Category: Investigations

“The final medical loss ratio (MLR) regulations will likely create a vacuum for affordable coverage that cannot be filled by Bronze plans under the state insurance exchanges. If the ‘essential benefits’ and ‘actuarial value’ requirements are equally as discriminatory, there will be no affordable options available and the cost of subsidies will skyrocket. As a result, millions of Americans that have policies today that could have qualified as Bronze plans will be forced to change their coverage or drop coverage because they can no longer afford it.”

“The Goldwater Institute’s lawsuit challenges IPAB’s very existence as an unlawful delegation of congressional power. Although most of the legal challenges to Obamacare have focused on the individual mandate to purchase government-prescribed health insurance, IPAB is no less central to the overall regulatory scheme. Many members of Congress voted for Obamacare only when convinced of the dubious premise that the law would constrain health-care costs. If IPAB is removed, the flimsy cost-containment rationale will disappear as well.”

“Starting in 2012, the government will charge a new fee to your health insurance plan for research to find out which drugs, medical procedures, tests and treatments work best. But what will Americans do with the answers? The goal of the research, part of a little-known provision of President Obama’s health-care law, is to answer such basic questions as whether that new prescription drug advertised on TV really works better than an old generic costing much less. But in the politically charged environment surrounding health care, the idea of medical effectiveness research is eyed with suspicion. The insurance fee could be branded a tax and drawn into the vortex of election-year politics.”

“If you want to get an understanding of how the health reform law works, both in theory and practice, it would be a good idea to take a look at the process called ‘rate review.’ The idea is that health insurance premiums can be restrained by forcing health insurance companies to explain ‘unreasonable’ premium increases to the Department of Health and Human Services (HHS), to the state authorities, and on their web sites.”

“Doctors’ feelings about the health-care overhaul law passed last year are about as mixed as their patients’, research released today shows…
Many of the 501 physicians surveyed indicated that they had sour feelings about specific aspects of the law.
Around three-fourths of the doctors worried about physician shortages and longer wait times as more people get health coverage, and also that emergency rooms would become overwhelmed. And 90% thought they would be paid less by insurance companies as a result of the law.”

“However, the bottom line is that Obamacare’s MLR regulations won’t deliver us a utopia of government-run single-payer health care. Instead, they will usher in a new era of private insurance monopolies and significantly drive up the cost of health insurance, things that neither liberals nor conservatives should cheer.”

“New Hampshire has a high percentage of Medicare Advantage enrollees. Last month, 7,600 of them received notices that their coverage was being cancelled. Obamacare and another federal law passed in 2008, the Medicare Improvement for Patients and Providers Act, are killing Medicare Advantage to steer senior citizens back into regular Medicare, which offers fewer choices and is more heavily controlled from Washington.
As a result, thousands of Granite State seniors are being forced to switch doctors because they have to switch coverage.”

“So clearly President Obama’s key promise will
be broken after the law fully takes effect. But the
deterioration in coverage already has begun as
many people already are losing the coverage they have now as health insurers are dropping out
of markets in many states. Some of the carriers
are exiting because of onerous state regulations,
others are victims of a faltering economy, but
the cascade has been accelerated by the rules that
already have taken effect and the many more that
are to come as a result of PPACA.”

“A loophole in the federal health care overhaul would allow many employers to game the system by dumping their sicker employees onto public health insurance exchanges, according to two University of Minnesota law professors. They say the loophole could have dire consequences for the financial health of the exchanges, which are a key part of President Barack Obama’s health care law. The online marketplaces are intended to make it easier to comparison shop for health plans and also to expand access to coverage for the uninsured.”

“The work reported here confirms earlier
studies showing that hospitals are able to
extract higher private payments when they
hold more market power. Public policy has
been ambivalent with respect to the ongoing
consolidation within hospital markets. While
antitrust regulatory agencies have challenged
a number of hospital mergers in the past few
decades, these challenges rarely culminated in
decisions to disallow a merger. Now provisions
of the ACA are encouraging further consolidation
of hospitals and physicians, and the final antitrust review regulations from the Department
of Justice and the Federal Trade Commission
have eliminated the proposed mandatory
review of certain prospective ACOs.”