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http://kaiserhealthnews.org/news/high-deductible-plans-bring-lower-costs-now-but-will-they-mean-pricey-consequences/

High-Deductible Plans Bring Lower Costs Now, But Will They Bring Pricey Problems?

Got a high-deductible health plan? The kind that doesn’t pay most medical bills until they exceed several thousand dollars? You’re a foot soldier who’s been drafted in the war against high health costs.

Companies that switch workers into high-deductible plans can reap enormous savings, consultants will tell you — and not just by making employees pay more. Total costs paid by everybody — employer, employee and insurance company — tend to fall in the first year or rise more slowly when consumers have more at stake at the health-care checkout counter whether or not they’re making medically wise choices.

Consumers with high deductibles sometimes skip procedures, think harder about getting treatment and shop for lower prices when they do seek care.

What nobody knows is whether such plans, also sold to individuals and families through the health law’s online exchanges, will backfire. If people choose not to have important preventive care and end up needing an expensive hospital stay years later as a result, everybody is worse off.

A new study delivers cautiously optimistic results for employers and policymakers, if not for consumers paying a higher share of their own health care costs.

Researchers led by Amelia Haviland at Carnegie Mellon University found that overall savings at companies introducing high-deductible plans lasted for up to three years afterwards. If there were any cost-related time bombs caused by forgone care, at least they didn’t blow up by then.

“Three years out there consistently seems to be a reduction in total health care spending” at employers offering high-deductible plans, Haviland said in an interview. Although the study says nothing about what might happen after that, “this was interesting to us that it persists for this amount of time.”

The savings were substantial: 5 percent on average for employers offering high-deductible plans compared with results at companies that didn’t offer them. And that was for the whole company, whether or not all workers took the high-deductible option.

The size of the study was impressive; it covered 13 million employees and dependents at 54 big companies. All savings were from reduced spending on pharmaceuticals and doctor visits and other outpatient care. There was no sign of what often happens when high-risk patients miss preventive care: spikes in emergency-room visits and hospital admissions.

The suits in human resources call this kind of coverage a “consumer-directed” health plan. It sounds less scary than the old name for coverage with huge deductibles: catastrophic health insurance.

But having consumers direct their own care also requires making sure they know enough to make smart choices like getting vaccines, but skipping dubious procedures like an expensive MRI scan at the first sign of back pain.

Not all employers are doing a terrific job. Most high-deductible plan members surveyed in a recent California study had no idea that preventive screenings, office visits and other important care required little or no out-of-pocket payment. One in five said they had avoided preventive care because of the cost.

“This evidence of persistent reductions in spending places even greater importance on developing evidence on how they are achieved,” Kate Bundorf, a Stanford health economist not involved in the study, said of consumer-directed plans. “Are consumers foregoing preventive care? Are they less adherent to [effective] medicine? Or are they reducing their use of low-value office visits and corresponding drugs or substituting to cheaper yet similarly effective prescribed drugs?”

Employers and consultants are trying to educate people about avoiding needless procedures and finding quality caregivers at better prices.

That might explain why the companies offering high-deductible plans saw such significant savings even though not all workers signed up, Haviland said. Even employees with traditional, lower-deductible plans may be using the shopping tools.

The study doesn’t close the book on consumer-directed plans.

“What happens five years or ten years down the line when people develop more consequences of reducing high-value, necessary care?” she asked. Nobody knows.

And the study doesn’t address a side effect of high-deductibles that doctors can’t treat: pocketbook trauma. Consumer-directed plans, often paired with tax-favored health savings accounts, can require families to pay $5,000 or more per year in out-of-pocket costs.

Three people out of five with low incomes and half of those with moderate incomes told the Commonwealth Fund last year their deductibles are hard to afford. Many households simply lack the resources to make out-of-pocket health costs, shows a recent study by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the Foundation.)

As in all battles, the front-line infantry often makes the biggest sacrifice.

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http://www.nytimes.com/2015/03/26/us/politics/obama-praises-affordable-care-act-on-its-5th-birthday.html

Obama Praises Affordable Care Act on Its 5th Birthday

President Obama marked the fifth anniversary of the Affordable Care Act by mocking the law’s longtime critics as wrong about their predictions that its passage would doom America’s health care system.

In an event at the White House on Wednesday, Mr. Obama said the law had decreased the ranks of the uninsured by a third, having enabled 16 million people to sign up for health coverage through the government marketplaces.

”We have been promised a lot of things in these past five years that didn’t turn out to be the case,” Mr. Obama said. “Death panels, doom, a serious alternative from Republicans in Congress.”

[...]

For Mr. Obama, the attacks may become easier to deflect, given the statistics that he cited at the event on Wednesday. He said that health care premiums would be $1,800 higher now if price growth in that industry had continued at the rate of five years ago. He said that cuts in Medicare drug costs had saved seniors $15 billion.

”It’s working, despite countless attempts to repeal, undermine, defund and defame this law,” Mr. Obama said.

“It’s not the job killer that critics have warned about for five years,” Mr. Obama said. “When this law was passed, our businesses began the longest streak of private sector job growth on record. Sixty straight months. Five straight years. Twelve million new jobs.”

Republicans insist that the economy would have been even better without the health care law. But after years in which the White House was on the defensive — especially when it came to the rocky implementation of the law — Mr. Obama on Wednesday was ready to simply brag about it.

”We know beyond a shred of a doubt that the policy works,” he said

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http://kaiserhealthnews.org/news/many-people-entitled-to-hefty-subsidies-still-opt-against-coverage/

Many People Entitled To Hefty Subsidies Still Opt Against Coverage

The good news: Three-quarters of people who were eligible for the most generous financial subsidies FREE MONEY on the federal health insurance exchange this year signed up for coverage, according to a new analysis by Avalere Health. The puzzler: Enrollment dropped off substantially for people with only slightly higher incomes who would also have qualified for significant subsidies FREE MONEY.

[...]

While 76 percent of eligible people with incomes between 100 and 150 percent of the federal poverty level ($11,670 to $17,505 for an individual) enrolled in plans in 2014, only 41 percent of those whose income was between 151 and 200 percent of poverty ($17,622 to $23,340) signed up. In the next income bracket, eligible individuals with incomes between 201 and 250 percent of poverty ($23,457 to $29,175), just 30 percent enrolled coverage on the federal marketplace, the analysis found.

Only 2 percent of eligible people whose incomes were 400 percent of the poverty level ($46,680) or higher enrolled on the exchange, the Avalere analysis found. Since they were ineligible for subsidies, those individuals had little motivation to buy a plan through the exchange and may have bought coverage outside it.

[...]

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[...]

Subsidies alone aren’t enough, she says.

“The carrots as a standalone don’t work,” Pearson says, referring to subsidies that are available to make coverage more affordable for people with incomes between 100 and 400 percent of the federal poverty level. “You have to make people aware of the mandate, and as the mandate penalties increase that will strengthen the effect.”

Unless they qualify for an exemption, most people are required by the law to have health insurance or face fines. The penalty for not having health insurance in 2014 was the greater of $95 or 1 percent of annual income. This year, the penalty increases to $325 or 2 percent of income, and in 2016 rises to $695 or 2.5 percent of income.

Stiffer penalties for not having coverage and redoubled efforts to reach out and educate people about the health law and their obligations may be keys to increasing enrollment for people in these income groups, says Caroline Pearson, a senior vice president at Avalere Health.

[...]

Baldo

Mar 28 2015, 01:53 AM

Obamacare flying machine begins a death spiral

Premiums are rising rapidly and the young and healthy are bailing out

...Obamacare includes both community rating and guaranteed issue. The hope of the politicians who passed Obamacare was the individual mandate would keep the relatively healthy from dropping insurance coverage, thereby avoiding a death spiral.

...According to the Manhattan Institute, premiums climbed by 41 percent on average from 2013 to 2014, and premiums are likely to rise sharply again after two insurance company bailout programs included in Obamacare expire in 2017.

Mason

Mar 29 2015, 11:04 PM

.
OBAMACARE DEPUTY CHIEF GOT $5 Million payment from Big Health Care days before taking Job.


http://dailycaller.com/2015/03/29/exclusive-health-industry-paid-acting-cms-chief-millions-when-he-joined-govt/


No Lobbyists at my table.

.

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Supreme Court: Health providers can't sue for more Medicaid money

Healthcare providers can't sue states for keeping Medicaid reimbursements low, the Supreme Court ruled Tuesday.

In a split 5-4 decision, the justices said five private companies serving Idaho Medicaid patients can't ask courts to force the state to pay them higher reimbursements.

The case Armstrong v. Exceptional Child Center was brought by five private companies providing Medicaid patients with in-home healthcare and other services. The firms said Idaho unfairly kept reimbursement rates at 2006 levels, even though care continued to grow more expensive.

In response, Idaho, backed by 27 other states and the Obama administration, said being forced to pay higher rates would be a burden on its budget. The state argued it's up to the federal government and not courts to decide whether states are obeying the Medicaid rules.

The court agreed in a majority decision written by Justice Antonin Scalia. "Their relief must be sought initially through the secretary rather than through the courts," he wrote. Justices Sonya Sotomayor, Anthony Kennedy, Ruth Bader Ginsburg and Elena Kagan dissented.

The ruling overturns a decision by the U.S. Court of Appeals for the Ninth Circuit.

LTC8K6

Apr 1 2015, 05:59 AM

So what happens when no one takes Medicaid patients?

[...]

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http://www.washingtontimes.com/news/2015/apr/1/administration-digs-over-obamacare-delays-says-joh/print/

Obama doubles down on Obamacare, slams Boehner’s ‘power’ grab lawsuit
By Tom Howell Jr.

The Obama administration is refusing to flinch in its belief that House Speaker John A. Boehner used novel and invalid legal theories to sue over how the president implemented his signature health law.

Justice Department attorneys asked a federal judge in Washington late Tuesday to toss the speaker's lawsuit, saying it exaggerates the perceived harm done by administrative delays to Obamacare, and that House Republicans cannot prove that the White House inflicted real damage on the legislative body.

"Federal courts sit only to decide actual cases and controversies, not abstract claims of legislative power," they told the U.S. District Court for the District of Columbia.

Their brief is the latest volley in the legal back-and-forth over the lawsuit, which alleges the Mr. Obama took unlawful steps to delay part of his health care law and is paying out funds to insurers without congressional approval.

Mr. Boehner filed his suit in November, three months after the House authorized the suit and after two law firms decided not to take part.

Democrats have criticized the lawsuit as misguided and a waste of federal time and money.

The suit formalized GOP complaints over Mr. Obama's use of executive authority and piggy-backed on criticism of the president's decision last fall to grant deportation amnesty to millions of illegal immigrants.

Mr. Boehner has said if Mr. Obama can "make his own laws," then future ones will as well, usurping or nullifying the will of a duly elected Congress.

Justice attorneys said the House does not have legal standing to sue, even if Mr. Boehner feels the administration is canceling out what legislators intended five years ago.

"The executive branch does not harm the House in any concrete and particularized way simply by interpreting and administering legislation enacted by a previous Congress in a manner with which the current House disagrees — whether the House labels that disagreement as 'nullification' or otherwise," the lawyers said in their latest brief.

They said House Republicans were merely speculating that Mr. Obama's actions would seriously harm the separation of powers between the legislative and executive branches, and that their lawsuit should fail even if a court grants them legal standing to proceed.

The Boehner lawsuit has two main prongs.

First, it says the White House stretched its authority by twice delaying the law's employer mandate and its associated penalties. The rule requires employers with 50 or more full-time workers or equivalents to provide health coverage or pay fines if at least one employee takes advantage of a tax credit on the health law's insurance exchanges.

Critics said the rule is would force employers to cuts jobs and hours, and the White House decided to phase in the rule through 2016 instead of allowing it to take effect in 2014 as anticipated by the law.

Republicans charged the delays were politically motivated, in that employers hoping to avoid the mandate might not slash jobs or cut workers' hours until after the midterm elections. Either way, it did not work out well for Democrats, who suffered sweeping losses in the contests earlier this month.

Republicans also are contesting a cost-sharing program estimated to pay out $3 billion to insurance companies in fiscal 2014 and $175 billion over the next 10 years. The program is designed to offset reduced co-insurance, co-pays and deductibles that insurers provide to qualified Obamacare enrollees as a condition of participating in the state-based health exchanges.

Mr. Boehner's suit says Congress never authorized the payments that are flowing out of a Treasury account.

kbp

Apr 2 2015, 06:28 AM

LTC8K6

Apr 1 2015, 05:59 AM

So what happens when no one takes Medicaid patients?

[...]

The providers have the option of not taking the Medicaid patients. This lawsuit looked difficult because of that.

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Oct. 1, 2015

States are allowed to shift children eligible for care under the Children's Health Insurance Program to health care plans sold on their exchanges, as long as HHS approves.