Monthly Archives: April 2016

Many health-insurance premiums rose again this year, sometimes by double digits. A lot of the increases were accompanied by higher deductibles as well. Insurers say the increases are justified because their costs have risen as more people with health problems have signed up for insurance in the wake of the Affordable Care Act.

The Affordable Care Act is now six years old. Perhaps more important for Massachusetts, this month marks the 10th anniversary of “Romneycare,” making it a good time to review that law’s impact.

Governor Mitt Romney’s original proposal was simple: Stop subsidizing hospital care and redirect the money to ensure that all residents have “minimum coverage”—in his mind, catastrophic insurance. Individuals could choose and pay for anything beyond that. The premise was that taxpayers should not have to cover the cost of care for those unwilling to pay for it.

A Health Connector was to serve as an exchange where individuals could buy insurance directly and which would test-drive market reforms. Unlike President Obama, Romney did not implement his creation.

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Supporters of the Affordable Care Act have declared victory on health care reform: they proudly note the decline in America’s uninsured rate, as well as the sizable enrollment of lower-income adults on the new individual-insurance exchanges (“ACA exchanges”). Yet after a brief rise, the number of insured Americans is now plateauing well below the ACA’s goal of universal coverage—rather than pay the ACA exchanges’ exorbitant premiums, middle-income adults are overwhelmingly opting to forgo health insurance and pay the individual-mandate tax instead.

Key Findings of this report from the Manhattan Institute:

• Nearly 30 million American adults remain uninsured.
• After an initial surge, enrollment on the ACA exchanges has slowed dramatically: since March 2015, only 1 million additional individuals have signed up for coverage.
• By February 15, 2015—the end of the ACA exchanges’ second enrollment period—fewer than half of eligible middle-income adults had signed up for coverage.

Before the passage of ObamaCare’s 2,400 pages of coercive mandates and profligate spending, the federal government had already largely wrecked the market for individually purchased insurance, in three interconnected ways.

First, it had effectively established two different health insurance markets—employer-based and individually purchased—by treating them differently in the tax code. Second, it had given an attractive tax break for employer-based insurance while denying it for individually purchased insurance (except for the self-employed). Third, having effectively split the market in two while favoring the employer-based side, it had made it hard for people to move from the employer-based market to the individual market, as it had allowed insurers to treat previously covered conditions as “preexisting.”

A popular conservative alternative, then, would repeal every word of ObamaCare while fixing this longstanding inequity in the tax code.

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Amid rising drug and health care costs and roiling market dynamics, the spokesperson for the nation’s health insurers is predicting substantial increases next year in ObamaCare premiums and related costs.

Without venturing a specific percentage increase, Marilyn Tavenner, the president and CEO of America’s Health Insurance Plans, said in an interview with Morning Consult that the culmination of market shifts and rising health care costs will force stark increases in health insurance rates in the coming year.

The warning to consumers from Tavenner, the former administration official who headed the Center for Medicare and Medicaid Services and oversaw the disastrous launch of HealthCare.gov, the ObamaCare website, comes at a time of growing uncertainty about the evolving makeup of the ObamaCare health insurance market.

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As part of an Obama­Care initiative meant to reward quality care, the Centers for Medicare and Medicaid Services is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-­satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?”

To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply ­misguided––if not downright dangerous. “The government is telling us we need to make sure a patient’s pain is under control,” says Dr. Nick Sawyer, a health-­policy fellow at the UC Davis department of emergency medicine. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”

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UnitedHealth is withdrawing from most of the 34 ObamaCare Exchanges in which it currently sells, citing losses of $650 million in 2016. A recent Kaiser Family Foundation report indicates UnitedHealth’s departure will leave consumers on Oklahoma’s Exchange with only one choice of insurance carriers.

Michael Cannon of the Cato Institute explains five results of UnitedHealth’s withdrawal from the exchanges:

1. UnitedHealth’s departure shows ObamaCare is suffering from self-induced adverse selection.

2. UnitedHealth’s departure is bad news for other carriers.

3. UnitedHealth’s departure shows ObamaCare premiums will continue to rise.

4. There will be more exits.

5. UnitedHealth’s departure shows quality of coverage under ObamaCare will continue to fall.

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The CEA presentation is notable in reflecting the core components of ACA advocates’ case for the law. It is fourteen slides long, and I find that its points break down into five main themes (in my own words):

1. The ACA represents a historic expansion of health insurance coverage.
2. The ACA is achieving policy goals such as reducing patient harm and hospital readmissions.
3. The ACA is helping to slow the growth of health care costs.
4. The ACA has been good for job creation.
5. The ACA is improving the federal fiscal outlook.

Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.

The plan, to be implemented over seven years, is based on a similar strategy pursued by the federal agency that oversees the government-run Medicaid and Medicare health insurance programs.

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