A project of the Galen Institute

Issue: "Premiums/Costs"

What will Obama do on employer mandate?

Elise Viebeck and Benjamin Goad, The Hill
Fri, 2014-07-18
"The White House needs to make a decision soon on whether ObamaCare's controversial employer mandate will take effect in 2015. With the mandate set to take effect in January, businesses are awaiting final word from the administration on whether they will be required to track and report how many of their employees are receiving coverage. Federal officials are late in delivering the final forms and technical guidance necessary for firms to comply, raising suspicions the mandate could once again be delayed. The mandate has been pushed back twice before, the first time in late summer. The delays to the mandate have angered House Republicans, who are now taking President Obama to court for what they say is his refusal to follow the letter of the law."

Biggest Insurer Drops Caution, Embraces Obamacare

Jay Hancock, Kaiser Health News
Fri, 2014-07-18
"UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year. “We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals. The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now. Even analysts who follow the company closely seemed surprised. “You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in.

Medicare Isn’t Fixed

James Capretta for National Review Online
Fri, 2014-07-18
"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.

Specialty Care Is A Challenge In Some ACA Plans

Carrie Feibel, Houston Public Media
Thu, 2014-07-17
"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.

The Administration Just Took Obamacare Away From the Territories

Jason Millman, Washington Post
Thu, 2014-07-17
"Looking for a place where Obamacare doesn't exist? Try moving to the U.S. Territories, where the Obama administration just provided a pretty big waiver from the law's major coverage provisions. The Affordable Care Act's design dealt a pretty big problem to the territories. It required insurers there to comply with the law's major market reforms — guaranteed coverage, mandated benefits, limits on profits, etc. — without requiring residents to get coverage or providing subsidies to help them afford coverage. The territories — Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam and the Northern Mariana Islands — have been warning for years that would destroy their insurance markets.

Three Conservative Ideas Buried Within Obamacare

Greg Scandlen, The Federalist
Tue, 2014-07-15
"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."

What We Learned About Obamacare July 8-14, 2014

Natalie Scholl, American Enterprise Institute
Tue, 2014-07-15
"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.

What’s Trending in Health Care? Conservative Ideas.

Drew Altman in Wall Street Journal
Tue, 2014-07-15
"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.

Medicaid Adds Another Million Enrollees in May

Chris Kardish, Governing magazine
Mon, 2014-07-14
"While enrollment in private health insurance through online marketplaces may be closed until Nov. 15, Medicaid and the Children’s Health Insurance Program added almost a million new patients in May, according to the Centers for Medicare and Medicaid Services. Between April and May 928,628 people signed up for Medicaid or CHIP across the 48 states that reported data, up from 805,038 who joined in April but down from the 1.4 million who joined in March. The May figures, released Friday, bring total enrollment to nearly 66 million. Medicaid is jointly funded by states and the federal government to serve low-income children, parents, the elderly and disabled people. The program was expanded through the Affordable Care Act to childless adults earning up to about $15,856 for a single household, though states can choose whether to expand. Twenty-six states and the District of Columbia have done so.

Why Improving Access to Health Care Does Not Save Money

Aaron E. Carroll, NY Times
Mon, 2014-07-14
"One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time. Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true. One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost.

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