Quote:

 

But then CoOportunity hit a kind of perfect storm, says Peter Damiano, director of the University of Iowa's public policy center. First, the co-op had to pay a lot more medical bills than those in charge expected.

"CoOportunity Health's pool of people was larger than expected, was sicker than expected," Damiano says. "So their risk became much greater than the funds that were available."

The reason the co-op's customers were sicker has a lot to do with what the insurance market looked like in Iowa before Obamacare. The largest insurer by far in the state was and still is Wellmark. But Wellmark decided not to offer any plans on Iowa's health exchange, leaving just CoOportunity and one other insurer — Coventry — offering plans on the exchange throughout the state.

On top of that, when the Obama administration in late 2013 allowed people to keep the insurance plan they already had, many customers happy with Wellmark stayed put. Damiano says this meant many of the customers who flocked to CoOportunity tended to be like Fairchild — people with expensive health problems who'd had trouble paying for insurance before, in the market Wellmark dominated.

longstop

Jan 14 2015, 10:25 AM

The UK NHS

Health Care Rationing: ‘Secret’ British NHS Trust Policy Won’t Send Ambulances to Terminally Ill Patients

http://pjmedia.com/tatler/2015/01/13/health-care-rationing-secret-british-nhs-trust-policy-wont-send-ambulances-to-terminally-ill-patients/

LTC8K6

Jan 14 2015, 03:48 PM

Iowa Obamacare Insurer’s Collapse Could Leave Customers On The Hook For Thousands

http://dailycaller.com/2014/12/29/iowa-obamacare-insurers-collapse-could-leave-customers-on-the-hook-for-thousands/


Health Insurance Startup Collapses In Iowa

http://www.npr.org/blogs/health/2015/01/14/376792564/health-insurance-startup-collapses-in-iowa

Quote:

 

But then CoOportunity hit a kind of perfect storm, says Peter Damiano, director of the University of Iowa's public policy center. First, the co-op had to pay a lot more medical bills than those in charge expected.

"CoOportunity Health's pool of people was larger than expected, was sicker than expected," Damiano says. "So their risk became much greater than the funds that were available."

The reason the co-op's customers were sicker has a lot to do with what the insurance market looked like in Iowa before Obamacare. The largest insurer by far in the state was and still is Wellmark. But Wellmark decided not to offer any plans on Iowa's health exchange, leaving just CoOportunity and one other insurer — Coventry — offering plans on the exchange throughout the state.

On top of that, when the Obama administration in late 2013 allowed people to keep the insurance plan they already had, many customers happy with Wellmark stayed put. Damiano says this meant many of the customers who flocked to CoOportunity tended to be like Fairchild — people with expensive health problems who'd had trouble paying for insurance before, in the market Wellmark dominated.

Quote:

 

http://www.desmoinesregister.com/story/news/2014/12/24/cooportunity-health-taken-iowa-insurance-division/20856151/

CoOportunity Health falters, taken over by state

CoOportunity Health, a fledgling Iowa health insurance company set up under the Affordable Care Act, has been taken over by state regulators and could soon go under, officials said Wednesday.

CoOportunity Health is an insurance cooperative, which was set up to give consumers and small businesses an alternative in a market with few choices. The company has received about $146 million in federal money under the Affordable Care Act, also known as Obamacare.

Insurance Commissioner Nick Gerhart said that CoOportunity Health has about 120,000 members in Iowa and Nebraska, and saw its available money drop from $47 million to $17 million from Oct. 31 to Dec. 12.
[...]

Quote:

 

http://kaiserhealthnews.org/news/health-law-test-to-cut-readmissions-lacks-early-results/

Health-Law Test To Cut Readmissions Lacks Early Results

Obama administration officials have warned that ambitious experiments run by the health law’s $10 billion innovation lab wouldn’t always be successful. Now there is evidence their caution was well placed.

Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmissions produced significant results compared with those from sites that weren’t part of the $300 million program, according to partial, early results. The closely watched program is one of many tests to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act.

Dozens of community agencies on aging, from Ventura County, Calif., to southern Maine were offered money to try to ensure that seniors leaving the hospital received care that reduced their chances of being readmitted within a month.

But an early evaluation found that only four groups out of 48 that were studied in the Community-based Care Transition Program significantly cut readmissions compared with those of a control group.

At the same time, 29 groups have either withdrawn from the program or been terminated by the Department of Health and Human Services for failing to achieve targets, agency officials said. The CCTP project, which has grown since the evaluation was done, now has 72 participating sites that administration officials hope will still produce readmission reductions and lessons in post-hospital care in return for the investment.

[...]

Quote:

 

http://blogs.wsj.com/washwire/2015/01/14/republicans-consider-reconciliation-in-taking-on-health-law/

Republicans Consider ‘Reconciliation’ in Taking on Health Law

Republicans head to an annual retreat this week wrestling with a subject that many within the caucus have preferred to avoid: whether to use a divisive procedural tool to attempt to repeal President Barack Obama‘s signature health law.

On Thursday, the chairmen of the six relevant committees–Senate Finance, Senate Commerce, and the Senate Health, Education, Labor and Pensions committees, and their House counterparts–will headline a panel discussion about health policy.

Republican opposition to the health-care law is not the issue – most of them are in agreement on that point. The question involves whether to use a politically divisive procedural tactic known as budget reconciliation to repeal the Affordable Care Act. The technique would allow Senate Republicans to drive through a repeal with a simple majority instead of the 60 votes necessary for most legislation to clear Senate procedural hurdles.

The reconciliation process is fraught with controversy, though both parties have used it to their advantage – and to pass major pieces of legislation. While it was designed to reconcile tax and spending legislation with the overall annual budget, it came over time to be used to enact more overtly political agendas.

Whatever the method, the notion of targeting the health law is a touchy one for many Republicans because it brings back memories of October 2013, when a Republican push to defund the law ended in a government shutdown. At the same time, it’s unavoidable for many Republicans because they vowed as candidates to do everything within their power to eliminate the law.

“I hope that every Republican follows through on the promises we made to the voters, and that is certainly what I am going to be urging our leadership to do,” said Sen. Ted Cruz (R., Texas), who led the 2013 charge to defund the health law and plans to attend the retreat.

Earlier this week, Mr. Cruz said at a Heritage Foundation event that Republicans “will get walloped” in the elections if they fail to deliver on the pledge to get rid of the health law.

Some of his fellow Republicans see it a little differently. Senate Commerce Chairman John Thune (R., S.D.) has proposed using reconciliation to drive through an overhaul of the tax code, and says that “it would awfully be hard to do both” a tax overhaul and a repeal of the health law.

House Speaker John Boehner (R., Ohio) has called for delaying the decision, saying that lawmakers should learn about the procedural maneuver before deciding whether and how to use it.

“Seventy-five percent of Congress has no idea what reconciliation is,” Mr. Boehner told reporters on Tuesday. “So there’s a lot of education that has to go on. At some point, we’ll decide if we’re going to have reconciliation. And if we do, we’ll make some decision much later on.”

Conservatives say there is urgency to act because the rhythms of political life offer only a small window of opportunity for using reconciliation to end the health law.

“It’s either now or never,” said Rep. Tim Huelskamp (R., Kan.), who plans to attend the retreat. He said that reconciliation was “the only way to do it,” but that Republicans needed to act this year because “next year we’ll say it’s too late and it’s too close to the election.”

Those making this argument have one point in their favor: Democrats used reconciliation to get the health law passed five years ago.

Quote:

 

http://www.latimes.com/business/la-fi-obamacare-unitedhealth-20150116-story.html

California rejects UnitedHealth's bid to sell Obamacare statewide

California's Obamacare exchange rejected a bid from the nation's largest health insurer to start selling coverage statewide next year..

The Covered California board adopted new rules Thursday that sharply limit where industry giant UnitedHealth Group Inc. could offer policies to individuals.

Many consumer advocates backed the exchange's decision. But California Insurance Commissioner Dave Jones panned it, saying Californians deserve more choice and competition statewide.

Covered California's move to limit UnitedHealth could be a boost to the four largest health insurers already in the exchange. Led by Anthem Inc., they accounted for 94% of state enrollment in the first year.

The earliest UnitedHealth could sell statewide is now 2017. Covered California's decision came Thursday afternoon, and the company didn't comment on its immediate plans.

UnitedHealth had a chance to join Covered California when it launched in the fall of 2013 as part of the health-law rollout. Instead, the company exited California's individual insurance market and bypassed most of the Obamacare exchanges nationwide.

Peter Lee, executive director of Covered California, said established insurers shouldn't be free to come in right away. Those insurers, he said, should not be allowed to undercut rivals who stepped up at the start and made significant investments to sign up 1.2 million Californians during the first open enrollment.

Thursday, the state said more than 228,000 people had newly enrolled since Nov. 15, when the latest open enrollment began. It ends Feb. 15.

"United or other plans that were in the market in 2012 should have a higher bar" to joining the state exchange, Lee said. "We think the health plans that helped make California a national model should not be in essence undercut by plans that sat on the sidelines."
The 'more equal' rules for some!

The board's newly adopted rules said UnitedHealth and other insurers that were operating prior to the health-law rollout are allowed to serve in only five of the state's 19 regions where there are fewer than three health plan choices.

Those areas are predominantly rural counties in Northern California, but they also include areas of Santa Barbara and San Luis Obispo counties.

Newly licensed health plans could apply to sell anywhere in the state. New York start-up Oscar Insurance Corp. fits that description, and it has expressed interest in selling policies in Covered California starting next year.

Insurers must notify the exchange of their interest for selling in 2016 by Feb. 16. It's up to Covered California whether to allow companies into its state-run marketplace.

Insurance chief Jones has repeatedly criticized the exchange for a lack of insurers in some areas. He reiterated that concern in an interview Thursday and said Covered California was favoring its existing insurers at the expense of consumers.

"Covered California's decision to substantially restrict where new health insurers can sell in 2016 protects the big health insurers' market share and hurts consumers by denying them additional choices," Jones said. The exchange "ought to be encouraging, not discouraging, new insurers to come in."

[...]

Quote:

 

http://www.cnsnews.com/news/article/susan-jones/burwell-obamacare-enrollment-we-have-ways-go

Burwell on Obamacare Enrollment: 'We Have a Ways to Go'

With one month of open enrollment left, almost 6.8 million people have either re-enrolled or newly enrolled in the federal Obamacare exchange, Health and Human Services Secretary Sylvia Mathews Burwell told a gathering in Washington Thursday.

"We have a ways to go," she admitted. "It's a short period of time to reach the 9.1 million," which is the goal Burwell set for this year's sign-up. Open enrollment for 2015 began on Dec. 15 and ends on February 15.

"So, every day we are working hard against that," Burwell said. "This is a week of Latino action, firmly focused on that group, and we're going to continue to focus across the populations that we're trying to reach."

HHS recently announced that 87 percent of people who selected 2015 plans through HealthCare.gov in the first month of open enrollment received financial assistance to lower the cost of their premiums.

Burwell said she's "out there traveling quite a bit, to different places" as part of the effort to "meet the consumer where they are" and give them the information they need to sign up at HealthCare.gov, which serves 37 states.

Asked about the "next steps" for Obamacare, Burwell said she's most focused right now on having a successful open enrollment. She also mentioned Medicaid expansion, which is up to each state; and "delivery system reform," which involves the way providers are paid (moving away from "fee for service" to "accountable" care).

She also told the group she's focused on reducing deaths from substance abuse and overdoses:

"For millions of Americans who rely on prescription pain killers, known as opioids, that are prescribed to them by their doctors, these drugs can be the difference between constant chronic pain or welcome relief. However, these drugs can be deadly," Burwell said. She noted that in 2009, drug overdoses overtook every other cause of injury death in the United States, outnumbering fatalities from car crashes for the first time.

"Meanwhile, in 2012 alone, 259 million opioid prescriptions were written. That's enough for every American adult to have a bottle. Rural America, including my home state of West Virginia, knows the tragedy of this issue all too well.

Burwell said the Obama administration wants to work with Congress in finding way to drive down opioid dependency.

"We have an opportunity to work together on improving opioid prescribing practices by enhancing prescription monitoring, data sharing, and clinical decision making. We also want to incentiv(ize) the development of abuse deterrent opioids, and expand the utilization of Naloxone, a drug that used to reverse overdoses. And there's more we can do together in the realm of medication assisted treatment, to help those who are addicted break that cycle."