Thursday, October 30, 2014

A Little More Obamacare Schadenfreude

A few accumulated Obamacare Schadenfreude articles.

Over 214,000 Doctors Opt Out of Obamacare Exchanges
Over 214,000 doctors won't participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows. That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It's also about a quarter of thetotal number of 893,851 active professional physicians reported by the Kaiser Family Foundation.

In January, an estimated 70% of California's physicians were not participating in Covered California plans.

Here are some of the reasons why:
  1. Reimbursements under Obamacare are at bottom-dollar - they are even lower than Medicare reimbursements, which are already significantly below market rates. "It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60," a study by the think-tank American Action Forum finds. "For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California's Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent."
  2. Doctors are expected to take on more patients to make up for the lost revenue, but that's not happening, because primary care doctors already have more patients than they can handle. "Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the PCPs time at lower pay," says the study.
  3. The study also points to two reasons that doctors might not get paid at all:  An MGMA study indicates that 75% of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they will get stuck with the bill.
  4. HHS requires that insurers cover customers for an additional 90 days after they have stopped paying their premiums: the insurer covers the first 30 - but, it's up to the doctor to recoup payment for the last 60 days. This is thenumber one reason providers are opting to not participate in the exchange plans. Currently, about a million people have failed to pay their premiums and had their plans canceled.
How long before the democrats try to force doctors to participate?

Death spiral? Short-term health plans grow as cheap alternative to ObamaCare
A fast-growing, short-term alternative to ObamaCare that allows customers to get cheap, one-year policies could put the government-subsidized plan into a death spiral.

The plans, the only ones allowed for sale outside of ObamaCare exchanges, generally cost less than half of what similar ObamaCare policies cost, and are increasing in popularity as uninsured Americans learn they are required to get health coverage. The catch -- that the policies only last for a year -- is not much of a deterrent, given that customers can always sign up for ObamaCare if their short-term coverage is not renewed.
Moreover, even the Obamacare policies, and indeed, the "long-term" policies available through employees change terms yearly.
“Applications rose 30 percent compared to last year,” Enrollment Specialist Carrie McLean told

Other providers said they also see rapid growth in the plans, which have a typical monthly premium of just over $100, compared to traditional plans that cost an average of $271.

“It’s because the product is typically half the cost of ACA plans, and you can chose any doctor or hospital,” Health Insurance Innovations CEO Mike Kosloske told
Obamacare, the perfect, expensive, governmental mandated solution for a problem that didn't exist.

And in a sign of their continued support of transparency, the Obama administration is encouraging Obamacare insurers to hide their enrollment statistics: Insurers’ Consumer Data Isn’t Ready for Enrollees
With health insurance marketplaces about to open for 2015 enrollment, the Obama administration has told insurance companies that it will delay requirements for them to disclose data on the number of people enrolled, the number of claims denied and the costs to consumers for specific services.

For months, insurers have been asking the administration if they had to comply with two sections of the Affordable Care Act that require “transparency in coverage.”

In a bulletin sent to insurers last week, the administration said, “We do not intend to enforce the transparency requirements until we provide further guidance.” Administration officials said the government and insurers needed more time to collect and analyze the data.

“We expect this will begin after a full year of claims data is available,” said Aaron Albright, a spokesman at the Centers for Medicare and Medicaid Services, when asked about the government’s eventual plan to enforce the transparency requirements.

Consumer advocates said they were disappointed because the information would be helpful to millions of consumers shopping for insurance in the open enrollment period that starts on Nov. 15. The data will not be available before the enrollment period closes on Feb. 15.
When the government goes out of its way to hide the data, it's a pretty good bet that it's not favorable.

Obamacare’s drip-fed success: The longer the health system stays in existence, the harder it will be to repeal
Mr Obama must be sorely tempted to declare “mission accomplished”. Only a year ago Republicans shut down the federal government – and flirted with a default on US sovereign debt – in a bid to stop Obamacare’s launch. Default was averted. But the shutdown coincided with the federal website’s collapse under a plague of glitches. Given his administration’s incompetence, Mr Obama has kept silent. The exchange was eventually fixed. Almost 8m Americans enrolled on it in 2014. That is expected to rise to 13m next year. If you include the impact of Medicaid expansion, there are roughly 10m fewer uninsured Americans than there were a year ago. That number will only grow.

Plenty of Americans still hate the law. US healthcare is complex and expensive. It is also unfair. Mr Obama has made it less unfair but added to its complexity and it will not be clear for years whether he has made it less expensive. The White House trumpets the fact that US healthcare inflation has dropped from its average of between 5 and 8 per cent a year, to between 2 and 3 per cent annually since 2010 when the ACA was passed. If this lower rate were sustained, most of America’s long-term deficit problems would vanish. Medicare and Social Security would stay solvent for decades longer.

Yet much of the disinflation is a result of the Great Recession, which has forced Americans to tighten belts. Some of it is also demographic. Only a portion comes from the impact of Obamacare. It is far too early to claim America has overcome its healthcare exceptionalism. It still spends more than twice as much on healthcare per head as the UK with worse outcomes. US life expectancy is lower than Britain’s while its under-five mortality rate is higher. It will take more than the ACA to turn that around.

Mr Obama’s signature law is also riddled with loopholes. For example, it requires businesses to offer insurance only to full-time employees. Last week Walmart dropped 30,000 from its coverage because they work for less than 30 hours a week. It also exempts small businesses – those with fewer than 50 employees – from the mandate. Many Americans have been forced to drop plans that they liked. And so on.

But there is the rub. Obamacare offers great room for improvement and it remains unloved by most of the US electorate. Yet a majority also increasingly values big chunks of it. “Repeal Obamacare” still has great punch with the Republican base. But “reform” is more in tune with the drift of public sentiment. In time, that is where reality is likely to go.
You don't "reform" Ebola. You starve it to death by denying it fresh victims, either by isolating the sick, or with a vaccine.

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