Saturday, January 17, 2015

Obamacare Schadenfreude for 1/17/15

A few more accumulated items of Obamacare Schadenfreude:

Apparently content with her supporting role in the destruction of the American healthcare system: Top ObamaCare official stepping down
The leader of the agency charged with the ObamaCare rollout is stepping down after five years on the job.

Marilyn Tavenner, administrator of the Center for Medicaid and Medicare Services (CMS), announced her departure Friday, which will take effect next month.

"It is with sadness and mixed emotions that I write to tell you that February will be my last month serving as the administrator for CMS," Tavenner wrote in an email to staff.
. . .
Republicans on the House Oversight Committee last month grilled Tavenner about the miscount, which had helped push the first-year enrollment total for ObamaCare past 7 million — a milestone that was celebrated by the administration at the time.

Tavenner said some figures were “inadvertently” double-counted, an explanation that was greeted with deep skepticism from Rep. Darrell Issa (R-Calif.), whose staff identified the error.
No word on what Ms. Tavenner will do next, but if Beltway tradition is to be  maintained, she'll probably move to a sweet, well paid NGO gig for a few years before re-appearing in the public eye as the prime mover in another debacle, like that other "Mistress of Disaster," Jamie Gorelick.

Coming soon to a workplace near you: 'wellness or else'
NEW YORK (Reuters) - U.S. companies are increasingly penalizing workers who decline to join "wellness" programs, embracing an element of President Barack Obama's healthcare law that has raised questions about fairness in the workplace.

Beginning in 2014, the law known as Obamacare raised the financial incentives that employers are allowed to offer workers for participating in workplace wellness programs and achieving results. The incentives, which big business lobbied for, can be either rewards or penalties - up to 30 percent of health insurance premiums, deductibles, and other costs, and even more if the programs target smoking.

Among the two-thirds of large companies using such incentives to encourage participation, almost a quarter are imposing financial penalties on those who opt-out, according to a survey by the National Business Group on Health and benefits consultant Towers Watson (For graphic see

For some companies, however, just signing up for a wellness program isn't enough. They're linking financial incentives to specific goals such as losing weight, reducing cholesterol, or keeping blood glucose under control. The number of businesses imposing such outcomes-based wellness plans is expected to double this year to 46 percent, the survey found.

"Wellness-or-else is the trend," said workplace consultant Jon Robison of Salveo Partners.
I remember well the Smithsonian's "wellness" program. Once a pair of overweight slobs from downtown came out to direct a "wellness" walk through the woods. However, the route was too rough for them, and besides. . . bugs! We did get free T-shirts out of the deal once in while, as well as constant email nags. But at least they didn't have an "or else" attached.

GOP tactics on ObamaCare move away from full repeal
In the past, some conservatives objected to any ObamaCare bills that fell short of full repeal. They argued it was impossible to fix the flawed legislation by doing anything other than fully repealing it.
No more.

When the newly GOP-controlled Senate votes on its first anti-ObamaCare legislation in the next few weeks, none of its members is expected to block the bills, according to aides and lobbyists familiar with discussions.

“I’m guessing that they’ve had this ‘squirrel finds a nut’ moment of reasonableness,” one Senate GOP aide said.

The party remains far from consensus on how to handle the law, but threats from the its far-right members have largely faded as members look to show a GOP Congress can govern ahead of 2016, when the party hopes to retake the White House.

“If we can show that we can lead, we might get an even bigger majority in 2016. We might get the White House,” the aide said. “Republicans can say, ‘See, we were right? Put us in charge, and we’ll repeal the whole damn thing.’ ”

The change in tone can be seen even among hard-line Republicans, including Sen. Ted Cruz (R-Texas), who recently said he wanted to fix the “most onerous” pieces of the Affordable Care Act.
Full repeal, of course, is impossible without veto proof majorities in both the House and Senate, so if anything can be done before the next election it will have to be incremental, and get significant approval from democrats. I don't see what's wrong with acknowledging political realities.

Even the WAPOs new lefty bloggeress is on board with making big changes in Obamacare. Catherine Rampell: Obamacare’s employer mandate must go
Republicans are right: The employer health insurance mandate is dumb.

But gently rejiggering it, as the GOP is trying to do, is not the solution. The mandate should instead get full death-panel treatment and be euthanized once and for all.

The employer mandate is one of the most contentious provisions of the United States’ most contentious law, the Affordable Care Act. Intended to help workers retain their health plans and encourage more employers to pitch in as part of the national effort to expand coverage, it works by requiring large firms to offer full-time staffers health insurance or else pay penalties.

Initially, the mandate applied to businesses with at least 50 full-time-equivalent workers, and full-time work was defined as at least 30 hours a week. Such sharp cut-offs detonated a wave of threats that unhappy employers would chop hours and staffing levels to avoid triggering penalties. The employer mandate — like other policies that incentivize employers to provide insurance — distorts the labor market in other, subtler ways, too, by putting downward pressure on wages (as employers offset the costs of health benefits) and rendering older workers less attractive (since they consume more health care).

The provision soon became the right wing’s poster child for all the ways Obamacare was both anti-business and anti-worker.

Aware of these political and economic toxicities, the White House delayed and watered down the mandate multiple times, leading many analysts to wonder whether it would ever fully go into effect.
Support like that has given "repeal" holdouts  hope: Wimping Out on Obamacare?
Republicans have now won two Obamacare elections, the first in 2010 and the second in 2014. (In 2012, their presidential nominee chose not to engage on the issue.) In the lead-up to their latest victory, Republicans ran far more ads against Obamacare than either party ran for or against anything else. Voters responded by giving the GOP 9 more Senate seats and 13 more House seats. The one candidate who ran on a genuine alternative to Obamacare, Ed Gillespie in Virginia, almost pulled off the upset of the night. Predicted by polls to lose by nearly ten percentage points, he lost by less than one.

One would think such resounding results would have given Republicans renewed confidence in pursuing repeal and reinvigorated interest in uniting behind a conservative alternative to pave the way to that repeal. One would expect the election to have reaffirmed the party’s long-held position that the “comprehensive,” 2,700-page overhaul of American medicine shouldn’t be “tweaked,” “fixed,” or “repaired,” but comprehensively repealed. That is, after all, what rank-and-file Republicans and a great many independ-ents surely had in mind when they cast their ballots for GOP candidates.

Unfortunately, the early signs suggest that House and Senate Republican leaders think voters sent them to Washington to make Obamacare better—on the margins, in ways that appeal to corporate interests. At a time when neither political party is doing a very good job of standing with everyday Americans, Republicans appear to be listening to the lobbyists of K Street rather than the voters on Main Street.
There's no shame in accepting and adapting to the real world. There's simply no way to repeal Obamacare in the next two years. Move on to fixing the worst aspects.

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