Some Obamacare Schadenfreude for Tuesday

Just cleaning out the Obamacare refrigerator again. It was starting to grow mold.

27.49% of Everyone's Tax Bill Is Spent on Health Care

In 2010, the year Obamacare passed and was signed into law, the healthcare percentage was 24.10. The following year, 2011, it dropped to 23.7 percent, and in 2012 dropped still further to 22.45 percent. After this, however, the trend sharply reversed. In 2013 the healthcare share jumped to 25.19 percent, and the latest numbers posted this week for 2014 show the highest proportion yet at 27.49 percent, a full 22 percent increase over 2012. This means that for every dollar a taxpayer pays in 2014, an additional nickel is going to pay for healthcare that had been spent elsewhere in 2012. Presently, over 27 cents on every dollar is spent by the federal government on health care, primarily Medicaid and Medicare.

Using simple math, akin to the projection of global warming, we can easily see that by the year 2050, health care will be using 100%+ of our GDP. Fortunately, the Chinese make good male nurses...

How Five Republicans Let Congress Keep Its Fraudulent Obamacare Subsidies

The rumors began trickling in about a week before the scheduled vote on April 23: Republican leadership was quietly pushing senators to pull support for subpoenaing Congress’s fraudulent application to the District of Columbia’s health exchange — the document that facilitated Congress’s “exemption” from Obamacare by allowing lawmakers and staffers to keep their employer subsidies.

The application said Congress employed just 45 people. Names were faked; one employee was listed as “First Last,” another simply as “Congress.” To Small Business Committee chairman David Vitter, who has fought for years against the Obamacare exemption, it was clear that someone in Congress had falsified the document in order to make lawmakers and their staff eligible for taxpayer subsidies provided under the exchange for small-business employees. . .

Shame. . .

Megan McArdle paints a dim view of Life Under Obamacare

What will the insurance market look like under those conditions? We can sketch some broad probabilities:

• If most of an insurers' customers are subsidized, pressure on prices will come from the government rather than consumers. . . Regulators will care a lot about price and specific metrics, not a lot about the actual preferences of consumers. So mandatory birth control may stay while ability to see a doctor in a timely manner may suffer. Insurers have already used up one of the easiest tricks, cutting pricey teaching hospitals out of their networks. It will be interesting for health wonks, but potentially painful for consumers, to see what goes next.
• Larger insurers are more likely to stay in the market. We've already seen a few insurers fail or exit, and they tend to be smaller ones -- start-up co-ops, or this elderly Wisconsin firm. This makes pretty good sense. .  .To the extent that Obamacare really does break the link between employment and insurance, as many advocates have dreamed, and employers start shifting their workers into exchange policies, HHS will be asking insurers to cannibalize their profitable sales for unprofitable ones.
• Writing exchange policies will be a riskier business. Thanks to the law of large numbers, bigger insurance pools are more stable and profitable insurance pools. . .  A smaller market means more risk -- and remember that the millions of people who have bought exchange policies are not in a single market, but are scattered across a lot of regional markets? You, the consumer.
• The exchanges will require continued infusion of state funds, or high fees. Exchanges enjoy considerable economies of scale, which allow you to amortize hardware and development costs across lots and lots of policies. Size is no guarantee that an exchange can cover its costs, of course. Even Covered California is far from being self-sustaining. But the smaller the insurance pool, the more subsidies the exchanges will require.
• The exchanges will be more politically vulnerable. If exchanges are mostly a transfer to low-income groups -- and so far, that's what they are -- rather than the broad middle-class program that was sold to the public, that will eventually become clear to voters. Those voters will look at the money being transferred from their pockets and into insurance subsidies, and ask whether those subsidies couldn't be trimmed a bit.
• The subsidy caps could put the whole market at risk. . .starting in 2019, if exchange subsidies exceed 0.54 percent of GDP, the subsidy formula shifts, so that future increases in subsidies are pegged to consumer price index -- which means that consumers would have to pay more out of pocket, and the taxpayers' risk would shrink. Of course, this is very speculative, because we don't know what health care costs will look like, and a smaller pool could mean that total subsidy payments would be lower, even if per-capita spending continued to rise.

Overall, I think that this is a real potential threat to the future of the insurance market. But as yet, it is only a highly speculative threat. We'll know more as the risk-adjustment programs begin to expire, insurers get more experience in setting rates, and states begin to publish more data on what insurers plan to charge.

That was quick: After Expanding Under Obamacare, This 123-Year-Old Insurance Company Is Closing Its Doors

After expanding to do business on the Affordable Care Act’s exchanges last year, a Wisconsin-based health insurance company founded in 1892 has announced it will close its doors.

Assurant Inc. announced last week one of its subsidiaries, Assurant Health, an insurance company, will either be sold or shuttered after losing tens of millions of dollars this year. The decision comes 18 months after the implementation of the Affordable Care Act, and industry watchers argue Assurant Health’s end can be attributed to the new health care law.
. . .
In a letter to its shareholders, Assurant Health said it lost money because of a reduction in recoveries under Obamacare’s risk mitigation programs and increased claims on the health care law’s 2015 policies.

House Dems seek repeal of Obamacare tax

A slew of Democratic House members want to repeal a controversial medical device tax in the next few weeks.

The effort, detailed in a letter released Monday, puts more heat on Democratic congressional leaders to support repeal of the tax created to help pay for Obamacare.

"Repealing this harmful tax would be a welcome relief for hundreds of innovative job-creators across the country," said Rep. Scott Peters, D-Calif., on the letter he signed along with 16 other Democrats given to House leaders in both parties.

But before we give them too much credit for trying to fix one of O'care's obvious flaws, they were quick to blame republicans for not acting quickly enough.

Dems to GOP: We’re ready to fix ObamaCare, why aren’t you?

Democrats are chiding Republican leaders in Congress as standing in the way of improvements to ObamaCare that enjoy bipartisan support.

More than a half-dozen proposed changes to the law have approval from at least some Democrats, including legislation to repeal a controversial cost-cutting board for Medicare that gained its 218th co-sponsor this week.

None of the ObamaCare proposals has been taken up by Republican leaders, angering Democrats who say important fixes are being bottled up by the GOP's fixation on full repeal.

“Absolutely, I think there are some things [we’d be willing to change],” said Sen. Chris Murphy (D-Conn.), the leader of the Senate’s "Affordable Care Act Works" campaign. “I am just not confident that Republicans in this Congress are focused on anything other than repeal.. . I think there’s general willingness to sit down and talk. I just don’t think we feel like we have a partner on the other side,” he added.

Democrats are looking to take advantage of a deepening divide within the Republican Party about what to do with President Obama’s healthcare law during his final two years in office, particularly as they await a pivotal ObamaCare decision from the Supreme Court that could strike down insurance subsidies for millions of people.

Remember when the Democrats were fully in charge, and we had to pass the bill to see what was in it? Good Times!

Speaking of poorly written laws: Obama administration clarifies birth control mandate

The guidance issued Monday is intended to eliminate remaining "ambiguity" in the requirements, the Department of Heath and Human Services said. "Today we are clarifying these coverage requirements," HHS Secretary Sylvia Mathews Burwell said.

It also details some other health services insurers must cover at no additional cost. That includes screening and genetic counseling for women more likely to have genetic mutations that increase risk for breast and ovarian cancer, preventive services for transgender patients and preventive services for adult children on their parents' plans.