Quote:

 

http://www.kaiserhealthnews.org/Stories/2014/September/26/employee-insurance-hospitalization-coverage.aspx

Debate Grows Over Employer Plans With No Hospital Benefits

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.

“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”

Timothy Jost is pretty sure the whole thing was a mistake.

“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits.

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year.

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them.

Although insurance sold to individuals and small businesses through the health law’s marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not.

Many policy experts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60 percent of the expected costs of a typical plan.

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed.

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment.

[...]

Quote:

 

http://www.washingtontimes.com/news/2014/sep/24/adler-cannon-economists-arguments-against-obamacar/

Economists’ arguments against Obamacare lawsuits backfire
New taxes and government subsidies are worse than a bad health care bill

Three years ago, we blew the whistle on the government behavior now being challenged in multiple Obamacare lawsuits, including Halbig v. Burwell and King v. Burwell. We performed much of the legal analysis underpinning those challenges. So it amused us when economists Henry Aaron, David Cutler and Peter Orszag tried to defend the government and counsel against Supreme Court review of King, yet inadvertently undercut the government on both counts.

Contrary to their characterization, plaintiffs Halbig and King do not challenge the Patient Protection and Affordable Care Act, much less attempt to “repeal or invalidate” it. The plaintiffs claim the clear language of the act exempts them from the law’s mandates, yet the government is subjecting them to those taxes anyway. They are asking the government to follow Obamacare, not strike it.

Nor are these cases “a joke.” The plaintiffs won before one appellate court (Halbig) and lost before another (King). Even the latter court found “a literal reading of the statute undoubtedly accords more closely with [the plaintiffs’] position,” and the government’s position is “only slightly” stronger.

Nor is the statute “vague.” Obamacare lets the government pay some people’s insurance premiums, and impose its mandate taxes on certain employers and individuals, but only in states with a health-insurance exchange that, quoting the law, was “established by the State.” There is nothing vague about that language, which Congress used repeatedly and consistently. There is nothing in the statute inconsistent with it, or suggesting Congress understood it to mean anything other than what it says. The plaintiffs live among the 36 states that did not establish exchanges. They are exempt from those taxes.

Nor does the statute support a contrary interpretation “when read in its entirety.” Tellingly, the economists cite no statutory language authorizing the government to tax the plaintiffs. Nor do they offer contemporaneous statements from the law’s authors supporting their reinterpretation.

Nor is the claim that Congress intended to withhold subsidies in those 36 states “absurd.” Withholding federal subsidies in uncooperative states is how Congress sought to induce states to implement Obamacare’s other major coverage expansion, too. As enacted, the legislation threatened to withhold 12 times as much funding — and to deny health coverage to the poorest of the poor — in states that did not expand their Medicaid programs. As we write, Obamacare is revoking exchange subsidies from hundreds of thousands of enrollees based on residency status and income.

No Obamacare supporter wanted to take coverage away from the poorest of the poor. Yet not even Mr. Aaron, Mr. Cutler or Mr. Orszag could deny that is precisely how Congress intended the law to operate.

Nor is it “absurd” to argue Congress would delink exchanges from the mandates and subsidies necessary to make them work. In court briefs, Mr. Aaron and Mr. Cutler admit Congress did exactly that in all U.S. territories.

Another signer of those briefs, the law’s chief architect Jonathan Gruber, further demonstrated the idea’s plausibility when, after the law was enacted but before this provision became a liability, he repeatedly told audiences, “If you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.”

In 2010, Mr. Aaron and Mr. Cutler joined dozens of scholars who admitted Obamacare was “imperfect,” but urged reluctant House Democrats to pass it anyway because (1) they thought Obamacare would prove popular, (2) “the allocation of premium subsidies” and “other limitations” of the bill “can be addressed through other means,” and (3) the alternative was no bill at all. Perhaps they believed the bill’s popularity would guarantee Democrats would continue to control Congress and make any needed changes.

It didn’t work out that way. Rather than rely on democracy to fix things, the trio is promoting something much worse than a bad health care bill; namely, the creation of new taxes and government subsidies outside the legislative process.

The Halbig and King plaintiffs make a startling yet credible case that with each passing month, the government is unlawfully handing billions of taxpayer dollars to private insurance companies, and subjecting more than 50 million Americans to illegal taxes. Agree or disagree, the need for final resolution of these cases is obvious and pressing. Only the Supreme Court can provide it.

The government’s allies know the longer it takes to resolve these cases, the more Americans will become dependent on those payments, which will prejudice the courts against the plaintiffs. To avoid prejudice, the Supreme Court should review King immediately, without waiting for lower courts to readjudicate Halbig.

Quote:

 

http://www.breitbart.com/Big-Government/2014/09/26/Busted-Obamacare-Website-Cost-2-1-Billion-Twice-What-White-House-Claimed

Report: Busted Obamacare Website Cost $2.1 Billion--Twice What White House Claimed

New data compiled by Bloomberg Government reveal that Obamacare has already cost taxpayers $73 billion, including $2.1 billion on its busted Obamacare website--a figure more than double what the Obama administration originally claimed.



As Bloomberg notes, its "analysis shows that costs for both healthcare.gov and the broader reform effort are far greater than anything publicly discussed" and are "substantially greater than what the Congressional Budget Office (CBO) initially estimated health reform would cost by this point."

The $73 billion figure, however, is a drop in the bucket compared to Obamacare's 10-year spending total. According to the Senate GOP Budget Committee, Obamacare will costs U.S. taxpayers $2.6 trillion over the decade.

Nationally, Obamacare remains unpopular. The RealClearPolitics average of polls finds that just 41% of Americans support Obama's signature legislative achievement

kbp

Sep 21 2014, 10:04 AM

Quote:

 

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

[...]

I must admit it signed up more than I had anticipated. I suppose the subsidies provided more incentive than I thought it would, paying a higher share of the premiums.

I'm still wondering how the deductibles are going to hit. If 85% get subsidies, they're of the income level that can't pay deductibles. The service providers are probably happy when they get paid on larger claims, but those not getting past the deductible is probably the busiest group. If half of them can only afford $50/month premiums, it's a good guess that they can't pay ....and most of the 85% probably can't.

Baldo

Sep 27 2014, 07:00 PM

snip

For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says

WASHINGTON — Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.

The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.

The inspector general, Daniel R. Levinson, said federal and state officials must do more to protect beneficiaries’ access to care, in view of the program’s rapid growth. Just since October, the administration says, eight million people with low incomes have enrolled. By 2016, the Congressional Budget Office estimates, one in four Americans will be on Medicaid at some time during the year....snipped

http://www.nytimes.com/2014/09/28/us/for-many-new-medicaid-enrollees-care-is-hard-to-find-report-says.html

Of course the Obama Administration blames the States. Silly States to trust Obama

Typical Obama BS. "We have provided Health Insurance"....

Quote:

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/26/should-you-be-able-to-see-any-doctor-you-want/

Should you be able to see any doctor you want?

People don't like being told "no," especially when it comes to something as personal as their health care. They also don't like rising health-care costs. And therein lies the health-care system's existential debate about narrow networks.

Narrow networks, which place greater limits on patients' choice of care providers, aren't new, but they're emerging as one of insurers' major levers for keeping down costs under the Affordable Care Act. The ultimate question for the health-care system and everyone who interacts with it is just what limits patients can accept before avoiding another 1990s-style backlash against managed care.

In just a few weeks, voters in South Dakota will actually get to weigh in on this question, thanks to a ballot initiative that would require health plans in the state to include any provider that meets their standards and wants in.

"Who would be against the concept of a patient being able to pick his own doctor and keep his own doctor?" said Stephen Eckrich, an orthopedic surgeon and sponsor of the South Dakota ballot initiative. Eckrich said he's seen patients have to drive 300-plus miles across the rural state just to find an in-network provider.

If approved, South Dakota would be added to the list of states with a so-called "any willing provider" laws that requires broader inclusion in health insurance networks. The health insurance industry opposes these laws, arguing that the laws hurt their ability to negotiate with physicians and hospitals and to drive efficient care — which, the industry says, translates to higher costs for patients. And over the past year, there's been increasing attention on these laws in some states, like Missouri, Mississippi, New Hampshire and Pennsylvania.

Twenty-seven states in all have some form of any willing provider law but they vary significantly, according to the National Conference of State Legislatures. Many of these states have had these laws on the books since the 1980s, and the laws can be broad, covering most of a state's doctors and hospitals, while others much narrower in scope apply to just pharmacies or certain provider types.

[...]

About 70 percent of health plans sold on the ACA's health insurance marketplaces this past year had narrow or ultra-narrow networks, according to McKinsey and Co., which defined "narrow" as excluding at least 30 percent of an area's largest hospitals. Narrow networks were increasingly being used before the ACA, but they've become more prevalent under the law, as illustrated by the following chart comparing 2013 individual market plan offerings against 2014.



[...]

Quote:

 

http://www.latimes.com/business/la-fi-0928-obamacare-doctors-20140928-story.html

Obamacare doctor networks to stay limited in 2015

Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year..

The state's largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state's insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.

This comes as insurers prepare to enroll hundreds of thousands of new patients this fall and get 1.2 million Californians to renew their policies under the Affordable Care Act.

Even as California's enrollment grows, many patients continue to complain about being offered fewer choices of doctors and having no easy way to find the ones that are available.

Some consumers have been saddled with huge medical bills after insurers refused to pay for care deemed out of network. These complaints have sparked a state investigation and consumer lawsuits against two big insurers.

[...]

Altogether, the 10 insurers in Covered California have contracted with an estimated 75% of California's licensed physicians, or nearly 90% of those considered active in the state. However, many of those doctors are available in just one or two health plans.

All of these insurance networks for individual policies are subject to change and regulatory review before taking effect Jan. 1.

[...]

Altogether, the 10 insurers in Covered California have contracted with an estimated 75% of California's licensed physicians, or nearly 90% of those considered active in the state. However, many of those doctors are available in just one or two health plans.

All of these insurance networks for individual policies are subject to change and regulatory review before taking effect Jan. 1.

Yet premiums for that stripped-down policy are going up as much as 9% compared with pricing for the PPO. State regulators have questioned the company's moves.

Health Net said its cutbacks were necessary to avoid even steeper rate hikes and it's confident the smaller network will be sufficient. Its separate HMO network is unchanged for 2015 after about 4,000 doctors were added this year.

The insurer is following the lead of its two rivals Anthem and Blue Shield, which opened last year with sharply limited networks.

For 2015, Blue Shield has proposed two health plans with up to 4% fewer physicians in the areas where they're sold. Overall, Blue Shield includes about two-thirds of its regular PPO doctors in its broadest exchange network.

[...]

In addition to shedding doctors, California's biggest insurers have promoted more restrictive policies known as EPO, or exclusive-provider organization, plans. Unlike a more generous PPO, an EPO typically does not provide any coverage for out-of-network providers. Consumers would be responsible for the full charges if they left their network.

Many consumers say those differences in coverage weren't disclosed fully.

The California Department of Managed Health Care is investigating whether Anthem and Blue Shield violated state law by misleading consumers and making it too difficult to get timely care.

[...]

Quote:

 

http://online.wsj.com/articles/hundreds-of-thousands-face-health-law-subsidy-deadline-1412006417

Hundreds of Thousands Face Health Law Subsidy Deadline

Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act.

The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for.

The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers.

Hundreds of thousands of people who obtained health coverage through state exchanges also have documentation issues and could potentially be getting subsidies they aren't eligible for.

Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act.

The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for.
[The verification is a function that was to be handled by the programing.]

The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers.

Hundreds of thousands of people who obtained health coverage through state exchanges also have documentation issues and could potentially be getting subsidies they aren't eligible for.

Individuals who signed up on HealthCare.gov for insurance and subsidies to lower their coverage costs were asked on their applications to estimate 2014 income and provide citizenship information. That information was checked against their 2012 tax returns. In some cases, the data didn't match.

In addition to the roughly 300,000 people affected by the income verification, another 115,000 people may lose coverage on Tuesday because they didn't provide requested documents verifying their citizenship or immigration status by a Sept. 5 federal deadline.

Collectively, more than 400,000 people who enrolled in health plans using HealthCare.gov have data-matching problems regarding their income or citizenship and immigration status.

[...]

Repayments may be limited to an amount between $300 and $2,500 for certain lower earners, according to the Internal Revenue Service. But higher earners may have to pay back the full amount.

Consumers who provide income data as requested by the federal government for Tuesday's deadline may in some cases still wind up owing at tax time if they were previously getting incorrect subsidy amounts and the total is more than they are entitled to for the year, said policy experts.

The income inconsistencies are a politically thorny issue for the Obama administration. Republicans in Congress said during a June hearing that the system for verifying income and eligibility information through the federal marketplace was incomplete.

[...]

Refresher on YET-TO-BE-COMPLTETED federal exchange costs...

 

$2.142 Billion - Cost from Bloomberg
$o.800 Billion - Estimate from HHS
$1.342 Billion - Excess Costs

I guess an increase to the 268% cost is good news for Obama ...it could have been worse!

Quote:

 

http://www.forbes.com/sites/michaelcannon/2014/09/29/the-halbig-subpoena/

The Halbig Subpoena

Last week, the House Committee on Oversight and Government Reform subpoenaed documents from the Treasury Department and IRS that could have a huge impact on Pruitt v. Burwell, Halbig v. Burwell, King v. Burwell, and Indiana v. IRS – four lawsuits that could have a huge impact on ObamaCare.

Those cases challenge the federal government’s ability to implement the Patient Protection and Affordable Care Act’s major taxing and spending provisions in the 36 states that failed to establish a health insurance “Exchange.” The federal government established fallback Exchanges within those states, but the PPACA says the IRS can implement the law’s Exchange subsidies, employer mandate, and (to a large extent) its individual mandate only “through an Exchange established by the State.” Nevertheless, the IRS issued a regulation implementing those taxes and expenditures in states with federal Exchanges anyway. That regulation that is being challenged as illegal by taxpayers, employers, school districts, and states, who claim the IRS is taxing them without congressional authorization.

The subpoenaed documents could have a big impact on those cases, including the D.C. Circuit’s upcoming en banc review of the panel-court decision for the plaintiffs in Halbig, and maybe even on the Supreme Court’s decision whether to review the Fourth Circuit’s ruling for the government in King. Obviously, the Treasury Department and the IRS have refused to make the subpoenaed documents public. But congressional investigators whom the agencies permitted to review the documents behind closed doors, and to interview the Treasury/IRS staff who wrote the challenged regulation, issued a report detailing troubling aspects of how the IRS developed the regulation.

According to investigators, prior to March 2011, the IRS’s draft regulations included the statutory requirement that subsidy recipients enroll in coverage through an Exchange “established by the State.” (The employer and individual mandates are tied to the availability of the subsidies.) In March 2011, however, IRS officials read a news article about how ObamaCare opponents were considering a constitutional challenge based on the fact that the PPACA offers subsidies only in states that establish Exchanges. That statutory requirement disappeared from the draft regulations at the same time IRS officials learned that opponents might challenge that feature of the law in court.
[This information has been posted here a few times. The administration's case to fabricate ambiguity that allows the IRS to reinterpret the law did not match what we knew of the reasoning used by the IRS. IOW, they were still searching for the excuse and continue to do so in their ever-changing cases presented... which makes if difficult and more confusing to follow so it must be ambiguous!

IRS officials then worked with officials at the Department of Health and Human Services to gut that requirement. The IRS cited no statutory provisions supporting its decision. Indeed, Treasury and IRS officials told congressional investigators they knew they had no statutory authority to gut this requirement. But they did it anyway. The move was unfortunate for many reasons, not least because the IRS is currently spending billions of dollars and subjecting more than 50 million individuals and employers (including the plaintiffs in those four cases) to the related taxes not pursuant to an act of Congress, but by administrative fiat.

It may be that the congressional investigators who reviewed the Treasury and IRS documents were a bunch of partisan hacks who misunderstood or misrepresented what they saw. If so, and if IRS officials indeed engaged in reasoned decision-making when developing this regulation, the subpoenaed documents will dispel the partisan rhetoric and support the government’s case in court. The IRS commissioner recently told Congress, “Wherever we can, we follow the law.” This would be a good time to show that comment wasn’t just useless posturing.

The only reason the government has to withhold those documents is if they show the IRS’s decision-making was not reasoned — or if the reason they wrote this regulation was a desire to skirt the law.

LTC8K6

Sep 30 2014, 10:02 PM

Federal district court rules against Obamacare subsidies on federal exchange

http://www.powerlineblog.com/archives/2014/09/federal-district-court-rules-against-obamacare-subsidies-on-federal-exchange.php