportunity, as well as risk. Many provider organizations (e.g. hospitals and physician groups) have responded to the changing healthcare delivery environment by safety in size through merger and acquisition. Payers are also buying or creating partnerships with hospitals, and hospitals are acquiring other hospitals and physician practices to become gigantic systems.”

“In February, the U.S. Department of Health and Human Services issued a ‘guidance bulletin’ regarding the compatibility of health savings accounts with Obamacare’s insurance regulations. According to HSA expert Roy Ramthun, the news isn’t good. ‘HSA plans will not be as affordable as they are today,’ says Ramthun.”