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.”
Highmark Health is cutting reimbursement to doctors by 4 percent effective April 1 for care provided to patients with health insurance bought through the government exchange — the latest effort to trim losses in a market segment that has caused headaches for carriers nationwide.
All Pennsylvania doctors who participate in Highmark’s health insurance plans and treat patients with coverage required by the Affordable Care Act will be affected by the reimbursement cut, said Alexis Miller, senior vice president of individual and small group markets.
The doctors’ pay cut is needed to stem losses in individual health-law coverage as the insurer looks for other ways to stop the bleeding, Ms. Miller said.
Vermont Sen. Bernie Sanders has energized Democratic voters with a proposal for a $1.38 trillion single-payer health care system that he says would provide universal coverage and make medical care more efficient.
By contrast, his opponent in the Democratic primary, Hillary Clinton, is promising to defend the Affordable Care Act and make reforms to help lower deductibles and other out-of-pocket costs.
In other words, Sanders wants revolution; Clinton wants to build on what President Obama started.
If elected, each candidate could potentially have a significant impact on the nation’s health care policies and the choices and costs facing consumers.
The leading candidates for the Republican nomination are all proposing to repeal ObamaCare. The difference between them is what they would replace it with.
Businessman Donald Trump and U.S. Sen. Ted Cruz of Texas both have said they want to increase competition to allow Americans to purchase insurance across state lines, but neither has offered a detailed plan for replacing President Obama’s signature law.
Jeb Bush and U.S. Sen. Marco Rubio of Florida would provide tax credits to help Americans purchase individual health insurance policies and give states more control of their insurance markets.
Meanwhile, Ohio Gov. John Kasich says the focus should be on improving primary care and rewarding providers that generate better health outcomes and help to hold down costs.
Whoever is nominated will have a chance to bring about a fundamental shift in health care policy.
Democratic candidate Bernie Sanders recently released his health-care plan: a government-run single-payer system for the U.S., similar to what many European countries have. Criticism of the plan has so far focused on its lack of political feasibility, but there is an even more important reason to be wary: Accounting for costs and tax increases, it would reduce labor supply by 11.6 million. In a struggling economy, with tepid wage growth, hurting employment should be the last thing on any politician’s agenda.
The plan truly promises everything under the sun. Not only will everyone be able to get any medical treatment needed — with no cost at the point of service — but the plan won’t require a terribly high tax increase.
The growing number of ObamaCare failures creates an opportunity for conservatives to make a persuasive case for a replacement, experts said at a policy briefing held by the Conservative Reform Network and the Hoover Institution in Washington, D.C., on Wednesday.
“On healthcare, we too often hear that people on our side, that conservatives don’t have a plan,” said Grace-Marie Turner, president of the Galen Institute. “Conservatives overwhelmingly agree on principals and pillars for reform and for a replace[ment] plan.”
For all the damage that ObamaCare has done, it has also led to an awakening among Americans about the inadequacies and costs of a government-centered health care system. This awakening has created an enormous opportunity for conservatives. But making the most of that opportunity will require being clear about what is wrong with ObamaCare, why it needs to be replaced, and what a replacement must involve.
Unfortunately, while many 2016 presidential candidates have backed the “repeal” part of the “repeal and replace” equation, few have addressed how they would start over.
They would do well to follow the advice of The Heritage Foundation. The think tank’s soon-to-be-released policy handbook for candidates, Solutions 2016, lays out the “then what” reforms candidates should be talking about:
- Remove regulatory and policy obstacles that discourage choice and competition.
- Encourage personal ownership of health care by reforming the tax treatment of health care.
- Transform health care coverage for low-income Americans by reforming Medicaid as a true safety net and glide path out of poverty.
- Modernize Medicare program to meet the demographic, fiscal, and structural challenges that threaten to bankrupt the system.
With the results now in from the Affordable Care Act’s third open enrollment period, it’s getting increasingly difficult to sugarcoat the extremely low numbers of enrollees relative to original projections. The 12.7 million people who signed up for an exchange plan amounts to just half as many enrollees as was projected by government and private sector research organizations when the ACA passed.
The Rand Corporation predicted 27 million, the Centers for Medicare and Medicaid Servicespredicted 24.8 million, the Urban Institute predicted 23.1 million, and the Congressional Budget Office predicted 21 million.
Last month, majorities in Congress voted to repeal the Affordable Care Act. Not surprisingly, President Obama vetoed the repeal bill, and the Republican Congress was unable to override the president’s veto.
As former leaders in Congress, we have a message for both sides in this debate: It’s time to give the states a chance.
This doesn’t mean that conservatives and Republicans have to give up the fight to reduce the regulations and taxes in the law. It also doesn’t mean that progressives and Democrats have to stop defending protections for the underinsured and uninsured.
Instead, it’s time to look to a provision of the Affordable Care Act — Section 1332 — that can achieve what both sides earnestly wish for: providing more Americans with access to more affordable, flexible, patient-centered health care.