Category: Implementation

Oscar Health was going to be a new kind of insurance company. Started in 2012, just in time to offer plans to people buying insurance under the new federal health care law, the business promised to use technology to push less costly care and more consumer-friendly coverage.

“We’re trying to build something that’s going to turn the industry on its head,” Joshua Kushner, one of the company’s founders, said in 2014, as Oscar began to enroll its first customers.

These days, though, Oscar is more of a case study in how brutally tough it is to keep a business above water in the state marketplaces created under the Affordable Care Act. And its struggles highlight a critical question about the act: Can insurance companies run a viable business in the individual market?

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Alaska, one of the reddest states in the country, is essentially bailing out its insurance market to prevent Obamacare from collapsing.

A bill passed by the heavily GOP state Legislature to shore up its lone surviving Obamacare insurer is awaiting the signature of Gov. Bill Walker, a Republican-turned-independent who was endorsed two years ago by former vice presidential candidate Sarah Palin. The legislation, originally proposed by Walker, sets up a $55 million fund — financed through an existing tax on all insurance companies — to subsidize enrollees’ costs as the state struggles with Obamacare price spikes and an exodus by all except one insurance company.

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Policymakers are keeping their eyes on the 2016 Social Security and Medicare trustees’ report to see if the White House will stand by its projection that Medicare will be solvent until 2030. The Congressional Budget Office estimates funds (PDF) for the program will dry up in 2026.

Also of interest is whether the trustees will call for the creation of an Independent Payment Advisory Board called for in the Affordable Care Act to reign in Medicare costs if they grew faster than a set rate. But the board, called the death panel by ACA opponents, has not yet been created. There hasn’t been the need, and some say, the willingness to expend the political capital.

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Obamacare has invented a dangerous new way to hide federal spending, including more than $100 billion designed to look like tax cuts.

In defiance of standard United States government accounting practices (and the government’s standard definitions of terms), Obamacare labels its direct outlays to insurance companies “tax credits” (not outlays)—even though they don’t actually cut anyone’s taxes. In this way, Obamacare is masking some $104 billion in federal spending over a decade.

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Maryland’s health cooperative filed a lawsuit Monday seeking to block the federal government from requiring it to pay more than $22 million in fees for a program designed to cover insurance company shortfalls.

The lawsuit by Evergreen Health Cooperative Inc. is the latest twist in the saga of health insurance co-ops set up under the Affordable Care Act to compete against larger, established insurers.

The co-ops were supposed to help keep premiums down by injecting competition into the industry. Instead, 13 of 23 startups that launched successfully have since collapsed, forcing more than 700,000 consumers to seek new insurance. A number of co-op officials have said they were hurt by the federal program because of a formula it used to spread out risk, which they say hurts them while benefiting large, already established insurance companies.

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California Governor Jerry Brown signed a bill into law allowing unauthorized immigrants to buy health insurance on a state exchange created under the U.S. Affordable Care Act, making the state the first in the country to offer that kind of coverage.

The law lets the state request a waiver from the federal government that will be needed to allow unauthorized immigrants to purchase unsubsidized insurance through Covered California, the state’s healthcare exchange.

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The U.S. Department of Health and Human Services on Thursday trotted out insurance executives who have found success selling health plans to individuals via the online insurance exchanges, a key part of the Affordable Care Act.

The conference, held in Washington and live-streamed to journalists and others, gave industry executives an opportunity to outline their strategies and challenges at a time when some major insurers are questioning the viability of plans sold on HealthCare.gov and the state-run exchanges.

In April, UnitedHealth Group Inc. announced it would stop offering exchange plans in many states next year, including Missouri and Illinois. The nation’s largest health insurer said it couldn’t make money on plans because of lower-than-expected enrollment and sicker people buying its plans.

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The Obama administration is seeking to limit short-term health policies that include features largely banned under the Affordable Care Act, a proposal that could crimp a profitable and growing business for some insurers.

Under a proposed rule released Wednesday, insurers would only be able to offer short-term health policies that last less than three months, and the coverage couldn’t be renewed at the end of that period. The proposal seeks to close a gap that has let healthier consumers purchase short-term plans that could last for nearly a year, sometimes using them as a cheaper substitute for ACA plans.

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Kentucky Governor Matt Bevin is making good on his campaign promise to close the doors on Kynect, the state’s Obamacare exchange. While Democratic former Governor Steve Beshear and a handful of Obamacare supporters have made waves about that decision, it has raised a bigger question: Does it make sense to run a state-based exchange?

Kynect is causing higher premiums for most residents of Kentucky, is not fiscally sustainable, and serves almost exclusively as a channel for Medicaid enrollment — Gov. Bevin is prudent to push to switch to the federal exchange.

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The looming collapse of the Obamacare exchanges is prompting calls for even more government involvement in healthcare — even a single-payer system.

It takes a special kind of reasoning to respond to the spectacular failure of government that is Obamacare by calling for, well, even more government.

Obamacare is faltering. No matter who wins in November, the next president will face a genuine crisis of the current president’s making.

And it defies logic to attempt to correct this entirely predictable failure of government with “fixes” that give the federal government even more control over Americans’ healthcare.

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