“Despite the president’s assurance that “if you like your health plan, you can keep your health plan,” Obamacare caused significant disruption to people’s coverage as the health insurance exchanges prepared for their first open enrollment. Beginning October 1, 2013, insurers knew they would struggle to price policies in the exchanges accurately.
The Affordable Care Act (ACA) included three mechanisms to backstop insurers’ risks: risk adjustment, reinsurance and risk corridors. The first, risk adjustment, consists of perpetual transfers of money from unexpectedly profitable insurers to unexpectedly loss-making insurers and is — at least conceptually — necessary to mitigate risk in a market where insurers are forbidden to charge beneficiaries actuarially accurate premiums.
The other two mechanisms, reinsurance and risk corridors, were designed to protect insurers from unforeseen losses in Obamacare’s first three years, when insurers would not have enough experience to know how much risk they faced. These financial protections are critical to insurers’ ability to survive in the exchanges through the end of 2016. Both schemes persist only through the first three years of Obamacare, by the end of which its architects believed actuarial risks in the exchanges will have stabilized.”
“Last Saturday, August 16, marked the 60th anniversary of the enactment of the Internal Revenue Code of 1954, which permanently established in federal law generous tax advantages for employer-paid health-insurance premiums. Those group health benefits are excluded from employees’ taxable wages and thereby are not subject to income and payroll taxes. This tax break has been praised as a pillar of our employer-based private health-insurance system, but its age is showing. A growing list of critics agrees that the tax exclusion needs to be changed. The key questions are when and how. We should expect a significant overhaul, but not a full retirement party, within the next five to ten years.
The simplified history of the tax exclusion for health care usually begins with a 1942 ruling by the War Labor Board that allowed employers to bypass wartime wage controls by providing fringe benefits to workers. In 1943, the Internal Revenue Service issued a special ruling that confirmed employees were not required to pay tax on the dollar value of group health-insurance premiums paid on their behalf by their corporate employers. Over the next decade, a number of IRS rulings and court decisions created additional uncertainty over the full scope of the tax exclusion. When Congress codified this area of tax policy in 1954, it provided many employers and unions with even stronger incentives to sponsor group health-insurance plans.”
“Almost 7 million people can sign up for health plans under ObamaCare even before the new enrollment period begins in November, according to an advocacy group.
Enroll America, an ObamaCare enrollment group with close ties to the White House, said Wednesday that millions of adults are eligible to sign up for insurance before Nov. 15 because they have moved, gotten married, had children, lost insurance or become American citizens.”
“It was late in the afternoon on a warm Friday in early fall and Doug Sumrell was mowing the lawn outside his suburban home in Evans, Georgia. As he pushed the mower across the yard, Sumrell began to feel faint — his chest tightened and the back of his neck started throbbing — so he went inside to take a break and drink a glass of water. But each time he went outside to finish the job, the feeling came back. He drove himself to the hospital as the sun was setting. On the way there, he left a message for his primary care doctor, Dr. Paul Fischer.
At the hospital, a cardiac enzyme test showed Sumrell’s levels were extremely high, a strong indication that Sumrell had experienced a heart attack. The emergency room doctors said that they wanted to admit him, but it was already after midnight and Sumrell’s symptoms had subsided. His wife was out of town and their dog Buddy needed to be let out. Sumrell checked himself out of the hospital.
He was jolted awake at 7:30 a.m. by the telephone. Dr. Fischer was on the line demanding that Sumrell return to the hospital immediately to meet Dr. Faiz Rehman, a cardiologist and friend of Fischer’s, to examine his heart. Within 15 minutes of arriving, Sumrell was in the hospital’s “cath lab,” where Dr. Rehman inserted a catheter through Sumrell’s groin and into his heart, allowing him to see blockages in Sumrell’s arteries. The news was bad: his left anterior descending artery — also known as the “widow maker” — was up to 98 percent blocked. “Lord, I would’ve stayed home and not told anybody if Dr. Fischer hadn’t interceded and gotten me down there and arranged everything,” Sumrell told me.”
“For all the endless talk about reforming the health care system these past five years, it’s remarkable how little we’ve done to solve its actual problems. Spending hundreds of billions of taxpayer dollars to subsidize insurance coverage for several million people? That’s the easy part. The hard part is addressing the fact that American health care is so expensive.
The high price of U.S. health care is the fundamental reason tens of millions of Americans are uninsured. It’s the principal suppressor of middle-class wage growth. It’s a constant threat to businesses’ operating margins, and it’s the primary driver of the federal debt.
In May the American Health Policy Institute surveyed the chief human resource officers of 360 large employers, representing 10 million workers. When asked what troubled them the most about the Affordable Care Act, 85% said “increasing access to the health care system without making significant improvements in the efficiency and affordability of that system.” Only 6% believed that “the ACA will help my company more effectively control health care costs”; 82% disagreed.
According to the Congressional Budget Office’s 2014 Long-Term Budget Outlook, the United States remains on an “unsustainable” trajectory, driven entirely by growth in the big federal health care entitlements: Medicare, Medicaid and Obamacare.”
“Carondelet Health Network, a Tucson, Ariz.-based division of Ascension Health, has agreed to pay $35 million to settle allegations that two of its hospitals inappropriately billed Medicare and other federal health programs for inpatient rehabilitation care.
The settlement is the highest amount paid in Arizona under the False Claims Act, according to the U.S. attorney’s office in Phoenix. From 2004 to 2011, the Justice Department alleged, the Carondelet hospitals billed the government for inpatient rehab services for patients who didn’t meet coverage criteria.
The Roman Catholic hospital system “expressly denies” the allegations in the settlement agreement.”
“Investigative journalist Sharyl Attkisson is taking the federal government to court.
Attkisson, a senior independent contributor to The Daily Signal, filed the lawsuit against the Department of Health and Human Services to obtain information about the troubled Obamacare rollout last year.
The former CBS News reporter and Emmy award-winning journalist won’t be going alone; the legal group Judicial Watch will represent her in court.
The lawsuit follows four unsuccessful Freedom of Information Act requests. In October 2013 and again in June of this year, Attkisson requested information from the Centers for Medicare and Medicaid Services (CMS) concerning the efficiency and security of the HealthCare.gov website.
All four requests went unanswered.”
“An Indiana man who purchased health insurance through Obamacare’s federal exchange says he was assured he had dental coverage. When he needed care, though, he learned that his insurance provider wouldn’t cover the work. Now, he’s warning others they could also be getting misleading information. “You might be very surprised you’re not covered when you were told that you were,” he says.”
“In April 2014, the Centers for Medicare & Medicaid Services (CMS) published detailed information on the $77 billion that 880 000 health care practitioners billed for some 6000 Medicare Part B services in 2012. This commentary by a former CMS administrator discusses how these data can be helpful, what is missing that might lead to misinterpretation, and why such transparency is here to stay.”
“A majority of people are worried about employers moving them on to insurance exchanges, with Republicans reporting the highest level of concern at 72 percent. But once they actually get insurance on the exchange, most Democrats and Independents, 43 percent and 39 percent respectively, think the shift would have “no impact” on their coverage. In contrast, most Republicans, 41 percent, think it would have a “very negative” impact. The majority of Republicans and Independents say they would consider looking for another job if they were shifted onto an exchange, at 62 percent and 52 percent respectively. Democrats reported that they would look for another job at a rate ten percentage points below Independents, at 42 percent.
Republicans are the most worried that their employer will shift health coverage to the insurance exchanges, with 72 percent reporting some level of concern. Independents and Democrats are less worried, with 60 and 53 percent respectively reporting some degree of concern.”