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http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

Why I Hope to Die at 75
An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly
By Ezekiel J. Emanuel

Seventy-five.

That’s how long I want to live: 75 years.

This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.

I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

By the time I reach 75, I will have lived a complete life....

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http://www.nytimes.com/2014/09/19/us/over-seven-million-still-have-coverage-under-health-act.html

Health Care Act Still Covers 7.3 Million

WASHINGTON — The Obama administration said Thursday that 7.3 million people who bought private health insurance under the Affordable Care Act had paid their premiums and were still enrolled.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, disclosed the latest count at a hearing of the House Committee on Oversight and Government Reform.

President Obama had announced in April that eight million people had signed up for coverage in the federal and state insurance exchanges, also known as marketplaces.

The chairman of the committee, Representative Darrell Issa, Republican of California, asked why the reported enrollment had dropped by 700,000 people, or about 9 percent.

“Individuals may have gotten employer-sponsored insurance, or found out they were eligible for Medicaid, and some individuals may have decided not to go forward and pay,” Ms. Tavenner said. Some, she added, may have gone “into the ranks of the uninsured.”

Federal computer systems still cannot keep a complete, up-to-date count of people enrolled in health plans under the Affordable Care Act, and the government relies heavily on reports from private insurers. With encouragement from the administration, some consumers have signed up or switched plans since April, taking advantage of “special enrollment periods” available to people who marry, divorce, have a baby or were stymied by “technical errors” at HealthCare.gov.

Administration officials said they were pleased that most consumers were paying their share of premiums. More than 85 percent of people with marketplace coverage are receiving subsidies in the form of tax credits that lower their premiums.

“The vast majority of consumers who gained private insurance coverage through the marketplace are paying $100 or less per month,” Ms. Tavenner told the committee. “In fact, nearly half of individuals selecting plans with tax credits in the federally facilitated marketplace — specifically, 46 percent — were able to get covered for $50 per month or less.”

[...]

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http://online.wsj.com/articles/obama-administration-says-7-3-million-who-picked-health-plans-on-exchanges-have-paid-premiums-1411058425

Obama Administration Says 7.3 Million Who Picked Health Plans on Exchanges Have Paid Premiums

[...]

The Obama administration plans to automatically renew the coverage and tax credits of more than 5 million people who had obtained coverage through HealthCare.gov last year, in an effort to reduce the risk of them dropping out.

The move also could have prevented the HealthCare.gov system from being overloaded by returning users at the same time that millions of newcomers arrive. But federal officials and insurers are now saying they want people who bought coverage last year to come back to the site after all, in order to tell the federal government about changes in their income that could affect the value of their tax credit for next year. People who have higher incomes get lower tax credits, and they are required to reimburse the federal government for any overpayment.

People who already have coverage will only have until Dec. 15 to make changes to their enrollment information that can take effect at the start of the new year. As a result, if people follow the advice, there could be a bigger influx of consumers to the site in a single month than the site has ever seen before.

Last year's enrollments were spread over a six-month period. In March, which was the busiest month for enrollments, 2.8 million people signed up through the site, and it stumbled under some of the influx.

CMS has said it is planning to bolster the site for a period of high volume, including installing a simpler application system for new users that runs in Amazon Web Services, and swapping out the old account-creation system, which became a significant bottleneck last year.

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http://www.shestokas.com/legal-news/halbig-king-not-about-obamacare-but-who-makes-our-laws/

Halbig & King, Not Just About Obamacare, But Who Makes Our Laws

Obamacare is clearly not out of the legal woods, as demonstrated by the Federal Appeals Court decisions of Halbig v. Burwell[1] and King v. Burwell[2] both decided on the same day and reaching different results. In Halbig the court found that the IRS had written law rather than enforced it and the King court found just the opposite. The cases are critical to the future of Obamacare and are likely to end up in the Supreme Court.

This controversy involves issues well beyond Obamacare. It is a rare matter that implicates the basic principles of American government: federalism and separation of powers. The relationship of the federal government to state governments and the proper roles of the legislative, executive and judicial branches of government are at the heart of these matters.

Background of Halbig and King[3]

The Affordable Care Act has varied penalties, taxes and benefits. Congress passed the law and delegated to several federal agencies, including the Internal Revenue Service its execution. The agencies have authority to issue regulations to enforce the law Congress wrote.

The law called for the creation of “insurance exchanges” to be set up and run by the states. If a state could not or would not set up such an “exchange” the federal government could set up and run an “exchange” in that state. Certain individuals who purchased insurance “through an exchange established by the state” are eligible for tax credits and subsidies. 36 states did not establish exchanges, and the federal government established and runs exchanges in those states.

The IRS established regulations about subsidies and credits[4] for individuals, not only in the states[5] that established exchanges but for individuals in the 36 states with federal exchanges. The legal question centers on if the IRS has authority to issue regulations on these issues for the states with federally exchanges.

One court says the IRS does not have the authority (Halbig) and the other court (King) says it does.[6] The issue goes to the heart of Obamacare and American government.

Federalism Prohibited Congress from Ordering States to Establish Exchanges

One of the founding principles of the United States was its unique concept of federalism. Power over specific subjects was given to the central government and all other matters were controlled by state governments.[7] Despite the growth of the federal government, states retain some vestiges of the sovereignty from the original design. One key remaining limit on the federal government is the inability to order the states to do certain things.

The clearest statement of this principle comes from Printz v. United States, 521 U.S. 898 (1997):

“Congress cannot compel the States to enact or enforce a federal regulatory program. Today we hold that Congress cannot circumvent that prohibition by conscripting the States’ officers directly. The Federal Government may neither issue directives requiring the States to address particular problems, nor command the States’ officers, or those of their political subdivisions, to administer or enforce a federal regulatory program.”

As for the Affordable Care Act, no matter how much Congress wished to command states to establish “insurance exchanges”, it simply was without power to do so.

Federalism Does Not Prohibit Congress from Creating Incentives Think FREE MONEY!

While Congress cannot command states to enforce a federal program, it can and does create incentives for states to engage in conduct the federal government desires. The federal government thought it was a good idea to lower the blood alcohol content for driving under the influence to .08. To coerce states to change their laws on this issue, the federal government threatened to withhold federal highway funds from states that refused to do so.

Eventually, faced with the loss of billions of federal dollars, each state lowered its legal blood alcohol limit.

In like fashion, the federal government offered to qualified citizens of each state tax credits and subsidies when their state established an insurance exchange. Unlike the .08 law, 36 states chose to forgo this benefit and did not establish exchanges.

[...]

The Halbig Court Followed its Duties, the King Court Did Not

The Halbig court read the law. It clearly gave the IRS authority to issue regulations when there was “an exchange established by the state”. Much like Congress has only the authority found in the Constitution’s listed powers, an executive agency only has the power given to it by Congress. The ACA does not mention IRS authority to issue regulations regarding the relevant subsidies, penalties and taxes when there has not been “an exchange established by the state”. Since the authority was not given by Congress, the IRS could not issue the regulations and declared the IRS actions illegal.

The King court read the law it thought Congress meant to write, not the law Congress wrote. Since the King court thought Congress meant to include exchanges established by the federal government, those judges expanded the power of the IRS to impose taxes, penalties and grant subsidies. The IRS was not faithfully executing the law, so the King court rewrote the law.

The Question is the Rule of Law, Not the Policy of Obamacare

The basic question in the Halbig and King matters is not whether the Affordable Care Act is good or bad policy, but rather, what part of government under our system is charged with writing the law. Congress was not created in Article I of the Constitution by accident. The legislature was designed to be first among equals. The president and his agencies are to faithfully execute and the courts are to enforce laws as written by the Congress, not as they might wish that Congress had written them.

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http://healthpolicyandmarket.blogspot.com/2014/09/the-73-million.html?m=1

The "7.3 Million"

The administration finally released the Obamacare enrollment count this week.

Like everything else about their scorekeeping we got a number. Just one number. A number that was conveniently better than we had expected. And, we got no real context for the number or any of the back-up information.

I thought this quote in a Politico article was telling:

• 
  
• The figure is complex to unravel. The number came from the health insurers, who told the Obama administration every month how many people are covered by Affordable Care Act plans. A CMS official said Thursday that in prior monthly reports, the numbers varied widely, but recently stabilized."
  

So this tells us a couple of things:

• 
  
• 1.The carriers have been reporting the number of people they have been insuring in the exchanges to the Obama administration for months.
  2.The monthly enrollment numbers have "varied widely."

Up until now, the administration as repeatedly said they didn't have the enrollment numbers.

Why haven't they released these monthly reports on an ongoing basis?

Why can't we see all of the prior reports?

The numbers have "varied widely?" Did they finally get a number they conveniently liked?

The 7.3 million enrollment number would seem to suggest only a 9% attrition factor when most carriers have been reporting that about 15% haven't paid just the first month's premium.

Even with the lack of transparency about just what these numbers mean, I can find at least one obvious problem with them. As I thought of the administration's release of 7.3 million it occurred to me that they said the 7.3 million included all enrollments through mid-August.

Under Obamacare, after a person has paid their first premium, a health plan can't cancel anyone until they have gone three months without making a payment.

So, they are effectively double counting by including the "adds" while also keeping the "deletes." The 7.3 million figure includes all of the enrollments that have occurred through mid-August. But the number also still includes every person who has failed to make a premium payment in June, July, and August––since the carriers can't yet knock them off the rolls. The health plans tell me there is a 2% to 4% monthly attrition rate. That means the 7.3 million could be overstated by 6% to 12% of the total.

When the administration kept repeating the "8 million enrolled" figure it was convenient to do so even though we all knew it was a misleading number.

Now the administration apparently finds the 7.3 million tally convenient.

One number, out of context, with no back-up.

Even though the back-up exists––and apparently has for months.

Transparency?

I don't think we will really know what's been going on until we ultimately get a Government Accountability Office (GAO) audit.

LTC8K6

Sep 21 2014, 08:05 PM

Tax refunds will be cut for (some) ACA recipients

http://www.usatoday.com/story/money/columnist/tompor/2014/09/21/susan-tompor-tax-refunds-will-be-cut-for-some-who-get-health-credits/15958211/

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A significant benefit of the Affordable Care Act is the opportunity to receive money-saving tax credits up front to cut the overall cost of health insurance, but now hundreds of thousands of consumers could owe back some of that money next April.

Those affected took advance payments of the premium tax credit for health insurance. Some married couples could owe $600 or $1,500 or $2,500 or even more. It might feel like a raw deal for some who are already suffocating under the escalating costs of health insurance.....

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But notices were sent this week to some consumers whose incomes don't match up to such things as 2012 tax return information.

Baldo

Sep 18 2014, 06:37 AM

Panel Urges Overhauling Health Care at End of Life

The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.

The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.

“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”.

Many of the report’s recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning. Medicare, which covers 50 million Americans and whose members account for about 80 percent of deaths each year, is considering doing just that, prompted by a recent request from the American Medical Association. Some private insurers are already covering such conversations, and many more would if Medicare did...snipped

http://www.nytimes.com/2014/09/18/science/end-of-life-care-needs-sweeping-overhaul-panel-says.html

Those darn Seniors who live too long.

Abort babies, abort those Seniors, of course Obama & his staff will get gold-plated care for life

kbp

Sep 22 2014, 03:04 PM

In the recent loss of my father, he was provided with a couple types of out-patient treatment (chemo's IIRC) and selected to pass at home months ahead of his death, all a part of the discussions with his general practitioner and specialist. I have no clue how they were paid for that, but I suspect the 'chit chat' sessions were not free!

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http://www.nytimes.com/2014/09/23/us/healthcaregov-website-is-given-overhaul.html

HealthCare.gov Is Given an Overhaul

WASHINGTON — The Obama administration is redesigning HealthCare.gov and says that 70 percent of consumers will be able to use a shorter, simpler online application form to buy health insurance when the second annual open enrollment period begins in mid-November.

Federal health officials said Monday that the shorter application had fewer pages and questions, fewer screens to navigate, and would allow people to sign up with fewer clicks of a computer mouse.

The new application is intended for people with uncomplicated household situations It can be used only by first-time applicants, not by people who have previously obtained coverage through the federal insurance marketplace.

“The streamlined application will allow people to get through the process a lot faster,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal marketplace.

Norma Licciardello, left, worked with Antonio Menendez, an agent from Sunshine Life and Health Advisors, as they browsed the Affordable Care Act website in March.

If it works as intended, the new application procedure will spare consumers from the frustration that many experienced last fall when they tried to buy insurance through HealthCare.gov.

“Instead of being user-friendly, the original website was user-hostile,” said Luke Chung, the president of FMS, a software development company in Vienna, Va.

The revamped website will have “a new look and feel” and will provide “a shorter, smoother, simpler user experience,” according to an internal memorandum prepared by the Department of Health and Human Services.

Consumers will be asked a series of questions to determine whether they should use the old or new application.

In these screening questions, the government asks: Does everyone applying for coverage have the same permanent home address? Is anyone an American Indian or a naturalized citizen? Are you and your spouse responsible for a child who lives with you but is not on your federal tax return? Do any of your dependents live with a parent who is not on your tax return?

Changes in the online application are being “randomly released to an increasing subset of HealthCare.gov users,” the administration said, and will be fully rolled out in time for the open enrollment season, which begins on Nov. 15. In theory, health officials said, this gradual approach will ensure that everything in the new application is working properly before they make it available to more users.

In a summary of the new procedure, health officials said: “We expect about 70 percent of applicants to use the shorter, updated application. The remaining 30 percent, who have more complicated household scenarios, will use the traditional marketplace application.”

Consumers can see the available health plans without identifying themselves, but will need to create accounts to buy insurance through HealthCare.gov.

“In the improved online application, account creation is completed on one, long screen, instead of using a separate screen for each section,” the administration said. “This requires fewer clicks and makes the account creation process simpler and faster.”

The new application has a feature known as backward navigation, which allows consumers to change information entered on previous screens. The old application did not have this capability, so consumers often had to start over if they wanted to correct an error.

Jessica F. Waltman, a senior vice president of the National Association of Health Underwriters, which represents agents and brokers, welcomed the new application. “This is something we’ve been seeking for quite a while — a procedure that allows people to jump the queue and get through the system faster if their case is neat and simple,” she said.

Consumer advocates, mindful of the problems that stymied users last fall, were cautiously optimistic.

At a news conference in April 2013, President Obama boasted that the administration had listened to criticism from consumer groups and shortened the individual application to three pages, from 21. “Especially in this age of the Internet,” he said, “people aren’t going to have the patience to sit there for hours on end.”

But that is exactly what many people did, as they struggled to create accounts and sign up for insurance in October and November.

The Government Accountability Office, an investigative arm of Congress, raised questions on Monday about financial management of the federal insurance exchange and related activities. The auditors said in a report that they could not verify the amounts spent on staff salaries, advertising, travel, public relations, polling, focus groups and conferences.

The new secretary of health and human services, Sylvia Mathews Burwell, a former White House budget director, has described improved management as one of her top priorities. But the department disagreed with recommendations from the G.A.O. about steps she should take to track spending and report more accurate data.

The auditors tried to determine how many federal employees had been shifted from Medicare, Medicaid and other programs to work on the insurance exchanges. Information provided by the administration “was not complete and was based on personal recollection unsupported by documentary evidence,” the report said.

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http://www.kaiserhealthnews.org/Stories/2014/September/24/hospitals-uncompensated-care-aca-obamacare-medicaid.aspx
Administration Says Hospitals Will Save $5.7B From Unpaid Bills Due To Health Law

Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 health care law, the Department of Health and Human Services said Wednesday.

States that have expanded their Medicaid programs will see about 74 percent of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so.

...Hospitals in states that have not expanded Medicaid are projected to save up to $1.5 billion this year, or about 26 percent of the total savings nationally, according to HHS.

...From the beginning of the health law’s open enrollment last October through July of this year, nearly 8 million additional people have enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), the agency reported.