Category: Impact

Under Obamacare, doctors have been strained by costly new regulations, intricate payment “reforms” that tie their Medicare reimbursement to complex federal reporting requirements, and mandates that they install and make “meaningful” use of electronic health records.

Add a new burden to the mix: The proportion of patients they see are rapidly shifting away from commercial health plans and toward Medicaid, which sometimes pays doctors pennies on the dollar that they were previously reimbursed under private insurance.

The data comes from ACAview, a product of athenahealth that aims to measure the impact of Obamacare on medical practices. The project, jointly funded with the Robert Wood Johnson Foundation, is the first large-scale examination of data derived directly from outpatient medical practices belonging to more than 60,000 providers. It gives a unique insight into how the Affordable Care Act is impacting patients at the point of care.

About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked with a smile.

“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”

I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.

The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”

New research about implementation of the Affordable Care Act finds that Obama administration regulations are allowing taxpayer subsidized health insurance for some people earning less than the statutory income floor and also for unlawful immigrants.

A new study by Andy S. Grewal, an associate professor at the University of Iowa College of Law, explains that the ACA provides tax credits to U.S. citizens with incomes between 100 and 400% of the Federal Poverty Level (FPL). However, IRS regulations were written to extend credits to citizens below 100% FPL in some cases.

Also, Section 36B of the ACA grants credits to some non-citizens with low-incomes only if they are themselves lawfully present in the U.S. and cannot obtain Medicaid coverage. IRS regulations, however, contradict the statute and allow subsidies if “the taxpayer or a member of the taxpayer’s family is lawfully present in the United States,” and “the lawfully present taxpayer or family member is not eligible for the Medicaid program.”

Employer groups and insurers are pushing to keep businesses with 51 to 100 workers exempt from a provision of the federal health law that they say could significantly increase their costs.

For these midsize employers, the Affordable Care Act’s requirements for what health plans must cover—and how they are priced—are set to take effect on Jan. 1, 2016.

Already the law requires insurers to sell individual and “small group” plans to everyone at the same price, regardless of their health. Those rules, which kicked in Jan 1, 2014 for businesses with 50 or fewer workers, also set standards for what health-benefits packages must cover.

“A different health care issue has emerged for Democrats, in sync with the party’s pitch to … middle-class voters … high out-of-pocket costs for people already covered. Democrats call it ‘underinsurance.’ After paying premiums, many low- and middle-income patients still face high costs when trying to use their coverage. … [T]he value of a health insurance card is being eaten away by rising deductibles … Several liberal-leaning organizations have recently focused on the issue.”

Obamacare has enmeshed many Americans in a bureaucratic nightmare. True, the law has helped some uninsured people obtain coverage. But millions of people have seen their health-insurance plans canceled, because the plans did not meet the requirements of the Affordable Care Act. Others, particularly young Americans, have seen premiums rise to pay for the roster of newly added benefits. Tommy Groves (not his real name), a young professional working at a small firm in Washington, D.C., was among the nearly 5 million Americans who received termination-of-coverage letters from their health-insurance providers because their plans did not comply with the ACA’s requirements. While about half the states offered to extend canceled plans for another year, later increased to two years, the District of Columbia required its residents to get new insurance.

Read more at: http://www.nationalreview.com/article/418322/obamacare-horror-story-young-americans-diana-furchtgott-roth-jared-meyer

The Obama administration has spent billions of taxpayer dollars implementing the Affordable Care Act, often taking vast liberties with statutory language. The administration’s actions were the subject of a House Ways and Means Oversight subcommittee hearing on Wednesday, chaired by Rep. Peter Roskam (R-IL).

Roskam is calling for a Special Inspector General to investigate the administration’s actions and track how tens of billions of dollars have been spent. Implementation of the sweeping and complex law stretches across eight separate federal agencies so no one agency IG can see the patterns and possible abuses taking place.

Rep. Roskam’s SIGMA Act (Special Inspector General for Monitoring the Affordable Care Act) would create an ObamaCare watchdog to conduct much-needed audits of the ACA to guard against further waste of tax dollars, such as the extraordinarily expensive and problem-prone exchange websites.

Following close to two years of reports of cost overruns on HealthCare.gov, increased premium prices and lost work hours since the implementation of the Affordable Care Act, Rep. Peter Roskam, R-Ill., is introducing legislation to appoint a watchdog to oversee the health care law and ensure the protection of taxpayer dollars.

The legislation calls for the creation of a special inspector general for monitoring the Affordable Care Act, or SIGMA.

“The false, rosy claims of Obamacare have largely been debunked, and there’s a level of dissatisfaction all around,” Roskam said in an interview with The Daily Signal. “More time and more attention is in the oversight function. [The legislation] doesn’t reinvent the wheel in that it doesn’t use the same legislative architecture, but what will do is force disclosure, and the public then has choices about how it wants to move forward.”

Republican chairmen of four House subcommittees—Tim Murphy of Pennsylvania, Tom Cole of Oklahoma, Tom Marino of Pennsylvania and Jim Jordan of Ohio—as well as Republican Sen. Rob Portman of Ohio, chairman of the Permanent Subcommittee on Investigations, and Rep. Bill Flores of Texas, chairman of the Republican Study Committee, support the bill.

One primary goal of the Affordable Care Act (ACA) was to expand access to affordable health care. However, in the five years since the ACA’s passage, we have found that while more people have health insurance, they do not necessarily have access to affordable health care.

In order to pay for the subsidies that have facilitated the expansion of health insurance coverage, many recipients of federal funds were forced to accept payment reductions. Hospitals were faced with cuts of $260 billion over ten years.[1] These reductions came in the form of delayed payment updates for Medicare hospital services and reduced Disproportionate Share Hospital (DSH) payments meant to compensate hospitals for treating a high percentage of patients for whom the hospital is often inadequately reimbursed. The justification for the cuts to hospital payments was based on assumptions that, by increasing insurance coverage to millions of people, fewer individuals would go to the emergency room (ER) to receive care—where they would potentially be treated for free subject to the Emergency Medical Treatment and Labor Act (EMTALA)[2]—and instead could seek care in non-hospital settings such as physician offices, outpatient clinics, urgent care centers, etc.

One of the key questions surrounding Obamacare is just how many people have been newly insured under the law. The answer is clouded by the fact that the White House and others have changed some rules of math for making these assessments.

For example, several years ago, the Obama Administration fiddled with Census Bureau’s definition of what it means to be “uninsured.” The new parameters, which were looser than the old factors, make it hard to construct comparisons between today’s figures for the total number of uninsured and the historical trends.

The Obama team also abruptly started to exclude uninsured illegal immigrants from the national tally on total number of uninsured Americans. Before Obamacare, these individuals were counted in that reporting, inflating the numbers. After Obamacare, these individuals didn’t get insurance, but suddenly didn’t get counted any more.

Now, a new analysis from the highly regarded managed care analyst at Goldman Sachs, Matthew Borsch, and his team, cast uncertainty on some of the recent data releases from the White House, and its network of academicians. In particular, the Goldman breakdown conflicts in some key ways with a recent analysis from RAND that was published in the journal Health Affairs and widely cited by the media.