Monthly Archives: February 2016

Leaders of some health cooperatives set up under the Affordable Care Act said it would be hard for the Obama administration to recoup more than $1 billion in federal loans made to some of the organizations that are now defunct, because most of the money has been spent.

A group representing existing co-ops, as well as leaders of some of the organizations, said there is little of the federal loan money remaining and some of what is left is needed to pay providers whose bills have yet to be paid. Obama administration officials have said they plan to use every available tool to recoup the federal loans, including legal action.

Thousands of doctors, hospitals and other providers in some states still haven’t been paid for health services they provided to members insured by the co-ops, which are organizations set up under the health law to offer health insurance to consumers and cut costs by giving established insurers more competition.

Health Republic Insurance Company of Oregon, a Lake Oswego-based insurer that is phasing down its operations, on Wednesday filed a $5 billion class action lawsuit on behalf of insurers it says were shorted by the federal government under an ObamaCare program.

The lawsuit, filed in the United States Court of Federal Claims, focuses on a program that was intended to offset insurer losses in the early years of the implementation of the Patient Protection and Affordable Care Act.

Instead, payments to insurers under the “risk corridor” program amounted to 12.6 percent of the amount expected for 2014, and are expected to be similarly low for 2015.

Federal law and regulations “are unequivocal about the payments the Government must make,” according to the lawsuit. “The law is clear: the Government must abide by its statutory obligations.”

With billions in taxpayer dollars at stake, the Obama administration has taken a “passive” approach to identifying potential fraud involving the president’s health care law, nonpartisan congressional investigators say in a report released Wednesday.

While the Government Accountability Office stopped short of alleging widespread cheating in President Barack Obama’s signature program, investigators found that the administration has struggled to resolve eligibility questions affecting millions of initial applications and hundreds of thousands of consumers who were actually approved for benefits.

The agency administering the health law — the Centers for Medicaid and Medicare Services — “has assumed a passive approach to identifying and preventing fraud,” the GAO report said. In a formal written response, the administration agreed with eight GAO recommendations while maintaining that it applies “best practices” to fraud control.

A new report dives into the problem-plagued development of the ObamaCare website and finds repeated warning signs that went unheeded before its failed launch.

President Obama has called the launch of healthcare.gov a “well-documented disaster,” and a Department of Health and Human Services Inspector General report provides a new in-depth look at the problems and lessons learned.

The IG report finds that the Centers for Medicare and Medicaid Services, which oversees healthcare.gov, received 18 “documented warnings” of problems with the site’s construction between July 2011 and July 2013. But the warnings were either not communicated across the agency or not acted upon, the report says.

A response to questions from Senator John Cornyn (R-TX) about federal spending on state-based ObamaCare exchanges reveals the improper spending of one million dollars in Arkansas. The states setting up their own exchanges have spent more than $3.2 billion in federal funds, and many of those states have presided over failed exchanges and have opted to have their citizens routed to the federal healthcare.gov ObamaCare exchange.

Responding to Sen. Cornyn, Centers of Medicare and Medicaid Services Acting Administration Andrew Slavitt wrote, “as part of CMS’s routine federal oversight of (exchanges), CMS found that the Arkansas SBM spent approximately $1 million of the state’s federal grant funding for activities that are not allowed under regulations.”

In a recent letter addressed to Senator John Cornyn (R-Texas), ObamaCare chief Andy Slavitt said the federal government will “recover its fair portion” of funds in the event a failed ObamaCare state exchange reaches a settlement with contractors.

Given that the federal government funded the overwhelming majority of state exchange projects with $5.5 billion in taxpayer funds, “fair portion” should be close to 100 percent.

Recently, Maryland reached a $45 million settlement with a contractor stemming from its state exchange debacle. But despite financing the Maryland exchange to the tune of nearly $200 million the federal government will receive only 70 percent of funds from the settlement.

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Funding a problem doesn’t solve a problem. There are ways to make health care more affordable and accessible with less government dependence. For starters, Congress should seriously reconsider the way the program is financially structured so states can be granted more flexibility to devise ways that can improve the value Medicaid brings to its beneficiaries.

The other component involves reducing regulation to make medical care more affordable, like repealing Certificate of Need, permitting mid-level providers to practice within their full scope of authority, exercising right-to-try laws, reducing the number of health insurance benefit mandates, or changing the federal tax code to allow the direct primary care market to expand.

Liberals have been claiming for decades that U.S. companies are at a disadvantage because they help finance health insurance for their workers while their competitors in nations with government-run health systems don’t bear those costs.

Instead of addressing the problem, ObamaCare made it worse.

• The law mandated that U.S. firms provide their workers with health insurance or pay a fine of $2,000 to $3,000 per worker, and imposed significant regulatory compliance burdens on them.
• The American Action Forum estimates that the Affordable Care Act has imposed costs of $50.1 billion in state and private-sector burdens and added 177.9 million annual paperwork hours.
• The Congressional Budget Office estimates that the law will result in a reduction in work hours equivalent to the loss of two million jobs over the next decade.

Earlier this year a report from the University of Pennsylvania found all but the most heavily subsidized ObamaCare enrollees would generally be better off financially if they forgo coverage and pay for their own medical care out of pocket. The group whose incomes fall between 1.38 and 1.75 times the poverty level will spend about three times the amount on premiums for a Silver plan as their out of pocket health care spending had they remained uninsured. For those earning more than 250 percent of poverty, most will be worse off financially compared to having remained uninsured. By design Obamacare is a bad deal for most people! Basically, except for the unlucky few who experience catastrophic health complaints, the vast majority of ObamaCare enrollees would be better off uninsured.

For tax year 2015, millions of Americans will be getting a new tax form related to health care reform measures.

Will you know what to do with yours when it arrives?

The Affordable Health Care Act mandated three new tax forms to be used as a kind of proof of insurance so taxpayers may avoid paying a penalty for failure to be covered. They are: