Thursday, July 16, 2015

Insuring Future Obamacare Schadenfreude

Stuff accumulates while you're not looking.

Salon shocked that Obamacare fails to control healthcare costs as promised:

Obamacare’s Bill Is Due - And thanks to skyrocketing premiums, you could be the one paying it.
Now that the Supreme Court has once again saved Obamacare, can we have an honest talk about it?
 Since your side has been lying from the get go, you first.
 The bill for the health care expansion is coming due, just as the recipients will be heading to the ballot box to vote in the first primaries for the 2016 election. More than a few are likely to be annoyed.
So it's a political problem for democrats? Good. It should be.
Last week Oregon’s insurance commissioner, Laura Cali, announced that the state had approved a 25 percent premium increase for the largest health insurer on the state’s exchanges. The second largest insurer did even better: It received permission to boost its monthly charge to consumers by 33 percent.

Oregon might be the first health insurance exchange equivalent of a penguin getting shoved off an ice floe, but it won’t be alone in the freezing-cold waters for long. For example, BlueCross BlueShield of Tennessee requested an average 36 percent price increase for the plans it offers—after receiving a 19 percent bump last year. And that sounds like a relative bargain compared with Minnesota and New Mexico, where the BlueCross BlueShield family is looking for increases of more than 50 percent. Even if the final numbers are lower than the asks, it seems quite likely these states will approve substantive premium increases.
Of course, the blame falls anywhere and everywhere besides the democrats.
The problem is simple. As Trudy Lieberman reported this month in Harper’s, the ACA made a decent stab at solving the problem of Americans lacking insurance. Unfortunately, the bargain struck to get the bill to a point where lobbyists for the hospital, insurance, and pharmaceutical industries to sign on, or at least not fight it, did not adequately address the issue of overall medical costs.
There's some truth here, but the fact is you were never going to push millions of poor and unhealthy people into coverage, cover pre-existing conditions and add new services (free birth control for example), without raising the overall costs of health care. To pretend otherwise was always a delusion.

Speaking of the insurance companies, Former Obamacare chief to lead top insurance lobby
The former chief of Medicare and Medicaid, who was responsible for overseeing the implementation of President Obama's healthcare law, will lead the insurance industry's top lobbying group.

Marilyn Tavenner, who in February stepped down from her role as chief administrator of the Centers for Medicare and Medicaid Services, will become the new head of America's Health Insurance Plans, which represents dozens of U.S. insurers.

AHIP's board of director unanimously elected Tavenner AHIP president on Wednesday, the group announced.

"There is no better individual than Marilyn to lead our industry through the increasingly complex health care transformation that is underway," said AHIP board chairman Mark Ganz in a statement.
You might recall that Tavenner was at the center of the disaster which was the roll out of Obamacare:
Tavenner, who's been with CMS since 2010, played a major role in the implementation of President Barack Obama's health-care law. Her agency wrote many of the new rules putting the Affordable Care Act in place and oversees the new health insurance exchanges created by the law. Tavenner was at the center of the disastrous rollout of in fall 2013, apologizing to Congress for the faulty enrollment Web site's performance.

Tavenner's email to staff didn't explain why she's stepping down. She faced another embarrassment in November, when she acknowledged that CMS had mistakenly inflated Obamacare enrollment by about 400,000 last summer because the agency included people who had bought stand-alone dental plans on the health insurance exchanges.
Failing upwards. But she probably at least knows where the bodies are buried.

This is probably her doing as well: GAO: Uh, has no real way to detect fraud
Now, we have reports from the Government Accountability Office that has no mechanisms to “detect fraud,” as phony applicants arranged by GAO investigators were reenrolled in 2015 with larger subsidies for their premiums (via AP):
Phony applicants that investigators signed up last year under President Barack Obama’s health care law got automatically re-enrolled for 2015. Some were rewarded with even bigger taxpayer subsidies for their insurance premiums, a congressional probe has found. The nonpartisan Government Accountability Office says 11 counterfeit characters that its investigators created last year were automatically re-enrolled by In Obama’s terms, they got to keep the coverage they had.
Six of those later were flagged and sent termination notices. But GAO said it was able to get five of them reinstated, by calling’s consumer service center. The five even got their monthly subsidies bumped up a bit, although GAO did not ask for it. The case of the sixth fake enrollee was under review. does not appear to be set up to detect fraud, GAO audits and investigations chief Seto Bagdoyan said in prepared testimony for a Senate Finance Committee hearing Thursday. A copy was provided to The Associated Press.’s document-processing contractor “is not required to seek to detect fraud,” said Bagdoyan. “The contractor personnel involved in the document-verification process are not trained as fraud experts and do not perform antifraud duties.”
They have no reason to try to detect fraud when the metric is the number of people "covered."

Just your daily reminder that Medicaid is a ‘humanitarian catastrophe’
I’m sure most of you already know this, but Medicaid expansion–a critical component of Obamacare–is an abject disaster. In Virginia, almost a quarter of doctors aren’t accepting new Medicaid recipients–and those already enrolled into this government-run health care program experienced no improvement in care.

So, how is this a good blueprint for the rest of the country? Well, as you know, it isn’t–and the figures get worse regarding who is actually receiving care under this government program. As the Foundation for Government Accountability reiterated during their conference in June, there are still a lot of misconceptions about Medicaid expansion.

For starters, let’s go over the talking points (again).
First, it’s not “free money;” the federal debt is projected to grow over $26 trillion dollars over the next decade.

Second, there is no flexibility whatsoever with Medicaid expansion. Nicholas Horton, FGA’s Policy Impact Specialist, noted that the Obama administration holds all the cards.

Third, the costs are easy to predict. This is a government program; need I say more.
. . .
Medicaid was meant to provide health care to low-income families and individuals, but since it became incorporated into the Obama administration’s ACA arsenal, it’s now taking resources from the truly destitute and subsidizing childless, able-bodied Americans since eligibility has been increased. Oh, and some convicts are getting a nice ride on the government’s dime . . .
And for all the cost, it doesn't even help the people it's supposed to help:
 Lastly, when it comes to overall care, Forbes’ Avik Roy has described Medicaid as a “humanitarian catastrophe” in 2011. For starters, on average, those who enrolled in Medicaid actually fare worse than Americans who remain uninsured.
Last July, I wrote about a landmark study conducted at the University of Virginia that found that surgical patients on Medicaid are 13 percent more likely to die than those without insurance of any kind. The study evaluated 893,658 major surgical operations from around the country from 2003 to 2007, and normalized the results for age, gender, income, geographic region, operation, and 30 background diseases.

Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.

Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.
But the administration is resting happy this week, after they beat the nuns: Denver's Little Sisters of the Poor lose contraception coverage ruling
The Denver-based Little Sisters of the Poor, who sued to avoid complying with the Obamacare contraception mandate, lost Tuesday in the 10th Circuit Court of Appeals, which ruled it must allow employees to have contraception coverage.

Little Sisters challenged the process it must follow to get out from under the contraception mandate but failed, the court decided, to show a substantial burden on the exercise of its religion.

The Affordable Care Act requires employers who provide health insurance coverage to include benefits for preventive care, including contraception, without cost to their insured employees.
The federal government adopted a regulation that exempts religious employers, such as churches, hospitals, universities, charities and other service providers such as the Little Sisters of the Poor, from covering contraceptives they oppose on religious grounds. However, these groups must actively seek an exemption. A third party then steps in to cover contraceptives for employees.
. . .
The court said the sisters must provide the health benefit, or actively apply for the exemption or pay IRS penalties. The court rejected the claim that complying with the law makes them "complicit" in delivery of contraception.

The Little Sisters' attorneys said they are reviewing the court's decision and considering whether to seek relief from the Supreme Court.

Last year, the Supreme Court ruled 5-4 in favor of Hobby Lobby, a closely held, family-owned corporation that argued providing contraception coverage for its workers violated its religious beliefs.

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