LTC8K6

Feb 12 2015, 07:31 AM

ObamaCare Co-Ops Headed Toward $2.5 Billion Meltdown

Crony Socialism: Among ObamaCare's many bad ideas was the attempt to create an entirely new industry of nonprofit insurance co-ops. It is fast turning into a huge, multibillion-dollar taxpayer boondoggle.

Created as an alternative to an outright "public option," the co-ops have received $2.5 billion in low-interest loans to help them get started.

Only about 500,000 enrolled in one of the 23 co-ops that ObamaCare spawned, which works out to $17,000 per enrollee, according to an analysis by the Daily Signal, a news site started by the Heritage Foundation.

The loans were supposed to provide the co-ops a years-long cushion to get their premiums right. But even with all this help, one of them — CoOportunity Health — is already insolvent, forcing its roughly 68,000 enrollees in Iowa and Nebraska to switch to other plans.

Just months before it went belly-up, CoOportunity was being hailed "as one of the most successful of the 23 such health-insurance co-ops organized nationally," according to the Des Moines Register.

The Community Health Alliance in Tennessee froze enrollment this January after posting an $8.5 million loss in the first nine months of last year.

These are likely to be the first of many such financial problems. A Standard & Poor's report out this week found that all but five of the co-ops had negative cash flow through Sept. 30, and 11 had bigger loss ratios than CoOportunity.

S&P also found that "medical loss ratios" — the percentage of premiums that go to pay medical claims — were "hopelessly high" for several co-ops, a sign they enrolled too many high-cost patients.

An earlier report from insurance rating firm A.M. Best also found trouble brewing. All but one co-op had operating losses through last September that totaled nearly $244 million. That led A.M. Best to say it "is concerned about the financial viability of these plans."

Now the co-ops are in Washington, "pushing federal officials to make it easier for the nascent plans to get significant private funding to stay solvent," according to Politico Pro.

Among the sticking points is whether the government will go to the back of the line when it comes to collecting on those debts.

Washington needs to pull the plug on this dubious experiment, not waste still more money to keep it on life support.

http://news.investors.com/ibd-editorials-obama-care/021115-738986-taxpayers-could-lose-25-billion-dollars-on-obamacare-created-co-ops.htm

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http://www.latimes.com/business/la-fi-obamacare-enrollment-20150212-story.html
Obamacare sign-ups expected to top 10 million amid sizable expansion

As the deadline for signing up for coverage through the Affordable Care Act approaches Sunday, enrollment in plans provided through the federal health law is on track to expand substantially over 2014..

Nationwide, preliminary tallies from state and federal health agencies suggest sign-ups should top 10 million and will probably go even higher in the final rush this weekend.

That total, though short of independent estimates that had projected 2015 enrollment at 13 million, still signals progress that will probably further drive down the nation's already falling uninsured rate.

Eight million people signed up on marketplaces in 2014 (though the final enrollment tally last year was less than 6.7 million, as some consumers dropped plans or shifted to different coverage through the year and others were dropped because of immigration issues)....

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http://www.wsj.com/articles/thousands-to-lose-health-insurance-over-residency-questions-1423693709
Thousands to Lose Health Insurance Over Residency Questions
Obama Administration to Cut Off Coverage for 200,000 Who Haven’t Proved Legal Residency

The Obama administration is cutting off health-insurance coverage under the Affordable Care Act for 200,000 people who haven’t proved they are legally residing in the U.S....

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http://www.washingtonpost.com/blogs/federal-eye/wp/2015/02/12/veterans-health-federal-it-management-among-governments-top-risks/

Veterans’ health, federal IT management rank among top government risks

Health-care delays for veterans and poorly managed information technology are among the U.S. government’s most pressing problems, federal auditors said Wednesday.

The issues showed up for the first time this year in the Government Accountability Office’s biannual high risk list, which flags federal programs especially susceptible to fraud, waste, abuse and mismanagement.

This year’s report identified 32 areas of concern. Among them was the Department of Veterans Affairs’ $55 billion health network, which was at the center of a nationwide scandal last year involving falsified wait-time data. The GAO suggested that the VA needs to address problems with timeliness and quality of care within the system.

Other issues for the VA include retaliation against whistleblowers, poor staff training, undeserved bonuses, and antiquated computer systems, according to auditors....

LTC8K6

Feb 12 2015, 09:40 AM

It has been the most frustrating experience i have ever had, with more telephone and internet work than I have ever done before, but I think we finally have SHOP coverage for all employees, and we have the veteran situation sorted out.

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http://www.latimes.com/local/lanow/la-me-ln-csu-study-20150209-story.html

Study finds it cheaper for students to buy insurance than go without

As this year’s deadline to sign up for Obamacare fast approaches, California State University officials are trying to show students that buying health insurance makes financial sense.

A new analysis from the CSU Health Insurance Education Project found that half the approximately 445,000 students in the CSU system are able to purchase health insurance for less than they would have to pay in fines for remaining uncovered.....

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http://kaiserhealthnews.org/news/advocates-press-for-uninsured-to-get-special-enrollment-option-after-they-see-tax-penalties/

Advocates Press For Uninsured To Get Special Enrollment Option After They See Tax Penalties

Sunday’s deadline for signing up for health insurance on the exchanges will have long passed by the time many people file their taxes this March and April. But that may be the first time it sinks in for some people that they owe a penalty for not having insurance last year. Consumer advocates want the government to give them a chance to sign up for 2015 coverage after the enrollment deadline.

But federal officials say they’re not making any promises.

“There’s still a lack of awareness about the requirement to have insurance and opportunities for people to get subsidies to make it more affordable,” says Rachel Klein, director of organizational strategy at Families USA, a consumer advocacy group.

Families USA and other consumer groups are urging the government to create a special enrollment period of up to 60 days for uninsured people who file their taxes after open enrollment ends on Sunday.

“This is a great teachable moment,” Klein says. Last year, Families USA advocated aligning the tax filing deadline with the open enrollment deadline.......

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http://www.nytimes.com/aponline/2015/02/12/us/politics/ap-us-health-overhaul.html

As Sign-Up Deadline Nears, a New Risk for Obama Health Law

Thousands of people signing up for health insurance this weekend may not realize it, but their coverage under President Barack Obama's law could be short-lived.

The 2015 enrollment season, which ends Sunday, has avoided last year's website meltdown so far. But a Supreme Court case could result in millions of consumers losing financial assistance for their premiums later in the year.

The Affordable Care Act still sits on shifting political sands.

"This would be devastating," said Nita Carter, who oversees statewide enrollment efforts for UHCAN Ohio, a health care advocacy group. "Without the subsidy, health insurance will be unaffordable for many. If it is unaffordable, then it is not accessible."

The Supreme Court case, called King v. Burwell, is the talk of Washington policy experts. But a recent Kaiser Family Foundation survey found that more than half of Americans have heard "nothing at all" about it and another 30 percent "only a little."

[...]

Two independent estimates say about 8 million people would drop coverage in a chain reaction that would also send premiums zooming for self-pay customers buying individual policies outside of the exchanges. Self-pay and subsidized consumers are in the same insurance pool. Without the subsidies, the healthiest might bail out.

[...]

While predicting victory at the court, Health and Human Services Secretary Sylvia M. Burwell has refused to discuss what backup plans the administration has, if any.

[...]

With the mechanics of sign-up season working relatively well, the administration seems on track to meet its target of 9.1 million people signed up and paying premiums. But with the Supreme Court case hanging over everything, big questions remain.

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http://www.forbes.com/sites/michaelcannon/2015/02/10/king-v-burwell-in-2013-nelson-admitted-he-didnt-know-if-aca-offered-subsidies-in-fed-exchanges/

King v. Burwell: In 2013, Nelson Admitted He Didn't Know If ACA Offered Subsidies In Fed. Exchanges

The plaintiffs in King v. Burwell claim the Patient Protection and Affordable Care Act only offers premium subsidies, as the statute says, “through an Exchange established by the State.” Members of Congress who voted for the PPACA – most recently Sen. Bob Casey (D-PA) and former Sen. Ben Nelson (D-NE) – now swear it was never their intent to condition Exchange subsidies on state cooperation.

Ironically, Casey’s and Nelson’s decision to wade into the King debate demonstrates why, when a statute is clear, courts traditionally assign no weight to what members of Congress claim they intended a law to say – especially if, as here, those claims come after a clear provision has proven problematic. While he claims he never intended to condition subsidies on states establishing Exchanges, Casey repeatedly voted to condition Exchange subsidies on state cooperation, has misrepresented what Congress intended the PPACA to do, and continues to misrepresent the PPACA on his Senate web site. Nelson’s claims about what Congress intended should likewise be taken with a grain of salt. In an unguarded moment in 2013, Nelson admitted that in 2009 he paid no attention to “details” such as whether the PPACA authorized subsidies in federal Exchanges.

All Sides Agree: Casey Supported Conditional Exchange Subsidies

Casey and Nelson exchanged a kabuki-esque correspondence exactly one day before amicus briefs supporting the government were due to be filed with the Supreme Court. Casey asked for Nelson’s recollection of whether, in 2009, Nelson or anyone else suggested the PPACA’s subsidies would only be available in states that established Exchanges. Perhaps more than anyone, Nelson was a pivotal figure in the debate over the PPACA. Not only did he insist on state-based Exchanges rather than a national Exchange run by the federal government, his was the deciding vote that enabled the bill to pass the Senate and become law – and he withheld his vote until his demands were met.

In his letter to Nelson, Casey discussed conditioning Exchange subsidies on state cooperation as if it were a foreign concept:

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• “The plaintiffs in King argue that the law was intentionally designed to deny tax credits to people in states with federally facilitated exchanges in order to “induce” states into operating their own Exchanges…
  
  [A]ccording to the King plaintiffs…residents of a state which did not operate its own Exchange would lose access to premium tax credits intended to ensure that those residents could afford health insurance.
  
  I do not recall you – or any other member of the House or Senate – insisting upon such a structure. I would appreciate any clarification you can offer regarding your role in shaping this important law, as I believe it will be beneficial to the American public and the justices themselves.

Yet conditioning Exchange subsidies on state cooperation is hardly a foreign concept to Casey. In 2009, he supported and voted for another health care bill that even the Obama administration and congressional Democrats acknowledge conditioned Exchange subsidies on state cooperation. That bill was S. 1697, reported by the Senate’s Health, Education, Labor, and Pensions Committee:

[HELP bill passage news video at link]

As Jonathan Adler and I explained in a brief we filed before the district court in King,every Democrat on the Senate’s HELP Committee voted in favor of S. 1697, and therefore in favor of conditioning Exchange subsidies on state cooperation:

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• 1.Sen. Jeff Bingaman (D-NM)
  2.Sen. Sherrod Brown (D-OH)
  3.Sen. Bob Casey (D-PA)
  4.Sen. Chris Dodd (D-CT)
  5.Sen. Kay Hagan (D-NC)
  6.Sen. Tom Harkin (D-IA)
  7.Sen. Jeff Merkley (D-OR)
  8.Sen. Barbara Mikulski (D-MD)
  9.Sen. Patty Murray (D-WA)
  10.Sen. Jack Reed (D-RI)
  11.Sen. Bernie Sanders (I-VT)
  12.Sen. Sheldon Whitehouse (D-RI).

In Casey’s words, then, he himself voted for a bill that “included the threat” that residents of uncooperative states “would lose access to premium…credits intended to ensure that those residents could afford health insurance.”

If you were a judge, what would you consider a better indicator of what Casey actually intended: what he repeatedly voted to enact, or what now he says to influence the courts after the clear language he voted to enact has proved problematic?

[...]

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http://www.latimes.com/business/hiltzik/la-fi-mh-the-lesson-of-louisiana-20150206-column.html

When a state blocks Obamacare, ERs close: The lesson of Louisiana

Baton Rouge, La., is about to lose one of its crucial hospital emergency rooms, and the reason is clear: The administration of Gov. Bobby Jindal has refused to expand Medicaid under the Affordable Care Act, and won't put up any other money to keep the facility open..

Because of the scheduled closure of the ER of Baton Rouge General Medical Center-Mid City, patients needing emergency treatment will have to travel as much as 30 minutes longer to reach the nearest ERs.

Jindal has tried to position himself as the last stalwart Republican opponent of the ACA, but his state's experience shows that his position is folly.

The ACA was designed to encourage states to expand Medicaid--almost entirely at federal expense--as a means of cutting the uncompensated medical care hospitals had been forced to provide for low-income individuals and families. Much of that care has been customarily delivered through the ER. [Yeah, and it was designed to encourage States to establish an exchange!]

In the expectation that Medicaid would pick up the slack, the ACA reduced so-called disproportionate share hospital payments, which went to hospitals serving a large number of the uninsured. So institutions in states that have refused to expand Medicaid, like Louisiana, have faced a double-whammy--they still have to serve a large number of uninsured patients, but they have less money to do so.

The ACA has reduced uncompensated care costs across the board--by $5.7 billion in fiscal 2014 compared with what they would have been otherwise, according to the Department of Health and Human Services. (See accompanying chart.)



But most of that effect is seen in Medicaid expansion states. The crisis has continued for hospitals in non-Medicaid expanding states. The problem is so acute that the Tennessee Hospital Assn. offered to pick up the state's cost of expansion. That wasn't enough: Conservative Republicans who dominate the state legislature on Wednesday voted in committee to kill a compromise plan by Republican Gov. Bill Haslam to expand Medicaid to cover more than 250,000 low-income uninsured adults.

In Baton Rouge, the Mid City ER, which recorded 45,000 patient visits last year, started facing a crisis in 2013, when it inherited the case load from a nearby ER that closed. According to the Baton Rouge Advocate, Mid City's losses were projected to hit $25 million to $30 million this year. The Jindal administration stepped in with a promised infusion of $18 million, but that turned out to be a stopgap aimed at staving off an ER closure threatened last summer. Now the ER is set to close within 60 days.

Jindal, who still evidently harbors fantasies of running for president, deserves blame for the situation. As other GOP governors have seen the light on Medicaid expansion--10 have reached agreements with the federal government recently--Jindal has become ever more obstinate.

He's been pushing his own Obamacare repeal-and-replace plan, which mostly involves eliminating the tax deduction for employer-sponsored health plans and replacing it with a deduction allowing people to buy coverage in the individual market.

Jindal has promoted his plan with a string of distortions about the ACA and the health insurance marketplace that suggest, at best, that he has no idea what he's talking about.

He's left even conservative opponents of Obamacare scratching their heads: Ramesh Ponnuru of National Review said it "shows how not to replace Obamacare." Jindal's plan, Ponnuru observed, would favor higher-income taxpayers while leaving lower-income Americans, those covered by existing exchange plans, and many of those now enrolled in employer plans, in the dust.

"The great flaw in Jindal's plan is that it would cause millions of people to lose their coverage," he wrote.

That would be an interesting experiment in social insurance. Unfortunately for Louisiana residents, Jindal is experimenting on them first.

• 
  
• "reduced so-called disproportionate share hospital payments, which went to hospitals serving a large number of the uninsured."

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APNewsbreak: Democrats seek relief from health law penalties

WASHINGTON (AP) — The official sign-up season for President Barack Obama's health care law may be over, but leading congressional Democrats say millions of Americans facing new tax penalties deserve a second chance.

Three senior House members told The Associated Press that they plan to strongly urge the administration to grant a special sign-up opportunity for uninsured taxpayers who will be facing fines under the law for the first time this year.

The three are Michigan's Sander Levin, the ranking Democrat on the Ways and Means Committee, and Democratic Reps. Jim McDermott of Washington, and Lloyd Doggett of Texas. All worked to help steer Obama's law through rancorous congressional debates from 2009-2010.

The lawmakers say they are concerned that many of their constituents will find out about the penalties after it's already too late for them to sign up for coverage, since open enrollment ended Sunday.

That means they could wind up uninsured for another year, only to owe substantially higher fines in 2016. The fines are collected through the income tax system.

...

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Covered California Sends Out Nearly 100,000 Tax Forms Containing Errors, Others Deal With Missing Forms

DANVILLE (KPIX 5) – Tens of thousands of people who buy their health insurance through Covered California will get an unpleasant surprise when they file taxes this year.

Stacy Scoggins gets plenty of mail from Covered California, but the one tax form the agency was required to send her by February 2nd still hasn’t arrived.

“After being on hold for 59 minutes, told me that the 1095-A was never generated,” Scoggins told KPIX 5 ConsumerWatch.

She’s talking about the 1095-A form, a document required for enrollees to file their tax returns. It’s a problem, for the recent widow who desperately needs to file now.

“I need my tax refund,” Scoggins said.

And she’s far from the only Covered California enrollee with 1095 problems. About 100,000 or 12 percent of the forms generated by Covered California have inaccuracies.

“We realized the data wasn’t exactly the same,” Covered California spokesperson Dana Howard told KPIX 5.

Howard said the problems are largely due to discrepancies between Covered California’s records, and the insurance companies. Information such as dates of coverage, number of family members enrolled and policy changes.

“There are some of these that are going to need reconciliation,” Howard said.

But he said Covered California sent them out anyway, to beat the February 2nd deadline.

“We did not want to hold up sending out the 1095s to everybody, so that we can correct those that we did have,” Howard said.

...