2014 - The Start of a Whole New Year of Obamacare Schadenfreude

The first day of 2014, the year that most of the "harder" parts of Obamacare are supposed to take place in, the individual and employer mandates.  We know the employer mandates were delayed a year (which puts them conveniently past the 2014 midterm election), and the rollout of the individual has gone so swimmingly that although it has not yet been formally rolled back, it's unlikely that anyone will be forced to pay a penalty tax for not having the insurance they were mandated to buy, and were unable to, thanks to the botched website and lack of planning by HHS.  However, lesser known aspects of the law come into force today.
 

With new year, Medicaid takes on a broader health-care role

Medicaid embarks on a massive transformation Wednesday — from a safety-net program for the most vulnerable to a broad-based one that finds itself at the front lines of the continuing political and ideological battle over the Affordable Care Act.
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Twenty-five states and the District expanded Medicaid under the Affordable Care Act. In many of those places, the program will be open for the first time to anyone whose income is below 138 percent of the poverty level — individuals making less than $15,856 a year or a family of four earning under $32,499 in 2013 dollars. That includes childless adults, who were excluded in most states despite a widely held misperception that all poor people automatically qualified for Medicaid.
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The newly eligible in these states come from many strata of society: homeless people, former inmates, low-paid workers, recent college graduates, retirees not yet old enough for Medicare and people like Kush, who are between jobs.
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Even in states that aren’t expanding Medicaid, there are some significant changes, including new Medicaid eligibility standards. For people who are not in long-term care, the program will no longer take into consideration how much participants have in assets, such as savings or retirement accounts.

Megan McCardle thinks that the exceptions and  exemptions that Obama has granted in the laws will ultimately kill it. Change Is Obamacare's Only Certainty 

...Sometime after March 31 -- probably not very far after -- I would expect the administration to announce that after careful thought, it has decided not to enforce the individual mandate for 2014. As we’ve already seen, the individual mandate is very politically vulnerable. And I suspect we’re not done with the emergency fixes.
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If the administration had been resolute in the face of early complaints, and had stuck to the rules it wrote before October, then it would be in a stronger position to deny the next round of complainers. But it hasn’t. And each round of special exceptions makes denying the next one harder: “The president was willing to help them, but not us! What’s wrong with us? Doesn’t the president care about people like me?” ...So I find it hard to believe that the mandate, or the clawback of overpayments, or any other rule that might upset people, will be enforced for 2014. And of course, that makes it more likely that none of them will be enforced, ever.
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But could Medicare subsidies be cut, or block-granted, giving states incentives to pare back enrollment? Of course. Could the mandate be effectively dismantled? Absolutely. Could the employer mandate be “delayed” indefinitely? Sure. In 2018, when the temporary “risk corridor” adjustments have gone away, and subsidies are capped, could adverse selection start driving people (and insurers) out of the market? Undoubtedly. And at that point, might guaranteed issue and community rating become vulnerable? That’s basically what happened in Washington state.

At that point, something called Obamacare would still exist, but it wouldn’t be anything like the comprehensive universal coverage its designers imagined. It would basically be a Medicaid expansion in some blue states, plus trivial tweaks to some insurance regulations.

If 2013 Was Hard on Obamacare, Just Wait for 2014

The drafters of Obamacare recognized that many elements of the law would be unpopular, while other provisions -- allowing people up to the age of 25 to remain on their parents’ plans, ending co-payments for preventive care or closing the “doughnut hole” in Medicare prescription drug coverage -- would be immensely popular with the voting public. These provisions all took effect shortly after the law was signed in 2010.
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Now that 2013 is drawing to a close, we see why Obamacare’s drafters did what they did. Obama’s approval ratings are at or near all-time lows, but that matters little to a White House that already won four more years...

First, some of Obamacare’s least popular provisions go into effect in 2014. This includes a new $60 billion tax on health insurers, which will be levied relative to premiums collected and directly passed on to consumers. And, of course, Obamacare’s requirement that individuals secure health insurance coverage (or pay a tax penalty) kicks in during the coming year as well.

Or not, see above.

Second, millions of Americans who buy their coverage on the individual market or get it through small employers will be shocked by just how much their premiums go up in 2014. The young and healthy will be especially susceptible to this rate shock, and this in turn will further drive them away from purchasing coverage in future years. . .

Third, not only will millions of Americans on the individual and small group markets who like their plans be unable to keep them in 2014, but many will experience what it’s like to be unable to continue seeing the doctors they know and trust. . .

Finally, Obamacare’s Medicare cuts will continue to hurt senior citizens. For the 14 million people enrolled in the Medicare Advantage program, the ACA’s $200 billion in cuts over the next 10 years will accelerate in 2014 and have tangible impacts on beneficiaries...Although the ACA is not solely responsible for the headwinds the Medicare Advantage program faces, it will (and should) shoulder most of the blame.

NBC’s Chief Medical Editor Forced Her Kids to Sign Up for Obamacare as Their ‘Patriotic Duty’



And of course, she wants a single payer system where she and others get to decide what is "fair" compensation for doctors. These are the people who control the message, if we let them.

Tom Coburn calls a spade a God damn shovel: The Year Washington Fled Reality

The past year may go down not only as the least productive ever in Washington but as one of the worst for the republic.
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On health care, President Obama oversaw a disastrous and, sadly, dishonest launch of his signature achievement. The president gave an exception to employers, but not to individuals, without any legal basis, and made other adjustments according to his whim. Even more troubling was his message over the past three years that if you like your plan, you can keep it, and that if you like your doctor, you can keep your doctor. We now know that the administration was aware that these claims were false, yet Mr. Obama continued to make them, repeatedly.

In 2014, millions of Americans will likely discover that the president's claim that the average family will save $2,500 on health insurance was equally disconnected from reality. . .

Judge Sotomayor - Nuns granted stay on birth control requirement:

The Supreme Court has thrown a hitch into President Barack Obama’s new health care law by blocking a requirement that some religion-affiliated organizations provide health insurance that includes birth control.

Justice Sonia Sotomayor decided late Tuesday night to block implementation of the contraceptive coverage requirement, only hours before portions of the law would have gone into effect on New Year’s Day.

Sotomayor acted on a request from an organization of Catholic nuns in Denver, the Little Sisters of the Poor Home for the Aged. Its request for an emergency stay had been denied earlier in the day by a federal appeals court.