Category: Investigations

“The Supreme Court announced Friday that it will hear the most serious challenge to the Affordable Care Act since the justices found it constitutional more than two years ago: a lawsuit targeting the federal subsidies that help millions of Americans buy health insurance.
More than 4 million people receive the subsidies, which the Obama administration contends are essential to the act by making insurance more affordable for low- and middle-income families.”

“This hasn’t exactly been a banner week for Democrats, but especially so for Barack Obama. The Washington Post corrected him twice this week on claims made by the President’s denial of reality in his post-election press conference, the first time in a formal fact-check from Glenn Kessler. Obama tried arguing that the election results didn’t really reflect on ObamaCare despite the success of Republicans in defeating Democrats who supported it — or even those who refused to answer the question — because ObamaCare has reduced the costs of health care in every year since its passage. That assumes facts not in evidence in terms of causal relationship, Kessler notes, and isn’t true on the facts anyway:
In fact, despite the president’s claim of a decrease of every year, the White House’s own chart shows that the 2013 estimate represents a slight uptick from 2012, when adjusted for inflation and population. As the White House report puts it, “the three years since 2010 will have recorded the three slowest health-care spending growth rates since record keeping began in 1960.” That is impressive, but it is not the same as health costs going down “every single year” since the law was passed in 2010. …”

“Sen. Mitch McConnell (R-Ky.) is planning to make ObamaCare a priority in his first weeks as leader of the Senate, vowing a sustained effort to dismantle the law piece-by-piece.
McConnell said the GOP will tackle unpopular aspects of the law such as the individual mandate, the medical device tax and the 30-hour workweek requiring employers to provide insurance.”

“Fox News’ Megyn Kelly grilled House Majority Leader Kevin McCarthy, R-Calif., about whether a Republican-controlled Congress would seek to repeal Obamacare.
After repeated questions from Kelly, McCarthy said, “I would press for [a vote to repeal Obamacare] when we have ability to replace it at the same time.””

“President Reagan gauged the success of a welfare program by how quickly people were able to move off government assistance and into remunerative work. Yet President Obama, the White House, and their allies are measuring the success of Obamacare by how many people can be enrolled in their new government entitlement programs.
The president celebrated the law’s “success” in getting seven million people enrolled in Medicaid and eight million (or so) people enrolled in exchange coverage, 87 percent of whom are receiving government subsidies for their insurance. And he hopes to lure another five million people onto Obamacare programs starting with the November 15 enrollment period. There is no expectation that participation in these government programs will be a temporary boost but rather that they will become a permanent fixture in people’s lives.”

“Since enactment of the Affordable Care Act (ACA) in 2010, much of the attention in the policy community has been on modernizing Medicare’s traditional fee-for-service (FFS) program. Through Accountable Care Organizations (ACOs), larger “bundles” of payments to fee-for-service providers for episodes of care, and tests of pay-for-performance models, the hope is that the traditional Medicare model can be remade through sheer force of bureaucratic will. The stated intent is to find a way to pay for value, not volume.
These efforts may or may not bear much fruit, but, over the longer term, it’s not likely to matter much. That’s because a more important transformation of Medicare is already well underway and is occurring despite more resistance than assistance from the program’s bureaucracy. According to the 2014 Medicare Trustees’ report, enrollment in Medicare Advantage – the private plan option in Medicare — has been surging for a decade. In 2005 there were 5.8 million Medicare beneficiaries enrolled in MA plans — 13.6 percent of total enrollment in the program. Today, there are 16.2 million beneficiaries in MA plans, or 30 percent of program enrollment. (See Table IV.C1) In addition, the Medicare drug benefit, which constitutes about 12 percent of total program spending, is delivered entirely through private plans.”

“When the Affordable Care Act marketplace opens on Nov. 15, consumers can expect healthcare.gov to have robust technology, amped-up functions, and a shorter application form for individual plans.
What they won’t see – and likely won’t know about – are the ongoing communication problems that many on the insurance industry say continue to plague the “back-end” transfer of consumer files between the website and insurance companies.”

“Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.
“No one would say it was a good night for the prospects of Medicaid expansion,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.”

“The Obama administration plans to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans, according to an official involved in the internal discussions.
The official requested anonymity until the announcement is made because “the guidance that will be issued is not finalized.””

“When Tony Smith lost his job as a corporate paralegal two years ago, a state program stepped in to help him keep his health insurance — and the expensive drugs his life had depended on since his 2008 HIV diagnosis.
Now Smith, 42, of Coral Springs, has been told he must sign up for coverage on Florida’s federally run insurance exchange or the state will stop helping him pay his premiums.
“The landscape of healthcare has changed, and with the passage of the Affordable Care Act we have the opportunity to access and enroll in cost-effective health plans,” an official at the AIDS Insurance Continuation Program wrote in a letter to Smith and other AICP beneficiaries.
But it is not clear that ACA insurance plans will be cheaper — or even affordable — for those with HIV and AIDS, according to patient advocates.”