A project of the Galen Institute

Issue: "Exchanges"

Meredith Cohn: Health exchange relies on non-competitive bidding to fix website

The Capitol Gazette
Tue, 2015-04-28
As the state struggled under the national spotlight to fix its deeply flawed online health insurance marketplace last year, officials awarded more than $84 million in contracts without competition, about a third of the money spent on the troubled website. About 15 companies benefited from the "sole-source" and "emergency" contracts that did not use competitive bidding, according to documents obtained by The Baltimore Sun through public information requests. The Maryland Health Benefit Exchange's lack of transparency has been criticized by government watchdogs and state officials, including Gov. Larry Hogan during his successful campaign, but the amount of the noncompetitive awards is now raising eyebrows among government procurement experts and prompting pledges from the administration to curtail the practice. - See more at: http://www.capitalgazette.com/bs-hs-exchange-contracting-20150417,0,807245,full.story#sthash.q5qkVCoy.dpuf

Peter Ubel: Under Obamacare, Competition Is Costly For Consumers

Forbes
Mon, 2015-04-20
Normally, market competition is good for consumers. More competition generally means competitors are battling each other to lower their prices and/or raise the quality of their goods. But when it comes to Obamacare, the market is working backwards, at least for people receiving health insurance subsidies through the exchanges. The more competitive the marketplace, often the more people have to pay for insurance. How did this happen? The Affordable Care Act, aka Obamacare, created a series of exchanges where people can shop for health insurance if they don’t already receive it from the government (e.g. Medicare or Medicaid) or from their employer. The exchanges are a pro-market approach to healthcare reform. But they aren’t a simple market, by any means. In part, they are complicated because most people purchasing insurance through the exchanges receive subsidies. If you earn less than 400% of the federal poverty limit, you’ll probably qualify.

Caroline Pearson: Exchanges Struggle to Enroll Consumers as Income Increases

Avalere
Thu, 2015-04-09
New analysis from Avalere finds that while exchanges have succeeded in enrolling very low-income individuals, they continue to struggle to attract middle and higher income enrollees. Specifically, as of the close of the 2015 open enrollment period, exchanges using HealthCare.gov had enrolled 76 percent of eligible individuals with incomes between 100 and 150 percent of the federal poverty level (FPL) or $11,770 to $17,655. However, participation rates declined dramatically as incomes increase and subsidies decrease. For instance, only 16 percent of those earning 301 to 400 percent FPL picked coverage through an exchange, even though they may be eligible for premium subsidies. “People receiving more generous subsidies are expected to enroll in the exchanges at higher rates. However, participation levels decline as incomes increase, even among individuals who would be eligible for both premium subsidies and cost-sharing reductions,” said Elizabeth Carpenter, director at Avalere.

Chris Conover: Uninsured Risk Fell At Least Twice As Much Under Eisenhower As Under Obama

Forbes
Thu, 2015-04-02
Obamacare reached age 5 on Monday [1]. As I’ve pointed out earlier, this anemic child is not exactly a picture of health, falling behind the lofty expectations set for it on many dimensions. But the one bright spot for its proud parents relates to how much the law has reduced the number of uninsured. The president’s Council of Economic Advisors ecstatically announced last December: “the drop in the nation’s uninsured rate so far this year is the largest over any period since the early 1970s.” A little perspective is in order. First, taking the CEA’s figures at face value (which my chart below does), this decline amounts to a 2.8 percentage point net reduction in the rate of being uninsured, that is, above and beyond the decline that would have occurred anyway according to CBO [2]. It may well be the biggest one-year decline since the 1970′s, but CBO’s expectation at the time the law was passed was that uninsured risk would drop by 6 percentage points in 2014 alone.

Jason Millman: Where Romneycare fell short — and what that could mean for Obamacare

The Washington Post
Thu, 2015-04-02
The landmark 2006 Massachusetts health-care law that inspired the federal overhaul didn't lead to a reduction in unnecessary and costly hospitalizations, and it didn't make the health-care system more fair for minority groups, according to a new study that may hold warnings for the Affordable Care Act. Massachusetts’ uninsured rate was cut by half to 6 percent in the years immediately following the health-care law signed by then-Gov. Mitt Romney. Blacks and Hispanics, who have a harder time accessing necessary medical care, experienced the largest gains in insurance coverage under the Massachusetts law, though they still were more likely to be uninsured than whites. The new study, published in the BMJ policy journal, examined the rates of hospitalizations for 12 medical conditions that health-care researchers say wouldn't normally require hospitalization if a patient has good access to primary care.

Sarah Hurtubise: New York Legislature Turns Down Tax On Obamacare Policies

The Daily Caller
Wed, 2015-04-01
The New York legislature voted down Gov. Andrew Cuomo’s proposal to tax health insurance policies to fund the state’s Obamacare exchange, calling the fees system used by the Obama administration and other states counterintuitive. The shrinking number of state-run Obamacare exchanges are facing a new problem this year — how to fund their ongoing operations now that start-up grants from the federal government are running out. In New York, like many other states, Cuomo proposed a tax on health insurance premiums to fund the state-run exchange’s operations. That tactic comes with its own concerns: some states, such as Hawaii, have smaller-than-expected enrollment and the per-policy fees aren’t bringing in enough money. Rhode Island is considering adopting a tax itself, but due to small enrollment in the tiny state, fees per Obamacare enrollee would likely climb higher than $30 every month, according to Modern Healthcare.

Chris Jacobs: Obamacare Enrollment Split: Subsidies vs. No Subsidies

The Wall Street Journal
Tue, 2015-03-31
Two reports released in the past week demonstrate a potential bifurcation in state insurance exchanges: The insurance marketplaces appear to be attracting a disproportionate share of low-income individuals who qualify for generous federal subsidies, while middle- and higher-income filers have generally eschewed the exchanges. On Wednesday, the consulting firm Avalere Health released an analysis of exchange enrollment. As of the end of the 2015 open-enrollment season, Avalere found the exchanges had enrolled 76% of eligible individuals with incomes between 100% and 150% of the federal poverty level—between $24,250 and $36,375 for a family of four. But for all income categories above 150% of poverty, exchanges have enrolled fewer than half of eligible individuals—and those percentages decline further as income rises.

Michael Cannon: Why the Supreme Court will overrule the IRS

The Richmond Times Dispatch
Mon, 2015-03-30
Kevin Pace is a jazz musician who teaches music appreciation in Northern Virginia. When the IRS announced it would impose the Affordable Care Act’s employer mandate here in the Old Dominion, Pace’s employer cut hours for part-time professors in order to avoid steep penalties. Pace lost $8,000 in income. That would be bad enough if the penalties the IRS is now imposing on Virginia employers were legal. Yet two federal courts have held they are not. In King v.

Obamacare Website Still Insecure, Subject to Attacks

Judicial Watch
Mon, 2015-03-30
More than a year after egregious security failures in the government’s healthcare website were exposed in congressional hearings, data remains compromised and the ill-fated site is still subject to cyberattacks and vulnerable to massive identity theft. In fact, just this week Judicial Watch obtained documents from the government that show a possible mass breach of the privacy of innocent Americans involving the disastrous Obamacare website (Healthcare.gov). The records, from the U.S. Department of Health and Human Services (HHS), also reveal that top officials with the Centers for Medicare and Medicaid Services (CMS) knew of massive security risks with the healthcare website but chose to roll it out without resolving the problems. When the Obamacare internet drama blew up in the administration’s face the Department of Homeland Security (DHS) was called to help clean up, according to the records recently made public by JW.

Edmund Haislmaier: Did 14.1 Million People Gain Health Coverage? Fact Checking the Obama Administration’s Claim

The Daily Signal
Tue, 2015-03-24
Looking closer, the 6.3 million-person enrollment drop in fully insured employee plans represents a sudden 10 percent decline in a market that previously had been eroding by about 1 percent to 3 percent a year. In contrast, the 1.4 million more individuals in self-insured plans equates to enrollment growth of about 1.5 percent in a market that, prior to Obamacare, was growing at about 1 to 3 percent a year—putting that uptick solidly within the pre-Affordable Care Act trend range. Thus, the data indicates Obamacare likely was responsible for a significant additional decline in fully insured employer group coverage. But, with respect to another anticipated effect—the expectation that more employers will shift to self-insured plans to escape Obamacare’s costly benefit mandates—the data does not indicate that is yet occurring to any noticeable extent.

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