Quote:

 

http://www.lifehealthpro.com/2015/05/01/sp-sees-ppaca-risk-corridors-program-funding-gap

S&P sees PPACA risk corridors program funding gap

Analysts at Standard & Poor's Ratings Services say the effects of funding restrictions on the Patient Protection and Affordable Care Act (PPACA) risk corridors program may cause the program to hurt small and midsize health insurers.

Drafters of PPACA created the risk corridors program in an effort to make selling health insurance under PPACA rules less risky, by using cash from health insurers with good underwriting results for 2014, 2015 and 2016 to help insurers that get poor results for those years.

Originally, insurers thought the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Health and Human Services (HHS) division running the risk corridors program, could use general HHS funding to help to make up for any lack of contributions from insurers with good underwriting results.

HHS officials said in April 2014 that they would try to run the program in a "revenue neutral" fashion, without using taxpayer money.

Congress later put a provision prohibiting HHS from using taxpayer money to fund the risk corridors program in a government funding bill. President Obama signed the bill into law in December 2014.

Deep Banerjee and other S&P analysts say in a new commentary that health insurers with good results for 2014 may pay in enough cash to cover only about 10 percent of the "receivables," or money that insurers with poor results are hoping to receive.

"Uncertainty of payment due to underfunding can cause volatility in the market for all participants," the analysts say.

About 56 percent of the carriers S&P analyzed recorded neither a payable nor a receivable for the risk corridors program. Another 30 percent recorded a receivable, and 14 percent recorded a payable. The analysts say some companies that could have posted receivables did not because they do not expect to be able to collect on risk corridors program receivables.

"Without adequate payments coming into the risk corridors, it is unclear to us how CMS can fund the program," the S&P analysts write.

A risk corridors program failure would be a nuisance for the big national carriers but could wipe out more than 50 percent of the recorded capital of some of the newer, smaller insurers, the analysts say.

A risk corridors program failure could reduce capital levels at some well-known nonprofit regional carriers by about 20 percent, the analysts estimate.

kbp

May 4 2015, 06:07 PM

Baldo

May 4 2015, 02:37 PM

...IMHO people in general just don't do much preventive care and it's a pipe dream to think some would.

The preventive care they have in mind to reduce overall costs involves out-of-pocket costs in visits to your general practitioner.

Quote:

 

http://www.washingtonpost.com/national/health-science/almost-half-of-obamacare-exchanges-are-struggling-over-their-future/2015/05/01/f32eeea2-ea03-11e4-aae1-d642717d8afa_story.html

Almost half of Obamacare exchanges face financial struggles in the future

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.

Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which now works smoothly.

The latest challenges come at a critical time. With two enrollment periods completed, the law has sharply reduced the number of uninsured and is starting to force change in the nation’s sprawling health-care system. But the law remains highly controversial and faces another threat: The Supreme Court will decide by the end of June whether consumers in the 34 states using the federal exchange will be barred from receiving subsidies to buy insurance.

[...]

Baldo

May 4 2015, 06:35 PM

kbp

May 4 2015, 06:07 PM

Baldo

May 4 2015, 02:37 PM

...IMHO people in general just don't do much preventive care and it's a pipe dream to think some would.

The preventive care they have in mind to reduce overall costs involves out-of-pocket costs in visits to your general practitioner.

My point is someone has to be responsible for their own health or that of their children. That means a level of personal responsibility. You cannot have a society which mandates others being responsible.. Besides I also believe there is a natural tendency to dismiss health concerns in most people. Yes one can go to a GP, but one has to go.

The Liberal solution typically bypasses personal responsibility

Quote:

 

http://www.wsj.com/articles/pioneer-model-saved-medicare-nearly-400-million-in-two-years-1430748437

Pioneer Model Saved Medicare Nearly $400 Million in Two Years
Centers for Medicare and Medicaid Services publish latest findings by independent actuaries

A key pilot program in the federal health law saved Medicare nearly $400 million over two years and is the first alternative-payment model certified to cut costs while improving health-care quality, the Centers for Medicare and Medicaid Services said.

That finding by independent actuaries makes the Pioneer Accountable Care Organization model eligible to be expanded to larger group of Medicare beneficiaries, CMS officials said.

“This is a crucial milestone in our efforts to build a health-care system that delivers better care, spends our health-care dollars more wisely, and results in healthier people,” Health and Human Services Secretary Sylvia M. Burwell said in a statement. Earlier this year, she announced a goal of moving 50% of Medicare payments to such value-based models by 2018.

The Pioneer ACOs have met with mixed success by other measures. Thirteen of the original 32 participating hospital systems have dropped out or switched to other models after failing to meet performance targets.

In an ACO, hospitals or groups of doctors who keep costs down for a group of Medicare patients, while meeting quality measures, stand to split the savings with Medicare. Nationwide, more than 3.5 million Medicare beneficiaries are part of ACOs run by some 400 health systems.

Those in the fast-tracked Pioneer program had prior experience delivering such value-based care and were eligible for more savings but also faced financial risk if patients’ costs rose instead. Many of them complained that the rules were complex and the benchmarks too strict for local conditions.

Only 13 of the 32 qualified to share savings with Medicare the first year; just 11 shared savings the second year, and two paid several millions in penalties.

The new analysis, published in the Journal of the American Medical Association, was more encouraging. CMS researchers found that the 600,000 patients in Pioneer ACOs spent, on average, $36 less per month in 2012 and $11 less per month in 2013 than comparable non-affiliated patients.

The Pioneer patients also had fewer hospitalizations, used fewer tests, procedures and imaging services, and reporting more timely care and better communication with clinicians than the comparison group, the JAMA analysis found.

Based on those results, along with findings that the Pioneers met 28 of 33 quality metrics, CMS’s independent Office of the Actuary certified that expanding the pilot program would net substantial savings for Medicare, a condition laid out in the Affordable Care Act.

[...]

Quote:

 

http://www.vox.com/2015/5/4/8545993/obamacare-costs-aco-savings

This small, wonky Obamacare program saved $384 million over 2 years

Obamacare took what an economist once described to me as the "spaghetti approach" to reducing health-care costs: throwing a bunch of different experiments at the wall and seeing what stuck.

Today, the law arguably had its first success: Medicare's independent actuary has certified that an Obamacare program has saved money — $384 million over the past two years, to be exact. And the Obama administration is now eying how to make this program bigger — and, ideally, generate even more savings.

[...]

Thirty-two hospital systems signed up to become Pioneer ACOs in 2012 (13 have since dropped out; you can read more about that, and what it means, here). And two papers reviewing the program's performance — published today here and here — are largely positive in their findings.

The Pioneer ACO hospitals saved $384 million in two years — $280 million in the first year and $105 million in the second. This worked out to a savings, on average, of about $300 per patient each year

[...]

The Pioneer ACO program was always meant as an experiment. Once it started, new hospitals couldn't join even as some participants dropped out. The Obama administration did launch other ACO programs in the meantime, but they were generally less aggressive, with smaller rewards for the doctors who did the best (and, in tandem, smaller penalties for those who screwed up). And those programs really haven't saved much money at all — not nearly as much as the Pioneers.

[...]

The challenge is whether the health-care system is ready. The systems that decided to sign up for the Pioneer program back in 2012 were, in fact, pioneers: they were generally bigger, more advanced hospital systems that felt they were ready to manage patients' care in a new way.

"We're talking about larger, more sophisticated health systems," says Chas Roades, chief research officer at the hospital consulting firm the Advisory Board. "For those who don't have any experience in managing risk, I don't think you'd want to leap in at the Pioneer scale."

And there are questions about whether the Pioneers themselves can keep delivering savings. Hospitals can typically make easier changes at the beginning to save money; they can switch patients to generic drugs, for example. But as they get further along in the experiment, it can get harder. The Pioneer ACOs, for example, saved twice as much money in their first year as they did in their second.

Quote:

 

http://www.cnsnews.com/news/article/susan-jones/boehner-giving-people-medicaid-insurance-almost-giving-them-nothing

Boehner: 'Giving People Medicaid Insurance Is Almost Like Giving Them Nothing'

Under Obamacare, more people may be insured, but that isn't helping them much, House Speaker John Boehner told NBC's "Meet the Press" on Sunday.

"You know why there are more people insured?" Boehner asked host Chuck Todd. "Because a lot more people are on Medicaid.

"And giving -- you know, we expanded Medicaid in a big way. And giving people Medicaid insurance is almost like giving them nothing. Because there aren't -- you can't find a doctor that will see Medicaid patients. And so where do they end up? The same place they used to end up, in the emergency room."

[...]

Baldo

May 7 2015, 08:50 PM

Obamacare program may be linked to ER opioid prescriptions

Experts say too many patients are being prescribed opioid painkillers by emergency room doctors, and a program created by Obamacare could be enabling the problem.

A new study released this week found 17 percent of nearly 20,000 patients were discharged from emergency rooms with an opioid prescription. Experts and lawmakers say a push under Obamacare for hospitals to get good patient satisfaction scores is one cause of the problem.

America is in the midst of an opioid "epidemic," according to the Centers for Disease Control and Prevention. Painkillers killed more than 16,000 people in 2013. A huge part of the problem is the prescribing of painkillers, which quadrupled from 1999 to 2013.

Emergency room prescriptions are part of this trend, but data are lacking on the reasons opioids are given out, according to the study published in the Annals of Emergency Medicine..Patients with back pain got the most opioids, followed by those with abdominal pain. "The majority of prescriptions had small pill counts and almost exclusively immediate-release formulations," according to the study.

Oxycodone, the active ingredient in Oxycontin, was the most prescribed, with 52 percent.

Doctors may feel pressured by hospital administrators to prescribe opioids because it may lead to a better score on a patient satisfaction survey, experts said.

A program created by Obamacare tied extra funding to high scores on the survey...snipped

http://www.washingtonexaminer.com/obamacare-program-may-be-linked-to-er-opioid-prescriptions/article/2564111

LTC8K6

May 8 2015, 02:15 PM

IRS unable to make sure people comply with Obamacare penalty: Treasury IG

http://www.washingtontimes.com/news/2015/may/8/irs-unable-make-sure-people-comply-obamacare-penal/

We are all shocked...

So, do the calculations of the costs of Obamacare include collecting these penalties?

Because the revenue from penalties probably just isn't going to show up, imo.