Saturday, February 15, 2014

Here We Go Again Obamacare Schadenfreude

We had a nice day yesterday after the passage of "Winter Storm Pax", according to The Weather Channel's silly new naming system, and now "Winter Storm Quintas" is riding along the same basic path, threatening the same people with even more crystalline global warming. If winter keeps up at this pace, TWC may run through the alphabet a couple of times.

It looks like we're pretty safely on the warm side of this one, if the warm side is 32.5 F.  It's gray and rainy, and a shift of the rain/snow line by a few tens of miles could give us some more snow.  Here we go again.

Pretty much like Obamacare Schadenfreude, the winter storm that keeps on giving. A motley lot to be sure, but when the news hands you over ripe avocados, make guacamole.

Some Democrats talking about bringing back the "bad apple" "junk," plans sold by "evil" insurance companies back into Obamacare:
Still no hard numbers but insurers are starting to talk and the numbers don't bode well for the system.
Fully one-fifth of the new enrollment numbers that HHS has been waving around are bogus. Their target for the end of January was 4.4 million sign-ups; a few days ago, they told the country they’d made it three-quarters of the way there with 3.3 million. In reality, once the deadbeats are bounced from the rolls by their new insurers, they’ll be in the ballpark of 2.6 million, or 60 percent of their target. And that’s after HHS pressured insurers to extend the payment deadline from December 31 into January, hoping that a little more time for slackers would pad the enrollment figures even more.
But even that 20% non-payment rate maybe low. Some insurers are saying the non-payment rate for their plans are 25% to 30% range.
Of course the answer to a failure of massive government is more government!
Now, some insurers and a pair of Senate Democrats are trying to change the law permanently so that individuals and small businesses can buy so-called copper plans. The plans likely would have lower premiums, but purchasers would pay more of their ordinary health costs upfront. Greater coverage would kick in for serious, unforeseen health episodes that would require, for example, a hospital stay.
Sens. Mark Begich of Alaska and Mark Warner of Virginia, both Democrats facing close re-election races this year, are sponsoring legislation that would allow people to buy copper plans on the exchanges. Moreover, insurance-industry officials have been talking up the idea with federal officials, though it is unclear whether the administration could make the change through regulations.
The White House said it was weighing the proposal. "The president remains open to all ideas that would genuinely improve the Affordable Care Act and appreciates the careful thought Mr. Begich has given to his legislation," an administration official said.
So what this amounts to is bringing back catastrophic plans. You know the ones the Democrats spent weeks calling "bad apple" and "junk" insurance.

Naturally the people that would be most drawn to these "low cost" programs would be the young invincibles that ObamaCare desperately needs to make this whole scheme work. So what happens if this passed and these young and healthy people start paying significantly less in premiums than the expected amount to keep the whole thing afloat?
So to salvage the government run system, the democrats are coming around to giving the young and poor that which they were often satisfied with in the first place, inexpensive, high deductible plans.  Of course, other Obamacare requirements (contraception, preventative care, and coverage of preexisting conditions) will continue (after all, what's the point if they don't) and even less palatable policies will need to be created to fill the niche.  May I suggest they be called pewter, pot metal and lead plans?

But it is a hopeful sign to see that they are seeing a glimmer of market forces.  It's a start.

Nanacy Pelosi claims there is no need to delay the individual mandate because, well, it's the law:

Go watch the video at the link.
A variation on the “you’re gonna love it once it’s fully enacted” chorus of fibs we’ve been hearing since this thing was passed in 2009. It isn’t really news, per se, that Rep. Nancy Pelosi is willing to support a pass for employers for this law that doesn’t go to individuals about to be hit with the mandate tax. It’s not news that she’s willing to ignore the many failings of the law and its implementation and refer to it as utterly “sound policy,” even as the worst Jenga tower every constructed is crumbling before her. But it is illustrative of the Democratic plan to put blinders on and say “but, but, we passed a law!” when faced with the unfairness of the system they’ve created and the waivers they’re granting. It’s also illustrative of how lazy an answer Democrats offer on this stuff. “It’s a totally different issue,” she says. Well, that settles that. Enjoy your sound policy. Unless their sound policy took your formerly sound policy away.

Really, her point (without saying it that way) is that the whole thing crumbles without the individual mandate.  What she calls a bug, I call a feature.

Uberwonk Megan McArdle dissects the numbers on the failure to enroll
Yesterday, the Obama administration announced health insurance enrollment figures for January. Here’s the rundown, for those of you who missed it:

  1. Almost 3.3 million people signed up for a policy as of Feb. 1. January projections actually slightly exceeded their target. That’s good news for the exchanges.
  2. Most people are choosing mid-range silver plans, rather than bare-bones catastrophic or bronze level plans (which is what many analysts had expected them to buy). This could be in part because people do seem to prefer more generous coverage, but is probably also due to the availability of special cost-reduction credits to people with incomes between 100 percent to 250 percent of the federal poverty line if they buy silver plans.
  3. The number 3.3 million represents people enrolled in a policy, not the number who have paid for their premiums. Most of the reporting -- which comes from insurance industry sources -- suggests that about 80 percent of those who signed up have actually paid the first month’s premium. That would put actual enrollees at more like 2.64 million. . .
  4. The demographic mix isn’t improving as hoped. In order to maintain an actuarially sound pool, and keep premiums down, the exchanges were supposed to have 40 percent of their customers between the ages of 18-34. The demographics slightly improved in January, but young adults still make up only 25 percent of the market.
  5. A lot of people are getting subsidies -- as expected. About 80 percent of the folks who bought policies on the exchange so far were eligible for subsidies. That seems high, but it’s roughly in line with estimates from the CBO, which showed six out of seven enrollees getting at least some subsidy from the federal government.
  6. We still have no idea how many of these people previously had insurance. If the administration knows, it is not sharing those numbers with anyone else.
So the big story is that they've created a middle class entitlement, subsidized health care for people making up to 250% of the poverty line, and the "young invincibles" aren't in a buying mood.  Moreover, most of the people taking the insurance are probably those who were forced out of old plans by Obamacare, and the administration is going to hold that news as long as possible.

California takes down online health insurance exchange for small businesses
California officials on Wednesday announced they are suspending online enrollment effective immediately for small businesses on the state’s new health insurance portal, known as Covered California. Health plans available through the state’s Small Business Health Options Program (or SHOP) will still be available but can only be purchased over the phone, via paper applications or through insurance agents.

State health officials say they will use the time to “implement a series of redesigns.”
“The SHOP portal was not meeting the needs of agents or small employers and needed improvements,” Covered California Executive Director Peter V. Lee said in a statement announcing the decision. “Taking the portal offline will not affect the paper application process, which has been the preferred enrollment method traditionally used by insurance agents in the small-group market.” . . .

The portals were meant to curb rising health care costs for small businesses by increasing competition among insurers. The White House has said they are intended to allow employers to purchase insurance with the same ease as buying a flight on Web sites like Expedia or Priceline — but in most states, it has not panned out that way yet.
But, according to Pelosi and Obama, it's working!

NYT: Private practice doctors are fleeing to hospitals, and that is not a pro
Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years. …

“In many places, the trend will almost certainly lead to more expensive care in the short run,” said Robert Mechanic, an economist who studies health care at Brandeis University’s Heller School for Social Policy and Management. …

But many of the new salaried arrangements have evolved from hospitals looking for new revenues, and could have the opposite effect. For example, when doctors’ practices are bought by a hospital, a colonoscopy or stress test performed in the office can suddenly cost far more because a hospital “facility fee” is tacked on. …

Hospitals have been offering physicians attractive employment deals, with incomes often greater than in private practice, since they need to form networks to take advantage of incentives under the new Affordable Care Act. Hospitals also know that doctors they employ can better direct patients to hospital-owned labs and services.

“From the hospital end there’s a big feeding frenzy, a lot of bidding going on to bring in doctors,” Mr. Mechanic said. “And physicians are going in so they don’t have to worry — there’s a lot of uncertainty about how health reform is going to play out.”

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