Baldo

Nov 23 2014, 04:35 PM

Obamacare’s Jonathan Gruber and the Superhero Oath

...public policies...so befuddle it that clear thinking on the subject becomes next to impossible.

...Similarly, Gruber admitted that Obamacare ...provide truly massive amounts of wealth redistribution disguised by making low-risk healthy people subsidize the costs of older unhealthy people.

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http://kaiserhealthnews.org/news/wall-street-is-bullish-on-2015-obamacare-enrollment/

Wall Street Is Bullish On 2015 Obamacare Enrollment

A group of Wall Street analysts predicted Friday that enrollment in health law insurance plans will be higher than the 9 million projected by the Obama administration because insurers are aggressively courting new customers and more small businesses are likely to send workers to the online exchanges in 2015.

Health sector analyst Carl McDonald of Citi Investment Research said he expects about 11 million people to enroll in individual health plans, based on his firm’s survey of clients in October.

“I’m more optimistic,” McDonald said at the 19th annual “Wall Street Comes to Washington” roundtable, sponsored by the Jayne Koskinas Ted Giovanis Foundation for Health and Policy.

More aggressive outreach by insurers and fewer glitches with the online marketplaces will create a “robust 2015,” agreed Ralph Giacobbe, an analyst at Credit Suisse.

But the analysts noted continuing challenges for insurers, from improving what McDonald called a “pretty poor” first-year effort to inform consumers about which doctors and hospitals are in their networks, to controlling spending as high-priced drugs hit the market.

Insurers are also projecting that this year’s enrollees will be younger and healthier than those who signed on in 2014, when the average age was 41, McDonald said. That was a problem for insurers who based this year’s premium rates on the expectation they would see younger customers, he said.

The analysts agreed that enrollment would be unaffected by the Supreme Court’s decision to hear a lawsuit challenging the provision of subsidies to residents of states that are relying on the federal exchange. Only 14 states ran their own marketplaces this year.

Nick Leventis, an independent health care sector analyst, said concerns about the case are overblown because the government “could easily give some type of waiver to the states to shift from the federal to the state exchange.”

But McDonald was less sanguine, although he said insurers are already discussing workaround ideas with state insurance officials. Still, he said that not all of the states would act if the court invalidated the subsidies. Some governors and state legislators would be unlikely “to do anything to help reform,” he said.

Giacobbe predicted that governors and lawmakers in such states would be under great pressure, not only from the hospital and insurance industries, but also from consumers, to find ways to keep the subsidies flowing.

It’s hard to take away a program once people are using it, he said, predicting, “This is not going to derail the ACA.”

Should subsidies be cut off by a ruling from the Supreme Court, the marketplaces where the subsidies were no longer available would essentially cease to function since all but the sickest customers would likely drop coverage, the analysts said.

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http://news.yahoo.com/health-exchanges-finances-face-test-2nd-161156732--politics.html

Health exchanges' finances face test in 2nd year

The federal government shelled out billions of dollars to get health insurance marketplaces going in the 14 states that opted to run their own. Now they must act like true marketplaces and start paying for themselves.

Under President Barack Obama's Affordable Care Act, state-run health insurance exchanges need to be financially self-sustaining starting in January. Some appear to be on that path, while others have shaky funding models or even none at all.

Some states, prohibited from using state money, are imposing fees on plans sold on the marketplaces. Others are spreading costs more widely — which, in one instance, has drawn a federal lawsuit.

Rhode Island received high marks for the smooth rollout of HealthSource RI amid last year's stumbles by the federal government, and the agency director says the state's health care reform "revolution" has begun. But the state does not have a way to pay for the exchange's long-term operations, and some lawmakers in the state General Assembly have suggested shifting to the federal exchange.

The cost to operate Rhode Island's exchange is estimated at $17 million a year, although an earlier estimate pegged the cost at $24 million. Republican state Rep. Patricia Morgan introduced a bill last session to transfer its operations to the federal government, but the legislation was held for further study.

"Think of what we can do with $24 million," she said.

Some states have decided to tap existing revenue.

New York is relying on two agencies' general revenue, while Maryland is using money from an existing 2 percent tax on insurance plans. Republican Delegate Anthony O'Donnell, a critic of Maryland's decision to create its own exchange, said he continues to question its sustainability. He said last week that he is concerned "about the entire structure and that it may collapse of its own weight."

To cut costs, Colorado's state-run exchange has reduced overall spending 18 percent, including on technology and marketing. It's imposing a 1.4 percent fee on monthly premiums for its plans but also approved charging a $1.25-a-month "general market" fee on all individual and small group policies, including those sold outside the state exchange.

Some lawmakers called the fee unfair, and one board member voted against it. It is expected to raise an estimated $13 million a year before it expires in 2016.

In the District of Columbia, which also is operating its own marketplace, the exchange's budget is being funded by a new 1 percent tax on all health insurance policies. The American Council of Life Insurers is suing, arguing it unfairly taxes insurance products that cannot be purchased on the exchange.

Taxing only plans offered on the exchange would have required a 17 percent tax to cover costs, officials said, reducing the benefit to low-income residents.

Earlier this year, California's exchange said it was setting aside $184 million in federal money to fight off projected budget shortfalls through 2016. About 1.1 million people enrolled in the first year, exceeding projections, and officials hope to grow that to 1.7 million during the second round of open enrollment.

Officials with Covered California, as the exchange is known, express confidence about its financial health. The agency's board has projected a $250 million reserve for the coming year, built partly from a $13.95 monthly surcharge on individual policies.

"We do not have a deficit; our enrollment is sufficient to fund ongoing operations through 2015-16," Covered California spokesman James Scullary said. "We remain committed to managing our resources prudently."

The Vermont marketplace, which is being funded by the state's health care provider tax, is on shakier ground. Officials there acknowledged it could face a $20 million shortfall by year's end. The state hopes pending federal grants will fill the gap.

In Rhode Island, HealthSource's individual market enrollment of more than 26,000 heading into the second sign-up period exceeded unofficial federal projections. Officials plan to continue using federal money through 2015. Beyond that, the funding mechanism is unclear.

"There's time, but there's not that much time, so these decisions need to be made," exchange Director Christine Ferguson said during a recent briefing.

She has called abandoning HealthSource short-sighted and warned that doing so could come with its own costs.

Democratic Gov.-elect Gina Raimondo wants to keep HealthSource local and has pledged to scrutinize its budget and get "creative." But the top House Democrat, Nicholas Mattiello, remains skeptical about its cost and value.

"At this point, Speaker Mattiello isn't satisfied that the exchange has made its case," spokesman Larry Berman said.

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http://www.nytimes.com/2014/11/24/us/politics/in-partisan-washington-health-law-faces-grave-legal-technicalities.html

In Partisan Washington, Health Law Faces Grave Legal Technicalities

In March 1997, two congressmen proposed a welfare law so detailed that it had 77 sections. Within a month it sailed through the House by voice vote

[...]

By 1997, however, the political guns had fallen silent. Though Democratic leaders of both the House and Senate had opposed the 1996 law, the fight was over. The top House Republican on the issue, Representative E. Clay Shaw Jr. of Florida, quietly consulted Mr. Clinton’s aides about ways the new welfare law needed clarification and adjustment to be implemented more effectively.

“We worked with the administration even though we shut down the government — twice,” recalled Ron Haskins, then Mr. Shaw’s top welfare adviser. In August, the numerous “technical corrections” to the 1996 bill were folded into a budget deal and passed into law.

Today the Affordable Care Act faces grave danger before the United States Supreme Court because such legislative repair work, once routine, has grown impossible.

The challenge in King v. Burwell, the case that the court recently accepted, rests on a part of the law creating taxpayer subsidies for the purchase of health insurance through marketplaces “established by the state.” That phrase, the plaintiffs argue, prohibits subsidies for purchasers using marketplaces established by the federal government for the 37 states that do not have their own.

The Obama administration and the law’s sponsors in Congress counter that they never intended such a prohibition. None was discussed in debates leading to the law’s passage. The Congressional Budget Office, which estimates the costs of legislation, never considered one. Subsidies for customers with modest incomes represent a linchpin of the law’s entire architecture.

A simple technical corrections bill, specifying that consumers using the federal marketplace would receive subsidies as well, would resolve the ambiguity. But his fellow Republicans, Mr. Haskins says, will not “lift a finger” to fix a law they loathe.

One reason is the fundamentally different partisan backdrops to the health and welfare debates. Mr. Clinton had campaigned on promises of welfare reform, traditionally a Republican priority, to brand himself “a different kind of Democrat” at a time when his party was struggling to compete in presidential elections.

That set up Mr. Clinton’s compromise with a Republican-led Congress. On health care, by contrast, a Democratic president pushed a longstanding priority of his party through a Democratic-controlled Congress.

Another reason is the rightward ideological shift in the Republican Party. The health law pushed by Mr. Obama strongly resembled a plan that Republican leaders themselves once proposed as an alternative to the 1993 plan that Mr. Clinton had offered in vain. [If we ignore a few important details!!!]

Republicans unanimously opposed Mr. Obama anyway, with a zeal that has not ebbed four years later.

“In the old days, like when I ran Medicare, when we had this kind of conflict in what appeared to be the intent versus the actual wording, we would go in and ask Congress for a rifle shot to clarify in the statute what needed to be said,” said Gail R. Wilensky, a Republican health care expert who served in the administration of President George Bush.

Instead, House Republicans who have repeatedly voted to repeal “Obamacare” vow to try again with the new Republican majority in the Senate. And a dispute that legislative aides once would have resolved with minor editing has been turned over to Supreme Court justices.

“In my experience there’s never been a controversial major piece of legislation that didn’t get followed by a technical change,” said Representative Henry A. Waxman, Democrat of California, who is retiring after a 40-year House career renowned for legislative craftsmanship.

“It’s become very difficult to legislate on any subject,” Mr. Waxman added. “On this one, it’s become such a part of the ideology of the Republican Party. They never wanted to change the law. They just want to stop it.”

It is just one example of how political polarization has compounded obstacles to action built into America’s constitutional system. Ideological and partisan lines have hardened and merged to form mutually reinforcing walls of division.

Frustration over the consequences underlies Mr. Obama’s determination to alter the immigration system with a stroke of his pen — which in turn promises to exacerbate those divisions.

Ms. Wilensky holds out hope that the court might yet prod Congress to act. If a majority of justices call on lawmakers to resolve the ambiguity, she reasoned, Republicans might then salvage the challenged subsidies in return for changes such as curbing health-care mandates on employers.

That may be wishful thinking.

“The kind of changes that Gail is talking about come from a mentality about negotiation between the two parties that used to be the rule here in Washington,” said Henry J. Aaron, a policy analyst at the Brookings Institution who served in Mr. Clinton’s administration.

“People of good will on both sides got together, they didn’t always agree, they worked out their differences and they dealt with problems,” Mr. Aaron said. “That is all too regrettably now missing from the scene here.”

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http://www.politico.com/story/2014/11/house-files-obamacare-lawsuit-113089.html

House files Obamacare lawsuit

The House of Representatives filed a long-awaited lawsuit Friday, alleging that the Obama administration ignored key aspects of its health care reform law when implementing the sweeping new government program.

The litigation, authorized by the House in July, addresses only the Affordable Care Act and makes no mention of immigration. However, the filing of the suit the morning after Obama unveiled his major executive actions on immigration was clearly intended to underscore GOP lawmakers’ desire to paint the president as a chief executive intent on overstepping his legal bounds.

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The White House dismissed the lawsuit Friday as meritless and as a waste of money.

“Instead of passing legislation to help expand the middle class and grow the economy, Speaker Boehner and House Republicans are spending hundreds of thousands of taxpayer dollars pursuing a lawsuit that is without any sound legal basis,” White House spokeswoman Brandi Hoffine said.

The new lawsuit claims that two specific aspects of implementation of the Obamacare law violated the terms of the legislation.

First, the suit complains about repeated delays of the employer mandate, which was supposed to kick in in January of this year. The administration delayed the requirement until next year for some employers and until 2016 for others.

Second, the litigation challenges payments to insurance companies under a cost-sharing provision that the suit argues was never authorized by law. Such “offset” payments amounted to $3 billion in 2014 and could total $175 billion over 10 years, the House claims.

[...]

Two conservative litigators, David Rivkin of Baker Hostetler and Bill Burck of Quinn Emanuel, were retained to handle the case earlier in the year. However, House aides say both backed out after being pressured by other clients to drop the litigation.

[...]

The contract ends on Jan. 3, 2015, or when the U.S. District Court rules on the lawsuit.

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New deception questions: Obamacare adviser warned of premium increases as Obama vowed savings

Predicted massive health insurance cost increases for Wisconsin residents in 2010 report
By Kelly Riddell - The Washington Times - Monday, November 24, 2014

While President Obama campaigned on a promise that his universal health care plan would lower premiums, his controversial adviser and plan architect was privately warning the state of Wisconsin that Obamacare was poised to massively increase insurance costs for average residents, internal documents show.

Jonathan Gruber, the MIT economist currently under fire for suggesting the Obama administration tried to deceive the public about the Affordable Care Act, was hired by former Democratic Wisconsin Gov. Jim Doyle in 2010 to conduct an analysis on how the federal health-care reform would impact the state.

Mr. Gruber's study predicted about 90 percent of individuals without employer-sponsored or public insurance would see their premiums spike by an average of 41 percent. Once tax subsidies were factored in, about 60 percent of those in the individual market were projected to see their premiums go up 31 percent, according to his analysis.

In addition, 53 percent of those insured by companies with fewer than 50 employees, would see their premiums rise by an average of 15 percent even after subsidies, Mr. Gruber forecasted. The report warned such increases could impact small companies' decision whether to provide health insurance to their workers.

"There remains some uncertainty about employer reactions given the many forces which might impact their decision to offer insurance," the report said.

The contrast between the Obama administration's optimistic rhetoric on Obamacare and Mr. Gruber's private warnings to Wisconsin is certain to attract new attention from the Republican-led Congress, which wants to know whether there was an effort by the administration to deceive the public about the true consequences of the law as Mr. Gruber suggested in a videotape that surfaced recently.

Mr. Gruber and the White House declined comment when contacted by The Washington Times this week.

The Gruber study, which was released publicly in August 2011 with little fanfare in the state of Wisconsin, was largely ignored by Mr. Obama, who campaigned in 2012 that insurance premiums would actually decrease under his healthcare legislation.

"So when you hear about the Affordable Care Act — Obamacare — and I don't mind the name because I really do care. That's why we passed it," the president declared in a campaign speech in Cincinnati, Ohio back in July 2012, "you should know that once we have fully implemented, you're going to be able to buy insurance through a pool so that you can get the same good rates as a group that if you're an employee at a big company you can get right now — which means your premiums will go down."

In Wisconsin, Republican Gov. Scott Walker, considered by many to be a potential 2016 presidential candidate, distrusted the campaign promises, largely because of the work Mr. Gruber had done for the state's previous administration, and has long advocated for repealing the law.

In addition to premium rate increases, Mr. Gruber's work estimated that 100,000 Wisconsinites would be involuntarily dropped from their employer sponsored health insurance also running counter to the President's claim at the time that if a you liked their health-care policy, you could keep it.

The study did project the implementation of Obamacare would decrease the state's number of uninsured by 65 percent by 2016, but doing so would come at the expense of other groups.

Wisconsin's working-class families would be forced to pay a hidden tax to pay for the purchase of health insurance for a family of four earning up to $89,400, the study said. It also showed Obamacare would shrink the numbers of people in the private insurance marketplace from 180,000 individuals to 30,000.

Mr. Walker has said he would like to see the Affordable Care Act repealed and after entering office in January 2011, he opted not to create a state-run marketplace and to instead rely on the federal one. Mr. Walker also has refused Obamacare's Medicaid expansion, refusing to accept federal aid offered under the Affordable Care Act, arguing he doesn't trust the federal government's pledge to cover the cost.

After entering office, Mr. Walker replaced Mr. Doyle's Office of Health Care Reform which had been created to carry out the federal Affordable Care Act with Wisconsin's Office of Free Market Health Care. It was that office that inherited Mr. Gruber's study.

The state of Wisconsin paid $443,718 to conduct the analysis with $200,000 going to Mr. Gruber himself, and the rest of the costs dedicated to Gorman Actuarial, a Massachusetts-based consultancy.

Mr. Gruber developed the model for the report that outlined the federal Affordable Care Act's impact on Wisconsin, and his contract ended June 30, 2011, according to Mr. Walker's office.

"Health care reform was supposed to provide affordable health care for Americans but major concerns have been demonstrated by the results of this study," said Dennis Smith, Wisconsin's Health Services Secretary, in a press release when the report was released in August 2011.

That year, Wisconsin had 33 health insurers actively participating in the individual market and 25 insurers in the small group market, a dynamic Mr. Walker's administration thought competitive and cost effective. The Badger State's uninsured rate is also better than the national average, with 9 percent of its population lacking insurance in 2013, compared with 14.5 percent nationally, according to U.S. Census Bureau estimations.

Because Mr. Gruber's contract was entered into under a previous administration and the vast majority of the work was performed for that administration, Mr. Walker declined to comment on Mr. Gruber's work for the state.

In 2011, Mr. Gruber defended his Wisconsin study to The Cap Times, a Wisconsin-based news site.

"They picked out the most negative aspects of the report to highlight," Mr. Gruber told the Cap Times in an interview in August 2011. "Overall I think health care reform is a great thing for Wisconsin."

Meanwhile, earlier this month, videotapes were leaked from a University of Pennsylvania speech Mr. Gruber gave last year where he refers to the "stupidity of the American voter" as to how Obamacare got passed legislatively, saying the lack of transparency of the bill was a "huge political advantage."

Mr. Gruber received about $400,000 from the U.S. Department of Health and Human Services for his work focusing on health care computer models. He has also been a frequent guest at the White House, meeting with senior officials more than a dozen times and the president himself, once, visitor logs show.

White House Press Secretary Josh Earnest said this month that Mr. Gruber only advised the administration on the economics of health care.

"He certainly is somebody who is well-versed in understanding how economics will have an impact on health care policy, but it's pretty evident from these videos that he doesn't have nearly as much insight as it relates to politics or communications or legislative strategy," Mr. Earnest said of Mr. Gruber.

A Kaiser Family Foundation analysis of 2015 premium changes as of November show that nationally the lowest cost bronze plans and lowest cost silver plans will increase two and four percent, respectively, with premiums rising as much as 43 percent in Minnesota counties and decreasing as much as 45 percent in Colorado.

In Wisconsin, the analysis found the premiums for the bronze and silver plans in Milwaukee increased by at least 5 percent, less than one percent after tax credits are applied.

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http://kaiserhealthnews.org/news/obama-officials-seek-to-clarify-abortion-coverage-rules/

Obama Officials Seek To Clarify Abortion Coverage Rules

The Obama administration is seeking to clarify rules for the coverage of elective abortion in health insurance exchanges. That is the issue that almost scuttled the Affordable Care Act before it became law.

A complicated compromise that got the final few anti-abortion Democrats to agree to vote for the measure in 2010 required every exchange to include health plans that do not cover abortions except in the cases of rape, incest or a threat to the life of the pregnant woman. Plans that do offer abortion other than in those cases are required to segregate funds and bill for that abortion coverage separately.

But that did not happen, at least not in the first year of exchange coverage. Twenty-three states passed laws banning coverage of elective abortions in all the plans offered on the exchange. A Government Accountability Office report in September looked at the 27 remaining states and found that in five every plan covered elective abortions. And many failed to separately bill for the abortion coverage, as the law required.

Asked about the report in October, Health and Human Services Secretary Sylvia Burwell insisted that no money is being improperly spent.

“There are no federal funds being used for abortions except, as the law states, cases of rape or incest or questions of the life of the mother,” she said. With regard to the specifics of the GAO report, “it’s one where we believe we need to ensure the law is being enforced, and right now [the Centers for Medicare & Medicaid Services] is working on the ways we’re going to communicate with states and insurers.”

A huge proposed regulation issued last Friday that outlines health plan standards for 2016 seeks to make abortion coverage rules clearer.

The regulations, among other things, specify ways in which insurers can assess and collect separate payments for abortion coverage, which must total at least $1 per month.

But anti-abortion groups are complaining that the guidance in the new rules does little to address the bigger problem: It is still extremely difficult for the average consumer to tell which plans include elective abortion coverage and which do not.

“It’s just not easy to find and it should be,” said Chuck Donovan, president of the Charlotte Lozier Institute, an anti-abortion research group.

“I know websites can be tricky,” he said. “But you can do these things with a checkmark and a box and I wish that they’d just come up with something simple two years ago as part of the upfront disclosure from the insurance companies.”

In an effort to make the information more widely available, the Lozier Institute has been doing the work itself, contacting individual insurance companies and their customers to discern which plans do and do not offer elective abortion. The resulting website, obamacareabortion.com, was unveiled last week in conjunction with the Family Research Council, another anti-abortion group.

[...]