“In 2010, President Obama signed into law the Patient Protection and Affordable Care Act, also known as the “Affordable Care Act,” the “ACA,” or “Obamacare.” The ACA will reduce the number of Americans without health insurance— an important goal—but it will do so by increasing the cost of U.S. health coverage. Increasing the cost of health coverage, in turn, will worsen two of the nation’s most important policy problems.
The first of those problems is the increasing unaffordability of private health insurance, a problem that is straining the budgets of middle-income Americans, and hampering social mobility. The second problem is the nation’s grave long-term fiscal instability, a problem primarily driven by government spending on health insurance and health care.
Indeed, the ACA will especially drive up the cost of private health insurance that individuals purchase directly. The law will dramatically expand Medicaid, a program with the poorest health outcomes of any health insurance system in the industrialized world. And the ACA, despite spending over $2 trillion over the next decade, will leave 23 million lawful U.S. residents without health insurance, according to estimates from the Congressional Budget Office (CBO).
In other words, the U.S. health care system remains in need of substantial reform, in ways that address the ACA’s deficiencies as well as the system’s preexisting flaws.”
“Opposition to the 2010 health care law has been above 50 percent for over a year. And that continues to be true, as the latest Fox News national poll finds voters oppose the law by a 52-41 percent margin.
Support for Obamacare has been as high as 43 percent (May 2014) and gone as low as 36 percent (January 2014).
The number opposing the law has ranged from 49 percent (June 2012) to a record-high 59 percent (January 2014).
As in the past, the new poll shows that most Democrats favor Obamacare (74 percent), while most Republicans (84 percent) and independents (61 percent) are against it.
Voters in every age group are more likely to oppose the law than favor it, with one exception: those ages 65 and over. And that group only favors it by two percentage points.”
“Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it.
They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan.
This is the newest challenge facing the Massachusetts Health Connector, the state agency that provides an online place to shop for insurance, as it struggles to emerge from the disastrous rollout of its website last year. Now that state and federal officials have said that Massachusetts has software that will work, Connector leaders want to get people to log on and choose a plan, starting Nov. 15.
To reach them, the Connector plans to place 2 million robocalls and knock on 200,000 doors, along with making personal phone calls, sending mail, buying print and broadcast advertisements, and holding community meetings and enrollment fairs.
The campaign is estimated to cost $15 million to $19 million, money the state will seek from the federal government.”
“This tax season will be a messy one for most of Obamacare’s 8 million enrollees.
Individuals and families who bought subsidized coverage have been receiving tax credits based on whatever amount they thought they would earn this year. Upon filing taxes, the IRS will reconcile the amount of subsidy received, based on expected income, with the person’s actual income.
That’s where things can get ugly.
If the person underestimated their income for the year — and got a higher subsidy than they actually deserved — they’ll owe the government the difference. But if they overestimated their income, and received too small a subsidy, they’ll see a bigger tax return.”
“There has not exactly been an overabundance of good news on Obamacare. So it did come as some surprise two weeks ago when the Department of Health and Human Services issued a press release with the headline: “Consumers have saved a total of $9 billion on premiums,” and the subheading; “Health care law will return to families an average refund of $80 each this year.”
There is nothing unusual or even untoward about the Obama administration doing what it can to put a positive spin on the law. But what makes this item interesting is it reveals how little the administration actually has to tout about Obamacare and how far it must reach to manufacture a success story.
The purpose of the press release was to announce data on the effects of Obamacare’s “medical loss ratio” regulation, which “requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers.”
For the 2013 plan year, insurers will be required to pay $332 million in premium refunds to 6.8 million individuals. That works out to $43.78 a person, or HHS’ figure of $80 per household for 4.1 million households. In other words, HHS is crowing that Obamacare benefited 2 percent of Americans by getting them small refunds from their insurers.
And by small, we mean small. The $332 million in refunds are out of the $270 billion insurers collected last year in premiums for individual and group major medical coverage subject to the MLR. That means about a penny in refunds for every $10 of premiums.”
“A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled…”
NOTE: This article is behind a paywall.
“Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn’t meet the Affordable Care Act’s requirements for value and affordability.
Many thought such low-benefit “skinny plans” would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 lower-benefit coverage along with at least one health plan that does qualify under ACA standards.
The results weren’t unexpected by benefits pros, who realized last year that ACA regulations would allow skinny plans and even make them attractive for some employers. But the new survey gives one of the first looks at how many companies will follow through and offer them.”
“When benefits enrollment season arrives this fall, employees around the country can expect to see the impact of corporate cost-cutting on their finances.
Benefits costs will rise only 5 percent for employers that take certain cost-reduction measures, instead of 6.5 percent for companies that do not, according to a June survey of employers representing 7.5 million workers by the National Business Group on Health.
Although costs are not rising as quickly, employees are still being squeezed.
The main way companies are keeping healthcare costs in line is by shifting workers into high-deductible health plans, defined by the Internal Revenue Service as having deductibles above $1,250 for an individual. (here)
For 2015, 81 percent of employers will offer a high-deductible plan as an option, up from 72 percent last year; while 32 percent will offer such plans as the only option, up from 22 percent last year.
The challenge employers face is: “How do you keep costs from spiraling out of control but not shift all of it to the employee?” said Karen Marlo, a vice president at NGBH who authored the report.”
“State officials offered assurances Wednesday that software fixes to the flawed MNsure health insurance exchange are happening as planned, and that the system should be in good working order by the Nov. 15 start of open enrollment.
Still grappling with consumer fallout and political pressure over last year’s troubled rollout, MNsure officials said changes are being made to the system that will allow more time for testing and that sufficient backup plans are in development if things go wrong.
MNsure is preparing for the “worst case, if that comes about,” interim Chief Operating Officer Wes Kooistra told the agency’s board of directors, but he added that all hands are on deck to ensure an “improved user experience for 2015.”
IBM installed its final software upgrades over the weekend, officials said, a move that should resolve one of several major logjams that have prevented consumers from seamlessly logging onto the MNsure website and enrolling in health insurance coverage.”
“When Covered California unveiled its initial slate of 13 carriers last year, their low rates got some attention — but so did their mix.
While Covered California couldn’t boast Aetna or UnitedHealthcare, which instead elected to leave the state’s individual market, four major insurers were on board: Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente.
And the exchange also had drawn in several smaller health plans, like Ventura County Health Plan, which were going to compete for share on the individual market for the first time.
“For me, the story is [these] new participants,” Micah Weinberg of the Bay Area Council told California Healthline last summer. “Who exactly they are, and how they are being offered in these marketplaces, is worth watching.”
But Ventura County quietly pulled out. A second small carrier, Alameda Alliance, was kicked out. And earlier this summer, a third carrier — Contra Costa Health Plan — was forced to drop out, citing state rules around offering on- and off-exchange plans.
That’s left Covered California with 10 plans — which would be a bounty for nearly any other state. Not so across California’s vast, 164,000-square-mile expanse, where many regions are essentially dependent on a lone insurer.
As “Road to Reform” tracked throughout last year’s enrollment period, the seven small insurers ended up splitting just a fraction of Covered California’s customers, while the “big four” insurers were responsible for almost 95% of all sign-ups across the state.
“It’s not just an issue of market concentration,” California Insurance Commissioner Dave Jones (D) told California Healthline. “It’s the absence of choice that exists for some consumers in some parts of California.””