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http://hotair.com/archives/2014/04/09/study-yep-early-obamacare-enrollees-are-sicker-than-average/

Study: Yep, early ObamaCare enrollees are sicker than average

Tantalizing circumstantial evidence about the demographic mix in the new ObamaCare exchange risk pools. The more those pools are dominated by the old and sick, the higher premiums will have to be next year to cover the cost of their expensive treatments. The X factor here, though, is that the study includes data only from people whose coverage was in effect in January and February. All the sign-ups in March before the deadline are missing from the picture, an important detail since it’s widely assumed that lots of healthy young “knuckleheads” waited until the last minute to enroll. If that’s true then the early crush of sick people might be manageable; premiums paid by twentysomething latecomers who don’t need much medicare care will simply be applied to paying for the sick, easing costs next year. If it’s not true, premiums are headed up, up, and away, and O-Care’s in trouble.

What makes this study significant, then, isn’t that it’s a surprise. No one’s surprised to find that the very ill rushed to get coverage once guaranteed issue went into effect. What makes it significant is that it seems to confirm that the healthy did, to some extent, hold back during early enrollment. Did they show up later or was that a bust too? Your health-care costs next year partly depend on the answer.

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• People who signed up early for insurance through the new marketplaces were more likely to be prescribed drugs to treat pain, depression and H.I.V. and were less likely to need contraceptives, according to a new study that provides a much-anticipated look at the population that signed up for coverage under the new health care law…
  
  Julie Huppert, vice president for health care reform at Express Scripts, said she expected to see the picture change as the year progressed. But she said this early glimpse was crucial for insurers, which were already setting their rates for next year…
  
  The study found that six of the 10 most costly drugs in the marketplace plans, in terms of total spending, were specialty drugs, in contrast to four of the top 10 drugs in employer plans. The higher use of specialty drugs could point to additional health care costs, some said.
  
  “The medication is only the tip of the iceberg,” said Daniel N. Mendelson, chief executive of the consulting firm Avalere Health. “What goes along with that is a need for physician visits and, often, hospitalizations associated with complications from the conditions.”

Here’s a quickie two-page breakdown from Express Scripts of their key findings. Note the table comparing conditions for which ObamaCare customers sought treatment to conditions treated among all other insured. Contraceptives are notably lower for O-Care users than for the rest of the population, a clue about the average age of the exchange risk pools circa March 1. More comparison details from Kaiser:

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• -More than 6 in every 1,000 prescriptions were for an HIV drug, a rate four times that of employer plans.
  
  -HIV/AIDS drugs Atripla and Truvada ranked in the top 10 for total amounts spent on drugs but did not hit the top 10 in spending among the comparison group.
  
  -Sovaldi, an $84,000 treatment approved in December to treat hepatitis C, came in second for total spending, while it ranked No. 8 in the comparison group.
  
  -The volume of pain medication was 35 percent higher; drugs to control seizures were 27 percent higher and antidepressants were 14 percent higher. Conversely, birth control prescriptions were 31 percent lower.

The Hepatitis C drug, in particular, is fantastically expensive at $1,000 per pill; the number of Americans with the disease is upwards of three million. That, in microcosm, is why O decided that bantering with Zach Galifianakis for a few minutes was worth doing. Anything he could do to get the attention, and later the money, of young invincibles by convincing them to sign up and help pay for all this was worth doing. Can’t wait to find out how he did when HHS finally releases the demographic data on enrollees.

Then again, maybe there’s another way to keep costs down. In lieu of an exit question, via Jim Geraghty, I’ll leave you with this:

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• As a proud new beneficiary of the Affordable Health Care Act, I’d like to report that I am doctorless. Ninety-six. Ninety-six is the number of soul crushing rejections that greeted me as I attempted to find one. It’s the number of physicians whose secretaries feigned empathy while rehearsing the “I’m so sorry” line before curtly hanging up. You see, when the rush of the formerly uninsured came knocking, doctors in my New Jersey town began closing their doors and promptly telling insurance companies that they had no room for new patients.

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http://www.forbes.com/sites/michaelcannon/2014/04/11/sebelius-resignation-may-create-more-problems-for-democrats-than-it-solves/

Sebelius Resignation May Create More Problems For Democrats Than It Solves
Michael F. Cannon

Last year, National Journal reporter Matthew Cooper waxed that despite the disastrous roll-out of HealthCare.gov, President Obama would retain Health and Human Services Secretary Kathleen Sebelius due to “a mutual affection that’s just strong enough to keep them bound together” plus “their shared love of basketball” and unspecified other “mystic chord[s) between the two lanky pols.” Well, the mystic chords weren’t enough, and Sebelius is on her way out the door. One might think this would help Democrats turn a corner on health care, but don’t count on it. President Obama’s pick to succeed Sebelius – Office of Management and Budget Director Sylvia Mathews Burwell — could face a brutal confirmation process, because she is his first and potentially only nominee to ObamaCare’s “death panel“: the Independent Payment Advisory Board. The last time senators suspected an Obama nominee of wanting to exercise IPAB-style powers over health care — i.e., Don Berwick’s ill-fated nomination to run Medicare and Medicaid — it was such a bloodbath that Democrats were afraid even to hold a vote. And Burwell would wield far more power than senators feared would fall into Berwick’s hands. By accepting Sebelius’ resignation, President Obama has given Republicans a weapon to use against vulnerable Democratic senators, and created more problems for the White House than if he had asked her just to stay put.

From one perspective, Burwell seems like a safe choice. The Senate confirmed her as OMB director by a vote of 96-0. And since Senate Democrats eliminated the filibuster for such nominations, she would need only 51 votes this time around. Currently, 55 senators caucus with the Democrats. So Senate Majority Leader Harry Reid (D-NV) could let four vulnerable Democratic senators walk, and she would still prevail.

But Burwell’s nomination is unlike any the Senate has ever considered before. Under the Patient Protection and Affordable Care Act, if the Senate does not confirm any nominees to the Act’s 15-member Independent Payment Advisory Board, then all of the Board’s powers fall to the Secretary of Health and Human Services.

And IPAB’s powers are considerable. The Board is an unconstitutional super-legislature. In some respects, its powers rival or exceed those of an entire chamber of Congress. As Diane Cohen and I explained in 2012:

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• When the unelected government officials on this board submit a legislative proposal to Congress, it automatically becomes law: PPACA requires the Secretary of Health and Human Services to implement it. Blocking an IPAB “proposal” requires at a minimum that the House and the Senate and the president agree on a substitute. The Board’s edicts therefore can become law without congressional action, congressional approval, meaningful congressional oversight, or being subject to a presidential veto. Citizens will have no power to challenge IPAB’s edicts in court.
  
  Worse, PPACA forbids Congress from repealing IPAB outside of a seven-month window in the year 2017, and even then requires a three-fifths majority in both chambers. A heretofore unreported feature of PPACA dictates that if Congress misses that repeal window, PPACA prohibits Congress from ever altering an IPAB “proposal.” By restricting lawmaking powers of future Congresses, PPACA thus attempts to amend the Constitution by statute.
  
  IPAB’s unelected members will have effectively unfettered power to impose taxes and ration care for all Americans, whether the government pays their medical bills or not. In some circumstances, just one political party or even one individual would have full command of IPAB’s lawmaking powers. IPAB truly is independent, but in the worst sense of the word. It wields power independent of Congress, independent of the president, independent of the judiciary, and independent of the will of the people.

The Senate has never confirmed someone to a position of such power. (IPAB didn’t exist when the Senate confirmed Sebelius.)

President Obama hasn’t nominated anyone else to IPAB so far, and he’d probably be foolish to do so. Each nomination could face a Berwick-style bloodbath in the Senate. If any of his nominees somehow survived — a big “if” — the president would then have less influence over IPAB than under a scenario where the Board’s powers fell to an HHS Secretary who serves at his pleasure. So Burwell may be the only IPAB nominee we ever see from this president.

Which is why senators will want to examine very closely Burwell’s views on IPAB, its powers, its constitutionality, and its relationship with Congress. I suggest Senate staffers use the Cohen-Cannon study to start compiling their lists of questions. (Other analyses either have missed that the PPACA purports to protect IPAB’s edicts from any congressional interference after 2020, or have made other basic interpretive errors.) The question confronting senators is, should Burwell be entrusted with more power than the entire Senate?

IPAB’s ability to turn Democratic votes should not be underestimated. Howard Dean has railed against IPAB in the pages of the Wall Street Journal. Twenty-four House Democrats have cosponsored legislation to repeal it. So have two vulnerable Senate Democrats: Mark Pryor (Ark.) and Kay Hagan (N.C.). Many more would rather not have to cast a vote on the issue at all.

President Obama may rue the day he accepted Kathleen Sebelius’ resignation. The Washington Post reports she will “remain until her successor is confirmed.” Instead of new leadership at HHS and a fresh start with ObamaCare, then, the president could find himself with the same old leadership and a politically damaging Senate fight over IPAB in an election year. Makes you wonder who the bad manager really was.

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http://www.cato.org/publications/policy-analysis/independent-payment-advisory-board-ppacas-anticonstitutional-authoritarian-superlegislature

The Independent Payment Advisory Board: PPACA’s Anti-Constitutional and Authoritarian Super-Legislature
By Diane Cohen and Michael F. Cannon
June 14, 2012

When a member of Congress introduces legislation, the Constitution requires that legislative proposal to secure the approval of the House of Representatives, the Senate, and the president (unless Congress overrides a presidential veto) before it can become law. In all cases, either chamber of Congress may block it.

In 2010, the Patient Protection and Affordable Care Act (PPACA) created the Independent Payment Advisory Board, or IPAB. When the unelected government officials on this board submit a legislative proposal to Congress, it automatically becomes law: PPACA requires the Secretary of Health and Human Services to implement it. Blocking an IPAB “proposal” requires at a minimum that the House and the Senate and the president agree on a substitute. The Board’s edicts therefore can become law without congressional action, congressional approval, meaningful congressional oversight, or being subject to a presidential veto. Citizens will have no power to challenge IPAB’s edicts in court.

Worse, PPACA forbids Congress from repealing IPAB outside of a seven-month window in the year 2017, and even then requires a three-fifths majority in both chambers. A heretofore unreported feature of PPACA dictates that if Congress misses that repeal window, PPACA prohibits Congress from ever altering an IPAB “proposal.” By restricting lawmaking powers of future Congresses, PPACA thus attempts to amend the Constitution by statute.

IPAB’s unelected members will have effectively unfettered power to impose taxes and ration care for all Americans, whether the government pays their medical bills or not. In some circumstances, just one political party or even one individual would have full command of IPAB’s lawmaking powers. IPAB truly is independent, but in the worst sense of the word. It wields power independent of Congress, independent of the president, independent of the judiciary, and independent of the will of the people.

The creation of IPAB is an admission that the federal government’s efforts to plan America’s health care sector have failed. It is proof of the axiom that government control of the economy threatens democracy.

IPAB may be the most anti-constitutional measure ever to pass Congress, and it is therefore tempting to dismiss IPAB as an absurdity that the body politic will soon reject. Until that occurs, IPAB will potentially empower just one unelected government official to impose any tax or regulation, to appropriate funds, and to wield other lawmaking powers.

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http://m.washingtonexaminer.com/hhs-rule-would-further-tighten-noose-on-individual-insurance-market/article/2547121

HHS rule would further tighten noose on individual insurance market
BY: Philip Klein

President Obama's health care law vastly expanded the role of the federal government in regulating health insurance, a job that has traditionally been left to state governments. Fearing that individuals might exploit an exception in the existing regulations, the Department of Health and Human Services has proposed a new rule that would further tighten the noose.

As most people know, under Obamacare, individuals must either purchase a federally-approved insurance policy or pay a penalty. The problem is, because Obamacare policies must provide a mandated set of benefits, they generally cost more. That makes them less attractive to healthier Americans with fewer medical needs. There is, however, another option available to people who don't want to purchase comprehensive insurance, but want some modicum of coverage.

Called “fixed-indemnity insurance,” these policies, in states where they’re available, pay beneficiaries a predetermined amount for certain medical costs. The policies do not comply with Obamacare, so beneficiaries are still subject to the individual mandate penalties. But because they can have significantly lower monthly premiums (think around $70 per month), it may be cheaper for individuals to purchase these non-compliant policies – even after taking into account the mandate.

With these policies achieving more attention and growing in popularity as individuals sought a way out of Obamacare, the scrutiny rose. Many liberals attacked these plans as a loophole within Obamacare, arguing that they were being marketed deceptively so that individuals would buy them thinking they were covered just as with regular insurance. But the plans are exempted from Obamacare's annual limit caps and because they only pay out a fixed amount, they can leave policyholders with an expensive stack of bills in the event of major medical losses.

HHS responded last month with a proposed rule that would only allow these plans to be exempted from Obamacare’s rules if individuals purchase them in tandem with another policy that is compliant with Obamacare. For instance, if you purchase qualifying insurance through an exchange that carries a higher deductible, you can still purchase a fixed-indemnity policy to help out with some of your out-of-pocket costs. But the plans would no longer be available to individuals looking to get around Obamacare by simply buying a bare-bones, non-compliant policy and paying the penalty.

In addition to taking away another choice remaining to individuals, the rule would represent a further expansion of federal power over the health insurance market.