a Brief Case
In the 34 states that did not establish Obamacare exchanges, Governors nervously await a Supreme Court ruling that could throw their health insurance markets into chaos. Meanwhile, many of the Governors who did establish exchanges are regretting their decision.
More than five years after its enactment, Obamacare has proven a bitter brew for many states. Nowhere is this more evident than in health care exchanges.
Exchanges began as a figment of Washington’s imagination.
The Washington Post
Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.
Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer-call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which is now working smoothly.
Americans’ tax burden is already $3 billion heavier because of Ohio Gov. John Kasich’s expansion of Medicaid under Obamacare.
By putting more able-bodied, working-age childless adults on Medicaid than Kasich projected, Obamacare expansion is reducing incentives to work and threatening traditional Medicaid recipients’ access to care faster and at greater cost than anticipated.
After Kasich expanded Medicaid unilaterally, a state panel approved $2.56 billion in Obamacare spending for the expansion’s first 18 months. The money was meant to last until July, but it ran out in February.
Kasich’s Obamacare expansion cost $323 million in March — 84 percent greater than estimates revised just six months earlier.
Michigan Capitol Confidential
The Foundation for Government Accountability has just published a report on state enrollments under the Obamacare Medicaid expansion. Here’s what the authors say about Michigan:
When Republican Governor Rick Snyder lobbied the Michigan legislature to adopt his Obamacare Medicaid expansion plan, he too sold it on the promise of low and predictable enrollment. His office predicted no more than 477,000 able-bodied adults would ever sign up, with 323,000 signing up in the first year.
But more able-bodied adults enrolled in ObamaCare expansion in the first three months than the state thought would sign up during the entire year. Despite the fact that Michigan did not expand Medicaid eligibility until April, nearly 508,000 adults signed up by the end of 2014, far more than the state thought would ever enroll. Enrollment continues to climb, with nearly 582,000 able-bodied adults signing up by April 2015.
McKenna Long & Aldridge LLP
Earlier this week, news surfaced that some HealthCare.gov users may have received an incorrect subsidy or Medicaid eligibility determination from the Marketplace. According to reports, HealthCare.gov has been counting Social Security income received by children when calculating the Modified Adjusted Gross Income (MAGI) for a household. Once calculated, MAGI is then used to help determine a household’s eligibility for Medicaid or subsidized private insurance. By including a child’s Social Security Income in a household’s income, the Federally-facilitated Marketplace (FFM) likely increased the overall household income, which could have resulted in some persons either not qualifying for Medicaid or an inaccurate tax credit determination. While CMS has acknowledged the error, the agency has so far not given an indication of how many households may be impacted.
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
SALEM, Ore. — Oregon had all the right ingredients for a sparkling Obamacare success story: a Democratic doctor as governor, an eager Legislature and a history of health care innovation.
Other states experienced their own particular brand of exchange fiascos. Add Hawaii, Minnesota, New Mexico, Idaho, and Vermont to the list.
The Obama administration says it does not have contingency plans should the Supreme Court decide the IRS acted illegally and the subsidies must stop. But Chairman Joe Pitts (R-PA) of the House Energy and Commerce Health Subcommittee has information that suggests otherwise.
He said during a recent congressional hearing that he has learned of a 100-page document showing the Obama administration is preparing contingency plans should the Supreme Court invalidate the federal subsidies in King v Burwell.
HHS Secretary Sylvia Burwell repeatedly denied the existence of such a document, and says she has no legal way around the Supreme Court. “That’s why you’re not hearing plans” from the administration, Burwell told Pitts.
It has been five years since the Affordable Care Act, better known as ObamaCare, was signed into law. The disastrous rollout of the federal marketplace website, Healthcare.gov, is well-known. According to a Bloomberg Government analysis released in September 2014, the cost of Healthcare.gov was more than $2 billion, more than twice the Obama administration's estimates. Appropriately, the federal marketplace has been a subject of numerous congressional hearings.
But state-run websites have also squandered hundreds of millions of federal tax dollars. While the House Committee on Oversight and Government Reform has been investigating some of the problems with state-run websites, much more can and should be done. Every House and Senate committee that oversees healthcare issues should carefully examine the roles played by the Centers for Medicare and Medicaid Services (CMS), state officials and contractors in the design and implementation of the websites.
The New England Journal of Medicine
On December 17, 2014, Vermont Governor Peter Shumlin publicly ended his administration's 4-year initiative to develop, enact, and implement a single-payer health care system in his state. The effort would have established a government-financed system, called Green Mountain Care, to provide universal coverage, replacing most private health insurance in Vermont. For Americans who prefer more ambitious health care reform than that offered by the Affordable Care Act (ACA), Shumlin's announcement was a major disappointment. Was his decision based on economic or political considerations? Will it damage the viability of a single-payer approach in other states or at the federal level?
Shumlin's exploration of a single-payer health care system, which included three assessments by different expert groups, was among the most exhaustive ever conducted in the United States.
Investor's Business Daily
Health Reform: Back in 2013, ObamaCare supporters couldn't talk enough about how California was a showcase for how the law would succeed. Isn't it funny that nobody is making such claims any more?
New York Times columnist Paul Krugman wrote a few months into ObamaCare's first open enrollment period that "What we have in California, then, is a proof of concept. Yes, ObamaCare is workable — in fact, done right, it works just fine."
It turns out that California is a proof of concept, but not in the way Krugman thought.
Read More At Investor's Business Daily: http://news.investors.com/ibd-editorials/042115-748892-california-obamacare-exchange-suffers-big-problems.htm#ixzz3Y99khm5d
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