Obamacare Schadenfreude - So Good She Quit

Another nice spring day here, Partly sunny, 66 degrees and rising, with a strong south wind.  time to go out and do some gardening. But first, more Obamacare Schadenfreude:

Sebelius quits after ObamaCare nightmare

ObamaCare has killed the career of its beleaguered point person.

Health and Human Services Secretary Kathleen Sebelius has quit her post following months of criticism. Sebelius’ resignation, confirmed Thursday in an e-mail from Dori Salcido, a department spokeswoman, comes little more than a week after the close of enrollment for the first ObamaCare coverage period.

It also follows recent efforts by the White House to rebound from the fiasco that marked the program’s launch last year, when massive technical glitches kept people from logging in to the HealthCare.gov Web site.

For a contrarian view, we go straight, or not so straight to Ezra Klein vi Ace, who reads Ezra so I don't have to:

Heckuva job, Seebey.

In case you think her resignation was caused by the fact that Obamacare and especially Healthcare.gov were disasters, nope, Ezra Klein, head of the comedy start-up Larfz.com, says different:

From The PJ Tatler:

While it would be nice to think that failure and dishonesty have caught up with Sebelius, the reality is that she is probably leaving government for more lucrative reasons.

As Sebelius leaves, OMB Director Sylvia Matthews Burwell has been nominated to replace her.

OMB Director Sylvia Matthews Burwell shut down the National Zoo's "Panda Cam" during the great "Reign of Pain" government shut down among other things.

Obamacare is Still Very Unpopular, and No Prog "Unskewing" of the Polls Can Change That

A much-publicized Washington Post/ABCNews poll claimed that Obamacare had suddenly garnered near-majority support from the country.

But a new USAToday poll finds that Obamacare is as unpopular as it's been for years, so that ABC poll was, as many suspected, simply an outlier, the 1-in-20 they mean when they warn that 1-in-20 times the poll will simply be wrong.

USAToday finds that Obamacare is at 37% approval, 50% disapproval, in line with all other polls. Except for that one ABC one.

And even worse, a majority says that Obamacare will have a major impact on how they vote this November.

Now progs are doing what progs will do, which to attempt to prove how clever they are by demonstrating that facts are not facts at all, but social constructs we invent in our minds to justify racism or something.

Obamacare, lies or Crap?



My rule of thumb to such questions is always "both."

More Calif. Doctors Illegally Charging Insured Patients Extra Fees

A growing number of California doctors are charging their insured patients extra fees to cover everyday office expenses — a practice that’s illegal under most health care policies, according to KNX1070′s investigative reporter Charles Feldman.

Some doctors say they need to charge the extra fees because of the rising costs of running a practice. Some even cite the Affordable Care Act, also known as Obamacare, as adding to their costs.
...
“There’s definitely a growing number of physicians across the country that are moving in that direction,” Doyle said. “And it should be noted that, up until several years ago, physicians did charge for certain services that were not covered, if you will, by insurance carriers such as preparing for school athletic forms, school participation forms, disability forms, things of that nature. Those were items that they had historically charged for — they’re now expanding that into a much wider area.”

And we have more about the Rand study on enrollments, and the Express Scripts study on the composition of the enrollees:

Two New Studies Raise Red Flags on Obamacare

Barack Obama wasted little time last week declaring victory as the deadline for enrollment in Affordable Care Act exchanges expired – well, more or less, anyway. The White House celebrated as it announced that 7.1 million consumers had signed up for health insurance through the federal and state exchanges, slightly exceeding their original goals and significantly outpacing expectations after the disastrous rollout of Obamacare last October. “The debate over repealing this law is over,” President Obama told the press on April 1. “The Affordable Care Act is here to stay.”

Last week, that sounded like wishful thinking. Two new studies released this week prove it.
. . .
In order to determine the scope of the celebration, then, we need outside surveys to give us an idea of the size and composition of the actual enrollment population in Obamacare. The first of the independent studies comes from the RAND Corporation, which studied the changes in the health insurance market between September 2013 – just before the rollout of the state exchanges – and the end of the open-enrollment period at the end of last month.

While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates.

First, a significant amount of this increase comes from Medicaid enrollments, not private insurance. Almost six million people enrolled in Medicaid, and earlier studies showed that a relatively small number of those came from the expansion built into the ACA; most of these would have been Medicaid-eligible prior to the reform.

Another 8.2 million more people enrolled in employer-provided health care, as 7.1 million left the “other” category and another 1.6 million left the individual insurance markets. Only 3.9 million actually enrolled in insurance plans through state or federal exchanges – not 7.1 million as claimed by Obama. That number falls far short of even the lowered expectations issued by HHS and the White House earlier this year.
. . .
Their new study shows, for instance, that the enrollees from state and federal exchanges have a 47 percent higher use of specialty medications than in commercial plans in general. “Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients,” the report reminds readers. “Despite comprising less than 1 percent of all U.S. prescriptions,” the report continues, “specialty medications now account for more than a quarter of the country’s total pharmacy spend.”

The medications themselves show that the care costs will increase relative to the existing risk pools as well. The rate for HIV medications in Obamacare exchange plans is four times higher than in existing commercial plans. Medication prescriptions are 35 percent higher, and anti-seizure medication increases 27 percent. Ironically, the only category where exchange consumers have lower demand than commercial-plan customers is in contraception – the focus of a big political battle in the employer mandate.

ObamaCare's Missing 3.2 Million

. . .The Rand study suggests that ObamaCare's greatest incentive effect--a function of both the mandate tax and the unattractiveness of individual plans--is to nudge employees to opt in to workplace plans. As for the incentives on employers, they go in both directions. But the law's main disincentive for ESI--the so-called Cadillac tax on expensive plans--doesn't take effect until 2018.

As for the individual marketplace, its viability is questionable even if the administration's overall enrollment figures turn out not to be wildly inflated. Because of price controls--a k a the ban on considering "pre-existing conditions" and limits on accounting for age in setting premiums--the exchanges depend on enrolling a substantial proportion of young, healthy people paying inflated premiums.

Preliminary data showed early enrollments skewing much older than the administration had hoped. And while no data are collected on enrollees' health status, a new study shows, as the New York Times reports, that "people who signed up early for insurance through the new marketplaces were more likely to be prescribed drugs to treat pain, depression and H.I.V.":

The study, to be released Wednesday by the major pharmacy-benefits manager Express Scripts, suggests that early enrollees face more serious health problems and are older than those covered by their employers. The study also showed a higher use of specialty drugs, which are often used to treat diseases like cancer and rheumatoid arthritis; the use of such drugs could hint at more costly medical problems.

The Times notes that "insurers have said anecdotally that those who signed up later tended to be younger and were presumably healthier." That's called regression to the mean. The question is whether it's close enough to the mean to stave off big premium increases for 2015. If not, marketplace policies will become even more unattractive, and those with employer-sponsored plans will guard them ever more jealously.

And finally, Megan McArdle, who actually stops to think about things before writing looked at the Rand Study and said "WTF?": More Puzzling Obamacare Numbers

. . . In fact, we know that at least one midpoint is quite far from the truth, because there is no way to reconcile the 3.9 million people it says bought exchange policies with the Barack Obama administration’s official data showing that 7.3 million had selected exchange plans by the end of March. Even if we factor in the three days the survey missed -- which saw a titanic surge in enrollments -- and even if we assume that only 80 percent of the people who selected a plan have actually paid for it, 3.9 million is too small. Well before data collection ended, the administration had already announced that plan signups had hit 6 million. Even with attrition of 20 percent, that should still have yielded 4.8 million marketplace policies in the RAND study. And indeed, 4.8 million is within its margin of error, though at the very high end.

Eventually, some of these questions will be resolved; we will know how many exchange policies are in effect and how many newly eligible people went on Medicaid, because the administration needs to know that number in order to pay for them. Until then, the best data set we have is this puzzling but useful study.

Admitting to uncertainty is the greatest (and rarest) form of scholarship.