Baldo

Jul 6 2014, 09:55 AM

Great Interview by Reason TV

How to Grow the Supply of Healthcare

Published on Jul 1, 2014

"For two or three generations, we've almost completely ignored the supply side" of health care, warns Robert Graboyes, an economist who specializes in health care issues. That's especially a big problem now that Obamacare is coming online. The whole point of the program, after all, is to increase demand for medical services. Yet even President Obama and his supporters acknowledge the plan does next to nothing to generate more doctors and more medical innovations.

Graboyes, a senior research analyst at George Mason's Mercatus Center, sat down with Reason TV's Nick Gillespie to outline immediate ways to grow the number of hospitals, doctors, and nurses to serve millions of newly insured patients.

Even more important is the need to increase the pace of the transformative medical innovation that has always extended lifespans and raised the quality of life, says Graboyes. At the dawn of "molecular medicine," in which drugs are targeted to specific individuals, the FDA's backward-looking and hyper-expensive approval process is more destructive than ever. Medicare's byzantine cost-codes freeze into place yesteryear's solutions. At the state level, "certificate of need" laws make it tougher than ever to expand or build new health care facilities.

We've got to "look for every obstruction to the supply and get rid of it," says Graboyes.

Video:
https://www.youtube.com/watch?v=Mwm5RY1IbKU

Passing out more insurance cards does not equal healthcare! It is what we have been saying here over & over again.

Interesting comments about the future and how the govt is impeding it

BTW talk about idiots with little business experience. Increase demand but don't increase supply.

Typical Marxist solution

Quote:

 

http://patterico.com/2014/07/03/why-a-theory-of-legal-interpretation-could-decide-whether-obamacare-subsidies-live-or-die/

Why a Theory of Legal Interpretation Could Decide Whether ObamaCare Subsidies Live or Die
Patterico @ 7:38 am

Here’s a fun little statutory interpretation question. The Affordable Care Act says that tax credits and subsidies are available when one enrolls in a health plan “through an Exchange established by the State under Section 1311.” A “State” is defined as “each of the 50 States and the District of Columbia.” Section 1311 is a provision that allows exchanges to be set up by states.

If one enrolls in a health plan through an exchange established by the federal government, they would not appear to be enrolled in a health plan “through an Exchange established by the State under Section 1311.” And thus, one is not eligible for a subsidy.

This is really happening — and it could be the death knell for ObamaCare subsidies, because most states didn’t bother to set up exchanges.

So, we have two competing schools of interpretation. One is: the language means what it means. You look at the language as it is reasonably understood by people reading it when it is passed. Nobody reading the word “State,” defined as “each of the 50 States and the District of Columbia,” would interpret it as “each of the 50 States and the District of Columbia and also the federal government under certain circumstances.”

But then we have another school of interpretation that says it doesn’t really so much matter what the law says — we have to look to what the lawmakers really meant. And there, it gets messy. Democrats will say: “Well, of course we meant for the subsidies to apply to policies bought on the federal exchange.” Jonathan Adler has long argued the contrary position: that the subsidies were intended to provide an incentive for the states to set up their own exchanges. Applying this theory of legal interpretation, some judge would have to wade through all the possible motivations Congressmen might have had for writing what they wrote, and decide between Adler’s view and the Dems’ view.

But you don’t even get to this argument unless you concede the proposition that what Congress “intended” can trump the plain language of what it actually wrote. I have criticized this position in the past. The only way you can have a rule of law is to interpret laws according to their objective reasonable meaning as understood at the time the law is written.

You can see the two schools of interpretation at work in the description of the argument of this case in the D.C. Circuit:
(quoted from http://talkingpointsmemo.com/dc/halbig-obamacare-ruling-looms-dc-circuit )

• 
  
• “If the legislation is just stupid, I don’t see that it’s up to the court to save it,” Judge A. Raymond Randolph said during oral arguments in March.
  
  Randolph, a George H.W. Bush appointee, said the text of the statute “seems perfectly clear on its face” that the subsidies are confined to state-run exchanges. Carter-appointed Judge Harry T. Edwards slammed the challengers’ claims as “preposterous.” So the deciding vote appears to be with George W. Bush-appointed Judge Thomas B. Griffith, who wasn’t resolute but sounded unconvinced of the Obama administration’s defense, saying it had a “special burden” to show that the language “doesn’t mean what it appears to mean.”

Whether ObamaCare lives or dies will likely depend — for now — on one judge’s view of his role. Does he follow the law as written? Or does he ignore the plain language of the law to try to ascertain some subjective meaning that Congress might have intended to express?

Of course, this will all eventually be headed to the Supreme Court, where Anthony Kennedy and Justice Roberts will end up grappling with the same question. I don’t hold out much hope for Kennedy on this issue.

Baldo

Jul 6 2014, 03:55 PM

Good article. it goes over 9 reasons why premiums are rising

Why Obamacare Is Pushing Up Health Insurance Premiums

Now that Obamacare has been enacted, Americans across the nation are seeing their health insurance bills spiking, leading to what has been a documented slide in full-time hiring, a drop in consumer discretionary spending, not to mention stagnant and declining real wages. In short: a broad economic contraction (yes, yes, who could have possibly foreseen this).

But how is it that insurers set their prices? As Bloomberg explains, insurers are calculating what to charge for health plans in 2015, which is no simple task. Actuaries can’t easily forecast how often the millions of new Obamacare enrollees will go to a doctor. New federal rules and expensive drugs will also increase costs. Wrong guesses could wipe out profits.

Here is a quick and dirty way to understand why premiums are going up...snipped

http://www.zerohedge.com/news/2014-07-06/why-obamacare-pushing-health-insurance-premiums

So that $2500 savings per family was one huge LIE!

The 9 Reasons:

 

1. Cost of claims
2. Benefit changes
3. Rising prices
4. Risk pool
5. Provider networks
6. Geography
7. Reinsurance
8. Taxes and fees
9. Profit and risk load

Quote:

 

http://capsules.kaiserhealthnews.org/index.php/2014/07/advocates-say-california-is-rejecting-free-money-to-renew-poor-peoples-insurance/?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=13387764&_hsenc=p2ANqtz-9EPtXYXoRMa_HAblilE7QT396lgbLkxl-S1nD1nzKaDPcXP9wEFUYFuVdH9S_y5rXXWOLpfZ4m0Icj8E6WOXVIiqMSQA&_hsmi=13387764

Advocates Say California Is Rejecting ‘Free Money’ To Renew Poor People’s Insurance
By Anna Gorman

This KHN story can be republished for free. (details)

Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage.

Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment.

Sens. Ed Hernandez and Mark Leno, both Democrats, said the money from the health care philanthropy is needed to help people through the process of keeping their health coverage. Moreover, taking the money would make the state eligible for another $6 million in matching funds from the federal government, they say.

“I can’t see leaving money on the table,” Hernandez said Thursday. “It doesn’t cost us a penny.”

The state Department of Finance, however, has said it doesn’t need the money. “We think this is just a duplication of efforts,” Keely Boster, chief deputy director of the department, said in a legislative hearing last month.

The state is already faced with a backlog of new Medi-Cal applicants because of the program’s expansion under the federal health law. Now, advocates say, it is imperiling continued access for existing beneficiaries.

“It’s a head scratcher to me,” said Kristen Golden Testa, health director of The Children’s Partnership, a nonprofit child advocacy organization. “Free money to help keep people covered seems to make a lot of sense to me.”

The decision was all the more perplexing given that California accepted a gift of $26.5 million last year from The California Endowment to help with expanded Medi-Cal enrollment, advocates said. Medi-Cal is the state’s version of the Medicaid program for low-income residents.

This time, the funds would be used help counties and community-based organizations complete renewals for beneficiaries, who must go through an annual process to ensure they continue to be eligible.

Advocates suggested that the state may not want the added cost of covering people who might otherwise drop out of the program – a common phenomenon among the poor and sometimes transient Medi-Cal population.

The state is responsible for about 50 percent of the costs of Medi-Cal beneficiaries eligible for coverage before Obamacare passed. The federal government is initially covering the entire cost for people who are newly eligible under the law.

If the state doesn’t accept the donated funds, about 3,600 people are expected to lose coverage, saving the state more than $8 million, according to a finance department document.

“We are very concerned that the state is putting up a lot of roadblocks,” said Judy Darnell, director of public policy at United Ways of California.

The Affordable Care Act expanded those eligible for Medi-Cal to childless adults and people who earn up to 138 percent of the federal poverty level, or about $16,000 for an individual and $27,000 for a family of three. California enrolled nearly two million people in the program, bringing the state’s total to 10.6 million. In addition, the state is facing the backlog of about 600,000 new applications.

At the same time, as many as one million beneficiaries each month are expected to seek annual renewals of their coverage, according to the Department of Health Care Services.

Department of Health Care Services spokesman Tony Cava said the renewals and the new applications together is “quite a large task” for the counties. “It is all happening at the same time,” he said.

Cava said he could not comment on the pending legislation.

Sen. Leno said at a recent legislative hearing that failing to accept the funds from The California Endowment “would be bureaucratic waste at its worst.”

“To deny this offer of financial support would be counterproductive and antithetical to the very reason that we did participate in Medi-Cal expansion,” he said.

New rules make the renewals different and more confusing this year, according to Elizabeth Landsberg of the Western Center on Law & Poverty, one of the co-sponsors of the Senate bill.

“Anything we can do to help consumers … will help streamline the process,” she said.

agorman@kff.org

Kaiser Health News’ coverage of California is supported by The California Endowment.

kbp

Jul 7 2014, 07:50 AM

The image ZeroHedge borrowed from Bloomberg is a guesstimate if one uses it to see what will happen in each separate pool. I'd guess it is some national average from years past.

Anyway, note that the insurers must spend 80% of premiums on care, leaving 20% for OH & Profit. The 80% (or greater if the insurer so chooses) is the Target. The 20% or less is a margin set in stone, with exception to the 3% maximum should they lose lots of money in the Target.

Quote:

 

Obamacare's next threat: A September surprise

Obamacare open enrollment closed March 31. The White House’s Obamacare war room did not.

Most state health insurance rates for 2015 are scheduled to be approved by early fall, and most are likely to rise, timing that couldn’t be worse for Democrats already on defense in the midterms

The White House and its allies know they’ve been beaten in every previous round of Obamacare messaging, never more devastatingly than in 2010. And they know the results this November could hinge in large part on whether that happens again.

So they’re trying to avoid — or at least, get ahead of — any September surprise.

Aware that state insurance rate hikes could give Republicans a chance to resurrect Obamacare as a political liability just weeks before the midterms, the White House’s internal health care enrollment outreach apparatus immediately redirected into a rapid-response, blocking-and-tackling research and press operation geared toward preempting GOP attacks on the issue.

In what aides say is a sign of a changed approach within the White House — but also heightened concerns around the midterms — they’re even coordinating with Hill Democrats, funneling localized background analysis and talking points to each state’s delegation through Senate Majority Leader Harry Reid (D-Nev.), House Minority Leader Nancy Pelosi (D-Calif.) and New York Sen. Chuck Schumer’s Senate Democratic Policy and Communications Committee. They’ve also relied on California Rep. Henry Waxman’s staff at the Energy and Commerce Committee to produce rebuttal reports, often in advance, on GOP claims about insurance.

“One of the lessons we’ve learned in implementing health care is to stay on it,” said Tara McGuinness, the White House senior communications adviser who has been spearheading the effort for the West Wing, reflecting on previous run-ins. “We are not going to let anyone distort the debate.”

They’ve got plenty to respond to already. “Empty Promises,” reads a heading on a recent fact sheet from Wyoming Republican Sen. John Barrasso’s Republican Policy Committee, citing President Barack Obama’s repeated promises that premiums wouldn’t rise. “When Washington Democrats were trying to win elections and push their health care plan into law, they repeatedly said their bill would drive down premiums and health care costs.”

With Democrats looking to hang on to Senate seats in many Republican-leaning states, they’ll be hoping that the final numbers don’t come in anywhere near the 24.6 percent hike that report from the anti-Obamacare Heritage Foundation projected for a family of four in Arkansas, or even the 13.1 percent increase in Alaska or 12.4 percent in Louisiana.

So far, although no state has finalized its rate, 21 have posted bids for 2015. Average preliminary premiums went up in all 21, though only a few by double digits

Every preliminary rate will be reviewed and negotiated by state and federal insurance authorities, and based on past years, many will end up cut significantly. But the White House and its allies recognize that “rates have gone up under Obamacare” will always make an easier headline than their response — the initial bids won’t necessarily be the final rate; the announced averages are misleading because they give equal weight to larger and smaller insurers; rates have gone up at a lower rate than would likely have happened otherwise; and subsidies are built into the law to compensate for some of those increases as well as potential end-of-year rebates for inordinate hikes.

They also recognize that, even if months from now the facts bear out their argument, they’d never be able to take back a first round of negative stories and resulting anxiety — or keep that material out of Republican campaign ads.

“Nobody out there knows anything about the medical-loss ratio,” said Sen. Chris Murphy (D-Conn.), who’s become the Senate point man for Obamacare rapid response, leading efforts to get Democrats to match Republicans in floor speeches and social media campaigns with supportive efforts of their own. But “if the premium increase is too high, you get your money back. That’s a pretty easy thing to explain.”

That’s where the six-person White House team, with backup from staffers at the Department of Health and Human Services, comes in. “Chance favors the prepared mind” goes the Louis Pasteur quotation that defines their ethos.

For months, the half-dozen White House communications and policy aides have been assembling state-by-state histories of health insurance rates before the Affordable Care Act was implemented, the drop-offs between initial rate proposals and final rates, and an analysis of the law’s effects and projections for 2015 — all condensed to fit on a two-page background and talking points document tailored for each state.

Then they wait, closely tracking developments in the states in order to be ready to pounce when rates are announced.

When they see a state preparing to announce premium proposals, McGuinness emails Reid’s and Pelosi’s offices, who then connect her team with the chiefs of staff and press aides for every Democrat in the state’s congressional delegation. They put together policy and communications briefings for the members’ staffs, and occasionally the members themselves.

“The amount of misinformation out there can be overwhelming, so you have to make sure that members have the historical trends, they have the new information in a straightforward way,” said Drew Hammill, Pelosi’s communications director and one of the White House’s primary points of contact on the effort, who said lawmakers had often been confused and overwhelmed by the state data in the past. “It’s setting the proper context that’s so crucial here.”
Continue Reading

Often, White House officials leave wrangling the local press to the offices that know state reporters best. But occasionally — in Ohio, for example, where there’s a major market, and a major opponent in Republican Lt. Gov. Mary Taylor — they will step in directly to help.

“Regardless of what they want to say or the rhetoric they want to use, in Ohio, consumers are paying more,” said Taylor, who oversees her state’s insurance department. “The facts are what the facts are. And the facts are that Obamacare is making things more expensive in Ohio.”

Taylor’s been leading the charge against Obamacare for years and hasn’t let up, still citing a predictive study from the consulting firm Milliman done last year because she says it has continued to track with the actual increases in rates to date. There are two more companies offering insurance in Ohio for 2015 than there were for 2014, but she says that this doesn’t account for an overall drop in competition and costs going up as a result of mandates.

The first bullet on the White House Obamacare strike team’s fact sheet for Ohio points out that rates on individuals went up in the state by double digits every year before Obamacare, too.

Taylor said she doesn’t buy the White House’s prediction that rates will drop significantly from the preliminary ones, which currently project an average 13 percent increase, though that’s an average that includes large market share insurers with rates that are now lower and small market share insurers with rates that have spiked.

As for the idea that final rates won’t match the preliminary ones, Taylor said, “It sounds like a political talking point to me,” explaining that she’s still in the process of reviewing the rates. “Are they expecting those rates are going to be cut in half? I don’t think so.”

Page 2 of the White House’s Ohio fact sheet is all about attempts to answer this question, citing drops in past years elsewhere around the country and larger trends in bringing down costs.

“Before the health law, Ohioans faced double-digit increases in premium costs each year,” said Sen. Sherrod Brown (D-Ohio), who was enlisted in the response once the preliminary rates came in. “Now, 85 percent of Ohioans purchasing plans on the exchange receive credits to make their health coverage more affordable.”

Sorting out who’s closer to reality will take data from all 50 states — and for any true statistical evaluation, several years’ worth.

“There is no clean and tidy story on rates,” said Brendan Buck, a spokesman for the national trade association America’s Health Insurance Plans, who until recently was at the forefront of public opposition to Obamacare as a spokesman for House Speaker John Boehner (R-Ohio). “They are going to vary state by state, market by market, and even within a market.”

Iowa’s seen one of the biggest spikes among the states that have come in so far — an average premium increase of 11.5 percent, though rates aren’t expected to be finalized until October. Even there, where Insurance Commissioner Nick Gerhart is an appointee of Gov. Terry Branstad, a Republican running for reelection, they’re holding off on drawing any conclusions.

“It’s a little early to name a trend when we’ve only had a few months of experience to make projections on,” said Gerhart spokesman Tom Alger.

But the White House and Democrats believe that if they can keep the storyline pointing toward decreases, or even just a muddle for now — and as far away from the doomsday, rates-through-the-ceiling stories that dominated coverage last year, they’ll neutralize Republican attacks.

“Everybody’s looking around the next corner, but I think there’s a growing confidence that we’ve figured out how to explain and message this bill,” Murphy said. “Some of these rate increases are going to look scary, but not compared to rate increases prior to the Affordable Care Act.”

Read more: http://www.politico.com/story/2014/07/obamacare-insurance-rates-white-house-108590_Page2.html#ixzz36nBjPrh8

Quote:

 

Why liberals are abandoning the Obamacare employer mandate

Robert Gibbs’ prediction that Obamacare’s employer mandate would — and perhaps should — be jettisoned shocked Democrats back in April.

By July, the former aide and longtime confidant of President Barack Obama had a lot more company. More and more liberal activists and policy experts who help shape Democratic thinking on health care have concluded that penalizing businesses if they don’t offer health insurance is an unnecessary element of the Affordable Care Act that may do more harm than good. Among them are experts at the Urban Institute and the Commonwealth Fund and prominent academics like legal scholar Tim Jost.

The employer mandate, Jost wrote in a Health Affairs post in June, “cries out for repair.” Repealing it “might not be such a bad idea,” if it’s replaced with something better for workers and businesses.

Leading Democrats in Congress aren’t bolting from the employer mandate, at least not before the November election. But the White House has delayed it twice in the past year, dubbed it “not critical” and said it will be phased in more slowly when its begins next year.

[...]
Read more: http://www.politico.com/story/2014/07/obamacare-employer-mandate-108578.html#ixzz36nGXun8K

Quote:

 

http://online.wsj.com/articles/sign-ups-not-the-only-way-to-gauge-health-laws-success-1404413482

Sign-Ups Not the Only Way to Gauge Health Law's Success
Enrollment Exceeded Expectations, But Other Measures Are More Important

[...]

To keep up with enrollment projections, twice as many people must sign up next year. More healthy people of all ages must enroll to offset the expenses of the very sick. And premiums must remain low to retain this year's enrollees, attract new participants, and check the cost of subsidies, which will grow as enrollment and premiums rise.

[...]

Of those who did enroll in the marketplace, a key question is how many were younger, healthier people. The Kaiser Family Foundation concluded that ideally 40% need to be age 18 to 34.

The figures vary by region, but nationally, only 28% are in that age bracket, according to the U.S. Department of Health and Human Services. Whether their relatively low number is worrisome depends on whether insurers anticipated the distribution and priced plans accordingly.

The gender breakdown of participants is also important because females are more expensive to insure than males, but under the new law they can't be charged more. Fifty-four percent of the individuals who enrolled on the exchanges are female, and 46% are male.

"If all the young people are female, you're going to have higher costs than if you are at a 50-50 ratio," said James T. O'Connor of Milliman, a provider of actuarial products and services.

Insurers will gather more details about the health of participants as they process claims, but meanwhile studies by pharmacy-benefits provider Express Scripts of pharmacy claims and by Inovalon, Inc., a health-technology firm, of medical claims have found an older, sicker population.

[...]

For insurers diving into the new marketplace, this has been the biggest wild card: It is difficult to price plans for individuals who have no claims history. Because of this uncertainty, the government implemented three mechanisms to reduce the financial risks.

Known as the "Three Rs," they are risk adjustment, reinsurance and risk corridor, and, in general they transfer money to insurers who happen to enroll more expensive individuals or who mis-priced plans. Two of the programs are transitional and will be eliminated after 2016, when the CBO projects average annual enrollment will increase to 24 million.

"By then, the theory is we're getting a more stable market, and it won't be needed," said Mairin Brady Mancino, an expert at Avalere, a national health-care consultancy.

Enrollment is expected to grow in part because the penalty for refusing to purchase insurance gets stiffer. This year, adults who forgo insurance must pay $95 or 1% of family income, whichever is higher. By 2016, the penalty increases to $695 or 2.5% of family income, whichever is higher.

"It starts to gain more teeth over time," Ms. Mancino said. "Now, for many people, it's cheaper to pay the penalty."

The next milestone will be when insurers lock in premiums for 2015. States participating in the federal exchange had until the end of June to submit rates, although insurers can update filings throughout the summer. Premiums will almost certainly increase, but at this stage, it's still a guessing game.

"There is not enough credible data to draw from for conclusions," said Bill Copeland, a health-care expert with Deloitte, a professional-services firm. "Open enrollment just closed. They're still paying claims and checking eligibility. I don't have one client that actually has a really good feeling for what their receivables are yet. It's really challenging now."

Quote:

 

http://www.cnsnews.com/news/article/barbara-hollingsworth/despite-obamacares-expanded-coverage-more-patients-going-er

Despite Obamacare's Expanded Coverage, More Patients Going to the ER
July 2, 2014

Despite expanded health insurance coverage under the Affordable Care Act (ACA), more people are going to hospital emergency rooms (ER) for treatment because they can’t get an appointment with a primary care physician, according to the American College of Emergency Physicians (ACEP).

“Nearly half of emergency physicians responding to a poll are already seeing a rise in emergency visits since January 1 when expanded coverage under ACA began to take effect,” according to ACEP, which gives overall emergency care in the U.S. “a dismal D+ grade.”

In addition, 86 percent “expect emergency visits to increase over the next three years,” and 77 percent say their ERs “are not adequately prepared for significant increases” in patient volume, according to the online poll.

“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” ACEP’s president, Dr. Alex Rosenau, explained. “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low.”

“When people can’t get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care,” Rosenau added.
[...]