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Healthcare Bill Part III; Obamacare
Topic Started: Mar 3 2014, 02:20 PM (48,690 Views)
kbp

Quote:
 
http://www.usatoday.com/story/opinion/2014/03/25/obamacare-irs-halbig-sebelius-health-care-insurance-column/6830651/

Hobby Lobby isn't today's most important case: Column
Halbig v. Sebelius could force Obama administration to follow its own law.


Tuesday, all eyes will be on a high-profile Obamacare case before the Supreme Court. But just a few blocks away, a lower court will hear a lesser-known Obamacare case that could have a far greater impact on the future of the law.

The Supreme Court hears oral arguments Tuesday in Sebelius v. Hobby Lobby, a case challenging the Obama administration's attempt to force private companies to purchase contraceptives for their employees contrary to the owners' religious beliefs. A ruling for Hobby Lobby would restore the religious freedom of potentially millions of employers and workers.

Just down the street, the Court of Appeals for the D.C. Circuit will hear oral arguments in Halbig v. Sebelius. Obamacare supporters call Halbig "the greatest existential litigation threat to the Affordable Care Act."

That description, while colorful, is not quite accurate. Halbig does not ask the courts to strike down any part of the law. It merely asks the court to force the administration to implement the law as Congress intended, a prospect that absolutely terrifies Obamacare supporters.
[...]

It's a good article, but rather windy in making a point. The short of the situation is Hobby Lobby deals with a regulation that violates rights (IMO), which could see new regulations, while Halbig would shut down all federal subsidies and related taxes in states operating under the federal web site according to law that can't legally be rewritten without Congress.

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wingedwheel
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Not Pictured Above
kbp
Mar 26 2014, 01:55 PM
Quote:
 
http://www.usatoday.com/story/opinion/2014/03/25/obamacare-irs-halbig-sebelius-health-care-insurance-column/6830651/

Hobby Lobby isn't today's most important case: Column
Halbig v. Sebelius could force Obama administration to follow its own law.


Tuesday, all eyes will be on a high-profile Obamacare case before the Supreme Court. But just a few blocks away, a lower court will hear a lesser-known Obamacare case that could have a far greater impact on the future of the law.

The Supreme Court hears oral arguments Tuesday in Sebelius v. Hobby Lobby, a case challenging the Obama administration's attempt to force private companies to purchase contraceptives for their employees contrary to the owners' religious beliefs. A ruling for Hobby Lobby would restore the religious freedom of potentially millions of employers and workers.

Just down the street, the Court of Appeals for the D.C. Circuit will hear oral arguments in Halbig v. Sebelius. Obamacare supporters call Halbig "the greatest existential litigation threat to the Affordable Care Act."

That description, while colorful, is not quite accurate. Halbig does not ask the courts to strike down any part of the law. It merely asks the court to force the administration to implement the law as Congress intended, a prospect that absolutely terrifies Obamacare supporters.
[...]

It's a good article, but rather windy in making a point. The short of the situation is Hobby Lobby deals with a regulation that violates rights (IMO), which could see new regulations, while Halbig would shut down all federal subsidies and related taxes in states operating under the federal web site according to law that can't legally be rewritten without Congress.

Could, but the pictures of Roberts in compromising positions with goats will insure 0bamacare stands.
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Baldo
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A hard road ahead for ObamaCare, and America

In response to Laszewski: 'Obama-care is Finished' Unless White House Acts Now:

I'll say this much for ObamaCare: it's already survived catastrophic failures that should have filled the streets of Washington with pitchforks and torches. It really help that the media undersells everything that goes wrong, and helps Team Obama get away with their standard "one news cycle at a time" spin strategy. The Obamanoids are free to say any insane thing it takes to squeeze out a few days of improved coverage; reporters who know better cheerfully relay their lies with minimal real-time criticism.

A week ago, we were told there was no way the ObamaCare deadlines would be moved - why, the Administration didn't even have the statutory authority to do it! That was good enough for the media to let Team Obama run a few days of B.S. advertising about the countdown to March 31, and scare a few more kids into singing up for this ripoff, before the old talking points turned to dust and blew away.

But I think Laszewski is on to something here: there's just no way this train wreck can lumber any further if those already agonizing insurance premiums double or triple. And that will cap off a year of bad news in which people start paying the trans-Constitutional individual mandate tax/penalty (look how badly the White House and its lapdogs freaked out when Matt Drudge talked about cutting the first check to pay his "liberty tax"), the employer market starts crumbling beneath the oncoming storm of Obama's Big Lie, horror stories about "doc shock" and bureaucratic ineptitude keep piling up, and the fiscal death spiral begins. Maybe we'll have a few headlines about the insurance industry bailout to add to the pile by Christmas.

There is no way to "fix" ObamaCare, however. Laszewski's idea for loosening up on the mandates would help a bit, but it's probably a non-starter with the Administration; King Barack I is not going to admit his mandates were idiotic ideas. He's invested a lot of political energy in protecting them - it would snap back into his face like a giant rubber band. Republicans would have a field day replaying video clips of Obama and his flunkies adamantly standing by the mandates he just abandoned. Even the lower-information voters would begin wondering what the point of the whole ObamaCare exercise was....snipped

http://www.breitbart.com/InstaBlog/2014/03/26/A-hard-road-ahead-for-ObamaCare-and-America


Expect a financial disaster for the Insurance Companies. I say the real numbers are horrendous!
Edited by Baldo, Mar 26 2014, 02:25 PM.
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Baldo
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Boehner 'What the hell is this, a joke?'

“What the hell is this, a joke?” Boehner said at his weekly press conference.

He was responding to the administration’s announcement on Tuesday evening that people who had begun the process of signing up for insurance through the federal exchanges would have until mid-April to do so, instead of March 31.

The Speaker called the move “another deadline made meaningless,” adding it to a litany of unilateral changes that the administration has made to the law.

“This is part of a long-term pattern of this administration manipulating the law for its own convenience,” Boehner said. “It’s not hard to understand why the American people question this administration’s commitment to the rule of law.”

The Speaker mocked the use of the “honor system” to determine who was eligible for an extension after the administration said it would make no effort to ensure that people had actually begun the process of signing up by March 31.

“Why don’t they just say, ‘We’ve moved the date to April 15’? Because that’s in effect what they’ve done,” Boehner said.

Administration officials cited “a surge in demand” as a reason for the extension, which they said is aimed at people with “special circumstances and complex cases.”

“Open enrollment ends March 31,” Health and Human Services spokeswoman Joanne Peters told The Hill in an email Tuesday evening. “We are experiencing a surge in demand and are making sure that we will be ready to help consumers who may be in line by the deadline to complete enrollment — either online or over the phone.”

Republicans have attacked the healthcare law from virtually every angle, criticizing both its underlying regulations and the administration’s repeated decision to delay or not fully enforce them. Boehner has criticized the early problems with the HealthCare.gov website, and on Wednesday, he was pressed on why people shouldn’t have more time to sign up for insurance because of them.

“The dates are the dates, and the law is the law,” he said. “The president doesn’t have the authority to change the law whenever he wants, which he continues to do.”

Boehner added later in the press conference: “The law says that enrollment stops at the end of March. That’s what the law says. I’ve got to live by the law; you’ve got to live by the law; the American people have got to live by the law. And guess what? The president needs to live by the law as well.”...snipped

http://thehill.com/blogs/healthwatch/health-reform-implementation/201791-boehner-what-the-hell-is-this-a-joke


The Joke was electing this unqualified & incompetent man as President in 2008 & then reelecting him in 2012.

What Obama is good at is Bull-shitting. That's his talent!

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kbp

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http://www.forbes.com/sites/michaelcannon/2014/03/26/who-needs-hobby-lobby-when-youve-got-halbig-yesterdays-appellate-arguments-in-halbig-v-sebelius/

Who Needs Hobby Lobby When You've Got Halbig? Yesterday's Appellate Arguments In Halbig v. Sebelius
By Michael Cannon


On January 1, the IRS began imposing taxes and spending billions of taxpayer dollars in the 34 states whose ObamaCare Exchanges were established by the federal government. But ObamaCare says the IRS can tax and spend only through “an Exchange established by the State.” In Halbig v. Sebelius and three similar cases, employers and taxpayers are challenging those illegal taxes and outlays. The stakes are high. The IRS’s defenders warn Halbig poses “the most significant existential threat to the Affordable Care Act.” The plaintiffs counter the IRS is engaging in taxation without representation and misappropriating taxpayer dollars on a massive scale. (Jonathan Adler and I did much of the legal and legislative research underpinning these lawsuits.) Yesterday, a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit heard oral arguments in Halbig. (Listen to the audio.) The panel consisted of Judges Harry T. Edwards (a Carter appointee), Thomas B. Griffith (a George W. Bush appointee), and A. Raymond Randolph (a George H.W. Bush appointee). Judging by the comments and questions these jurists posed, I would guess Edwards is firmly in the government’s camp, while Randolph sides with the plaintiffs. Griffith is a tougher call. Yet while Randolph was clearly the most skeptical of the government’s case, Griffith was also quite skeptical.

The first part of the hearing essentially descended into a shouting match between Edwards and plaintiffs’ counsel Michael Carvin. Edwards accused the plaintiffs of wanting to gut the Act. It’s an ironic charge to level at people who are suing to force the government to adhere to the Act. But just take a moment to think about what Edwards is saying: hewing to what ObamaCare actually says would gut the Act.

Edwards demanded that Carvin produce evidence that anyone in Congress even cared about whether states would run the Exchanges. This was also odd. The statute and legislative history are replete with such evidence. The Act directs states to establish Exchanges. It provides unlimited start-up funds to states for that purpose. State-run Exchanges insulated ObamaCare from charges that it was a federal takeover of health care. Senators whose votes were crucial to passage, notably Ben Nelson (D-NE) and Joe Lieberman (I-CT), demanded that states run the Exchanges. Groups as varied as the National Association of Insurance Commissioners, the Blue Cross and Blue Shield Association, the New America Foundation, and the Heritage Foundation testified in favor of state-run Exchanges and against federal Exchanges. Even the government’s counsel, Assistant Attorney General Stuart F. Delery, later conceded, “Incentives were provided to states to establish their own Exchanges.”

Edwards challenged Carvin to explain how is it that, if Congress intended to use the subsidies to induce states into establishing Exchanges, so many states didn’t get the message. Here, Randolph interjected that many people were aware of this incentive. There was media coverage, and dozens of members of Congress wrote the IRS complaining about its attempt to gut this provision. But the better response is simpler: if states didn’t get the message, it’s because the IRS’s unlawful tax-credit rule misled them.

Randolph was just as critical of the government as Edwards was of the plaintiffs, if more understated. When the government’s lawyer argued that federally established Exchanges meet the requirement that Exchanges be “established by the State,” Randolph cut him off: “That is a leap. That is not statutory interpretation.”

Randolph also seemed to be the the most steeped in the statute and its legislative history. He repeatedly made the subtle yet powerful point that the information-reporting requirements of 26 U.S.C. 36B(f)(3) are in fact not part of the Patient Protection and Affordable Care Act. They are amendments made to the Internal Revenue Code by the Health Care and Education Reconciliation Act. That’s significant. If the PPACA authorized subsidies in federal Exchanges prior to the HCERA, then there is no need to cite the reporting requirements. If it didn’t, then the reporting requirements certainly did not add that authority, and there is no need to cite them. As it is, Congress passed two bills, neither of which authorized tax credits in federal Exchanges.

Randolph raised several issues that Jonathan Adler and I discussed in our amicus brief. On the claim that plaintiffs are focusing on just one isolated phrase in the law, Randolph noted that the subsidy-eligibility rules actually use the phrase seven times. (We counted nine.)

On the claim that no one in Congress contemplated withholding subsidies in federal Exchanges, he noted that one of the PPACA’s antecedents — a bill approved in 2009 by the Senate’s Health, Education, Labor, and Pensions Committee — also denied Exchange subsidies to residents of states that refused to establish an Exchange. That prohibition lifted after four years, but the bill permanently withheld subsidies if states refused to cooperate in other ways.

On the supposedly odd placement of the language restricting eligibility for subsidies (nominally, tax credits) to states that establish Exchanges, Randolph showed that its placement was not odd at all. Indeed, Congress had previously enacted almost identical tax-credit eligibility rules. In 2002, Congress created Section 35 of the Internal Revenue Code, which conditioned “Health Coverage Tax Credits” for certain individuals on their state enacting certain federally specified regulations. When Congress created ObamaCare’s refundable “premium-assistance tax credits” in Section 36B, it was basically copying what was already in federal law, including Section 35′s “coverage month” concept. Randolph even asked Delery, “Is 36B’s structure copied from Section 35?” Delery dodged the question.

Randolph also made a point that I’ve only ever seen raised in the Health Matrix article Adler and I coauthored: the reporting requirements make perfect sense in federal Exchanges, because they allow federal Exchanges to tell individual enrollees the exact size of the subsidy they would receive if their state establishes an Exchange. That would put tremendous political pressure on states to cooperate, and therefore advances the Act’s purpose of inducing states to operate Exchanges.

Randolph’s got some laughs when he suggested that the statute was poorly written but not absurd: “There is an absurdity principle, but there is not a stupidity principle. If the law is just stupid, I don’t think it’s up to the court to save it.” Hmm. ObamaCare as a stupid law…where have I heard that before?

The real question mark appears to be Judge Griffith. He was silent for much of Carvin’s presentation, save for a few mildly skeptical questions. (For example, he asked if anyone noticed this condition on subsidies other than Adler and me. As Randolph explained, the answer is yes.)

Griffith was much more engaged during, and skeptical of, the government’s presentation. He repeatedly stressed to the government that the tax-credit eligibility rules are crystal clear: a taxpayer must be enrolled “through an Exchange established by the State” in order to receive a tax credit. He stressed that the relevant question is not whether a federal Exchange is the same type of Exchange as one established by the state; the relevant question is who established the Exchange. He rather pointedly and amusingly pressed the government to admit that the Secretary of Health and Human Services is not a state. He asked the government why Congress did not make a federal Exchange the equivalent of a state-established Exchange, the way it did with Exchanges established by U.S. territories. He asked the government, “If I were to disagree with you and think established by the State under section 1311 means established by the State under section 1311, would your argument be over?” He asserted that the legislative history “is a wash” and doesn’t resolve the issue in either direction, presumably leaving only the statute. He stressed it is the government that bears the burden of justifying its departure from the plain meaning of the statute. He noted that, in any bill, Congress makes political compromises that frustrate one or another statutory purpose, and asked the government, “How are we supposed to account for that?” He asked the government whether, if Congress didn’t legislate clearly enough to fulfill its purpose, “is it our job to fix the problem?”

Griffith’s final question also poses a problem for the government. He asked about a notice of supplemental authority in which the government suggested the IRS might continue to issue subsidies and impose taxes through federal Exchanges even if the court declares the IRS has no statutory authority to do so. Griffith pointed out that such “28(j)” notices exist to apprise the court of new judicial rulings that bear on the instant case. But the most recent case the government cited in its notice is 15 years old. Judge Randolph added the government had already been given an opportunity to address the issue it raised in the notice, and called the government’s behavior “highly improper.” (Read my summary of the plaintiffs’ motion to strike the government’s notice, and Josh Blackman’s analysis.)

None of which tells us whether this potential swing vote will uphold or vacate the IRS’s tax-credit rule. But Griffith did seem very skeptical of that regulation’s legality.

Don’t let this post’s title confuse you. I deeply appreciate the efforts of those working to protect religious freedom from ObamaCare in Sebelius v. Hobby Lobby (which went to oral arguments yesterday before the Supreme Court) and similar cases. (Read the reactions to the Hobby Lobby hearing by my Cato Institute colleagues Ilya Shapiro and Roger Pilon.) The title is part transparent attempt to trick the search engines, and part reminder that while Hobby Lobby cannot solve Halbig’s problem, Halbig can solve Hobby Lobby’s problem.

Hopefully, this D.C. Circuit panel will invalidate the IRS’s illegal taxes and spending, and allow the law to work as Congress intended.


Even the government’s counsel, Assistant Attorney General Stuart F. Delery, later conceded, “Incentives were provided to states to establish their own Exchanges.”

My opinion is biased, but I'm totally lost on how they could rule Congress meant something entirely different than they wrote ...9 times.
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kbp

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http://www.weeklystandard.com/blogs/no-insurance-better-unapproved-insurance-under-obamacare_786056.html

No Insurance Is Better than Unapproved Insurance Under Obamacare
Obamacare penalizes the ‘wrong’ insurance 18 times more than no insurance.


...If your employer offers you insurance that doesn’t provide free ella, or anything else on the list of “preventive services”—as defined by Health and Human Services Secretary Kathleen Sebelius and ultimately by Obama—then it’s subject to a fine of $36,500 a year. But if your employer doesn’t offer you insurance at all, it’s subject to a fine of $2,000 a year. Actually, for now your employer’s choice is between a fine of $36,500 or $0, as Obama has extralegally decreed that fines for not providing insurance (but not fines for providing insurance that doesn’t cover all “preventive services”) will be waived until after we get to the other side of the midterm elections.

As Rep. Diane Black (R., Tenn.) put it after the oral arguments, “Only Obamacare could create a system that carries 18 times the fine for providing insurance coverage to employees than for not providing any coverage at all.”

Maybe it’s time for an alternative to Obamacare.

That speaks volumes on dictating what lifestyle can be provided in this nation!
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kbp

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http://www.foxnews.com/politics/2014/03/27/democrats-said-to-push-for-new-changes-to-obamacare-amid-midterm-fears/

Democrats push for new changes to ObamaCare amid midterm fears

Several Democratic senators moved Thursday to "improve" parts of ObamaCare, proposing numerous changes to the law amid concerns that it could cost Democrats House seats and possibly the Senate in November.

The proposals came from a half-dozen senators, some of whom are facing reelection in the fall and most of whom represent moderate-to-conservative states. Since Democrats currently control the Senate, the proposals will put Senate Majority Leader Harry Reid, D-Nev., in an uncomfortable position -- forcing him to decide whether to put the bills to a vote or sideline them, despite the political risks for his party's incumbents.

"There is more to be done," the senators wrote in an op-ed in Politico, outlining the proposed changes.

Sens. Mark Warner, D-Va.; Mark Begich, D-Alaska; Mary Landrieu, D-La.; Heidi Heitkamp, D-N.D.; Joe Manchin, D-W.Va.; and Sen. Angus King, I., Maine, are behind the proposals.

Among other ideas, they called for allowing "copper" plans on the government-run health exchanges. The new insurance plans would offer lower premiums and higher out-of-pocket costs than the "bronze," "silver" and "gold" options currently offered.

"I've always been a believer that the law was not perfect, but you should continue to work to improve it," Begich told The Wall Street Journal, which first reported on the proposals. "People are seeing that as it's implemented, there are tweaks you need to do and there's just nothing wrong with that."

The senators, while defending the law itself, proposed numerous other fixes, including restoring startup funds for "consumer-driven health insurance cooperatives" and directing state regulators to look at allowing insurance to be sold across state lines. Plus, they called for sparing employers with fewer than 100 workers from being required to offer health insurance to their staff.

Warner, who faces a formidable midterm challenge from former Republican National Committee Chairman Ed Gillespie, said on Fox News earlier this week that he supports allowing Americans to purchase health insurance across state lines.

Earlier this month, Republican David Jolly defeated Democrat Alex Sink in a Florida special election largely seen as a referendum on ObamaCare. Democrats, however, downplayed the loss in the Republican-leaning congressional district.

Republicans must pick up six seats to win control of the Senate. Conservative groups such as Americans for Prosperity are reportedly pouring million into races in which Democratic incumbents have supported ObamaCare.

House Democrats must gain 17 seats to win a majority next fall. It looms as a very steep challenge in view of the traditional midterm headwinds facing a party in control of the White House and a generally sour public mood, now compounded by controversy surrounding the health care law.

It is unclear if Reid, D., Nev., would bring any of the bills aimed at fixing ObamaCare to the floor. Democratic aides told The Journal that the effort has sparked debate about whether making the changes would return public attention to the health law's flaws.

Democratic strategist Steve Murphy said the fixes could help vulnerable lawmakers more than changes from the Obama administration that are immediately criticized by Republicans.

"Democrats should fight back hard on what eliminating ObamaCare would mean, and they also should demonstrate a willingness to make ObamaCare better," Murphy told The Journal......

...The new insurance plans would (A) offer lower premiums and higher out-of-pocket costs than the "bronze," "silver" and "gold" options currently offered. ... (B) restoring startup funds for "consumer-driven health insurance cooperatives" and directing state regulators to look at allowing (C) insurance to be sold across state lines.

The cost per uninsured that now has coverage should be the topic of GOP campaigns.

(A) The ability to regulate what each person must have covered in their policies should be solved by NOT mandating it instead of reducing what is required. The majority have more than they need and the changes proposed would mainly apply only to the poor that can't afford the present out-of-pocket and the young that do not necessarily need coverage.

(B) This is a FREE MONEY nightmare waiting to happen. A cross between national coverage and self-insurance that will lead to management failures while providing a socialistic competition for private insurers.

(C) Theft of a Republican plan, which I'm not so sure would work well. Policies have rates based on pools within a state in accordance with regulations of that state. This invites the federal government to take over control states presently hold. I like the competition it provides, but such an approach stirs up the question on how to set premiums if the networks costs come from are unknown to the actuaries looking for data to base the premiums on. It seems like the same companies are often in various states, while the premium variances would come from that state's regulations and the prices of the providers. Surely a doctor in New York has a higher overhead cost than another in Kansas City, as the cost of living varies extremely between the two locations.

The solutions offered do not even come close to solving WHY the costs for Obamacare are so high.
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kbp

This person wrote a column at the link below:

  • Margaux J. Hall is the Center for Reproductive Rights Fellow at Columbia Law School.
Quote:
 

After rambling on she reaches the point where she solves what she sees as a problem:

  • One way to remedy this conflict would be by establishing policy that makes employers into legal fiduciaries—like investment and pension managers and others who safeguard our personal investments. Such fiduciaries are entrusted with duties of care and loyalty to those who benefit from their services. They must act in the sole interest of those they serve, without regard to their own financial, moral, or other preferences. Employers, acting as legal fiduciaries, could invest employees’ remuneration in insurance plans offering a diversified pool of health benefits that reflect employees’ needs. We could require employers to ask about employees’ coverage needs before selecting health insurance plans for the next enrollment year, a practice that is largely nonexistent to date. For example, through an annual confidential survey, employers could capture employees’ health needs, aggregate them, and approximate a best-fit health plan or plans to satisfy employees’ needs.

    Such a reconceptualization would be groundbreaking. Under this revised model, employers would act on behalf of employees and in their exclusive interest in buying health insurance. Employees’ needs—economic, moral, or otherwise—would come first.
The short description of her remedy is to provide "...approximate...best-fit health...plans to satisfy employees’ needs."

What a brilliant idea! Just imagine employee needs and wants being considered when a company considers what plans to offer ....wait, would an Obamacare repeal provide that?

I suspect she'd be better off letting others decide what is best for her!

Edited by kbp, Mar 27 2014, 12:16 PM.
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Baldo
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Here’s How We Can Fix Obamacare if We Act Now and Stop Pretending the Problems Don’t Exist

By Robert Laszewski - March 26

To properly price the exchange health insurance business going forward the carriers have to sharply increase the rates.

A senior executive for Wellpoint, which sells plans in 14 Obamacare exchanges, is quoted in a Reuters article telling Wall Street analysts there will be big rate increases in 2015, “Looking at the rate increases on a year-over-year basis on our exchanges, and it will vary by carrier, but all of them will probably be double digits.”

If the health plans do issue double digit rate increases for 2015, Obamacare is finished.

There are a ton of things that need to be fixed in Obamacare. But, I will suggest there is one thing that could save it.

The health insurance companies have to submit their new health insurance plans and rates between May 27 and June 27 for the 2015 Obamacare open-enrollment period beginning on November 15th. Any major modifications to the current Obamacare regulations need to be issued in the next month to give the carriers time to adjust and develop new products.

If the administration goes into the next open enrollment with the same unattractive plan offerings costing a lot more than they do today, they will not be able to reboot Obamacare.

Simply, health insurance plans that cost middle-class individuals and families 10% of their after-tax income and have average Silver Plan deductibles of more than $2,500 a month are not attractive and people won’t buy them any more enthusiastically next fall than they already have. See:Obamacare: The Uninsured Are Not Signing Up Because the Dogs Don’t Like It

Doubling the fines for not buying in 2015 will only give the Democrats more political problems––and it doesn’t look to me like they are going to enforce the fines anyway.

Health insurance plan executives are now faced with a daunting decision. How do they price the 2015 Obamacare exchange plans?

Even if the administration announces they have signed-up about 6 million people by March 31, the number of people enrolling would be well below expectations––only about 25% of those subsidy eligible will have signed up by the deadline. An enrollment that small guarantees the risk pool is sicker and more expensive than it needs to be in order to be sustainable.

But dramatically increasing the rates will only assure even fewer healthy people will sign up for 2015 and some of those who signed up for 2014 will back out over the higher rates. This is what a “death spiral” looks like.


The health plans will be helped considerably by the “3Rs” Obamacare reinsurance scheme that makes $20 billion available for 2014 – 2016 to cushion the costs of bringing the previously uninsurable into the new health insurance system.

But the reinsurance scheme only limits most of the carriers’ annual underwriting losses––it doesn’t eliminate them.

By the end of 2016, just one year past the next plan year, the insurance companies need to get their Obamacare health plans on a profitable footing.

So, how do the insurance companies set their prices for 2015?

Do the carriers go easy on their renewals continuing to price their offerings below profitable levels, relying on the temporary reinsurance scheme to cover most of their losses, fearing that a big rate increase would finish off Obamacare and hoping the administration can reboot Obamacare in 2015 by getting the enrollment to acceptable levels?

Or, do they presume Obamacare cannot be rebooted given the currently unattractive plan offerings and it’s hopeless to continue to take losses on something that has little or no chance of ever succeeding?

For insurers to have faith Obamacare is worth the continued investment and the risk the administration needs to quickly demonstrate they understand this program is in big trouble and they are willing to make big changes to save it.

And, whatever insurance executives think, do Democrats want to go into the November elections offering the same unattractive health plan offerings at even higher prices? Open enrollment doesn’t begin until November 15 but the plans will be out and will be well publicized before Election Day.

The administration can go a long way toward fixing this and do it within the scope of the statute and their regulatory authority.

Here’s what I would suggest.

Give carriers the ability to offer plans outside the Bronze, Silver, Gold, and Platinum structure.

Let them offer people plans they will find attractive––premium, deductibles, and benefits.

But, require any new plans to:

Satisfy the 60% actuarial minimum in the statute––no “junk” plans.
Give consumers the detail to compare the standard Silver Plan to any new offerings––full transparency.

Give carriers the ability to swap current benefit mandates (that were set by regulation not statute) for lower premiums and deductibles and be completely transparent in what those trade-offs are while still complying with the underlying statutory requirement that the plans must be worth at least 60% of total health care costs. The administration has the power to do this within the scope of the law.

Would such a range of choices lead to anti-selection within Obamacare?

Yes. But it would be manageable just as broad choices are manageable within the Medicare Part D program and the Medicare Advantage program where consumers are very happy with the choices they are offered and the plans have succeeded in getting an excellent spread of risk.

Without the sense Obamacare is salvageable the Obama administration risks having carriers giving up hope that Obamacare will ever work. The administration needs the insurance companies to believe this is fixable for them to remain committed.

Ardent Obamacare supporters won’t want to do this.

Want to save Obamacare? Want to have at least a chance of avoiding an Election Day debacle in November?

I believe the administration has about a month to give health plans the confidence this can be saved.

If the carriers do what the Wellpoint executive has told Wall Street analysts they are about to do, Obamacare is finished. The “death spiral” will have begun.

But there is a way for the Obama administration to get the new health law back on track.

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.


So in other words let the insurance carriers sell what they want to sell?

What a novel idea...
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Baldo
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Here’s How We Can Fix Obamacare if We Act Now and Stop Pretending the Problems Don’t Exist

By Robert Laszewski - March 26

To properly price the exchange health insurance business going forward the carriers have to sharply increase the rates.

A senior executive for Wellpoint, which sells plans in 14 Obamacare exchanges, is quoted in a Reuters article telling Wall Street analysts there will be big rate increases in 2015, “Looking at the rate increases on a year-over-year basis on our exchanges, and it will vary by carrier, but all of them will probably be double digits.”

If the health plans do issue double digit rate increases for 2015, Obamacare is finished.

There are a ton of things that need to be fixed in Obamacare. But, I will suggest there is one thing that could save it.

The health insurance companies have to submit their new health insurance plans and rates between May 27 and June 27 for the 2015 Obamacare open-enrollment period beginning on November 15th. Any major modifications to the current Obamacare regulations need to be issued in the next month to give the carriers time to adjust and develop new products.

If the administration goes into the next open enrollment with the same unattractive plan offerings costing a lot more than they do today, they will not be able to reboot Obamacare.

Simply, health insurance plans that cost middle-class individuals and families 10% of their after-tax income and have average Silver Plan deductibles of more than $2,500 a month are not attractive and people won’t buy them any more enthusiastically next fall than they already have. See:Obamacare: The Uninsured Are Not Signing Up Because the Dogs Don’t Like It

Doubling the fines for not buying in 2015 will only give the Democrats more political problems––and it doesn’t look to me like they are going to enforce the fines anyway.

Health insurance plan executives are now faced with a daunting decision. How do they price the 2015 Obamacare exchange plans?

Even if the administration announces they have signed-up about 6 million people by March 31, the number of people enrolling would be well below expectations––only about 25% of those subsidy eligible will have signed up by the deadline. An enrollment that small guarantees the risk pool is sicker and more expensive than it needs to be in order to be sustainable.

But dramatically increasing the rates will only assure even fewer healthy people will sign up for 2015 and some of those who signed up for 2014 will back out over the higher rates. This is what a “death spiral” looks like.

The health plans will be helped considerably by the “3Rs” Obamacare reinsurance scheme that makes $20 billion available for 2014 – 2016 to cushion the costs of bringing the previously uninsurable into the new health insurance system.

But the reinsurance scheme only limits most of the carriers’ annual underwriting losses––it doesn’t eliminate them.

By the end of 2016, just one year past the next plan year, the insurance companies need to get their Obamacare health plans on a profitable footing.

So, how do the insurance companies set their prices for 2015?

Do the carriers go easy on their renewals continuing to price their offerings below profitable levels, relying on the temporary reinsurance scheme to cover most of their losses, fearing that a big rate increase would finish off Obamacare and hoping the administration can reboot Obamacare in 2015 by getting the enrollment to acceptable levels?

Or, do they presume Obamacare cannot be rebooted given the currently unattractive plan offerings and it’s hopeless to continue to take losses on something that has little or no chance of ever succeeding?

For insurers to have faith Obamacare is worth the continued investment and the risk the administration needs to quickly demonstrate they understand this program is in big trouble and they are willing to make big changes to save it.

And, whatever insurance executives think, do Democrats want to go into the November elections offering the same unattractive health plan offerings at even higher prices? Open enrollment doesn’t begin until November 15 but the plans will be out and will be well publicized before Election Day.

The administration can go a long way toward fixing this and do it within the scope of the statute and their regulatory authority.

Here’s what I would suggest.

Give carriers the ability to offer plans outside the Bronze, Silver, Gold, and Platinum structure.

Let them offer people plans they will find attractive––premium, deductibles, and benefits.

But, require any new plans to:

Satisfy the 60% actuarial minimum in the statute––no “junk” plans.
Give consumers the detail to compare the standard Silver Plan to any new offerings––full transparency.

Give carriers the ability to swap current benefit mandates (that were set by regulation not statute) for lower premiums and deductibles and be completely transparent in what those trade-offs are while still complying with the underlying statutory requirement that the plans must be worth at least 60% of total health care costs. The administration has the power to do this within the scope of the law.

Would such a range of choices lead to anti-selection within Obamacare?

Yes. But it would be manageable just as broad choices are manageable within the Medicare Part D program and the Medicare Advantage program where consumers are very happy with the choices they are offered and the plans have succeeded in getting an excellent spread of risk.

Without the sense Obamacare is salvageable the Obama administration risks having carriers giving up hope that Obamacare will ever work. The administration needs the insurance companies to believe this is fixable for them to remain committed.

Ardent Obamacare supporters won’t want to do this.

Want to save Obamacare? Want to have at least a chance of avoiding an Election Day debacle in November?

I believe the administration has about a month to give health plans the confidence this can be saved.

If the carriers do what the Wellpoint executive has told Wall Street analysts they are about to do, Obamacare is finished. The “death spiral” will have begun.

But there is a way for the Obama administration to get the new health law back on track.

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.
http://thehealthcareblog.com/blog/2014/03/26/heres-how-we-can-fix-obamacare-if-we-act-now-and-stop-pretending-the-problems-dont-exist/


So in other words let the insurance carriers sell what they want to sell?

What a novel idea...
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kbp

Baldo
Mar 27 2014, 12:24 PM
Here’s How We Can Fix Obamacare if We Act Now and Stop Pretending the Problems Don’t Exist

By Robert Laszewski - March 26
snip
Response: http://s1.zetaboards.com/Liestoppers_meeting/single/?p=874525&t=5402308
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Baldo
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kbp
Mar 27 2014, 12:29 PM
Baldo
Mar 27 2014, 12:24 PM
Here’s How We Can Fix Obamacare if We Act Now and Stop Pretending the Problems Don’t Exist

By Robert Laszewski - March 26
snip
Response: http://s1.zetaboards.com/Liestoppers_meeting/single/?p=874525&t=5402308
The one thing we can be sure about. It will be expensive. Nothing is ever less expensive in DC, especially if Govt & the Insurance Companies agree.
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kbp

http://talkingpointsmemo.com/dc/halbig-sebelius-dc-circuit-arguments

The Lawsuit That Could Still Destroy Obamacare

A few street blocks away from Supreme Court oral arguments Tuesday on the contraceptive mandate, an appeals court heard a separate case that poses a far greater threat to Obamacare and could cripple the law.

And while many have considered it a long shot, it showed clear signs of life.

The case is about whether the Affordable Care Act permits the federally-run insurance exchange to provide subsidies to consumers. Crafted by Case Western law professor Jonathan Adler and Cato's Michael Cannon, it charges that the plain language of the statute confines the provision of premium tax credits to "an Exchange established by the State" -- and not the federal exchange, which serves residents whose states opted not to build one.

The Obama administration won the case in January at the D.C. District Court, where Clinton-appointed Judge Paul L. Friedman labeled the challengers' claim "unpersuasive." He said Congress designed the federal exchange on behalf of states, so it functions as such for the purpose of the law. A ruling against the government, Friedman said, would "violate the basic rule of statutory construction that a court must interpret a statute in light of its history and purpose."

But the landscape was vastly different when the case came before a three-judge panel on the D.C. Circuit Court of Appeals comprising one Democratic appointee and two Republican appointees, according to audio of Tuesday's arguments.

Carter-appointed Judge Harry T. Edwards was the only member of the panel to side with the government's position, describing the challenge as "preposterous" and repeatedly hammering Michael Carvin, the lawyer for the plaintiffs.

George H.W. Bush-appointed Judge A. Raymond Randolph antagonized the law and sounded firmly in the opponents' camp, saying that the "text of the statute seems perfectly clear on its face" that premium tax credits are only for state-run exchanges.

"There's an absurdity principle, but I don't think there a stupidity principle," Randolph said. "If the legislation is just stupid, I don't see that it's up to the court to save it."

So the decision could come down to George W. Bush-appointed Judge Thomas B. Griffith, who sounded plainly unconvinced that the statute permits the federal exchange to provide subsidies. He said the legislative history arguments were a "wash" and that the government bears a "special burden" in proving their case.

"Don't you have a special burden to show from legislative history that that doesn't mean what it appears to mean?" Griffith asked the government's lawyer. "If we know the clear purpose of Congress and yet they don't legislative clearly enough to achieve that purpose, is it our job to fix the problem?"

Unlike the birth control challenge, which carries broad legal implications but implicates only a small portion of Obamacare, a loss for the administration in this case, Halbig v. Sebelius, would deal a fatal blow to Affordable Care Act. The federal exchange serves 36 states, and the millions of residents in those states would not be able to afford insurance without subsidies. That would render the individual mandate impracticable and imperil the market regulations that guarantee coverage to consumers regardless of health status.

The chief congressional architects of Obamacare -- including Senate Majority Leader Harry Reid (D-NV), erstwhile House Speaker Nancy Pelosi (D-CA), former Senate Finance Chair Max Baucus (D-MT) and others -- signed a brief arguing that the law never intended or suggested that the premium tax credits were confined to state-run exchanges. The brief, submitted by the liberal Constitutional Accountability Center, said there is "no support" for the challengers' position.

If the three-judge panel rules against the law, the administration can still appeal for an en banc ruling, in which each of the 11 active judges votes. That could be friendlier to President Barack Obama because Democrats have a 7-4 split on the active bench -- four of the judges were appointed by Obama himself.

The challengers haven't won anywhere yet. But similar cases are percolating in other district and appeals courts, and Obamacare supporters are more wary of writing off this challenge after initially dismissing the lawsuit against the individual mandate as a fool's errand. If the opponents start racking up even a few victories in court, the case could find its way back to the Supreme Court, where four justices voted in 2012 to wipe out Obamacare in its entirety and one of them succeeded at making the Medicaid expansion optional.

"The only people who thought this case was a long shot are the people who didn't look at the facts," Cannon, an architect of the Halbig challenge, told TPM.
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kbp

From last post:

  • The Obama administration won the case in January at the D.C. District Court, where Clinton-appointed Judge Paul L. Friedman labeled the challengers' claim "unpersuasive." He said Congress designed the federal exchange on behalf of states, so it functions as such for the purpose of the law. A ruling against the government, Friedman said, would "violate the basic rule of statutory construction that a court must interpret a statute in light of its history and purpose."

    and

  • "Don't you have a special burden to show from legislative history that that doesn't mean what it appears to mean?" [Judge Thomas B.] Griffith asked the government's lawyer. "If we know the clear purpose of Congress and yet they don't legislative clearly enough to achieve that purpose, is it our job to fix the problem?"

    and

  • The chief congressional architects of Obamacare -- including Senate Majority Leader Harry Reid (D-NV), erstwhile House Speaker Nancy Pelosi (D-CA), former Senate Finance Chair Max Baucus (D-MT) and others -- signed a brief arguing that the law never intended or suggested that the premium tax credits were confined to state-run exchanges. The brief, submitted by the liberal Constitutional Accountability Center, said there is "no support" for the challengers' position.
So they lost because the first judge interpreted it had some "purpose" that overrides the exact text NINE TIMES, the swing judge now is making it the defendant's "burden" to provide evidence of that "purpose" that defies the text, and "chief congressional architects of Obamacare" are arguing they never intended the text to dictate that states establish exchanges by using rewards for doing such.

What are they facing?
Quote:
 
http://www.cato.org/sites/cato.org/files/documents/adlercannon_amicus.pdf
...BRIEF OF JONATHAN H. ADLER AND MICHAEL F. CANNON AS AMICI CURIAE IN SUPPORT OF THE APPELLANTS
(page 19)
G.Senator Reid Strengthened the Language Restricting Tax Credits to State-Established Exchanges Prior to Final Passage
When Senate leaders merged the Finance and HELP bills to create the PPACA in Sen. Reid’s office, they strengthened the Finance language conditioning premium-assistance tax credits on states establishing an Exchange.

The Finance bill used a cross-reference to define “coverage months” as occurring only when taxpayers purchased insurance through an Exchange “established by the State.” While Reid and his staff were overseeing the crafting of the PPACA, that already clear provision was augmented with language explicitly repeating, within the “coverage month” definition, that coverage months occur only when taxpayers enroll in a qualified health plan “through an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act.” Compare America’s Healthy Future Act of 2009, supra, § 1205, with PPACA § 1401, 26 U.S.C. § 36B(c)(2)(A)(i).

Note also that, while Senate leaders were strengthening the Finance language conditioning Exchange subsidies on state cooperation, they dropped the Finance language conditioning small-business tax credits on states enacting the required rating rules. This change had no practical effect because the PPACA still conditioned Exchange subsidies on states implementing those and other insurance regulations.

Now Reid & crew did a copy/paste, revised what they did not want or need from that copy, and then strengthened the ACA subsidy requirement of "an Exchange established by the State" by adding the phrase that it was to be a part of "section 1311 of the Patient Protection and Affordable Care Act."

I'm lost as to how anyone can find a "purpose" other than what the text clearly states NINE TIMES.

Edited by kbp, Mar 27 2014, 01:10 PM.
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Baldo
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Welcome to the newest heath-care proposal-- The Copper Plan!

Six Senators, Fearing Political Cost, Urge Changes to Health Act

WASHINGTON — Six senators, five Democratic and one independent, on Thursday rolled out a series of policy proposals they said were intended to fix and improve President Obama’s signature health care law.

Three of the Democrats — Senators Mark Begich of Alaska, Mary L. Landrieu of Louisiana and Mark Warner of Virginia — are up for re-election in 2014. Their unveiling of the policy prescriptions comes as vulnerable Democratic candidates in both the House and Senate are under increasing pressure to distance themselves from the Affordable Care Act.

The other Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin III of West Virginia, as well as Senator Angus King, independent of Maine, rounded out the group of centrists who laid out their plans in an op-ed article in Politico Magazine Thursday.

The move reflects part of a broader strategy by Democrats, who are grappling with the awkward reality of how to escape the embrace of the health care law — which passed with no Republican votes and has become a political liability — while not going as far as their Republican counterparts who are trying to repeal it....snipped

...The package of roughly a half-dozen policy proposals is intended to increase choice and affordability when consumers are choosing a health care plan, as well as to ease the burden on small businesses. Many of the proposals have already been pushed by individual senators....snipped

...Some of the measures include: adding a “Copper Plan” to the existing marketplace options (Platinum, Gold, Silver, and Bronze), which would cost less but have a higher deductible; directing state insurance regulators to create health plans that could be sold across state lines — a move the senators believe would increase both consumer options and competition; making small-business health care tax credits available longer and making them accessible to more employers, to make it easier for small businesses to cover their employees; and offering an additional, permanent way to enroll in the health care marketplace other than HealthCare.gov, the government website whose rollout has been plagued by problems....snipped

http://www.nytimes.com/2014/03/28/us/politics/six-senators-fearing-political-cost-urge-changes-to-health-act.html


Seems more like a Hail Mary to save the Democratic senators seats in Nov. I doubt it will pass, but that isn't the point, just a false cover.

What's next the Toilet Paper Plan?
Edited by Baldo, Mar 27 2014, 01:25 PM.
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