Universal Health Care Messaging
Bob Jensen at Trinity University


Introduction

The Lies and Deceptions

December 31, 2015

December 31, 2014

December 31, 2013

September 30, 2013

June 30, 2013

March 31, 2013

December 31, 2012

September 30, 2012

June 30, 2012

March 31, 2012

December 31, 2011

September 30, 2011

June 30, 2011

March 31, 2011

December 31, 2010

September 30, 2010

July 29, 2010

July 17, 2010

June 29, 2010

June 10, 2010

May 27, 2010

May 20, 2010

May 10, 2010 

April 29, 2010

April 20, 2010 

April 8, 2010  

March 30, 2010 

March 18, 2010

March 8, 2010

February 23, 2010  

February 15, 2010 (including Health Insurance in Germany)

February 1, 2010

January 26, 2010

January 17, 2010 

January 5, 2010

December 23, 2009

December 17, 2009

December 7, 2009 

November 25, 2009

November 17, 2009

November 10, 2009 (The Most Frightening Legislation in the Shrinking History of the United States)

October 26, 2009

October 15, 2009

October 5, 2009

September 24, 2009

September 15, 2009 Update

September 3, 200 9 Update

August 26, 2009 Update

August 17, 2009 Update

August 07, 2009 Update

Canada

Finding and Using Health Statistics --- http://www.nlm.nih.gov/nichsr/usestats/index.htm

Bob Jensen's threads on economic statistics and databases ---
http://www.trinity.edu/rjensen/Bookbob1.htm#EconStatistics

 

Introduction

America, what is happening to you?
“One thing seems probable to me,” said Peer Steinbrück, the German finance minister, in September 2008....“the United States will lose its status as the superpower of the global financial system.” You don’t have to strain too hard to see the financial crisis as the death knell for a debt-ridden, overconsuming, and underproducing American empire.
Richard Florida, "How the Crash Will Reshape America," The Atlantic, March 2009 ---
http://www.theatlantic.com/doc/200903/meltdown-geography

 

Medical Malpractice Lottery for Lawyers or Criminals or Both

Tax Provisions in the 2010 Act (including changed investment strategies regarding tax exempt bond investments)

History Timeline of Health Care Reform in the United States

Something AARP Wants Kept Secret

Introductory Quotations and Links

Full Text of H.R. 3962 --- http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3962
 

Obamacare --- http://en.wikipedia.org/wiki/Obamacare#Term_.22Obamacare.22
Although President Obama never proposed using that term, eventually he said is was an honor for him to assi8ate his name with this legislation that he promoted to be the crowning achievement of his Presidency. "President Obama endorsed the nickname, saying, "I have no problem with people saying Obama cares. I do care."

First of all, it’s called the ‘Affordable Care Act"
House Minority Leader Nancy Pelosi more unhappy with the use of the word "Obamacare in 2014.

Brookings: The Patient Protection and Affordable Care Act (links to hundreds of studies) ---
 
http://www.brookings.edu/research/topics/affordable-care-act

"Chuck Schumer: Passing Obamacare in 2010 Was a Mistake:  The Senate’s No. 3 Democrat says that his party misused its mandate," by Sarah Mimms, National Journal, November 25, 2014 ---
http://www.nationaljournal.com/congress/chuck-schumer-passing-obamacare-in-2010-was-a-mistake-20141125

Chuck Schumer upbraided his own party Tuesday for pushing the Affordable Care Act through Congress in 2010.

While Schumer emphasized during a speech at the National Press Club that he supports the law and that its policies "are and will continue to be positive changes," he argued that the Democrats acted wrongly in using their new mandate after the 2008 election to focus on the issue rather than the economy at the height of a terrible recession.

"After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs and built on the partial success of the stimulus, but unfortunately Democrats blew the opportunity the American people gave them," Schumer said. "We took their mandate and put all of our focus on the wrong problem—health care reform."

The third-ranking Senate Democrat noted that just about 5 percent of registered voters in the United States lacked health insurance before the implementation of the law, arguing that to focus on a problem affecting such "a small percentage of the electoral made no political sense."

The larger problem, affecting most Americans, he said, was a poor economy resulting from the recession. "When Democrats focused on health care, the average middle-class person thought, 'The Democrats aren't paying enough attention to me,' " Schumer said.

Continued in article

"Sen. Chuck Schumer: Obamacare Focused 'On The Wrong Problem,' Ignores The Middle Class" by  Avik Roy, Forbes, November 26, 2014 ---
http://www.forbes.com/sites/theapothecary/2014/11/26/sen-chuck-schumer-obamacare-focused-on-the-wrong-problem-ignores-the-middle-class/

Despite the enduring unpopularity of Obamacare, Congressional Democrats have up to now stood by their health care law, allowing that “it’s not perfect” but that they are proud of their votes to pass it. That all changed on Tuesday, when the Senate’s third-highest-ranking Democrat—New York’s Chuck Schumer—declared that “we took [the public’s] mandate and put all our focus on the wrong problem—health care reform…When Democrats focused on health care, the average middle-class person thought, ‘The Democrats aren’t paying enough attention to me.’”

Sen. Schumer made his remarks at the National Press Club in Washington. “Democrats blew the opportunity the American people gave them…Now, the plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed,” Schumer maintained. “But it wasn’t the change we were hired to make. Americans were crying out for the end to the recession, for better wages and more jobs—not changes in health care.”

“This makes sense,” Schumer continued, “considering 85 percent of all Americans got their health care from either the government, Medicare, Medicaid, or their employer. And if health care costs were going up, it really did not affect them. The Affordable Care Act was aimed at the 36 million Americans who were not covered. It has been reported that only a third of the uninsured are even registered to vote…it made no political sense.”

The response from Obama Democrats was swift. Many, like Obama speechwriters Jon Lovett and Jon Favreau and NSC spokesman Tommy Vietor, took to Twitter. “Shorter Chuck Schumer,” said Vietor, “I wish Obama cared more about helping Democrats than sick people.”

Jensen Comment
So what's wrong with the ACA?
Firstly it expanded the piñata for fraud --- Medicaid. Half the people on Medicaid in Illinois were found not to be eligible for Medicaid.  It's bad in most other states that just are paying for audits while the Federal government is paying the tab.

Secondly it's a windfall for ACA insurance companies since the Federal government guarantees their profits and promises taxpayer money if they begin to fail. In capitalism, business firms are supposed to take on financial risks.

Thirdly, the affordable policies have 40%-60% co-pays that essentially prevents insured people from going to doctors, medical clinics, and hospitals unless they are really, really sick because of what it costs them up front. Insurance companies love that, because they are selling insurance that people don't use as much as they should be using that insurance.

Fourthly, insurance companies love the ACA because paying for medical services and medications for people behind on the payments of their ACA premiums are passed on to doctors and hospitals after 30 days. Is it any surprise that so many doctors and hospitals are refusing to accepted patients with ACA insurance?

And the list of complaints against the ACS goes on and on --- See below


I'm in favor of nationalized health care. Between 2008 and 2010 the Democrats had substantial majorities in the House and Senate and an enormously popular President Obama could've legislated nationalized health care without any help from a single Republican. Instead the Democrats  blew it and gave birth to an abomination that is yet another unfunded entitlement nail in the coffin of the United States.

But every system has rationing in some form or another. Rich Canadians unwilling to wait many months for treatments pay cash in the USA for immediate health care. Rich Swedes go elsewhere as well, often to Switzerland or the USA.

I also like Germany's combination of public and private health insurance system for a number of reasons, including the fact that it like the health plans of most other nations is a pay-as-you go plan.
Health Insurance in Germany --- http://www.toytowngermany.com/wiki/Health_insurance

Don't confuse wanting a government-managed health care system like the one in Germany with the private insurance company rip off in the ACA in the USA where insurance companies have guaranteed profits while shifting the bad debts to the doctors and hospitals.

To add pain to misery these ACA insurance companies are offering over-priced policies with enormous deductibles that discourage patients from having medial treatments except in emergencies.

Hopefully, President Hillary Clinton will have the courage to reduce for-profit insurance companies to offer only supplemental elective plans like they do in Germany and for Medicare in the USA.

I vote for the German system that operates a lot like Medicare for all ages of citizens but with better fraud controls. I used to lean toward the Canadian system, but it's elective medical procedure delays for new hips, knees, and shoulders forces too many Canadians to pay cash for such procedures in the USA. when they grow weary of waiting out Canadian health plan approval.

What bothers me the most are the blatant lies our leaders broadcast to voters just to get a health care bill passed. I would be much less critical if they had flat out been honest about what they really intend for this legislation to cost. One example of a political lie is that Cadillac insurance plans will be taxed. The unions didn't object very loudly because they know full well that by 2018 when the tax is supposed to commence, Congress will have repealed all or most of the Cadillac tax.  The same is true with many other provisions of the legislation that can be altered at taxpayer expense. Also our leaders promised that nearly a half trillion dollars will be saved by reducing third party payments to physicians. But those projections are easily altered if physicians truly demand higher reimbursements.

I just wish that Congress had passed a pay-as-you-go tax as part of this legislation, where people at all levels of income and wealth pay their fair share of the health benefits they receive. Middle class America should foot their own bills for health care through substantial tax increases on the middle class.

"A Simple Theory for Why School and Health Costs Are So Much Higher in the U.S.," by Andrew O’Connell, Harvard Business Review Blog, April 7, 2014 ---
http://blogs.hbr.org/2014/04/a-simple-theory-for-why-school-and-health-costs-are-so-much-higher-in-the-u-s/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29&cm_ite=DailyAlert-040814+%281%29&cm_lm=sp%3Arjensen%40trinity.edu&cm_ven=Spop-Email 

Jensen Comment
One reason higher education costs more in the USA is that more attempts are made to bring college education to everybody with nearby physical campuses such as community colleges and online degree programs from major universities. In Europe and most other parts of the world higher education is available only to a much smaller portion of the population. In Germany, for example, less than 25% of young graduates are admitted to college and opportunities for adult college education are much more limited than in the USA. Those other nations, however, often offer greater opportunities for learning a trade that does not require a college education.

There are many reasons health care costs more in the USA. One reason is that the USA is the world leader in medical and medication research. Another reason is that the USA imposes a costly private sector insurance intermediary where other nations offer insurance from a more efficient public sector.

Still another reason is that malpractice lawsuits are a legal punitive damages lottery in most parts of the USA such that hospitals and physicians must pay ten or more times as much for malpractice insurance relative to nations like Canada that restrict malpractice to actual damages only, leaving out the lottery for lawyers.

Still another reason is that the USA keeps extremely premature babies alive that other nations throw away. Even more expense if what Medicare spends on keeping people hopelessly and artificially alive, dying people that other nations let slip away without all the very costly artificial life extensions.

On November 22, 2009 CBS Sixty Minutes aired a video featuring experts (including physicians) explaining how the single largest drain on the Medicare insurance fund is keeping dying people hopelessly alive who could otherwise be allowed to die quicker and painlessly without artificially prolonging life on ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/

National Bureau of Economic Research: Bulletin on Aging and Health --- http://www.nber.org/aginghealth/

Leading ACA Act Blogs ---
http://www.zanebenefits.com/blog/15-best-health-reform-blogs

WHO: World Health Statistics --- http://www.who.int/gho/publications/world_health_statistics/e

 


A Personal Experience
Why many physicians will turn away their Medicare patients just like my wife was turned away by her surgeon in the South Texas Spinal Clinic in San Antonio because she was on Medicare
--- http://www.trinity.edu/rjensen/Health.htm#SpinalClinic 

"The Worst Bill Ever:   Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all," The Wall Street Journal, November 1, 2009 ---
http://www.trinity.edu/rjensen/Health.htm#110709
Jensen Comment
Nancy Pelosi catered to just about every special interest in the United States (except Medicare patients) and doled out earmark frauds like jelly beans to get economy/jobs destroying bill through the House. Please pray for Senate sensibility.

Frightening Clauses in the Pending House Bill (H.R. 3962) in November 2009

 

The End of the American Dream

Jensen Choice

Affordable Care Act Chart --- http://www.trinity.edu/rjensen/ObamaCareChart.pdf

20 Questions About the Affordable Care Act

The Top Ten Myths About Medicare

A Brief History of Health Insurance in the United States --- http://everylearner.com/bm/knowledgenews/americana/health-insurance-history-1.shtml
A key stimulus was in 1945 when the National War Labor Board made it possible for unions to negotiate coverage.
More importantly, however, business firms could get tax deductions for health benefits that were not taxable,
Thereby, workers did not have to pay for health insurance out of after-tax dollars.

Humor

The Wall Street Journal Guide to the Affordable Care Act, October 14, 2009 --- Click Here
http://online.wsj.com/article/SB10001424052748704471504574441193211542788.html?mod=djemEditorialPage

"Follow the Money," by Ben Shapiro, Townhall, October 21, 2009 ---
http://townhall.com/columnists/BenShapiro/2009/10/21/follow_the_money

Fathom the odd hypocrisy that the administration wants every citizen to prove they are insured, but people don't have to prove they are citizens.
Ben Stein

 

October 15, 2010 message from Bob Jensen to the AECM

Hi David,

There are many reasons why people cannot or should not stay in the main careers. Professional athletes are generally over the hill before age 40 in terms of beating out their competitors, but they generally find alternative employment. We can't trust many pilots and bus drivers and combat buddies after age 55. But they too can find alternative employment.

Trinity University has a management professor named Don VanEynde who was a Battalion Commander in Vietnam, earned a PhD from Columbia University after military retirement, and has been one of the most popular, if not the most popular, campus-wide professors for 15 years. He's still going strong even though he's older than me. .

Professors have many advantages in that many physical ailments like Professor Fordham's arthritis do not detract from outstanding performance as long as wisdom, memory, scholarship, and enthusiasm have not yet waned. .

When tragedy does strike at any age that prevents working in virtually any productive capacity, it's possible to start collecting social security and Medicare before the prescribed ages for retirement. Due to being injured on the job as a surgical nurse, my wife commenced collecting SS disability benefits and Medicare when she 54 years old. After her spinal injury (she was ordered by a surgeon to lift a 300 lb instrument table over a power cord and had to be put immediately on traction for 30 days in the hospital) she worked for 10 more painful years before undergoing the first of her eventual 12 spine surgeries. Each surgery led to worse enduring pain --- http://www.trinity.edu/rjensen/Erika2007.htm She most certainly is not a poster child for million-dollar spine surgeries. Worker compensation paid for the early surgeries until she was declared eligible for social security disability and Medicare.

The problem is that Congress provided disability entitlements without nearly enough funding such that these entitlements now are enormous drivers of present and future multi-trillion deficits being passed on to current and future children in the United States. Extending SS retirement ages will most certainly increase the numbers of disability claims, but the majority of older workers are gratefully not eligible for disability status before retirement at higher ages. Disabled people can start collecting Medicare at any age as soon as they are declared eligible for SS disability benefits.

Disabled people should've been funded outside the SS retirement system, but members of Congress were too chicken to establish a separate Disability and Medical Fund. They sneaked the financial entitlements of the disabled onto the SS retirement and Medicare systems and passed the funding deficits on to our present and future children.

Between 1776 and 1950 the care of the elderly and disabled was the responsibility of their own savings, their parents, their children, and in extreme cases the County Homes. After the disabled became the responsibility of the Federal government, heirs confiscated their parents' savings and children were unburdened of parental care responsibilities. Federal and state governments took on the housing, care, and feeding of every disabled person. In theory, savings of the elderly are to be used for nursing home care, but fraud is rampant in terms of passing these costs on to taxpayers.

We can argue endlessly whether disabled people should be the responsibilities of their families or taxpayers or employers. For example, perhaps I should've been more financially responsible for my wife's disability than the social security and Medicare systems. On this subject I can truly be an academic who can take on any side in a debate. Perhaps worker compensation insurance should've covered my injured wife for a longer period of time, but the worker compensation insurance firm worked tooth and nail to pass her on to SS and Medicare.

The point is that government funding for the disabled should be a pay-as-you-go system taxation rather than a Ponzi scheme of deficit financing. The present entitlement system is not only unfair to future generations, it threatens the very survival of the United States --- http://www.trinity.edu/rjensen/Entitlements.htm

Bob Jensen


Deficit tops $1 trillion second year in a row ($1.29 trillion before November and December) ---
http://money.cnn.com/2010/10/15/news/economy/treasury_fy2010_deficit/index.htm

Long-term problem:
There has been a lot of political hysteria expressed over the annual deficits of the past two years.

Fiscal experts note, however, that the abnormally large deficits incurred in the wake of the financial crisis are not the primary source of the country's biggest fiscal problems.

The biggest source of fiscal concern remains the so-called structural deficit, which is made up primarily of spending on the big three entitlement programs. That structural deficit will continue to balloon faster than the economy grows long after the current downturn has ended.

Indeed, the Government Accountability Office projects that by the end of this decade, the vast majority of all federal tax revenue will be swallowed up by just four things: Interest payments on the country's debt, and the payment of Medicare, Medicaid and Social Security benefits.

The president's bipartisan fiscal commission, charged with recommending ways to get U.S. debt under control, will issue a report in December.


I'm in favor of health care reform that completely nationalizes health insurance phased in reasonably with high tax pay-as-you-go restriction and strict cost-saving caps on punitive damage lawsuits. I really favor former Senator Bill Bradley's long-forgotten Canada-like proposal:

The bipartisan trade-off in a viable health care bill is obvious: Combine universal coverage with malpractice tort reform in health care. Universal coverage can be obtained in many ways — including the so-called public option. Malpractice tort reform can be something as commonsensical as the establishment of medical courts — similar to bankruptcy or admiralty courts — with special judges to make determinations in cases brought by parties claiming injury. Such a bipartisan outcome would lower health care costs, reduce errors (doctors and nurses often don’t report errors for fear of being sued) and guarantee all Americans adequate health care. Whenever Congress undertakes large-scale reform, there are times when disaster appears certain — only to be averted at the last minute by the good sense of its sometimes unfairly maligned members. What now appears in Washington as a special-interest scrum could well become a triumph for the general interest. But for that to happen, the two parties must strike a grand bargain on universal coverage and malpractice tort reform. The August recess has given each party and its constituencies a chance to reassess their respective strategies. One result, let us hope, may be that Congress will surprise everyone this fall.
Bill Bradley, "Tax Reform’s Lesson for Health Care Reform," The New York Times, August 30, 2009 ---
http://www.nytimes.com/2009/08/30/opinion/30bradley.html?_r=1

IOUSA (the most frightening movie in American history) ---
(see a 30-minute version of the documentary at www.iousathemovie.com )

I have come to the conclusion that the real reason this gifted communicator (Obama) has become so bad at communicating is that he doesn't really believe a word that he is saying. He couldn't convey that health-care reform would be somehow cost-free because he knows it won't be. And he can't adequately convey either the imperatives or the military strategy of the war in Afghanistan because he doesn't really believe in it either. He feels colonized by mistakes of the past. He feels trapped by the hand that has been dealt him.
Leftist Leaning Tina Brown, "Obama's Fog War," The Daily Beast ---
http://www.thedailybeast.com/blogs-and-stories/2009-12-03/what-is-obama-talking-about/
Jensen Comment
And President Obama was the dealer.

Voters are increasingly worried about unemployment, but Democratic leaders in Congress remain obsessed with passing health- care reform. Senate Majority Whip Richard Durbin was asked recently if a health-care bill would pass the Senate by the end of this month. "It must," he said. "We have to finish it." Still, many in the trenches are uneasy about the sprawling, complex bill they privately acknowledge has no bipartisan support, doesn't seriously tackle soaring costs and will increase insurance premiums. That may explain Majority Leader Harry Reid's haste—he has ordered a rare Sunday session this weekend to hurry up the debate. Public support for the bill averages only 39.2% backing in all polls compiled by Pollster.com.
John Fund, "Why Dems Are Obsessed by Health Reform:  They believe the liberal base expects them to deliver and will punish them if they don't," The Wall Street Journal, December 4, 2009 ---
http://online.wsj.com/article/SB10001424052748704007804574575584229775884.html#mod=djemEditorialPage


America spends far more on health care per capita than any other nation in the world.
One reason is that America spends trillions each year on people that other nations let go of for cost reasons:

(1) Extremely premature and lightweight newborns that other nations cannot or do not afford to save;
(2) Dying people prolonged by machines in intensive care units that have no hope of leaving ICU alive.

Born at 9.1 Ounces  She Would've been thrown away in most other nations
Cozy in her incubator, set to 81.5 degrees, heart going at 174 beats a minute as she snoozed in her red, footy pajamas, Oliviyanna Harbin-Page may be a global record-holder. Born Aug. 5 to 16-year-old Jamesha Harbin of Eight Mile after 21 to 24 weeks of gestation, Oliviyanna weighed only 259 grams, or 9.1 ounces -- possibly making her, according to the University of South Alabama Children's & Women's Hospital, the world's smallest surviving baby. She now weighs 3 pounds 2 ounces. One of three girl triplets -- the other two are identical, she is fraternal
"Baby who may be world's smallest surviving newborn could go home soon," by Roy Hoffman, al.com, December 18, 2009 ---
http://blog.al.com/live/2009/12/baby_who_may_be_worlds_smalles.html

What went so wrong in the health care system of the United States?
Mostly what went wrong is our ill-conceived and underfunded attempts to reform the system!

The New York Times Timeline History of Health Care Reform in the United States ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html
Click the arrow button on the right side of the page.

The $61 Trillion Margin of Error, and What "Empire Decline" Means in Layman's Terms
This is a bipartisan disaster from the beginning and will be until the end

David Walker --- http://en.wikipedia.org/wiki/David_M._Walker_(U.S._Comptroller_General)

Niall Ferguson --- http://en.wikipedia.org/wiki/Niall_Ferguson

Call it the fatal arithmetic of imperial decline. Without radical fiscal reform, it could apply to America next.
Niall Ferguson, "An Empire at Risk:  How Great Powers Fail," Newsweek Magazine Cover Story, November 26, 2009 --- http://www.newsweek.com/id/224694/page/1
Please note that this is NBC’s liberal Newsweek Magazine and not Fox News or The Wall Street Journal.

. . .

In other words, there is no end in sight to the borrowing binge. Unless entitlements are cut or taxes are raised, there will never be another balanced budget. Let's assume I live another 30 years and follow my grandfathers to the grave at about 75. By 2039, when I shuffle off this mortal coil, the federal debt held by the public will have reached 91 percent of GDP, according to the CBO's extended baseline projections. Nothing to worry about, retort -deficit-loving economists like Paul Krugman.

. . .

Another way of doing this kind of exercise is to calculate the net present value of the unfunded liabilities of the Social Security and Medicare systems. One recent estimate puts them at about $104 trillion, 10 times the stated federal debt.

Continued in article --- http://www.newsweek.com/id/224694/page/1

Niall Ferguson is the Laurence A. Tisch professor of history at Harvard University and the author of The Ascent of Money. In late 2009 he puts forth an unbooked discounted present value liability of $104 trillion for Social Security plus Medicare. In late 2008, the former Chief Accountant of the United States Government, placed this estimate at$43 trillion. We can hardly attribute the $104-$43=$61 trillion difference to President Obama's first year in office. We must accordingly attribute the $61 trillion to margin of error and most economists would probably put a present value of unbooked (off-balance-sheet) present value of Social Security and Medicare debt to be somewhere between $43 trillion and $107 trillion To this we must add other unbooked present value of entitlement debt estimates which range from $13 trillion to $40 trillion. If the Affordable Care Act passes it will add untold trillions to trillions more because our legislators are not looking at entitlements beyond 2019.

The Meaning of "Unbooked" versus "Booked" National Debt
By "unbooked" we mean that the debt is not included in the current "booked" National Debt of $12 trillion. The booked debt is debt of the United States for which interest is now being paid daily at slightly under a million dollars a minute. Cash must be raised daily for interest payments. Cash is raised from taxes, borrowing, and/or (shudder) the current Fed approach to simply printing money. Interest is not yet being paid on the unbooked debt for which retirement and medical bills have not yet arrived in Washington DC for payment. The unbooked debt is by far the most frightening because our leaders keep adding to this debt without realizing how it may bring down the entire American Dream to say nothing of reducing the U.S. Military to almost nothing.

Niall Ferguson, "An Empire at Risk:  How Great Powers Fail," Newsweek Magazine Cover Story, November 26, 2009 --- http://www.newsweek.com/id/224694/page/1

This matters more for a superpower than for a small Atlantic island for one very simple reason. As interest payments eat into the budget, something has to give—and that something is nearly always defense expenditure. According to the CBO, a significant decline in the relative share of national security in the federal budget is already baked into the cake. On the Pentagon's present plan, defense spending is set to fall from above 4 percent now to 3.2 percent of GDP in 2015 and to 2.6 percent of GDP by 2028.

Over the longer run, to my own estimated departure date of 2039, spending on health care rises from 16 percent to 33 percent of GDP (some of the money presumably is going to keep me from expiring even sooner). But spending on everything other than health, Social Security, and interest payments drops from 12 percent to 8.4 percent.

This is how empires decline. It begins with a debt explosion. It ends with an inexorable reduction in the resources available for the Army, Navy, and Air Force. Which is why voters are right to worry about America's debt crisis. According to a recent Rasmussen report, 42 percent of Americans now say that cutting the deficit in half by the end of the president's first term should be the administration's most important task—significantly more than the 24 percent who see health-care reform as the No. 1 priority. But cutting the deficit in half is simply not enough. If the United States doesn't come up soon with a credible plan to restore the federal budget to balance over the next five to 10 years, the danger is very real that a debt crisis could lead to a major weakening of American power.

The Meaning of Present Value
Initially it might help to explain what present value means. When I moved from Florida State University to Trinity University in 1982, current mortgage rates were about 18%. As part of my compensation package, President Calgaard agreed to have Trinity University carry my mortgage. I purchased a home at 9010 Village Drive for $300,000 by paying $100,000 down and signing a 240 month mortgage at 12% APR and a 1982 present value of $200,000. At payments of $2,202 per month my total cash obligation (had I not refinanced from a bank when mortgage rates went below 12%) would've been $528,521. However, since money has time value, the present value of that $528,521 was only $200,000.

In a similar manner, Professor Ferguson's $104 trillion present value translates to over $300 trillion in cash obligations of Social Security and Medicare before being tinkered with changed entitlement obligations.

The "Burning Platform" of the United States Empire
Former Chief Accountant of the United States, David Walker, is spreading the word as widely as possible in the United States about the looming threat of our unbooked entitlements. Two videos that feature David Walker's warnings are as follows:

David Walker claims the U.S. economy is on a "burning platform" but does not go into specifics as to what will be left in the ashes.

The US government is on a “burning platform” of unsustainable policies and practices with fiscal deficits, chronic healthcare underfunding, immigration and overseas military commitments threatening a crisis if action is not taken soon.
David M. Walker, Former Chief Accountant of the United States --- http://www.financialsense.com/editorials/quinn/2009/0218.html
 

An "Empire at Risk"
Harvard's Professor Niall Ferguson is equally vague about what will happen if the U.S. Empire collapses from its entitlement burdens.
Niall Ferguson, "An Empire at Risk:  How Great Powers Fail," Newsweek Magazine Cover Story, November 26, 2009 --- http://www.newsweek.com/id/224694/page/1

This is how empires decline. It begins with a debt explosion. It ends with an inexorable reduction in the resources available for the Army, Navy, and Air Force. Which is why voters are right to worry about America's debt crisis. According to a recent Rasmussen report, 42 percent of Americans now say that cutting the deficit in half by the end of the president's first term should be the administration's most important task—significantly more than the 24 percent who see health-care reform as the No. 1 priority. But cutting the deficit in half is simply not enough. If the United States doesn't come up soon with a credible plan to restore the federal budget to balance over the next five to 10 years, the danger is very real that a debt crisis could lead to a major weakening of American power.

The precedents are certainly there. Habsburg Spain defaulted on all or part of its debt 14 times between 1557 and 1696 and also succumbed to inflation due to a surfeit of New World silver. Prerevolutionary France was spending 62 percent of royal revenue on debt service by 1788. The Ottoman Empire went the same way: interest payments and amortization rose from 15 percent of the budget in 1860 to 50 percent in 1875. And don't forget the last great English-speaking empire. By the interwar years, interest payments were consuming 44 percent of the British budget, making it intensely difficult to rearm in the face of a new German threat.

Call it the fatal arithmetic of imperial decline. Without radical fiscal reform, it could apply to America next.


Empire Collapse in Layman's Terms
In 2010, hundreds upon hundreds of people will daily sneak across the U.S. border illegally in search of a job, medical care, education, and a better life under the American Dream. By 2050 Americans will instead be exiting in attempts to escape the American Nightmare and sneak illegally into BRIC nations for a job, medical care, education, and a better life under the BRIC Dream.

A BRIC nation at the moment is a nation that has vast resources and virtually no entitlement obligations that drag down economic growth --- http://en.wikipedia.org/wiki/BRIC

In economics, BRIC (typically rendered as "the BRICs" or "the BRIC countries") is an acronym that refers to the fast-growing developing economies of Brazil, Russia, India, and China. The acronym was first coined and prominently used by Goldman Sachs in 2001. According to a paper published in 2005, Mexico and South Korea are the only other countries comparable to the BRICs, but their economies were excluded initially because they were considered already more developed. Goldman Sachs argued that, since they are developing rapidly, by 2050 the combined economies of the BRICs could eclipse the combined economies of the current richest countries of the world. The four countries, combined, currently account for more than a quarter of the world's land area and more than 40% of the world's population.

Brazil, Russia, India and China, (the BRICs) sometimes lumped together as BRIC to represent fast-growing developing economies, are selling off their U.S. Treasury Bond holdings. Russia announced earlier this month it will sell U.S. Treasury Bonds, while China and Brazil have announced plans to cut the amount of U.S. Treasury Bonds in their foreign currency reserves and buy bonds issued by the International Monetary Fund instead. The BRICs are also soliciting public support for a "super currency" capable of replacing what they see as the ailing U.S. dollar. The four countries account for 22 percent of the global economy, and their defection could deal a severe blow to the greenback. If the BRICs sell their U.S. Treasury Bond holdings, the price will drop and yields rise, and that could prompt the central banks of other countries to start selling their holdings to avoid losses too. A sell-off on a grand scale could trigger a collapse in the value of the dollar, ending the appeal of both dollars and bonds as safe-haven assets. The moves are a challenge to the power of the dollar in international financial markets. Goldman Sachs economist Alberto Ramos in an interview with Bloomberg News on Thursday said the decision by the BRICs to buy IMF bonds should not be seen simply as a desire to diversify their foreign currency portfolios but as a show of muscle.
"BRICs Launch Assault on Dollar's Global Status," The Chosun IIbo, June 14, 2009 ---
http://english.chosun.com/site/data/html_dir/2009/06/12/2009061200855.html

Their report, "Dreaming with BRICs: The Path to 2050," predicted that within 40 years, the economies of Brazil, Russia, India and China - the BRICs - would be larger than the US, Germany, Japan, Britain, France and Italy combined. China would overtake the US as the world's largest economy and India would be third, outpacing all other industrialised nations. 
"Out of the shadows," Sydney Morning Herald, February 5, 2005 --- http://www.smh.com.au/text/articles/2005/02/04/1107476799248.html 

The first economist, an early  Nobel Prize Winning economist, to raise the alarm of entitlements in my head was Milton Friedman.  He has written extensively about the lurking dangers of entitlements.  I highly recommend his fantastic "Free to Choose" series of PBS videos where his "Welfare of Entitlements" warning becomes his principle concern for the future of the Untied States 25 years ago --- http://www.ideachannel.com/FreeToChoose.htm 


"Social Security to See Payout Exceed Pay-In This Year," by Mary Williams Walsh, The New York Times, March 24, 2010 ---
http://www.nytimes.com/2010/03/25/business/economy/25social.html?hp

The bursting of the real estate bubble and the ensuing recession have hurt jobs, home prices and now Social Security.

This year, the system will pay out more in benefits than it receives in payroll taxes, an important threshold it was not expected to cross until at least 2016, according to the Congressional Budget Office.

Stephen C. Goss, chief actuary of the Social Security Administration, said that while the Congressional projection would probably be borne out, the change would have no effect on benefits in 2010 and retirees would keep receiving their checks as usual.

The problem, he said, is that payments have risen more than expected during the downturn, because jobs disappeared and people applied for benefits sooner than they had planned. At the same time, the program’s revenue has fallen sharply, because there are fewer paychecks to tax.

Analysts have long tried to predict the year when Social Security would pay out more than it took in because they view it as a tipping point — the first step of a long, slow march to insolvency, unless Congress strengthens the program’s finances.

“When the level of the trust fund gets to zero, you have to cut benefits,” Alan Greenspan, architect of the plan to rescue the Social Security program the last time it got into trouble, in the early 1980s, said on Wednesday.

That episode was more dire because the fund could have fallen to zero in a matter of months. But partly because of steps taken in those years, and partly because of many years of robust economic growth, the latest projections show the program will not exhaust its funds until about 2037.

Still, Mr. Greenspan, who later became chairman of the Federal Reserve Board, said: “I think very much the same issue exists today. Because of the size of the contraction in economic activity, unless we get an immediate and sharp recovery, the revenues of the trust fund will be tracking lower for a number of years.”

The Social Security Administration is expected to issue in a few weeks its own numbers for the current year within the annual report from its board of trustees. The administration has six board members: three from the president’s cabinet, two representatives of the public and the Social Security commissioner.

Though Social Security uses slightly different methods, the official numbers are expected to roughly track the Congressional projections, which were one page of a voluminous analysis of the federal budget proposed by President Obama in January.

Mr. Goss said Social Security’s annual report last year projected revenue would more than cover payouts until at least 2016 because economists expected a quicker, stronger recovery from the crisis. Officials foresaw an average unemployment rate of 8.2 percent in 2009 and 8.8 percent this year, though unemployment is hovering at nearly 10 percent.

The trustees did foresee, in late 2008, that the recession would be severe enough to deplete Social Security’s funds more quickly than previously projected. They moved the year of reckoning forward, to 2037 from 2041. Mr. Goss declined to reveal the contents of the forthcoming annual report, but said people should not expect the date to lurch forward again.

The long-term costs of Social Security present further problems for politicians, who are already struggling over how to reduce the nation’s debt. The national predicament echoes that of many European governments, which are facing market pressure to re-examine their commitments to generous pensions over extended retirements.

The United States’ soaring debt — propelled by tax cuts, wars and large expenditures to help banks and the housing market — has become a hot issue as Democrats gauge their vulnerability in the coming elections. President Obama has appointed a bipartisan commission to examine the debt problem, including Social Security, and make recommendations on how to trim the nation’s debt by Dec. 1, a few weeks after the midterm Congressional elections.

Although Social Security is often said to have a “trust fund,” the term really serves as an accounting device, to track the pay-as-you-go program’s revenue and outlays over time. Its so-called balance is, in fact, a history of its vast cash flows: the sum of all of its revenue in the past, minus all of its outlays. The balance is currently about $2.5 trillion because after the early 1980s the program had surplus revenue, year after year.

Now that accumulated revenue will slowly start to shrink, as outlays start to exceed revenue. By law, Social Security cannot pay out more than its balance in any given year.

For accounting purposes, the system’s accumulated revenue is placed in Treasury securities.

In a year like this, the paper gains from the interest earned on the securities will more than cover the difference between what it takes in and pays out.

Mr. Goss, the actuary, emphasized that even the $29 billion shortfall projected for this year was small, relative to the roughly $700 billion that would flow in and out of the system. The system, he added, has a balance of about $2.5 trillion that will take decades to deplete. Mr. Goss said that large cushion could start to grow again if the economy recovers briskly.

Indeed, the Congressional Budget Office’s projection shows the ravages of the recession easing in the next few years, with small surpluses reappearing briefly in 2014 and 2015.

After that, demographic forces are expected to overtake the fund, as more and more baby boomers leave the work force, stop paying into the program and start collecting their benefits. At that point, outlays will exceed revenue every year, no matter how well the economy performs.

Mr. Greenspan recalled in an interview that the sour economy of the late 1970s had taken the program close to insolvency when the commission he led set to work in 1982. It had no contingency reserve then, and the group had to work quickly. He said there were only three choices: raise taxes, lower benefits or bail out the program by tapping general revenue.

The easiest choice, politically, would have been “solving the problem with the stroke of a pen, by printing the money,” Mr. Greenspan said. But one member of the commission, Claude Pepper, then a House representative, blocked that approach because he feared it would undermine Social Security, changing it from a respected, self-sustaining old-age program into welfare.

Mr. Greenspan said that the same three choices exist today — though there is more time now for the painful deliberations.

“Even if the trust fund level goes down, there’s no action required, until the level of the trust fund gets to zero,” he said. “At that point, you have to cut benefits, because benefits have to equal receipts.”


Where Did Social Security Go So Wrong?
Social Security in the United States currently refers to the Federal Old-Age, Survivors, and Disability Insurance (OASDI) program. It commenced only as an old age ("survivors:") retirement insurance program as a forced way of saving for retirement by paying worker premiums matched by employer contributions into the SS Trust Fund. Premiums were relatively low due heavily to the proviso that the SS Trust Fund got to keep all the premiums paid for each worker and spouse that did not reach retirement age (generally viewed as 65).  Details are provided at
http://en.wikipedia.org/wiki/Social_Security_(United_States)#Creation:_The_Social_Security_Act

If Congress had not tapped the SS Trust Fund for other (generally unfunded social programs of various types), the SS Trust Fund would not be in any trouble at all if it were managed like a diversified investment fund. But it became too tempting for Congress to tap the SS Trust Fund for a variety of other social programs, the costliest of which was to make monthly living allowance payments to each person of any age who is declared "disabled." In many cases a disabled person collects decades of benefits after having paid less than a single penny into the SS Trust Fund. It's well and good for our great land to provide living allowances to disabled citizens, but without funding from other sources such as a separate Disability Trust Fund fed with some type of other taxes, the disability payments mostly drained the SS Trust Fund to where it is in dire trouble today.

The obligation to pay pensioners as well as disabled persons was passed on to current and future generations to a point where the Social Security and Disability Program is no longer self-sustaining with little hope for meeting entitlement obligations from worker premiums and employer matching funds. The SS Trust Fund will have deficits beginning in 2010 that are expected to explode as baby boomers collect benefits for the first time.

Where Did Medicare Go So Wrong?
Medicare is a much larger and much more complicated entitlement burden relative to Social Security by a ratio of about six to one or even more. The Medicare Medical Insurance Fund was established under President Johnson in1965.

Note that Medicare, like Social Security in general, was intended to be insurance funded by workers over their careers. If premiums paid by workers and employers was properly invested and then paid out after workers reached retirement age most of the trillions of unfunded debt would not be precariously threatening the future of the United States. The funds greatly benefit when workers die before retirement because all that was paid in by these workers and their employers are added to the fund benefits paid out to living retirees.

The first huge threat to sustainability arose beginning in 1968 when medical coverage payments payments to surge way above the Medicare premiums collected from workers and employers. Costs of medical care exploded relative to most other living expenses. Worker and employer premiums were not sufficiently increased for rapid growth in health care costs as hospital stays surged from less than $100 per day to over $1,000 per day.

A second threat to the sustainability comes from families no longer concerned about paying up to $25,000 per day to keep dying loved ones hopelessly alive in intensive care units (ICUs) when it is 100% certain that they will not leave those ICUs alive. Families do not make economic choices in such hopeless cases where the government is footing the bill. In other nations these families are not given such choices to hopelessly prolong life at such high costs. I had a close friend in Maine who became a quadriplegic in a high school football game. Four decades later Medicare paid millions of dollars to keep him alive in an ICU unit when there was zero chance he would ever leave that ICU alive.

On November 22, 2009 CBS Sixty Minutes aired a video featuring experts (including physicians) explaining how the single largest drain on the Medicare insurance fund is keeping dying people hopelessly alive who could otherwise be allowed to die quicker and painlessly without artificially prolonging life on ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/

What is really sad is the way Republicans are standing in the way of making rational cost-benefit decisions about dying by exploiting the "Kill Granny" political strategy aimed at killing a government option in health care reform.
See the "Kill Granny" strategy at --- www.defendyourhealthcare.us

The third huge threat to the economy commenced in when disabled persons (including newborns) tapped into the Social Security and Medicare insurance funds. Disabled persons should receive monthly benefits and medical coverage in this great land. But Congress should've found a better way to fund disabled persons with something other than the Social Security and Medicare insurance funds. But politics being what it is, Congress slipped this gigantic entitlement through without having to debate and legislate separate funding for disabled persons. And hence we are now at a crossroads where the Social Security and Medicare Insurance Funds are virtually broke for all practical persons.

Most of the problem lies is Congressional failure to sufficiently increase Social Security deductions (for the big hit in monthly payments to disabled persons of all ages) and the accompanying Medicare coverage (to disabled people of all ages). The disability coverage also suffers from widespread fraud.

Other program costs were also added to the Social Security and Medicare insurance funds such as the education costs of children of veterans who are killed in wartime. Once again this is a worthy cause that should be funded. But it should've been separately funded rather than simply added into the Social Security and Medicare insurance funds that had not factored such added costs into premiums collected from workers and employers.

The fourth problem is that most military retirees are afforded full lifetime medical coverage for themselves and their spouses. Although they can use Veterans Administration doctors and hospitals, most of these retirees opted for the underfunded  TRICARE plan the pushed most of the hospital and physician costs onto the Medicare Fund. The VA manages to push most of its disabled veterans onto the Medicare Fund without having paid nearly enough into the fund to cover the disability medical costs. Military personnel do have Medicare deductions from their pay while they are on full-time duty, but those deductions fall way short of the cost of disability and retiree medical coverage.

The fifth threat to sustainability came when actuaries failed to factor in the impact of advances in medicine for extending lives. This coupled with the what became the biggest cost of Medicare, the cost of dying, clobbered the insurance funds. Surpluses in premiums paid by workers and employers disappeared much quicker than expected.

A sixth threat to Medicare especially has been widespread and usually undetected fraud such as providing equipment like motorized wheel chairs to people who really don't need them or charging Medicare for equipment not even delivered. There are also widespread charges for unneeded medical tests or for tests that were never really administered. Medicare became a cash cow for crooks. Many doctors and hospitals overbill Medicare and only a small proportion of the theft is detected and punished.

The seventh threat to sustainability commenced in 2007 when the costly Medicare drug benefit entitlement entitlement was added by President George W. Bush. This was a costly addition, because it added enormous drains on the fund by retired people like me and my wife who did not have the cost of the drug benefits factored into our payments into the Medicare Fund while we were still working. It thus became and unfunded benefit that we're now collecting big time.

In any case we are at a crossroads in the history of funding medical care in the United States that now pays a lot more than any other nation per capita and is getting less per dollar spent than many nations with nationalized health care plans. I'm really not against the Affordable Care Act legislation. I'm only against the lies and deceits being thrown about by both sides in the abomination of the current proposed legislation.

Democrats are missing the boat here when they truly have the power, for now at least, in the House and Senate to pass a relatively efficient nationalized health plan. But instead they're giving birth to entitlements legislation that threatens the sustainability of the United States as a nation.

In any case, The New York Times presents a nice history of other events that I left out above ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html

"THE HEALTH CARE DEBATE: What Went Wrong? How the Health Care Campaign Collapsed --
A special report.; For Health Care, Times Was A Killer," by Adam Clymer, Robert Pear and Robin Toner, The New York Times, August 29, 1994 --- Click Here
http://www.nytimes.com/1994/08/29/us/health-care-debate-what-went-wrong-health-care-campaign-collapsed-special-report.html

November 22, 2009 reply from Richard.Sansing [Richard.C.Sansing@TUCK.DARTMOUTH.EDU]

The electorate's inability to debate trade-offs in a sensible manner is the biggest problem, in my view. See

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/19/AR2009111904053.html?referrer=emailarticle 

Richard Sansing

The New York Times Timeline History of Health Care Reform in the United States ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html
Click the arrow button on the right side of the page. The biggest problem with "reform" is that it added entitlements benefits without current funding such that with each reform piece of legislation the burdens upon future generations has hit a point of probably not being sustainable.

Call it the fatal arithmetic of imperial decline. Without radical fiscal reform, it could apply to America next.
Niall Ferguson, "An Empire at Risk:  How Great Powers Fail," Newsweek Magazine Cover Story, November 26, 2009 --- http://www.newsweek.com/id/224694/page/1

. . .

In other words, there is no end in sight to the borrowing binge. Unless entitlements are cut or taxes are raised, there will never be another balanced budget. Let's assume I live another 30 years and follow my grandfathers to the grave at about 75. By 2039, when I shuffle off this mortal coil, the federal debt held by the public will have reached 91 percent of GDP, according to the CBO's extended baseline projections. Nothing to worry about, retort -deficit-loving economists like Paul Krugman.

. . .

Another way of doing this kind of exercise is to calculate the net present value of the unfunded liabilities of the Social Security and Medicare systems. One recent estimate puts them at about $104 trillion, 10 times the stated federal debt.

Continued in article

This is now President Obama's problem with or without new the Affordable Care Act entitlements that are a mere drop in the bucket compared to the entitlement obligations that President Obama inherited from every President of the United States since FDR in the 1930s. The problem has been compounded under both Democrat and Republican regimes, both of which have burdened future generations with entitlements not originally of their doing.

Professor Niall Ferguson and David Walker are now warning us that by year 2050 the American Dream will become an American Nightmare in which Americans seek every which way to leave this fallen nation for a BRIC nation offering some hope of a job, health care, education, and the BRIC Dream.

Bob Jensen's threads on health care ---
http://www.trinity.edu/rjensen/Health.htm

Bob Jensen's threads on entitlements ---
http://www.trinity.edu/rjensen/entitlements.htm


Quotations

Let me get this straight.
We're about to get a health care plan shoved down our throats that is Written by a committee whose head says he doesn't understand it, Passed by a Congress that hasn't read it but exempts themselves from it, signed by a president that also hasn't read it, With funding administered by a treasury chief who was caught not paying his Taxes, overseen by a surgeon general who is obese, and financed by a Country that's nearly broke.
What could possibly go wrong?

IS THIS A GREAT COUNTRY OR WHAT!

Forwarded by Maureen

Video Shocker
"Health Care Shocker: Special Democratic Voting Counties Would Get Protected Medicare Benefits," Brietbart ---
http://www.breitbart.tv/healthcare-shocker-special-democratic-voting-counties-would-get-protected-medicare-benefits/

"How can Obama Top a Great Speech," by Joan Walsh, Salon, September 10, 2010 --- http://www.salon.com/opinion/walsh/politics/2009/09/10/healthcare_speech/index.html 
Jensen Answer
Dear Ms Walsh, President Obama can top his great speech by filling in details of truthful estimates of the Affordable Care Act costs and how he plans to finance these added costs of wider coverage of health issues and more people covered. Thus far his sweeping claims of cost savings sound like snake oil.

Video tutorial on the President's strategy and the legislative process for passing health reform legislations --- http://www.kaiseredu.org/tutorials/reformprocess/player.html

H.R.  3200 Summary
http://www.trinity.edu/rjensen/Health.htm#HR3200
Introduced in the House on July 14, 2009
Also see http://www.defendyourhealthcare.us/houseandsenatebills.html

H.R.   676  Summary ---
http://www.trinity.edu/rjensen/Health.htm#HR676
Introduced in House on January 26. 2009

U.S. Debt/Deficit Clock --- http://www.usdebtclock.org/

Bob Jensen's threads on pending economic disaster ---
http://www.trinity.edu/rjensen/Entitlements.htm

Jensen Comment
Because of the present health care system in the United States is unjust and inefficient, I am in favor of a National Health Plan modeled after the Canadian National Health Plan where Canadians are taxed for a huge portion of their health services irrespective of their levels of income. Any system that does not make users of the system share heavily in the cost of the services will be unjust, abused, and inefficient --- http://www.trinity.edu/rjensen/Health.htm#Canada

Having said that I prefer a Canadian-style national health plan for the U.S., I wish democrats in Congress would use their power and vote one in in spite of protests around the country. With a 60-vote surplus in the House and only needing 51 votes in the Senate, the Democrats could vote in National Health Care in an instant. The reason they won't is that most of them would be voted out of office the next time they come up for re-election. They know this!

But Americans at all levels of income would have to agree to much higher taxes
The average Canadian family spends more money on taxes than on necessities of life such as food, clothing, and housing, according to a study from The Fraser Institute, an independent research organization with offices across Canada. The Canadian Consumer Tax Index, 2007, shows that even though the income of the average Canadian family has increased significantly since 1961, their total tax bill has increased at a much higher rate.

The Fraser Institute, April 16, 2007 --- http://www.newswire.ca/en/releases/archive/April2007/16/c5234.html
Jensen Comment
I put the portion of the Canadian tax dollars going into comparable health and social services contained in the Affordable Care Act legislation to be about 40% of each Canadian's tax dollar where malpractice coverage and government fraud is greatly controlled relative to the United States
---
http://www.trinity.edu/rjensen/Health.htm#Canada
Canada greatly restricts the number of free riders in the system and negotiates much lower prescription drug prices relative to insurance companies and Medicare in the United States. Malpractice awards in Canada are tightly controlled.

So the present (health care) system is an unsustainable disaster, but you can keep your piece of it if you want. And the Democrats wonder why selling health care reform to the public has been so hard?
Ramesh Ponuru,
"the Affordable Care Act's Fatal Flaw:  Democrats claim their plans will save money, but they have too many conflicting goals," Time Magazine August 17, 2009, Page 35
Jensen Comment
The problem is that they keep adding expensive medical services that sound great on paper, but few people, companies, and certainly not government can afford these uncapped benefits.

YouTube - ABC's John Stossel Destroys/Pulverizes/Crushes Obama's anti-American 'Health Care' Plan --- Click Here

Congressman Mike Rogers' opening statement on Health Care reform in Washington D.C. ---
http://www.youtube.com/watch?v=G44NCvNDLfc

Jacob Hacker: Fixing America's Healthcare System (not humor) ---
http://fora.tv/2008/07/21/Jacob_Hacker_Fixing_America_s_Healthcare_System

Jack Webb on Health Care and America (Humor) ---
http://pubsecrets.wordpress.com/2009/09/05/just-the-facts-barack/

Video:  Jon Stewart reveals Glenn Beck speaking about health care from both ends of his digestive tract ---
http://www.thenation.com/blogs/notion/462437/breaking_rush_newt_and_sarah_supported_death_panels_too

Americans who want to tip the debate in the most progressive direction should take advantage an opening provided at the last minute during negotiations to get a bill approved by the House Energy and Commerce Committee. And they should do so by advocating even more aggressively for single-payer health care.
John Nichols, "Why Single Payer Advocacy Matters Now More Than Ever ," The Nation, August 4, 2009 --- Click Here
Jensen Comment
Passionate advocates of universal health care are screaming "yes, yes, yes" without even caring how health care will be funded or whether or not it will further destruct the U.S. economy. The cannot care because they're so willing to vote yet before a funding proposal is even put forth. I actually favor single-payer nationalized health care but I'm unwilling to destroy by beloved homeland in a passionate rage for the gold plated version that this debt-ridden nation can ill afford at the present time --- http://www.trinity.edu/rjensen/Entitlements.htm
"Schumer: Healthcare Changes This Year 'No Matter What'" --- Click Here
U.S. Debt/Deficit Clock --- http://www.usdebtclock.org/

Jesus, the Great Healer, wants Obamacare according to MSNBC (even if top preachers are "dreadfully silent"). Watch the video ---
http://hotair.com/archives/2009/08/13/msnbc-host-hey-wouldnt-jesus-want-us-to-have-universal-health-care/

But what helps many Americans as individuals may hurt society as a whole. That's the paradox. Unchecked health spending is depressing take-home pay, squeezing other government programs—state and local programs as well as federal—and driving up taxes and budget deficits. The president has said all this; he simply isn't doing much about it. He offers the illusion of reform while perpetuating the status quo of four decades: expand benefits, talk about controlling costs. The press should put "reform" in quote marks, because this is one "reform" that might leave the country worse off.
Robert J. Samuelson, Health Reform That Isn't:  Despite the Rhethoric, Costs (and trillion dollar deficits) Will Rise, Newsweek Magazine, August 3, 2009, Page 26 --- http://www.newsweek.com/id/208439/page/2
Samuelson is the author of The Great -Inflation and Its Aftermath.

For starters, $1 trillion of extra debt-financed spending would cause the government to pay about $300 billion of extra interest in the next decade. Moreover, the CBO's method of estimating the cost of such a program doesn't recognize the incentives it creates for households and firms to change their behavior. The House health-care bill gives a large subsidy to millions of families with incomes up to three times the poverty level (i.e., up to $66,000 now for a family of four) if they buy their insurance through one of the newly created "insurance exchanges," but not if they get their insurance from their employer. The CBO's cost estimate understates the number who would receive the subsidy because it ignores the incentive for many firms to drop employer-provided coverage. It also ignores the strong incentive that individuals would have to reduce reportable cash incomes to qualify for higher subsidy rates. The total cost of ObamaCare over the next decade likely would be closer to $2 trillion than to $1 trillion.
Martin Feldstein, "ObamaCare's Crippling Deficits The higher taxes, debt payments and interest rates needed to pay for health reform mean lower living standard," The Wall Street Journal, September 7, 2009 ---
http://online.wsj.com/article/SB10001424052970203585004574393110640864526.html?mod=djemEditorialPage

In 1935 President Franklin Roosevelt engineered the Social Security Act with honest and well-defined components of benefits and costs. It was intended to only be a supplemental pension program to force people to save something for their retirements. Later on Congress muddled the program up by adding social services (such as lifetime pensions for disabled people of all ages and death benefits for families of soldiers who died in service). Medicare and Medicaid health coverage was later added to massively increase the entitlements obligations of Social Security as pension fund (as originally crafted).

The Wall Street Journal Guide to Obamacare, October 14, 2009 --- Click Here
http://online.wsj.com/article/SB10001424052748704471504574441193211542788.html?mod=djemEditorialPage

Bumper Stickers --- http://www.upyoursobama.com/

The Promise and Peril of Big Data --- http://www.aspeninstitute.org/sites/default/files/content/docs/pubs/InfoTech09.pdf

Frightening Clauses in the Pending House Bill (H.R. 3962) in November 2009

Full Text of H.R. 3962 --- www.defendyourhealthcare.us .


"We Pay Them to Lie to Us," by my hero John Stossel, Townhall, November 25, 2009 ---
http://townhall.com/columnists/JohnStossel/2009/11/25/we_pay_them_to_lie_to_us 

When you knowingly pay someone to lie to you, we call the deceiver an illusionist or a magician. When you unwittingly pay someone to do the same thing, I call him a politician.

President Obama insists that health care "reform" not "add a dime" to the budget deficit, which daily grows to ever more frightening levels. So the House-passed bill and the one the Senate now deliberates both claim to cost less than $900 billion. Somehow "$900 billion over 10 years" has been decreed to be a magical figure that will not increase the deficit.

It's amazing how precise government gets when estimating the cost of 10 years of subsidized medical care. Senate Majority Leader Harry Reid's bill was scored not at $850 billion, but $849 billion. House Speaker Nancy Pelosi said her bill would cost $871 billion.

How do they do that?

The key to magic is misdirection, fooling the audience into looking in the wrong direction.

I happily suspend disbelief when a magician says he'll saw a woman in half. That's entertainment. But when Harry Reid says he'll give 30 million additional people health coverage while cutting the deficit, improving health care and reducing its cost, it's not entertaining. It's incredible.

The politicians have a hat full of tricks to make their schemes look cheaper than they are. The new revenues will pour in during Year One, but health care spending won't begin until Year Three or Four. To this the Cato Institute's Michael Tanner asks, "Wouldn't it be great if you could count a whole month's income, but only two weeks' expenditures in your household budget?"

To be deficit-reducers, the health care bills depend on a $200 billion cut in Medicare. Current law requires cuts in payments to doctors, but let's get real: Those cuts will never happen. The idea that Congress will "save $200 billion" by reducing payments for groups as influential as doctors and retirees is laughable. Since 2003, Congress has suspended those "required" cuts each year

Do you feel the leaked information from a global warming alarmist organization is meaningful? This was an illegal information leak that should be ignored It makes me question my belief in global warming activists It's an example of dangerous scientific politicization I haven't really heard about the controversy

This was an illegal information leak that should be ignored (1 %)

It makes me question my belief in global warming activists (8 %)

It's an example of dangerous scientific politicization (86 %)

I haven't really heard about the controversy (5 %)

Our pandering congressmen rarely cut. They just spend. Even as the deficit grows, they vomit up our money onto new pet "green" projects, bailouts for irresponsible industries, gifts for special interests and guarantees to everyone.

Originally, this year's suspension, "the doc fix," was included in the health care bills, but when it clearly pushed the cost of "reform" over Obama's limit and threatened to hike the deficit, the politicians moved the "doc fix" to a separate bill and pretended it was unrelated to their health care work.

Megan McArdle of The Atlantic reports that Rep. Paul Ryan of Wisconsin asked the Congressional Budget Office what the total price would be if the "doc fix" and House health care overhaul were passed together. "The answer, according to the CBO, is that together they'd increase the deficit by $89 billion over 10 years." McArdle explains why the "doc fix" should be included: "They're passing a bill that increases the deficit by $200 billion in order to pass another bill that hopefully reduces it, but by substantially less than $200 billion. That means that passage of this bill is going to increase the deficit."

From the start, Obama has promised to pay for half the "reform" cost by cutting Medicare by half a trillion over 10 years. But, Tanner asks, "how likely is it that those cuts will take place? After all, this is an administration that will pay seniors $250 to make up for the fact that they didn't get a Social Security cost-of-living increase this year (because the cost of living didn't increase). And Congress is in the process of repealing a scheduled increase in Medicare premiums."

Older people vote in great numbers. AARP is the most powerful lobby on Capitol Hill. Like the cut in doctor's pay, the other cuts will never happen.

I will chew on razor blades when Congress cuts Medicare to keep the deficit from growing.

Medicare is already $37 trillion in the hole. Yet the Democrats proudly cite Medicare when they demand support for the health care overhaul. If a business pulled the accounting tricks the politicians get away with, the owners would be in prison.

Something AARP Wants Kept Secret

"McCain Urges Seniors to Abandon AARP," Fox News, December 3, 2009  ---
http://www.foxnews.com/politics/2009/12/03/mccain-aarp-betrayed-senior-citizens/

"Medicare Part D 'Reforms' Will Harm Seniors An ObamaCare change will cost taxpayers a bundle and lead to poorer drug coverage," Tom Scully, The Wall Street Journal, December 7, 2009 ---
http://online.wsj.com/article/SB10001424052748704107104574569930258127214.html#mod=djemEditorialPage

There is a little-noticed provision buried deep in both the House and Senate health-care reform bills that is intended to save billions of dollars—but instead will hurt millions of seniors, impose new costs on taxpayers, and charge employers millions in new taxes.

As part of the Medicare Modernization Act in 2003, Congress created a new drug benefit—called Medicare Part D—for retirees at a cost of about $1,900 per recipient per year. Many private employers already provided drug coverage for their retirees, and the administration and Congress did not want to tempt employers into dropping their coverage. Actuaries calculated that if the government provided a subsidy of at least $800, employers would not stop covering retirees.

The legislation created a $600 tax-free benefit (the equivalent of $800 cash for employers), and it worked. Employers continued to cover about seven million retirees who might have otherwise been dumped into Medicare Part D.

It was a good arrangement for all involved. An $800 subsidy is cheaper than the $1,900 cost of providing drug coverage. And millions of seniors got to keep a drug benefit they were comfortable with and that in many cases was better than the benefit offered by the government.

But now that subsidy is coming in to be clipped. This fall congressional staff, looking for a new revenue source to pay for health reform, proposed eliminating the tax deductibility of the subsidy to employers. The supposed savings were estimated by congressional staff to be as much as $5 billion over the next decade.

It sounds smart—except that nobody asked how many employers will drop retiree drug coverage. Clearly, many will. The result is that, instead of saving money, the proposed revenue raiser will force Medicare Part D costs to skyrocket as employers drop retirees into the program.

The careful calculation that was made in 2003 to minimize federal spending and maximize private coverage will go out the window if this provision becomes law. Any short-term cost savings that Congress gets by changing the tax provision will be overwhelmed by higher costs in the long run.

Some members in the House want to mitigate the cost of this provision by mandating that employers maintain existing levels of retiree coverage despite the reduced subsidy. But it's not that simple. A mandate would increase costs on businesses, which in turn would make it harder for those businesses to hire new employees. The mandate would effectively be a tax on employers that provide retiree benefits; this in turn will simply induce some unknown number of employers to terminate their retiree drug programs before the mandate kicks in.

In short, if the changes that are proposed for employer subsidies in the current Medicare Part D program are enacted, everyone will lose. Unions will lose as employers seek ways to drop retiree drug coverage. Seniors will lose as employers drop them into Medicare Part D. Medicare and taxpayers will lose as they face higher costs. And employers will lose as they find it harder to provide benefits.

To make matters worse, accounting rules for post-retirement benefits will require companies that keep their retiree benefits to record the entire accrued present value of the new tax the day the provision is signed into law. This would cause many employers to immediately post billions in losses, which could significantly impact our financial markets.

There are many reasons to pass health-care reform. There is no reason to hurt seniors, employers and taxpayers in the process. Businesses are struggling, and the Medicare trust funds have plenty of problems as it is. It makes no sense to make these problems worse.

Mr. Scully was the administrator of the Centers for Medicare and Medicaid Services from 2001-04 and was one of the designers of the Medicare Part D benefit.


"What the Pelosi Health-Care Bill Really Says:  Here are some important passages in the 2,000 page legislation," by Betsy McCaughey, The Wall Street Journal, November 7, 2009 --- Click Here

The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

What the government will require you to do:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

Video Shocker
"Health Care Shocker: Special Democratic Voting Counties Would Get Protected Medicare Benefits," Brietbart ---
http://www.breitbart.tv/healthcare-shocker-special-democratic-voting-counties-would-get-protected-medicare-benefits/

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."

These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

For the text of the bill with page numbers, see www.defendyourhealthcare.us .

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York state.

 

Making Sense of Health Care Reform (from the AccountingWeb on September 1, 2009) ---
http://www.accountingweb.com/topic/tax/making-sense-health-care-reform

We're old enough to remember when advocates for the Affordable Care Act promised that it would "bend the cost curve" and reduce expensive hospital visits, particularly at emergency rooms. So far, the opposite is occurring.
James Freeman, "There Goes Another ObamaCare Argument," WSJ, August 6, 2014 ---
http://online.wsj.com/articles/there-goes-another-obamacare-argument-1407242712?tesla=y&mod=djemMER_h&mg=reno64-wsj


'The Unaffordable Care Act:  Premiums are spiking around the country. Obama is in denial," The Wall Street Journal, July 10, 2015 ---
http://www.wsj.com/articles/the-unaffordable-care-act-1436569086?tesla=y

The Affordable Care Act was supposed to make insurance, well, more affordable. But now hard results are starting to emerge: premium surges that often average 10% to 20% and spikes that sometimes run as high as 50% or 60% or more from coast to coast. Welcome to the new abnormal of ObamaCare.

This summer insurers must submit rates to state regulators for approval on the ObamaCare exchanges in 2016—and even liberals are shocked at the double-digit requests, or at least the honest liberals are. Under ObamaCare, year-over-year premium increases above 10% must also be justified to the Health and Human Services Department, and its data base lists about 650 such cases so far.

In a study across 45 states, the research outfit Health Pocket reports that mid-level Exclusive Provider Organization plans are 20% more expensive in 2016 on average. HMOs are 19% more expensive, and for all plan types the average is 14%.

President Obama dropped by Nashville last week to claim Tennessee as a state where “the law has worked better than we expected” and “actually ended up costing less than people expected,” so let’s test the reality of those claims. As a baseline, in 2015 premium increases for Tennessee plans ranged from 7.5% to 19.1%.

For 2016 BlueCross BlueShield of Tennessee—one of the state’s two major insurers—is requesting a 36.3% increase. One product line from Community Health Alliance Mutual is rising 32.8%, while another from Time Insurance Co. hits 46.9%. Offerings from Cigna, Humana and UnitedHealthcare range from 11% to 18%. If this means ObamaCare is working better than the President expected, then what, exactly, was he expecting?

Continued in article

Obama's Whoppers on the ACA --- Click Here
http://townhall.com/columnists/donaldlambro/2015/07/08/obamas-whoppers-will-bite-him-in-the-end-and-the-democrats-too-in-2016-n2022375?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=


"Hospitals Expected More of a Boost From Health Law Expansion of Medicaid hasn’t had the financial impact that was anticipated," by Christian Weaver, The Wall Street Journal, June 3, 2015 ---
http://www.wsj.com/articles/hospitals-expected-more-of-a-boost-from-health-law-1433304242?KEYWORDS=Hospitals

The health law’s expansion of Medicaid in many states hasn’t benefited nonprofit hospitals in those states as expected, according to a new report by Moody’s Investors Service.

Hospitals in the mostly blue states that expanded Medicaid were largely expected to benefit from fewer unpaid bills and more paying customers, but that hasn’t generally translated into better operating margins or cash flow, Moody’s found.

Performance improved across the board—including in the mostly Republican-led states that opted out of the law’s Medicaid expansion—as the economy gained steam last year and unemployment declined.

In expansion states, hospitals’ unpaid bills fell 13% on average last year compared with 2013, the report found. But, their 2014 operating margins didn’t increase any more than hospitals in the 22 states that have sat out the expansion, the report shows.

“Clearly, reducing bad debt is positive, but it is not this silver bullet,” said Daniel Steingart, a Moody’s analyst and author of the report. He said the findings call into question “a narrative out there that Medicaid expansion has lowered bad debt and that is driving [financial] improvements at hospitals.”

Continued in article

Jensen Comment
When I lived in San Antonio, over $1,000 of my property tax billing went to the Bexar County Hospital to cover charity medicine and bad debts of people who were treated but did not pay for the treatments. As a rule there's at least one hospital in larger cities, usually the largest non-profit hospital, that receives local tax dollars to contribute toward the hospital's bad debts.

Obamacare's promise of relieving the burden of local taxpayers for charity medicine turned into another one of the lies. Indeed there are fewer bad debts due to expanded Medicaid coverage such that more Federal dollars are pouring into hospitals who accept Medicaid patients. However, the bad news is that Medicaid only covers (according to the article) about half the cost of treating Medicaid patients in hospitals. This leaves hospitals with tow choices. Provide lower-cost care or ask for more dollars from local taxpayers to cover the added losses of the expanded Medicaid coverage.

It turns out that states who refused to expand Medicaid coverage are better off for having refused.


MediCal is California's Version of Medicaid free medical services for poor people. MedicCal also has a price-fixing program that is preventing many doctors and hospitals from providing services to patients insured by MediCal. This is an example of where price fixing either results in either having no goods and services or inferiors goods and service.

"Medi-Cal a waiting game for many low-income Californians," by Tracy Seipel, San Jose Mercury News, February 7, 2015 ---
http://www.mercurynews.com/health/ci_27481258/obamacare-medi-cal-waiting-game-many-low-income 

Julie Moreno felt lucky to be among more than 2.7 million previously uninsured Californians to be added to Medi-Cal, the state's health care program for the poor.

Until she needed cataract surgery.

For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend's mother to have the procedure done elsewhere last February.

One year into the explosive, health law-induced growth of Medi-Cal, it appears one of the most alarming predictions of critics is coming true: The supply of doctors hasn't kept up with demand. One recent study suggests the number of primary care doctors in California per Medi-Cal patient is woefully below federal guidelines.

"If you're pregnant, you get help," Moreno said. "But if you're 49 and not pregnant, you have to wait for everything."

In fact, seven months after Moreno's surgery, her original surgeon's office called just to say they still couldn't fit her in.

At least 1.2 million Californians have signed up for a private insurance plan since enrollment began in October 2013 under the Affordable Care Act, better known as Obamacare. But it's Medi-Cal that has witnessed the largest growth -- 2.7 million since the controversial law opened the program up to many more recipients in January 2014.

By mid-2016, more than 12.2 million people -- nearly a third of all Californians -- will be on Medi-Cal, state health officials say.

Those officials continue to insist that the current delays to see a doctor and crowded emergency rooms are all part of to-be-expected growing pains. But many experts say the problems are so widespread they shouldn't be ignored.

"California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients," said Dr. Del Morris, president of the California Academy of Family Physicians, which represents many of the first-line doctors who treat Medi-Cal patients. "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"

Morris and other experts say the situation is about to get worse, in part because of Medi-Cal's health care reimbursement rates.

For years, the rates paid by Medi-Cal -- called Medicaid in the rest of the country -- have been among the nation's lowest. A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31. A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.

Even before the latest cuts, Medi-Cal doctors -- particularly specialists -- in California's rural areas often seemed nearly impossible to find. And the shortage of Medi-Cal physicians appears to be causing spikes in the number of Medi-Cal patients being treated in hospital emergency rooms around the state. Data from the Office of Statewide Health Planning and Development show that in the first three quarters of 2014, "treat and release" visits to emergency rooms by Medi-Cal patients jumped 30 percent from the same period the year before.

At least once a week at the MayView Community Health Center in Mountain View, the clinic is so swamped that it is forced to send Medi-Cal patients to hospital emergency rooms "because they cannot go anywhere else," clinic operations director Harsha Mehta said.

Since January 2014, Axis Community Health in Pleasanton has added about 1,700 new Medi-Cal patients to its five facilities that serve the Tri-Valley area, bringing the total to about 14,000. While 700 of those patients were already being treated at Axis before they enrolled in Medi-Cal, the overall jump in new patients is forcing Dr. Divya Raj, Axis' medical director, to hire more hard-to-find doctors.

A recent report by the California HealthCare Foundation that tried to determine if the state has enough doctors to handle the influx of Medi-Cal patients reinforces Raj's trepidation.

The report found the ratio of patients to full-time primary care doctors participating in Medi-Cal -- including family medicine physicians, general internists, pediatricians and ob/gyns -- was 35 to 49 physicians per 100,000 enrollees, well below the federal guidelines of 60 to 80.

"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."

Bait and Switch for Primary Care "Doctors"
Nationwide there was an enormous shortage of primary care doctors before Obamacare. Obamacare greatly increased the demand for such doctors, thereby, making the shortage much worse. This has led to nationwide bait and switch primary care that is similar to three of the medical clinics in Littleton, New Hampshire. Each clinic has one MD and one or more added "physicians assistants" who are not medical doctors but can examine patients and prescribe common medications.

The bait and switch part is that patients in each clinic are not allowed to see the MD at all or must wait much longer for an appointment to see the the MD. In the meantime they are encouraged to be examined by only the physicians assistant or to go to emergency rooms.

Another sad part of the bait and switch tactic is that many specialists such as those at the Dartmouth medical center will only see patients referred by an MD or osteopath. Without such referrals patients are not allowed to make appointments with such specialists such as dermatologists, psychiatrists, and surgeons.

One other clinic up here has a really lousy and uncaring foreign-trained MD and an osteopath. My primary care doctor is the osteopath. He seems pretty good to me, but then my medical needs are fairly simple and routine. Our Littleton Regional Hospital does have an outstanding emergency room, although it's not a trauma center and has to send a relatively large number of patients by helicopter to the Dartmouth medical center about 50 miles away.

Of course patients with serious problems have discovered how to get referrals. The go directly to emergency rooms and maybe wait the better part of a day to be examined. But they eventually leave with a referral to see a specialist provided that specialist will accept their insurance.

The huge problem in New Hampshire is that nearly half (slightly less this year) of the hospitals and specialists will not accept ACA insurance.


"How Obamacare Is Ruining Health Insurance," by John C. Goodman, Forbes, February 11, 2015 ---
http://www.forbes.com/sites/johngoodman/2015/02/11/how-obamacare-is-ruining-health-insurance/

The health insurance market is changing. And the changes are not good. Even before there was Obamacare, most insurers most of the time had perverse incentives to attract the healthy and avoid the sick. But now that the Affordable Care Act has completely changed the nature of the market, the perverse incentives are worse than ever.

Writing in Sunday’s New York Times Elizabeth Rosenthal gives these examples:

But aren’t these insurers worried that if they mistreat their customers, their enrollees will move to some other plan? Here’s the rarely told secret about health insurance in the Obamacare exchanges: insurers don’t care if heavy users of medical care go to some other plan. Getting rid of high-cost enrollees is actually good for the bottom line.

To appreciate how different health insurance has become, let’s compare it to the kind of casualty insurance people buy for their home or their cars.

Dennis Haysbert is the actor I remember best for playing the president of the United States in the Jack Bauer series, 24.  You probably know him better as the spokesman for Allstate. In one commercial he is standing in front of a town that looks like it has been demolished by a tornado. “It took only two minutes for this town to be destroyed,” he says. And he ends by asking “Are you in good hands?”

The point of the commercial is self-evident. Casualty insurers know you don’t care about insurance until something bad happens. And the way they are pitching their products is: Once the bad thing happens, we are going to take care of you.

Virtually all casualty insurance advertisements carry this message, explicitly or implicitly. Nationwide used to run a commercial in which all kinds of catastrophes were caused by a Dennis-the-Menace type kid. In a State Farm ad, a baseball comes crashing through a living room window. Nationwide’s “Life comes at you fast” series features all kinds of misadventures. And of course, the Aflac commercials are all about unexpected mishaps.

The Case Against Obamacare: An eBook From Forbes
Don’t be fooled. The new health law has disrupted coverage for millions, and driven up costs for millions more.

My favorite casualty insurer print ad is sponsored by Chubb. It features a man fishing in a small boat with his back turned to a catastrophe. He is about to go over what looks like Niagara Falls. Here’s the cutline: “Who insures you doesn’t matter. Until it does.”

Now let’s compare those messages to what we see in the health insurance exchange. Federal employees have been obtaining insurance in an exchange, similar to the Obamacare exchanges, for several decades. Every fall, during “open enrollment,” they select from among a dozen or so competing heath plans. In Washington, DC where the market is huge, insurers try to attract customers by running commercials on TV, in print and in other venues.

Continued in article


From the CFO Journal's Morning Ledger on December 9, 2014

Workers to bear burden of ACA cost increases ---
http://blogs.wsj.com/cfo/2014/12/08/workers-to-bear-burden-of-aca-cost-increases/?mod=djemCFO_h

Workers in the U.S. should expect health care to take a bigger bite out of their paychecks next year, CFO Journal’s Vipal Monga reports. According to Bank of America Merrill Lynch, finance chiefs at U.S. companies expect the Affordable Care Act to increase healthcare costs next year, and the majority expect to pass that along to their employees.

Jensen Comment
There were only supposed to be savings for workers under the ACA. What went wrong?

"ObamaCare by the Numbers: Part 2," by John Cassidy, The New Yorker, March 2010 ---
http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html

. . .

Does Santa Claus live after all? According to the C.B.O., between now and 2019 the net cost of insuring new enrollees in Medicaid and private insurance plans will be $788 billion, but other provisions in the legislation will generate revenues and cost savings of $933 billion. Subtract the first figure from the second and—voila!—you get $143 billion in deficit reduction.

The first objection to these figures is that the great bulk of the cost savings—more than $450 billion—comes from cuts in Medicare payments to doctors and other health-care providers. If you are vaguely familiar with Washington politics and the letters A.A.R.P. you might suspect that at least some of these cuts will fail to materialize. Unlike some hardened skeptics, I don’t think none of them will happen. One part of the reform involves reducing excessive payments that the Bush Administration agreed to when it set up the Medicare Advantage program in 2003. If Congress remains under Democratic control—a big if, admittedly—it will probably enact these changes. But that still leaves another $300 billion of Medicare savings to be found.

The second problem is accounting gimmickry. Acting in accordance with standard Washington practices, the C.B.O. counts as revenues more than $50 million in Social Security taxes and $70 billion in payments towards a new home-care program, which will eventually prove very costly, and it doesn’t count some $50 billion in discretionary spending. After excluding these pieces of trickery and the questionable Medicare cuts, Douglas Holtz-Eakin, a former head of the C.B.O., has calculated that the reform will actually raise the deficit by $562 billion in the first ten years. “The budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed,” he wrote in the Times. “So fantasy in, fantasy out.”

Holtz-Eakin advised John McCain in 2008, and he has a reputation as a straight shooter. I think the problems with the C.B.O.’s projections go even further than he suggests. If Holtz-Eakin’s figures turned out to be spot on, and over the next ten years health-care reform reduced the number of uninsured by thirty million at an annual cost of $56 billion, I would still regard it as a great success. In a $15 trillion economy—and, barring another recession, the U.S. economy should be that large in 2014—fifty or sixty billion dollars is a relatively small sum—about four tenths of one per cent of G.D.P., or about eight per cent of the 2011 Pentagon budget.

My two big worries about the reform are that it won’t capture nearly as many uninsured people as the official projections suggest, and that many businesses, once they realize the size of the handouts being offered for individual coverage, will wind down their group plans, shifting workers (and costs) onto the new government-subsidized plans. The legislation includes features designed to prevent both these things from happening, but I don’t think they will be effective.

Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.

Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)

If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”

So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.

The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.

Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)

In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead.

Even if the government tried to impose additional sanctions on such firms, I doubt it would work. The dollar sums involved are so large that firms would try to game the system, by, for example, shutting down, reincorporating under a different name, and hiring back their employees without coverage. They might not even need to go to such lengths. Firms that pay modest wages have high rates of turnover. By simply refusing to offer coverage to new employees, they could pretty quickly convert most of their employees into non-covered workers.

The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it. According to the C.B.O., somewhere between eight and nine million workers will lose their group coverage as a result of their employers refusing to offer it. That isn’t a trifling number. But the C.B.O. says it will be largely offset by an opposite effect in which employers that don’t currently provide health insurance begin to offer it in response to higher demand from their workers as a result of the individual mandate. In this way, some six to seven million people will obtain new group coverage, the C.B.O. says, so the overall impact of the changes will be minor.

Continued in article

"Senate Bill Sets a Plan to Regulate Premiums," by Robert Pear, The New York Times, April 20, 2010 --- http://www.nytimes.com/2010/04/21/health/policy/21healt

. . .

Grace-Marie Turner, president of the Galen Institute, a research center that advocates free-market health policies, said the Democrats’ proposal was unlikely to succeed in lowering insurance costs.

“Capping premiums without recognizing the forces that are driving up costs would be like tightening the lid on a pressure cooker while the heat is being turned up,” Mrs. Turner said.

Mrs. Feinstein said her bill would close what she described as “an enormous loophole” in the new law. And she said health insurance should be regulated like a public utility.

“Water and power are essential for life,” Mrs. Feinstein said. “So they are heavily regulated, and rate increases must be approved. Health insurance is also vital for life. It too should be strictly regulated so that people can afford this basic need.”

The 6 Biggest Whoppers In Gruber's ObamaCare Comic Book ---
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm

. . .

What the reviewers failed to mention is that the book is also chock-a-block with misinformation and outright falsehoods about the law Gruber helped construct — many of which Gruber himself exposed later on. Among the most glaring:

• Gruber claims that for individuals and small firms qualifying for a tax credit, "this bill will lower your health care costs." But Gruber would later go on to tell several states the opposite. One of them was Wisconsin, where he said fewer than 6% would see lower premiums, and 41% would get hit with hikes of 50% or more. Meanwhile, millions learned that Gruber's claim was a fantasy last year, when they confronted ObamaCare's sky-high premiums after seeing their existing plans canceled.

• Gruber declares that the law doesn't raise taxes on anyone "with incomes below $200,000 per year." Yet several of the dozens of tax hikes stuffed into the bill hit the middle class, or soon will. Americans for Tax Reform counted seven big ones.

• In the section on the Cadillac tax, which depicts Gruber tooling around in a Caddy, he claims this tax would apply "only to the top few percent of health insurance plans" and would hit more only if premiums climb faster than inflation.

But in videotaped comments, Gruber explains that the tax was purposely designed to start small and then eventually hit all employer plans, "essentially getting rid of the exclusion for employer-sponsored plans."

• Gruber emphatically declares that ObamaCare will cut the federal deficit by $1 trillion over its second decade because "the deficit-reducing effects of this legislation grow over time."

But all the Congressional Budget Office said was that a "rough outlook" for ObamaCare's second decade resulted in deficit cuts "in a broad range of around one-half percent of GDP." And that assumed the law was enacted exactly as written, and worked exactly as predicted, both of which have already failed to come true.

When the Government Accountability Office ran the numbers using more realistic scenarios, it found ObamaCare adding significantly to the long-term deficit. The CBO, meanwhile, has given up making even short-term forecasts of ObamaCare's impact on the deficit.

• Throughout the book, Gruber cites CBO projections of ObamaCare's effects on premiums and coverage, calling it "the best independent source for evaluating bills like the ACA." What he doesn't mention is that when the CBO developed its health care forecasting model in 2007, Gruber had a role in creating it. It even credits Gruber for his "helpful comments and feedback ... throughout the model's development."

And in a 2011 paper, Gruber himself said that his own health care model "mirrors the CBO approach to modeling health reform."

• Gruber says that if the law's many cost-control measures work as expected, "the ACA will end up solving our cost problem in the U.S." But earlier this year Gruber told the Washington Post that it was "misleading" to say ObamaCare will save money. "The law isn't designed to save money," he said. "It's designed to improve health, and that's going to cost money."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


"Supreme Court Battle Brewing Over Medicaid Fees," by Phil Galewitz, WebMD, January 12, 2015 ---
http://www.webmd.com/health-insurance/20150112/supreme-court-battle-brewing-over-medicaid-fees

Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection.

But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, she was finally able to get Nathaniel an appointment nearly a week later near their South Florida home. That was in 2005.

Last month, ruling in a lawsuit brought by the state’s pediatricians and patient advocacy groups, a federal district judge in Miami determined Nathaniel’s wait was “unreasonable” and that Florida’s Medicaid program was failing him and nearly 2 million other children by not paying enough money to doctors and dentists to ensure the kids have adequate access to care.

The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. In the past two decades, similar cases have been filed in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia– with many resulting in higher pay.

But while providers and patient advocates nationwide hailed the Florida decision, they are deeply worried about a U.S. Supreme Court case that they say could restrict their ability across the country to seek judicial relief from low Medicaid reimbursement rates.

The high court on Jan. 20 will hear a case from Idaho seeking to overturn a 2011 lower court order to increase payments to providers serving Medicaid enrollees with development disabilities. In the original case, five centers serving developmentally disabled adults and children argued that Idaho was unfairly keeping Medicaid reimbursement rates at 2006 levels despite studies showing that the cost of providing care had risen.

Idaho officials argue only the state and federal government should be able to set provider fees in Medicaid and all other “private parties,” including patients and providers, should not be able to use the court system to gain higher rates. Twenty-seven states and the Obama administration are supporting Idaho’s appeal, along with the National Governors Association

 


November 2014

The 6 Biggest Whoppers In Gruber's ObamaCare Comic Book ---
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm

. . .

What the reviewers failed to mention is that the book is also chock-a-block with misinformation and outright falsehoods about the law Gruber helped construct — many of which Gruber himself exposed later on. Among the most glaring:

• Gruber claims that for individuals and small firms qualifying for a tax credit, "this bill will lower your health care costs." But Gruber would later go on to tell several states the opposite. One of them was Wisconsin, where he said fewer than 6% would see lower premiums, and 41% would get hit with hikes of 50% or more. Meanwhile, millions learned that Gruber's claim was a fantasy last year, when they confronted ObamaCare's sky-high premiums after seeing their existing plans canceled.

• Gruber declares that the law doesn't raise taxes on anyone "with incomes below $200,000 per year." Yet several of the dozens of tax hikes stuffed into the bill hit the middle class, or soon will. Americans for Tax Reform counted seven big ones.

• In the section on the Cadillac tax, which depicts Gruber tooling around in a Caddy, he claims this tax would apply "only to the top few percent of health insurance plans" and would hit more only if premiums climb faster than inflation.

But in videotaped comments, Gruber explains that the tax was purposely designed to start small and then eventually hit all employer plans, "essentially getting rid of the exclusion for employer-sponsored plans."

• Gruber emphatically declares that ObamaCare will cut the federal deficit by $1 trillion over its second decade because "the deficit-reducing effects of this legislation grow over time."

But all the Congressional Budget Office said was that a "rough outlook" for ObamaCare's second decade resulted in deficit cuts "in a broad range of around one-half percent of GDP." And that assumed the law was enacted exactly as written, and worked exactly as predicted, both of which have already failed to come true.

When the Government Accountability Office ran the numbers using more realistic scenarios, it found ObamaCare adding significantly to the long-term deficit. The CBO, meanwhile, has given up making even short-term forecasts of ObamaCare's impact on the deficit.

• Throughout the book, Gruber cites CBO projections of ObamaCare's effects on premiums and coverage, calling it "the best independent source for evaluating bills like the ACA." What he doesn't mention is that when the CBO developed its health care forecasting model in 2007, Gruber had a role in creating it. It even credits Gruber for his "helpful comments and feedback ... throughout the model's development."

And in a 2011 paper, Gruber himself said that his own health care model "mirrors the CBO approach to modeling health reform."

• Gruber says that if the law's many cost-control measures work as expected, "the ACA will end up solving our cost problem in the U.S." But earlier this year Gruber told the Washington Post that it was "misleading" to say ObamaCare will save money. "The law isn't designed to save money," he said. "It's designed to improve health, and that's going to cost money."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 


November 13, 2014
Here are three crucial facts about the ACA that both the White House and the media didn’t want you to know about ---
http://www.foxnews.com/opinion/2014/11/13/3-things-white-house-doesnt-want-to-know-about-obamacare-plus-3-things-coming/?cmpid=NL_opinion


1. HUGE DEFICITS AND NEW TAXES.
According to the Congressional Budget Office, the latest projections for the net cost of ObamaCare over the next ten years are just over $1.4 trillion. Whereas President Obama promised in 2009 that it would cost less than $1 trillion over ten years. In order to partially pay for this, ObamaCare has added more than 20 new taxes totaling over $500 billion.

2. BUREAUCRACY. Speaking of Orwellian politics, ObamaCare includes 159 new boards and agencies to restrict and govern your health care choices.

3. STILL MORE BUREAUCRACY.
Dysfunctional state exchanges with high deductible policies, narrow doctor networks,
including federally-run exchanges in 36 states which may not be allowable under the law (SCOTUS currently considering this case). 

Here are three new things coming up in 2015 that are highely controversial:

1. PENALTIES WILL RISE – INDIVIDUAL MANDATE.
In 2014, people are facing a penalty of $95 per person or 1% of income. 

In 2015, the penalty will more than triple to $325 per person or 2% of income, whichever is higher. 

If an American failed to get coverage this year, the penalty will be taken out of their tax refund in early 2015. 

2. SERIOUS RATE HIKES FOR CHEAPER OBAMACARE PLANS.
According to Investor’s Business Daily, the lowest cost bronze plan will increase an average of 7 % in many cases, the lowest cost silver plan by 9%, and the lowest priced catastrophic policy will climb 18 percent on average. Double digit rate hikes are anticipated in several southern and Midwestern states including Kansas, Iowa, Louisiana, North and South Carolina, Tennessee, Iowa, and Virginia.  

Subsidies will continue to be a huge part of the program. In 2014, subsidies provided ¾ of the premiums for the federally-run exchanges.  

3. EMPLOYER MANDATE WILL TAKE EFFECT.
After being delayed for a year, large businesses (100 or more employees in 2015, 50 or more in 2016) will be required to offer affordable (and subsidized) health plans to at least 70 percent of their full time employees or face a $2,000-$3,000 penalty per employee. 

This mandate will lead to fewer full time employees being hired.

Continued in article


"Audit found ineligible people on Minnesota's public-health rolls," Brian Lambert, Minneapolis Post, November 12, 2014 ---
http://www.minnpost.com/glean/2014/11/audit-found-ineligible-people-states-public-health-rolls

The AP story says, “Minnesota's legislative auditor says the state Department of Human Services has failed to adequately verify the eligibility of people who enroll in public health care programs through the state's health insurance exchange MNsure. In a report released Wednesday, the Office of the Legislative Auditor says it found many instances where department paid for Medical Assistance and MinnesotaCare benefits for people who weren't eligible because their incomes were too high or didn't qualify for other reasons. It says the department also charged incorrect MinnesotaCare premium rates.”

"Audit reveals half of people enrolled in Illinois Medicaid program not eligible," by Craig Cheatham, KMOV Television, November 4, 2013 ---
http://www.kmov.com/news/just-posted/Audit-reveals-half-of-people-enrolled-in-IL-Medicaid-program-not-eligible-230586321.html?utm_content=buffer824ba&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer

"Medicaid Spending Has Exploded, And It Will Keep Rising Faster Than Expected

"Medicaid Spending Has Exploded, And It Will Keep Rising Faster Than Expected," by John R. Graham, Daily Caller, November 12. 2014 ---
http://dailycaller.com/2014/11/12/medicaid-spending-has-exploded-and-it-will-keep-rising-faster-than-expected/

According to the Centers for Medicare & Medicaid Services (CMS), spending on Medicaid, the jointly funded state-federal welfare program that provides health benefits to low-income people, increased 6.7 percent in 2013 to $449.5 billion. And it will keep growing at a fast rate.

In 2014, total Medicaid spending is projected to grow 12.8 percent because Obamacare has added about 8 million dependents. A large minority of states have chosen to increase residents’ eligibility for Medicaid by expanding coverage to adults making up to 138 percent of the federal poverty level.

Unfortunately, more states are likely to expand this welfare program. This is expected to result in a massive increase in the number of Medicaid dependents: From 73 million in 2013 to 93 million in 2024. Medicaid spending is expected to grow by 6.7 percent in 2015, and 8.6 percent in 2016. For 2016 to 2023, spending growth is projected to be 6.8 percent per year on average.

This comprises a massive increase in welfare dependency and burden on taxpayers. Further, official estimates often low-ball actual experience. This is because it is hard to grapple with how clever states are at leveraging federal dollars.

The Office of the Inspector General of the U.S. Department of Health & Human Services has just released a report that summarizes a decade of research on how states game the system to increase spending beyond that which the federal government anticipated.

The incentive lies in Medicaid’s perverse financing merry-go-round. In a rich state like California, for example, the federal government (pre-Obamacare) spent 50 cents on the dollar for adult dependents. So, if California spent 50 cents, it automatically drew 50 cents from the U.S. Treasury. And most states had a bigger multiplier. Which state politician can resist a deal like that?

Continued in article


Jonathan Gruber --- http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29#Controversies

. . .

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.[17][18][19] While he did disclose his HHS connections in an article for the New England Journal of Medicine, his oversight in doing this earlier was defended by Paul Krugman in The New York Times.[20]

One heavily-scrutinized part of the ACA reads that subsidies should be given to healthcare recipients who are enrolled "through an Exchange established by the State". Some have read this to mean that subsidies can be given only in states that have chosen to create their own healthcare exchanges, and do not use the federal exchange, while the Obama administration says that the wording applies to all states. This dispute is currently part of an ongoing series of lawsuits referred to collectively as King v. Burwell. In July 2014, two separate recordings of Gruber, both from January 2012, surfaced in which he seemed to contradict the administration's position.[5] In one, Gruber states, in response to an audience question, that "if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits",[21] while in the other he says, "if your governor doesn't set up an exchange, you're losing hundreds of millions of dollars of tax credits to be delivered to your citizens."[22] When these recordings emerged, Gruber called these statements mistaken, describing them as "just a speak-o — you know, like a typo".[21]

In November 2014, a series of four videos emerged of Gruber speaking at different events, from 2010 to 2013, about ways he felt the ACA was misleadingly crafted and marketed to get the bill passed; in several of these videos he specifically refers to American voters as ill-informed and "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage. Gruber said the bill's inherent "lack of transparency is a huge political advantage" in selling it.[23] The comments caused significant controversy.[24][25][26][27][28] In two subsequent videos, Gruber was shown talking about the decision (which he attributed to John Kerry) to have the bill tax insurance companies instead of patients, which he called fundamentally the same thing economically but more palatable politically. In one video, he stated that "the American people are too stupid to understand the difference" between the two approaches, while in the other he said that the switch worked due to "the lack of economic understanding of the American voter."[29] In another video, taken in 2010, Gruber expressed doubts that the ACA would significantly reduce health care costs, though he noted that lowering costs played a major part in the way the bill was promoted.[30]


"Yes, Jonathan Gruber Is An Obamacare “Architect” The health law’s allies are trying to distance themselves from the economist’s remarks about the deception involved in passing the law. But they’re only proving him right," by Peter Suderman, Reason Magazine, November 18, 2014 ---
http://reason.com/archives/2014/11/18/yes-jonathan-gruber-is-an-obamacare-arch

Jonathan Gruber --- http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29#Controversies

Obamacaregate Question
Who disclosed the embarrassing Johathan Gruber videos?

Vox is a liberal/progressive Website, and this is a pretty good explanation of the Gruber embarrassment to date.
"The Jon Gruber controversy and what it means for Obamacare, explained," by Sarah Kliff, Vox, November 16, 2014 ---
http://www.vox.com/2014/11/13/7211279/obamacare-jon-gruber-controversy

. . .

4) Who keeps finding all these clips?

 

Rich Weinstein, a forty-something investment advisor whose insurance policy was canceled under Obamacare, has surfaced the last three videos. Dave Weigel has written a great profile of him, including this part where Weinstein describes how he got started:

"When Obama said 'If you like your plan, you can keep your plan, period'-frankly, I believed him," says Weinstein. "He very often speaks with qualifiers. When he said 'period,' there were no qualifiers. You can understand that when I lost my own plan, and the replacement cost twice as much, I wasn't happy."

So Weinstein, new plan in hand, started watching the news. "These people were showing up on the shows, calling themselves architects of the law," he recalls. "I saw David Cutler, Zeke Emanuel, Jonathan Gruber, people like that. I wondered if these guys had some type of paper trail. So I looked into what Dr. Cutler had said and written, and it was generally all about cost control. After I finished with Cutler, I went to Dr. Gruber. I assume I went through every video, every radio interview, every podcast. Every everything."

Continued in article

Jensen Comment
What are the biggest mistakes when the ACA was enacted?

Answer
In my opinion, apart from the technical things that need to be corrected such as foisting patient bad debts (due to premium payment lapses) on doctors and hospitals, the biggest mistake was the CBO's estimates of ACA costs, cost estimates that are largely traceable to Johathan Gruber.

"Pelosi Claims Health Care Reform to Save $1.3 Trillion," by Matt Cover, CNS News, March 26, 2010 ---
http://www.cnsnews.com/news/article/63373

According to the Congressional Budget Office, (in 2014) the latest projections for the net cost of ObamaCare over the next ten years are just over $1.4 trillion.
http://www.foxnews.com/opinion/2014/11/13/3-things-white-house-doesnt-want-to-know-about-obamacare-plus-3-things-coming/?cmpid=NL_opinion

Jensen Comment
Doesn't that add up to a $2.7 trillion change in estimated costs in four years?

Another embarrassment is how RomneyCare in Massachussets that preceded the ACA for the USA foisted RomneyCare costs on to Federal taxpayers. Governor Romney (and Ted Kennedy's legacy) should be embarrassed along with President Obama about Professor Gruber's revelations. ---
http://hotair.com/archives/2014/11/17/gruber-romneycare-just-a-way-to-rip-off-the-feds-for-400-million-a-year/


Obama personally asked me to help disguise unhelpful Obamacare facts.
Jonathan Gruber --- http://hotair.com/archives/2014/11/17/gruber-obama-personally-asked-me-to-help-disguise-unhelpful-obamacare-facts/


"Jonathan Gruber’s ‘Stupid’ Budget Tricks:  His ObamaCare candor shows how Congress routinely cons taxpayers," The Wall Street Journal, November 14, 2014 ---
http://online.wsj.com/articles/jonathan-grubers-stupid-budget-tricks-1416009107?tesla=y&mod=djemMER_h&mg=reno64-wsj

As a rule, Americans don’t like to be called “stupid,” as Jonathan Gruber is discovering. Whatever his academic contempt for voters, the ObamaCare architect and Massachusetts Institute of Technology economist deserves the Presidential Medal of Freedom for his candor about the corruption of the federal budget process.

In his now-infamous talk at the University of Pennsylvania last year, Professor Gruber argued that the Affordable Care Act “would not have passed” had Democrats been honest about the income-redistribution policies embedded in its insurance regulations. But the more instructive moment is his admission that “this bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies.”

Mr. Gruber means the Congressional Budget Office, the institution responsible for putting “scores” or official price tags on legislation. He’s right that to pass ObamaCare Democrats perpetrated the rawest, most cynical abuse of the CBO since its creation in 1974.

In another clip from Mr. Gruber’s seemingly infinite video library, he discusses how he and Democrats wrote the law to game the CBO’s fiscal conventions and achieve goals that would otherwise be “politically impossible.” In still another, he explains that these ruses are “a sad statement about budget politics in the U.S., but there you have it.”

Yes you do. Such admissions aren’t revelations, since the truth has long been obvious to anyone curious enough to look. We and other critics wrote about ObamaCare’s budget gimmicks during the debate, and Rep. Paul Ryan exposed them at the 2010 “health summit.” President Obama changed the subject.

But rarely are liberal intellectuals as full frontal as Mr. Gruber about the accounting fraud ingrained in ObamaCare. Also notable are his do-what-you-gotta-do apologetics: “I’d rather have this law than not,” he says.

Recall five years ago. The White House wanted to pretend that the open-ended new entitlement would spend less than $1 trillion over 10 years and reduce the deficit too. Congress requires the budget gnomes to score bills as written, no matter how unrealistic the assumption or fake the promise. Democrats with the help of Mr. Gruber carefully designed the bill to exploit this built-in gullibility.

So they used a decade of taxes to fund merely six years of insurance subsidies. They made-believe that Medicare payments to hospitals will some day fall below Medicaid rates. A since-repealed program for long-term care front-loaded taxes but back-loaded spending, meant to gradually go broke by design. Remember the spectacle of Democrats waiting for the white smoke to come up from CBO and deliver the holy scripture verdict?

On the tape, Mr. Gruber also identifies a special liberal manipulation: CBO’s policy reversal to not count the individual mandate to buy insurance as an explicit component of the federal budget. In 1994, then CBO chief Robert Reischauer reasonably determined that if the government forces people to buy a product by law, then those transactions no longer belong to the private economy but to the U.S. balance sheet. The CBO’s face-melting cost estimate helped to kill HillaryCare.

The CBO director responsible for this switcheroo that moved much of ObamaCare’s real spending off the books was Peter Orszag, who went on to become Mr. Obama’s budget director. Mr. Orszag nonetheless assailed CBO during the debate for not giving him enough credit for the law’s phantom “savings.”

Then again, Mr. Gruber told a Holy Cross audience in 2010 that although ObamaCare “is 90% health insurance coverage and 10% about cost control, all you ever hear people talk about is cost control. How it’s going to lower the cost of health care, that’s all they talk about. Why? Because that’s what people want to hear about because a majority of Americans care about health-care costs.”

*** Both political parties for some reason treat the CBO with the same reverence the ancient Greeks reserved for the Delphic oracle, but Mr. Gruber’s honesty is another warning that the budget rules are rigged to expand government and hide the true cost of entitlements. CBO scores aren’t unambiguous facts but are guesses about the future, biased by the Keynesian assumptions and models its political masters in Congress instruct it to use.

Republicans who now run Congress can help taxpayers by appointing a new CBO director, as is their right as the majority. Current head Doug Elmendorf is a respected economist, and he often has a dry wit as he reminds Congressfolk that if they feed him garbage, he must give them garbage back. But if the GOP won’t abolish the institution, then they can find a replacement who is as candid as Mr. Gruber about the flaws and limitations of the CBO status quo. The Tax Foundation’s Steve Entin would be an inspired pick.

Democrats are now pretending they’ve never heard of Mr. Gruber, though they used to appeal to his authority when he still had some. His commentaries are no less valuable because he is now a political liability for Democrats.

 

"Academic Built Case for Mandate in Health Care Law," by Catherine Rampell, The New York Times, March 28, 2012 ---
http://www.nytimes.com/2012/03/29/business/jonathan-gruber-health-cares-mr-mandate.html?pagewanted=all&_r=1&

After Massachusetts, California came calling. So did Connecticut, Delaware, Kansas, Minnesota, Oregon, Wisconsin and Wyoming.

They all wanted Jonathan Gruber, a numbers wizard at M.I.T., to help them figure out how to fix their health care systems, just as he had helped Mitt Romney overhaul health insurance when he was the Massachusetts governor.

Then came the call in 2008 from President-elect Obama’s transition team, the one that officially turned this stay-at-home economics professor into Mr. Mandate.

Mr. Gruber has spent decades modeling the intricacies of the health care ecosystem, which involves making predictions about how new laws will play out based on past experience and economic theory. It is his research that convinced the Obama administration that health care reform could not work without requiring everyone to buy insurance.

And it is his work that explains why President Obama has so much riding on the three days of United States Supreme Court hearings, which ended Wednesday, about the constitutionality of the mandate. Questioning by the court’s conservative justices has suggested deep skepticism about the mandate, setting off waves of worry among its backers — Mr. Gruber included.

“As soon as I started reading the dispatches my stomach started churning,” Mr. Gruber said of the arguments on Tuesday, while taking a break from quizzing his son for a biology test. “Losing the mandate means continuing with our unfair individual insurance markets in a world where employer-based insurance is rapidly disappearing.”

Mr. Gruber, 46, hates traveling without his wife and three children, so he is tracking the case from his home in Lexington, Mass. There he crunches numbers and advises other states on health care, in between headbanging at Van Halen concerts with his 15-year-old son and cuddling with the family’s eight parrots. (His wife, Andrea, volunteers at a bird rescue center.)

If the court rules against the mandate, Mr. Gruber says he believes the number of newly insured Americans could fall to eight million from the projected 32 million. He insists that without a mandate, the law will result in a terrible spiral: only relatively sick Americans will choose to get insurance, leading premium prices to rise and causing the healthier of even those sick people to drop their insurance, sending prices higher and higher.

Some other economists quibble, though, with Mr. Gruber’s pessimistic assessment.

“My general thought about the mandate is if insurance is affordable and accessible, most people will buy it anyway,” said David Cutler, an economist at Harvard and longtime collaborator of Mr. Gruber’s.

Others, like Paul Starr, a Princeton sociologist, say they believe Mr. Gruber’s work does not account for how hard it will be to enforce the mandate.

“There is this groupthink about how important the mandate is,” Mr. Starr says. “Most people don’t understand or won’t acknowledge how weak the enforcement mechanism is.”

Mr. Starr said he thought Mr. Gruber in particular was overstating the effectiveness of the mandate because “it’s his baby.”

 That said, it is difficult for too many other experts to categorically refute Mr. Gruber’s work, since he has nearly cornered the market on the technical science behind these sorts of predictions. Other models exist — built by nonprofits like the RAND Corporation or private consultancies like the Lewin Groupbut they all use Mr. Gruber’s work as a benchmark, according to Jean Abraham, a health economist at the University of Minnesota and former senior economist in both the Obama and George W. Bush administrations.

“He’s brought a level of science to an issue that would otherwise be just opinion,” Mr. Cutler says. “He’s really the only person who has been doing all this careful modeling for so long. He’s the only person you can go to for that kind of thing, which is why the White House reached out to him in the first place.”

Mr. Obama had made health care reform a cornerstone of his campaign, and wanted to announce a credible proposal quickly after taking office. But members of the Obama administration’s transition team said they had inherited an executive branch that had vastly underinvested in modeling research on health care, especially compared to the technical modeling that had been done in areas like tax policy.

“Creating a good model from scratch would have taken months, maybe years,” said Lawrence H. Summers, who was the director of President Obama’s National Economic Council and had advised Mr. Gruber on his dissertation when they were at Harvard.

Mr. Gruber had already spent years researching government mandates, starting with his 1991 dissertation about how mandated employer benefits cut into workers’ wages.

He also did similar analyses, on a broader range of public policies for the Treasury Department in the Clinton administration from 1997-98. He was recruited by Mr. Summers, who was then deputy secretary of Treasury.

Then in 2001, after returning to M.I.T., Mr. Gruber received an e-mail from Amy Lischko, who was then an assistant commissioner in the Massachusetts healthy policy department under then-Gov. Jane M. Swift, a Republican.

She was familiar with his work, and contracted him to model some potential ways that Massachusetts could expand health insurance coverage.

“He certainly wasn’t as well known then as he is now in the health care arena,” said Ms. Lischko, now a professor at Tufts University School of Medicine. “We couldn’t exactly kick the tires on these kinds of models back then, but we knew he had done work on simulations before.”

Mr. Gruber calls himself a “card-carrying Democrat.” He and his wife host a “great quadrennial Democratic victory party” whether or not the Democratic candidate wins, he said. But given his reputation and relatively rare expertise, he still ended up working for two Republican governors in Massachusetts.

When Mr. Romney succeeded Ms. Swift in 2003, he proposed using an individual mandate to help the state achieve universal health care coverage. Mr. Gruber was again brought in to analyze the idea, which he had not formally modeled before.

“Romney saw it as a traditional Republican moral issue of personal responsibility, getting rid of the free riders in the system, not as much of an economic issue,” Mr. Gruber said. “Not only were the Republicans for it, the liberals hated it. People forget that.”

Mr. Obama had vehemently opposed an individual mandate before his election in 2008.

After the Massachusetts plan passed in 2006, Arnold Schwarzenegger, then the Republican governor of California, invited Mr. Gruber to Sacramento to help model a similar proposal.

“That was awesome,” Mr. Gruber says, his eyes widening at the memory. “I got to see the sword from Conan the Barbarian.”

The California proposal fell apart, but soon Mr. Gruber had a little cottage industry helping states model potential health system changes. He also serves on the Massachusetts board that oversees the state’s new health care exchanges.

Along with these credentials, Mr. Gruber’s position as an adviser to the influential Congressional Budget Office also left him perfectly positioned to advise the White House on health reform.

“The most important arbiter of everything was the C.B.O.,” said Neera Tanden, who was a senior adviser for health reform at the Department of Health and Human Services.

The C.B.O.’s assessment of a bill’s efficacy and costs strongly influences political debate, but the office does not publicly reveal how it calculates those numbers.

“We knew the numbers he gave us would be close to where the C.B.O. was likely to come out,” Ms. Tanden said. She was right.

After Mr. Gruber helped the administration put together the basic principles of the proposal, the White House lent him to Capitol Hill to help Congressional staff members draft the specifics of the legislation.

This assignment primarily involved asking his graduate student researchers to tweak his model’s software code. It was also almost entirely conducted from his home office, while his children were at school and then after they had gone to bed.

“If I wanted to be in Washington, I’d have taken a job in Washington,” he said. “I wanted to be around for my family.”

Even though he was brought in by the White House, Congressional staff members from both parties trusted him because he was seen as an econometric wonk, not a political agent. But soon his very involvement with the bill caused questions about his objectivity to be raised in the news media.

During and after the bill’s slog through Congress, he frequently spoke with reporters and wrote opinion pieces supporting the Affordable Care Act but did not always mention his role in helping to devise it.

He says he regrets not being more upfront about his involvement with the administration. But he does not apologize for publicly advocating the legislation, and continuing to do so — including through a comic book he wrote to explain the law.

Yes, I want the public to be informed by an objective expert,” he says. “But the thing is, I know more about this law than any other economist.”

 

The unintentional Obamacare Wrecking Ball Professor from MIT
MIT economist Jonathan Gruber is one of the foremost architects of Obamacare, having bragged that he "knows more about this law" than anyone else in his field. He's also emerged as an unintentional one-man wrecking ball against Obamacare, making public statements that have undermined the Obama administration's legal and political defenses of the president's signature domestic legacy.
http://www.townhallmail.com/zlzjrctbjjwkrbjbkbrptkgllfkllbftddpcqrwdbwmdms_wzvdnjvgdsn.html

The Astonishing Omission in the Wall Street Journal's Story About Obamacare Enrollment
http://www.newrepublic.com/article/120268/wall-street-journal-article-latinos-obamacare-omits-medicaid

"Watch Obamacare Architect Jonathan Gruber Explain Why "Lack of Transparency" Was Key to Passing the Health Care Law," by Peter Suderman, Reason Magazine, November 10, 2014 ---
http://reason.com/blog/2014/11/10/watch-obamacare-architect-jonathan-grube

. . .

It's even harder to believe now that he has admitted that he thinks it's fine to mislead people if doing so bolsters the policy goals he favors. It's really quite telling, about the law and also about Gruber. Gruber may believe that American voters are stupid, but he was the one who was dumb enough to say all this on camera.

Jensen Comment
Condoning the misleading of the public for political purposes by a scientist borders on fabrication of data and may be in violation of his university's (MIT) academic integrity policy.

Similar issues arose in the allegations against Phil Jones regarding integrity of his climate temperature recordings ---
http://en.wikipedia.org/wiki/Climatic_Research_Unit_email_controversy
Professor Jones stepped aside temporarily but was reinstated. Nevertheless these and similar allegations badly damaged the public's confidence in climate change data.

Jon Krosnick, professor of communication, political science and psychology at Stanford University, said scientists were overreacting. Referring to his own poll results of the American public, he said "It's another funny instance of scientists ignoring science." Krosnick found that "Very few professions enjoy the level of confidence from the public that scientists do, and those numbers haven't changed much in a decade. We don't see a lot of evidence that the general public in the United States is picking up on the (University of East Anglia) emails. It's too inside baseball."[139]

The Christian Science Monitor, in an article titled "Climate scientists exonerated in 'climategate' but public trust damaged," stated, "While public opinion had steadily moved away from belief in man-made global warming before the leaked CRU emails, that trend has only accelerated."[140] Paul Krugman, columnist for the New York Times, argued that this, along with all other incidents which called into question the scientific consensus on climate change, was "a fraud concocted by opponents of climate action, then bought into by many in the news media."[141] But UK journalist Fred Pearce called the slow response of climate scientists "a case study in how not to respond to a crisis" and "a public relations disaster".[142]

A. A. Leiserowitz, Director of the Yale University Project on Climate Change, and colleagues found in 2010 that:

Climategate had a significant effect on public beliefs in global warming and trust in scientists. The loss of trust in scientists, however, was primarily among individuals with a strongly individualistic worldview or politically conservative ideology. Nonetheless, Americans overall continue to trust scientists more than other sources of information about global warming.

In late 2011, Steven F. Hayward wrote that "Climategate did for the global warming controversy what the Pentagon Papers did for the Vietnam war 40 years ago: It changed the narrative decisively."[143] An editorial in Nature said that many in the media "were led by the nose, by those with a clear agenda, to a sizzling scandal that steadily defused as the true facts and context were made clear."

Jensen Comment
Professor Gruber's confession will similarly affect the public opinion of the way Obamacare was foisted on the public. This is not a proud moment in science or the life of a scientist and his university.

Also see ethics issues at
http://www.ethicssage.com/2014/11/gruber-should-be-fired-from-mit-for-violating-academic-integrity.html

Flackcheck Patterns of Deception ---
http://www.flackcheck.org/patterns-of-deception/affordable-care-act/?gclid=CMWP97rJhsICFWxk7AodCA8AqQ

Bob Jensen's threads on professors who cheat ---
http://www.trinity.edu/rjensen/Plagiarism.htm#ProfessorsWhoPlagiarize

From the CFO Journal's Morning Ledger on November 6, 2014

Health insurers woo consumers in crowded market
http://online.wsj.com/articles/health-insurance-deadline-prompts-marketing-blitz-to-drum-up-business-1415202655?mod=djemCFO_h
Health insurers are unleashing a blizzard of ads, letters, live events and other efforts to reach consumers, as the industry ramps up for the reopening of the health law’s marketplaces on Nov. 15. Meanwhile, small-business owners test-driving the federal government’s new online health-insurance exchange report a mixed experience with the site ahead of its planned opening in 10 days.

Jensen Comment
Health insurance is currently a very good business for companies, because bad debts from people who do not pay contracted premiums are passed on to the doctors and hospitals after 30 days. In any case Obamacare promises guaranteed profits for insurance companies at taxpayer expense if necessary. This is not capitalism since one of the tenants of capitalism is that businesses take risks risks of losses and failure.

It's the doctors and hospitals that take the financial risks. In New Hampshire nearly half the hospitals refuse to admit patients with ACA insurance except in dire emergencies. Many doctors are turning patients away unless they have something other than ACA medical insurance.

Another good thing for insurers is that the deductibles have become so huge (40% to 60%) that insured people put off getting medical care until absolutely necessary --- thereby greatly reducing the number of claims to be processed and paid.

My point is that just to say that more people now have ACA health insurance is not saying a whole lot about the quality of health care that this insurance is buying. There will probably be gridlock for years in Washington DC for any attempts to bring quality health care to all citizens of the USA. I favor national health insurance, although national health insurance plans in most non-OPEC nations like Sweden, Denmark, and the UK are doing badly these days. I consider Canada to be an OPEC nation. Germany is doing better because it allows people to take on supplemental health insurance using their own savings.

The USA is now an one of the world's largest oil producers, but gridlock politics have all but destroyed possibilities for great health care for all citizens. It's one of the best nations for health care for people who can afford to pay for the services, including those lucky enough to be on Medicaid or Medicare.

 


A long-delayed correction of a lie
"You Might Lose Your Doctor Under Obamacare," WebMd, March 14, 2014 ---
http://hotair.com/archives/2014/03/14/great-news-80-of-employers-have-or-may-raise-deductibles-thanks-to-obamacare/

Voters in November might be ready to show Democrats what they think about removing choice and hiking costs, as well as their arrogance in determining that a few politicians in Washington know better about their choices than they do. Unfortunately, Barack Obama doesn’t appear to have figured out this problem. In an interview with WebMD, Obama finally acknowledged that, contra his promise, people might not be able to keep the doctors they liked, but that they probably shouldn’t have liked those doctors in the first place.

Jensen Comment
Why won't he still admit the truth. Many of those doctors that "they liked" tend to be so good that they get more than enough business without working for medical clinics and

Here in New Hampshire 10 of the 26 hospitals and many of the best physicians in the state refuse to go on network. One of the main reasons is that patients in default on their health exchange premiums must be treated for 90 days with physicians and hospitals bearing the treatment costs for the last 60 of those 90 days. God forbid that the fat-cat insurance companies or the Federal government take the risks of paying for the free care during those 60-days.


Questions
Was President Obama correct in promising that the ACA insurance would transfer Medicaid patients from ER rooms to ACA networked physicians?

How does the ACA expansion of Medicaid greatly increase the moral hazard of new Medicare patients?

One of the naive promises made by President Obama was that uninsured people previously seeking free care in Emergency Rooms (ER) would relieve the ER rooms for all the new Medicaid patients who could now have access to network physicians with their new free medical care and medication insurance policies. This was naive because he should have known that previous Medicaid patients preferred ER rooms even when they had  freeMedicaid insurance. He should have known that when Oregon expanded the number of people on Medicaid that demand for ER services increased by 40%.

People receiving free medical care and medications are inclined to favor ER services even when they can have care from network physicians. Reasons are complicated especially when walk-in medical clinics are available. One reason is that walk-in clinics serving Medicaid patients are not usually as close by as hospitals with ER services. The physicians in the ER facilities are likely to not only be MDs, they are sometimes better MDs that the staff of walk-in medical clinics who often hire newly graduated MDs still in residency or physicians assistants. In other words, if you want the best physicians the odds are usually better for ER rooms than networked ACA physicians and walk-in clinics.

When walk-in clinics are not convenient, getting an appointment with a networked physician may take weeks or even months. Top physicians are available 24/7 for emergency patients and non-emergency Medicaid patients. Insured patients not on Medicaid may be discouraged by co-pays of expensive ER services. But Medicaid patients never have to worry about co-payments.

Last night CBS News reported that ER use expanded by 40% due to new Medicaid patients.

 

"Medicaid Expansion Boosted Emergency Room Visits In Oregon," by Julie Royner, NPR, January 3, 2014 ---
http://www.wbur.org/npr/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon

Giving poor people health insurance, the belief was, would decrease their dependence on hospital emergency rooms by providing them access to more appropriate, lower-cost primary care.

But a study published in the journal Science on Thursday finds that's not the case. When you give people Medicaid, it seems they use both more primary care and more emergency room services.

"Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations," says Amy Finkelstein, an economics professor at MIT and one of the authors of the study. "Including visits for conditions that may be most readily treatable in primary care settings."

In other words, people are going to the emergency department for things that aren't emergencies. This is exactly what policymakers hoped to avoid by giving people health insurance – including the huge increase in Medicaid coverage coming as part of the Affordable Care Act.

And the increase in ER use found in the study was significant – "about 40 percent," Finkelstein said.

This would be a good place to point out this is not just any study. It is the third major paper from something called the Oregon Health Insurance Experiment, which Finkelstein heads along with Katherine Baicker from the Harvard School of Public Health.

The experiment was a rare opportunity to create a randomized controlled experiment – the gold standard of scientific research. It came about almost by accident, thanks to Oregon's decision in 2008 to expand its Medicaid program via a lottery.

The result, said Finkelstein, was that the groups of people with or without insurance were identical, "except for the fact that some have insurance and some don't. You've literally randomized the allocation of insurance coverage."

And that gave researchers the ability to compare the effects of having health insurance — in this case, Medicaid.

The first paper from the research team, published in 2011, was mostly positive. It found that people who got Medicaid coverage were more likely to use health services in general, less likely to suffer from depression, and less likely to suffer financial problems related to medical bills than those who remained uninsured.

The results in the second paper, published last spring, were more equivocal. Researchers found no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes.

It's not clear that the emergency room results will translate nationwide: The study only lasted 18 months and the study population is both more while and more urban than the rest of the nation.

But that's not stopping critics of Medicaid expansion.

"When you make ER care free to people, they consume more of it. They consume 40 percent more of it," says Michael Cannon, head of health policy for the libertarian Cato Institute. "Even as they're consuming more preventive care. And so one of the main arguments for how Obamacare was going to reduce health care costs is just flat out false."

Cannon says the study will likely further hurt President Obama's credibility for vowing that expanding Medicaid would help get people out of emergency rooms. But what's likely to bother the administration even more, he says, is what it may do to the half of the states that have yet to adopt the Medicaid expansion.

"This study is going to make it less likely that the 25 states that decided not to expand Medicaid are going to change their minds and decide to expand Medicaid," Cannon predicts.

But this study doesn't come as much of a surprise to those people who actually run Medicaid programs around the country.

"This is not something that is unexpected and not something that we're not prepared for," says Kathleen Nolan. She's director of state policy and programs for the National Association of Medicaid Directors.

Continued in article

Jensen Comment
The majority of new Medicaid patients will be poor, although it is possible for millionaires to now qualify for Medicaid with devious financial planning such as low income students having million dollar trust funds. The poor patients have incentives to game the ER services for prescription pain medicine. With one network physician or clinic, there will be records as to when prescriptions can be renewed. Given the Administration's track record for implementing databases, I strongly doubt that a Medicaid patient intent upon selling prescription pain killers can be prevented by traveling around to different hospital ER service for prescriptions that would not be granted if the ER physician was aware of the last time a Medicaid patient received such a prescription in another hospital and another and another.

I'm not certain how well pharmacies share prescription data or even if privacy laws even allow CVC and Walgreen and Wal-mart to even share a person's prescription data without receiving permission from the patient.

The moral hazard is greater with poor people in need of selling their pills like they sell food stamps.

Can prescription data be shared between different corporations without patient consent?

And then there's the problem of granting Medicaid to people who do not qualify for Medicaid. For example, an audit in Illinois revealed that half the people on Medicaid did not qualify for Medicaid. This appears to be yet another entitlement going crazy at taxpayer expense.

Bob Jensen's health care messaging updates --- http://www.trinity.edu/rjensen/Health.htm


The Lies and Deceptions

Americans stubbornly resist this landmark legislation in part because virtually every major claim about its benefits is turning out to be false—and people recoil when misled.
Karl Rove, The Wall Street Journal, September 30, 2010 ---
http://online.wsj.com/article/SB10001424052748704116004575522073624475054.html?mod=djemEditorialPage_t


Hi Norma,

Due in heavy part that the Affordable Care Act is passing both its deductible nonpayment bad debts and its premium non-payment bad debts (two of the three months of a three-month nonpayment grace period), many hospitals like the Andersen Cancer Center and many doctors (70% in California) are refusing to serve patients insured by the exchanges. The TV networks and major newspapers seem to conspire to not report this.
 
You may not be able to choose your doctor or hospital unless you pay cash or go on a high premium Cadillac plan that, in 2015, will cease to be tax deductible by you or your employer..
 
After his gun control initiatives failed in Congress, President Obama unilaterally added very expensive mental health coverage to the Affordable Care Act without mentioning that most psychiatrists will refuse to serve patients having any type of insurance..  Psychiatrists are already in short supply in the USA. Nearly half already only serve cash-paying patients and currently won't bill any insurance companies, including Medicare or Medicaid. I think even more will reject the the exchanges.
 
I have a relative who needs psychiatric medications daily. Even though her husband is on a good state university medical insurance plan for coverage of most of her medical needs, she's dependent upon the only (overworked) psychiatrist in the area. That psychiatrist does not accept insurance.
 
Why are there so few psychiatrists?
One reason is that psychiatry is the most dangerous medical specialty. Exhibit A is the recent mass murderer James Holmes in Aurora, Colorado who was booted off campus for threatening his psychiatrist. Personally I think another reason is that doctors do not like going into a specialty having such a low proportion of cure rates and having to be on call 24/7 (usually to prevent suicides).
 
Something will have to be done to prevent passing bad bad debts onto hospitals and doctors.
Now that the GOP has given up on deficit reduction (Sen. Ryan lied by excluding interest on the debt in his budget), perhaps  legislation to Federal coverage of bad debts on to the Federal government along with assurances that doctors can bill at their full rates they charge cash paying patients. The blow to the deficit will be devastating since patients have little incentive to pay their deductibles if the government will pay those deductibles.
 
What we now have is two political parties so desperate to win elections that both are now promising nearly-free medical coverage that will explode the deficit and provide false promises about the quality of medical care in short supply to meet exploding demand.
Medical care will be almost free as long as the government fails to seriously prevent frauds in Medicaid. Medicare phony disability coverage,  and the Affordable Care Act subsidies --- all three of which are now frauds out of control due to failed government enforcement

 

"Obamacare: Silence of the Insurers," by Jonah Goldberg, Townhall, December 18, 2013 ---
http://townhall.com/columnists/jonahgoldberg/2013/12/18/obamacare-silence-of-the-insurers-n1764535?utm_source=thdaily&utm_medium=email&utm_campaign=nl

When will the insurers revolt?

It's a question that's popping up more and more. On the surface, the question answers itself. We're talking about pinstriped insurance company executives, not Hells Angels. One doesn't want to paint with too broad a brush, but if you were going to guess which vocations lend themselves least to revolutionary zeal, actuaries rank slightly behind embalmers.

Still, it's hard not to wonder how much more these people are willing to take. Even an obedient dog will bite if you kick it enough. Since Obamacare's passage, the administration has constantly moved the goalposts on the industry. For instance, when the small-business mandate proved problematic in an election year, the administration delayed it, putting its partisan political needs ahead of its own policy and the needs of the industry.

But the insurers kept their eyes on the prize: huge guaranteed profits stemming from the diktat of the health insurance mandate. When asked how he silenced opponents in the health industry during his successful effort to socialize medicine, Aneurin Bevan, creator of the British National Health Service, responded, "I stuffed their mouths with gold."

Hence, the insurers were ready on Oct. 1. They rejiggered their industry. They sent out millions of cancellation letters to customers whose plans no longer qualified under the new standards set by the Affordable Care Act. They told their customers to go to the exchanges to get their new plans.

But because President Obama promised Americans "if you like your health care plan, you can keep it," (PolitiFact's "Lie of the Year"), those cancellations became a political problem of Obama's own making.

In response, the president blamed it on the insurance companies or "bad apple" insurers. White House spokesman Jay Carney insisted that it was the insurance companies that unilaterally decided not to grandfather existing plans. (The Washington Post's "Fact Checker" columnist, Glenn Kessler, gave this claim "Three Pinocchios.")

Then, just last week, Health and Human Services Secretary Kathleen Sebelius announced that she was "urging" insurers to ignore both their contracts and the law and simply cover people on the honor system -- as if they were enrolled and paid up. She also wants doctors and hospitals to take patients, regardless of whether they are in a patients' insurance network or even if the patient is properly insured at all. Just go ahead and extend the deadline for paying, she urged insurers; we'll work out the paperwork later.

Of course, urging isn't forcing. But as Avik Roy of Forbes notes, the difference is subtle. Also last week, HHS also announced last week that it will consider compliance with its suggestions when determining which plans to allow on the exchanges next year. A request from HHS is like being asked a "favor" by the Godfather; compliance is less than voluntary.

The irony, as Christopher DeMuth recently noted in the Weekly Standard, is that if the architects of Obamacare had their way, the insurers would have been in even worse shape today. The original plan was for a "public option" that would have, over time, undercut the private insurance market to the point where single-payer seemed like the only rational way to go. If it weren't for then-Sen. Joe Lieberman's insistence that the provision be scrapped, DeMuth writes, "Obamacare's troubles would today be leading smoothly to the expansion of direct federal health insurance to pick up millions of canceled policies and undercut rate increases on terms no private firm could match."

In other words, the insurers knew the administration never had their best interests at heart but got in bed with it anyway.

Continued in article

Jensen Comment
Until recently the enthusiasm of medical insurance companies was understandable since the the losses for deductible portions of contracts were passed on mostly to patients themselves and possibly their doctors. Most medical service bad debts of for default of premium payments were passed on to hospitals and doctors.

Also the big and prosperous insurance companies were allowed to opt out of participating in the more risky health insurance exchanges. Most did opt out such that the government had to make loans for new exchange companies to to become insurers for individuals not covered by their employers. These exchanges are poorly capitalized, and many will probably have to be bailed out by the government if and when they encounter insolvency.

To get more heavily capitalized insurance companies to participate would require higher premium rates and more protection against bad debt losses. But this in turn would raise premiums dramatically and be counter to the whole purpose of the Affordable Care Act ---  to get more people insured and using more preventative care options. High premiums and low deductibles could destroy the Affordable Care Act by making more rather than fewer people insured.

The silence of the media on astute health care providers is more problematic.
Many of the biggest and best hospitals like the Andersen Cancer Center will not serve patients covered by the exchanges. Over 70% of California's physicians will not serve patients covered by the exchanges (except in the case where emergency treatment is called for).

Has any media source complained that with proper investment planning very wealthy people, especially college students on trust funds, may get free Medicaid medical care and medications.

Jensen Question
I asked the following question on the Turbo Tax Forum Regarding the Affordable Care Act Questions:
Question
I'm told that only income, not wealth, will be the deciding factor on eligibility for Medicaid beginning in 2014.
If I'm a full time student having zero income and $10 million trust fund of stock paying no dividends, will I be eligible for Medicaid?

A Turbo Tax expert says that wealth may still be a criterion in the states that rejected the Medicaid expansion. Having valuable assets is no longer a criterion in those states that yielded to Whitehouse pressure and temporary funding to expand Medicaid roles.

There are 24 states who are not expanding Medicaid and may, therefore, still deny Medicaid to millionaires. The other 26 states may now grant free health care to millionaires who strategically lock in their wealth for long-term growth and negligible current income ---
https://www.statereforum.org/tracking-health-coverage-enrollment-by-state


"What 2014 means for Obamacare," by Sarah Kliff, The Washington Post, January 1, 2013 ---
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/01/what-2014-means-for-obamacare/

. . .

The next Obamacare fight is going to be about access.
After three months of enrollment, January will be the first month when shoppers can see what they purchased. We know that the plans for sale on the marketplace tend to have relatively limited networks, as insurers restricted doctor access to hold down premium prices. New subscribers could find that a doctor they want isn't in network, and get frustrated. Co-payments may seem alarmingly high -- a byproduct of keeping premiums low. While the health-care system probably has the capacity to absorb a few million new insurance subscribers (for a variety of reasons explored here) there is still room for issues about access to specific doctors and the price tag that comes along with trips to the doctor's office.

Continued in article

Jensen Comment
While the new Medicaid patients will probably flood the hospital ERs instead of seeking out network physicians, the patients on plans requiring co-payments and deductibles will probably seek out physicians on their network plans. Hospital ERs tend to charge large co-payments which of course do not matter to Medicaid patients since they do not have to pay any co-payments.

 

In some instances physicians who are suing the ACA network insurers after being dropped by the networks
",MDs sue ObamaCare insurer over dropped doctors" by Geoff Earle, Fox News, December 28, 2013 ---
http://nypost.com/2013/12/28/mds-sue-obamacare-insurer-over-dropped-doctors/

A group of New York doctors is suing insurance giant UnitedHealthcare, charging that it booted doctors from its network to avoid cost hikes imposed by ObamaCare.

The company’s decision to kick more than 2,000 docs from its Medicare Advantage network threatens to harm elderly and disabled patients, according to the filing in Brooklyn federal court.

“By terminating numerous physicians from the . . . network, United seeks to stem financial losses occasioned by reduced federal payments under the Affordable Care Act,” the suit launched by the Medical Society of the State of New York claims.

“This, of course, comes at the expense of physicians,” the suit continues, arguing that the company violated doctors’ contracts by failing to give sufficient notice, among other things.

Tugging at the heartstrings, the suit specifically mentions elderly and disabled patients “who must now either find new physicians (including traveling farther distances to find a participating . . . provider), switch plans to continue treatment with the terminated physicians, or pay significant additional out-of-pocket costs to continue treatment with an ‘out-of-network’ provider.”

It accuses United of “shifting the financial burdens imposed by the Affordable Care Act from itself, a multibillion-dollar company,” to providers and patients.

Medical Society President Sam Unterricht told The Post the company’s decision was unfair to patients, since they had to choose a new plan under Medicare Advantage, a private alternative to traditional Medicare, by Dec. 7, when company Web sites still showed doctors who were being kicked out of the network at the start of the new year.

“For some people who are medically fragile it can really be dangerous. There can be gaps in care,” he said.

Unterricht said reduced Medicare Advantage payments to physicians are being used as a cost-saving measure to fund ObamaCare. He said docs would get paid 20 percent or even 40 percent less per patient.

“A lot of doctors are not going to be able to accept that and really give good medical care at that kind of a price,” he said.

Continued in article

Jensen Comment
This is a reversal of the stories we are hearing about physicians boycotting the ACA networks.

We are seeing a bit about this up here. In their separate offices in our Littleton Regional Hospital three different medical network groups each dropped one of its MDs. Interestingly, all three of the dropped physicians at one time or another been general practitioners for my wife or me. The dropped MDs were all women MDs who were replaced by new and much cheaper Physician Assistants who are permitted, at least up here, to examine patients like a physician and write prescriptions.

One of the MDs, Dr. Virginia Jeffryes, after facing the huge expense of starting a new practice, was hired back by her network group but now has to commute to Whitefield. Dr. Kathleen Smith and Dr. Robin Hallquist are incurring the expenses of commencing new practices in Littlleton and Twin Mountain respectively. The startup expenses include renting office space, hiring medical and administrative staff, buying computers and other equipment,, going it alone for malpractice insurance premiums. Plus there is an enormous amount of red tape involved in getting permission to bill third parties like Medicare and Worker Comp.

I firmly believe these quality physicians were dropped by their respective medical network groups and replaced by Physician Assistants (PAs) and/or Osteopaths to save money. That, however, is only my opinion since I have no inside tracks to the accounting records.

One of the network groups retained a cheap and uncaring MD trained in another country. She needs and attitude adjustment. I'm told by a neighbor who works in the hospital that her patients are continually asking for another "doctor" be it a PA or an Osteopath.

Why didn't the group fire the lousy MD and retain the high quality MD? That's a no-brainer question for a managerial accounting student.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


Deloitte's Map of the Number of Healthcare Exchanges Estimated Per State ---
http://www.deloitte.com/assets/Dcom-UnitedStates/Local Assets/Documents/Health Plans/us_hp_hix_IndividualMarketCompetition_81313.pdf
For example, New Hampshire and West Virginia have one whereas Texas has 11, Wisconsin has 13, and New York has 16.
Each carrier does have multiple plans that vary largely on the size of the deductibles with bronze plans having 40% deductibles and silver having 30% deductibles. Prices vary in different states. Prices also vary with age and smoking.

There are differences even among states who are not providing their own exchanges. Currently there are 26 states who rely on Federally provided exchanges ---
https://www.statereforum.org/where-states-stand-on-exchanges
Why does Maine have only two exchanges while Texas has 11 exchanges?

How to Mislead With Statistics and Graphs

Question
If you were teaching statistics how could you use the following article to illustrate how to mislead with statistics?

"Obamacare Prices: Competition Lacking in Some Exchanges," by John Tozzi, Bloomberg Businessweek, December 19. 2013 ---
http://www.businessweek.com/articles/2013-12-19/obamacare-prices-competition-lacking-in-some-exchanges?campaign_id=DN122313

The drafters of the Affordable Care Act imagined vibrant marketplaces that would give consumers options from many insurers. So far, competition is limited: 40 percent of Americans live in counties with three or fewer companies selling Obamacare policies, leaving them more wireless carriers to choose from than health plans.

 

Jensen Comment
No matter how much we preach that correlation is not causation, journalists, students, and even professors fall into the same old trap of not digging deeper for causes rather than implying that correlation is synonymous with causation.

Yes premiums do seem to be correlated with competition. But how much is the competition really affecting price relative to underlying causal factors that affect such things as companies refusing to enter the competition?

Insurance companies themselves are not very forthcoming about why they avoid certain markets other than providing vague statements about those markets not being profitable. The bottom line is that I don't know why there is so little medical insurance competition in some parts of the country relative to other parts of the USA. But I would not be so naive to imply that lack of competition is a causal factor. Where there's lack of competition there are most likely either underlying barriers to entry or other causal factors that make medical insurance less profitable in those areas. Charging higher prices for insurance in those markets is a result of whatever factors are driving potential competitors out of those markets.

A skilled analyst would probe deeper as to why there is so little competition in come counties and states.

  • Could regulations at the state or county level be making the insurance market so unprofitable that most companies elect not to enter those markets?

     
  • Could litigation risks may be so high in a state or county that most companies are avoiding the market?

     
  • Could there be underlying causes result in higher medical service costs that drive the competition away in some counties?  For example, some states have more county hospitals that are funded by property taxes, thereby allowing for lower priced services of the hospitals.

     
  • Could it be that some counties/states have a higher proportion of people likely to become bad debts? Remember that in case an insured person defaults on a premium, the insurance company must pay for the medical care of that person for 30 days and the health care provider must pick up 60 more days in a 90-day grace period where a person remains insured in spite of defaulting on payments under Obamacare.

     
  • Could health differences explain the reluctance of companies to enter some markets. Health differences around the country explain between 75 percent and 85 percent of the cost variations." Jordan Rau in Kaiser Health News.
    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/29/trouble-for-obamacare-in-new-hampshire/

December 24 reply from the TurboTax Forum

Hello rjensen,

SweetieJean commented on an answer to your question: Why does the number of exchanges vary so greatly. For example, New Hampshire and West Virginia have only one exchange whereas New York has 16 exchanges and Texas has 11 exchanges?

Saw a recent article about someone who had only 1 insurance in their Exchange, but their across the street neighbor (who lived in a different zip code) had 15.  In very rural areas (NH, WV), there isn't enough of a customer population for most insurance companies to make a profit.

 

To view the comment, click (or copy and paste in your browser) the link below:
https://ttlc.intuit.com/replies/3351534

 


I never knew about ACA consumer add-on taxes until this was reported today by CBS News
"As Obamacare Deadline Looms, Insurance Companies Pile On The Taxes," CBS News, December 26, 2013 ---
http://newyork.cbslocal.com/2013/12/26/as-obamacare-deadline-looms-insurance-companies-pile-on-the-taxes/

. . .

And there’s more: most insurance companies don’t tell you about the taxes they add to their premiums. The numbers will vary, but one subscriber said their tax amount is $23.14 a month, or nearly $278 annually.;

Other add-ons include:

* A 2 percent premium tax on every health plan.

* A user fee of 3.5 percent to sell through the online marketplace.

* A $2-per-policy fee.

Nonetheless, supporters of the Affordable Care Act claim the neediest will get the best coverage.

“People who make a little more will pay more; people who make a little less will pay less,” Arevalo said.

Critics say most insurers don’t specifically post taxes on invoices, and some question how, in the case Brennan showed earlier, Alabama Blue Cross-Blue Shield was able to be so specific.

Watch the video


Surely Chuck you cannot argue that having premiums and choices of plans vary so drastically across zip codes is fair.
"COST, NUMBER OF HEALTH CARE PLANS VARY WIDELY BY COUNTY," USA Today ---
http://www.usatoday.com/story/news/nation/2013/11/21/affordability-obamacare-plans-varies-state-county/3641821/
Look at the maps!

The variable premiums and deductibles that were somewhat unfair by zip codes before the ACA have exacerbated those and are increasingly unaffordable in some zip codes. The USA Today (December emphasizes this ---
"Lack aid? Many counties have only pricey plans," by Jayne O'Donnell, USA Today, December 26, 2013 ---
http://www.usatoday.com/story/news/nation/2013/12/25/affordability-healthcaregov-plans-usa-counties/4165513/

 More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that's affordable — by the government's own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.

 Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.

More than a third don't offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.

Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.

The USA TODAY analysis looked at whether premiums for the least expensive plan in any of the metal levels was more than 8% of household income. That's similar to the affordability test used by the federal government to determine whether premiums are so expensive consumers aren't required to buy plans under the Affordable Care Act.

The number of people who earn close to the subsidy cutoff and are priced out of affordable coverage may be a small slice of the estimated 4.4 million people buying their own insurance and ineligible for subsidies. But the analysis clearly shows how the sticker shock hitting many in the middle class, including the self-employed and early retirees, isn't just a perception problem. The lack of counties with affordable plans means many middle-class people will either opt out of insurance or pay too much to buy it.

The prices of exchange plans have shocked many shoppers, especially those who had plans canceled because they did not meet the ACA coverage requirements. But experts are not surprised.

"The ACA was not designed to reduce costs or, the law's name notwithstanding, to make health insurance coverage affordable for the vast majority of Americans," says health care consultant Kip Piper, a former government and insurance industry official. "The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace."

Along with underscoring how high rates are in many places, the analysis could portend more problems for the health law's troubled rollout. The Congressional Budget Office projected 7 million people would sign up for the law by the end of 2014 and enrollment is already falling several million short of that goal. Insurers need a lot of relatively healthy people to sign up for insurance to make up for the higher cost of insuring the less healthy. Highly subsidized lower-income consumers who haven't had insurance before often weren't getting regular doctors' visits. If many of those making about $50,000 for an individual or about $62,000 in household income for a couple opt out of the new health care system, it will deprive it of some of the counterbalancing effect needed.

Still, about 95% of consumers live in states where the average premiums are below earlier estimates, says Department of Health and Human Services spokeswoman Joanne Peters.

"The new Marketplace is night and day from what consumers faced in the individual market before the health care law, where they could see unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they can even get coverage without being denied for a pre-existing condition," says Peters.

Many ACA-compliant plans will cover prescription drugs, routine care for chronic conditions and primary care visits even before deductibles are met, Peters notes.

But those aren't the plans that are affordable to many middle-class individuals buying insurance. In many cases, catastrophic plans — which USA TODAY excluded from its analysis — may be all that's left for consumers on the exchanges. These high-deductible plans are generally only available for consumers under 30, who are least likely to need to use them, but they can also be purchased by people who don't have other affordable options available in their area. These plans generally require consumers to pay all of their medical costs up to a certain amount — often $6,000 or more — although preventive benefits such as physicals have to be covered under the new law.

President Obama said last week that people whose plans were canceled and think the options on the exchanges are too expensive aren't required to buy insurance or can buy a catastrophic plan through what's known as a "hardship exemption." But most people actually do want insurance, says financial counselor and author Karen McCall.

"Every one of those people, if they have any consciousness and aren't totally self-medicating, would prefer to have insurance," says McCall, author of the book Financial Recovery. "You could go a year and not get any benefit of health insurance, but there is a deep emotional need to know that we have proper insurance."

State and federal exchange officials approve the rates health insurers can offer, and plans are then subsidized to levels that make them affordable for those below 400% of the poverty level. Karen Pollitz, a senior fellow at the Kaiser Family Foundation, acknowledges that catastrophic and even bronze plans would be very difficult for many 40 or 50-something consumers to afford with their $5,000-$6,000 annual deductibles.

"Most people don't have that kind of money in the bank, and I think it's going to create problems for people," Pollitz says.

Although premiums are unaffordable in many places now, protections in the law will prevent the massive jumps in premiums that characterized the individual insurance market before the ACA, she says.

Individual policies before had only the "optics of affordability and no dependability," Pollitz says. "What good is protection if it doesn't work when you need it?"

More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that's affordable — by the government's own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.

Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.

More than a third don't offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.

Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.

Jensen Comment
If we are going to have affordable health care for all then the premiums should be affordable by all and not my some zip codes suffer much more than people living in other zip codes.


 

  1. The new rules in many states for extending free Medicaid on the bases of only income without tests of assets (such as students having million dollar trust funds) are huge moral hazards for millions of people to get totally free medical service and medications. My wife's long term friend (for over years) has a daughter living across the street in Longview Texas. The daughter put her share of their $200,000 plus house into her husbands name, divorced her husband, quit her job, and is now on welfare and Medicaid for herself and her children. She still lives in the house with her husband and readily admits this was a sham divorce. Her "husband" makes over $70,000. She tells the welfare folks she's living across the street with her parents --- which is a blatant lie.


    In Texas she had to sign off on her ownership of the house. In one of the states relaxing Medicaid rules she should get Medicaid and completely own the house herself. as long as her "former husband" paid the property taxes and other house expenses. In fact she could own a million dollar house and still get Medicaid's free health care.

     
  2. In order to make their premiums lower (with or without subsidies) most people are opting for bronze and silver plans where they must pay 30%-50%) of all medications and medical care. If they get hit with big bills most of these people just do not have the money to pay their deductibles. Either they will forego treatment or pass their bad debts on to doctors and hospitals .

     
  3. The ACA law should have been enacted only after rule enforcement checks were in place. I think the law should not have commenced without having the IRS matching incomes against subsidies and Medicaid expansion.

     
  4. In the past people who defaulted on premiums became uninsured people who were treated in special facilities such as county hospitals funded by taxpayers. Now people who default on premiums get a 90-day grace period where insurance companies pay their medical costs for 30 days and the doctors and hospitals have to pay for their medical care for 60 days.
     
  5. President Obama was smart to delay the employer-provided plans for a year. The main advantage of this is that employees are not yet shocked by how much more they will be paying out-of-pocket for higher premiums, higher co-pays, and hi9gher deductibles.
    "Employees will pay more for health care in 2014: New year likely to bring higher deductibles and co-pays, smaller employer contributions." by Julie Appleby, USA Today, December 19, 2013 ---
    http://www.usatoday.com/story/money/personalfinance/2013/12/19/employee-health-insurance/3958071/

 

Jensen Comment
The problem is that the ACA is just not sustainable unless drastic changes are made. The ACA assumed that wealthier and healthier people were going to pay for almost all the expansion of free Medicaid medical care and subsidized premiums. But the prices that were set are just not affordable to too many people and in order to have medical plans other people are opting for high deductibles that they will not be able to pay in times of expensive medical care needs.  Furthermore, the pricings are too variable and unfair across all the counties of the USA.

The ACA is just not sustainable. It should have been a national health plan from the beginning. Turning it into a national health plan in the future will be an enormous shock to the slowly expanding economy and a disaster to the entitlements disaster.

But I don't really care all that much. I will be dead before the enormous disasters hit.
I just hate the fraud and unfairness that the ACA is exacerbating. It turns out that the preconditions problem for uninsured people was not all that great a problem that could have been solved much more cheaply. The majority of the the problem with uninsured people was that they either could not afford or did not want to afford medical insurance that is now ever more costly to many of these same peopl


"Obama's Mental Health Solution Falls Flat," by Nicole Bailey, Townhall, December 2, 2013 ---
http://townhall.com/tipsheet/nicolebailey/2013/12/12/obamas-mental-health-solution-falls-flat-n1761910?utm_source=thdailypm&utm_medium=email&utm_campaign=nl_pm

. . .

The Obama administration has expanded mental health care coverage, but the latest research shows that psychiatrists often do not accept insurance at all. When only 43% of psychiatrists accept Medicaid, it is difficult to see how expanded coverage will help mental health patients.

Psychiatrists accept medical insurance less frequently than other specialists across the board, according to the study published in JAMA Psychiatry by researchers from three separate medical schools:
 

  • 55.3% of psychiatrists accepted medical insurance in general, compared to 88.7% of other physicians
  • 54.8% of psychiatrists accepted Medicare, compared to 86.1% of other physicians
  • 43.1% of psychiatrists accepted Medicaid, compared to 73.0% of other physicians

The mainline media seems to avoid the greatest concerns of the Affordable Care Act --- concerns about making hospitals and doctors absorb most of the costs of medical care during the 90-day premium default grace period and the cost of serving patients who afterwards renege on paying the deductible portions that they agreed to pay to get lower premium plans.

The USA now has a dual health care program --- the highest quality health care in the world for the wealthy on Cadillac medical insurance plans and inferior quality health care in the chaos of the Affordable Care Act that will force soaring inflation in health care provider pricings. Your local Congressional representative is signing up for a Cadillac plan paid for by taxpayers.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


the Affordable Care Act:  Limits Placed Upon Choosing Your Own Doctor and Hospital

Jensen Comment
The media along with President Obama led us to believe that medical insurance plans were going to vary only be the amount of the deductibles and age of the applicant. We are now learning more about differences in medical networks of hospitals and doctors. The President kept insisting that we could keep our present doctors. Technically that was not a lie, but what was left unsaid is that to literally keep your favored doctors and hospitals you may have to opt for the more expensive Cadillac plans having "broader network coverage "of physicians and selective hospitals that opted out of serving the lower-priced limited network plans.

Dr. Ezekiel Emanuel --- http://en.wikipedia.org/wiki/Ezekiel_Emanuel

"ObamaCare in Translation Ezekial Emanuel explains what the President really meant about your doctor," The Wall Street Journal, December 8, 2013 ---
http://online.wsj.com/news/articles/SB10001424052702304014504579246552456954872?mod=djemEditorialPage_h

. . .

Mr. Wallace: "It's a simple yes or no question. Didn't he say if you like your doctor, you can keep your doctor?"

Dr. Emanuel: "Yes. But look, if you want to pay more for an insurance company that covers your doctor, you can do that. This is a matter of choice. We know in all sorts of places you pay more for certain—for a wider range of choices or wider range of benefits. The issue isn't the selective networks. People keep saying, 'Oh, the problem is you're going to have a selective network.'"

Mr. Wallace: "Well, if you lose your doctor or lose your hospital—"

Dr. Emanuel: "Let me just say something. People are going to have a choice as to whether they want to pay a certain amount for a selective network or pay more for a broader network."

Mr. Wallace: "Which means your premiums would probably go up."

Dr. Emanuel: "They get that choice. That's a choice you've always made."

It's nice to hear a central planner embrace choice, except this needs translating too. The truth is that you may be able to pay more to keep your doctor, but only after you choose one of ObamaCare's preferred plans that already costs you more than your old plan that ObamaCare forced you to give up.

Jensen Comment
What Dr. Emanuel failed to mention is that the "broader expensive network" plans are Cadillac plans for which employers lose their tax deductions.

The Cadillac Tax: A Game Changer for U.S. Health Care:  Can you explain this tax to your students?
Do you understand the Cadillac Tax provision of the Affordable Healthcare Act that will have a monumental 2018 impact on healthcare coverage of employees who are now covered by employer plans --- plans now costing the government over $250 billion per year? But not for long!

Do you understand the Cadillac Tax provision?
Me neither. As Nancy Pelosi said years ago, Congress passed the ACA before anybody in the USA had a chance to study all the surprises in this the enormous bill.

If you're covered presently on your employer's plan you should most certainly learn about the Cadillac Tax provision that kicks in in 2018.

"The Cadillac Tax: A Game Changer for U.S. Health Care." by Jonathan Gruber (MIT), Harvard Business Review Blog, November 15. 2013 ---
http://blogs.hbr.org/2013/11/the-cadillac-tax-a-game-changer-for-u-s-health-care/

Jensen Comment
Non-profit organizations, especially labor unions, for whom Cadillac plans are especially popular will be allowed to keep their plans without penalty since tax deductions are not of concern to them.

Having preferred networks of doctors and hospitals is not unheard of in national health care plans. Germany, for example, has both public health insurance plus premium coverage with private insurance. Cuba notoriously has bourgeoisie plans for members of the Communist Party and the wealthy versus  proletariat plans for the poor people.

If you Congressional representative brags about signing up for Obamacare ask if he or she has a Cadillac Obamacare plan that lets them choose their own doctors and hospitals.


President Obama's Blatant Political Payoff:  Unions Get Tax-Free Cadillac Health Plans Unlike the Rest of the USA
Oops Some Selected Corporations Get Breaks as Well
"Unions Get Big ObamaCare Christmas Present As Other Self-Insured Groups Get Scrooged," by Larry Bell, Forbes, December 22, 2013 ---
http://www.forbes.com/sites/larrybell/2013/12/22/unions-get-big-obamacare-christmas-present-as-other-self-insured-groups-get-scrooged/

As a presumed constitutional scholar, Barack Obama should know that while a president has authority to check the Legislative Branch by recommending legislation to be passed by Congress, or through presidential veto, he or she cannot legislate through executive fiat or pick which parts of the law to comply with or decline. Article 2, Section 3, Clause 5 of our Constitution requires that the president “…shall take care that the Laws be carefully executed.” It doesn’t limit those laws or encapsulated provisions to the particular ones that he or she likes.

Speaking before the House Judiciary Committee on December 3, Professor Jonathan Turley of George Washington University observed that the president isn’t taking that “Laws be faithfully executed” oath very seriously, particularly with regard to his signature Affordable Care Act (aka.“ObamaCare”).

Although Turley had voted for Obama and professes to agree with him on health care and other issues, he warned that his power grabs are causing “the most serious constitutional crisis in my lifetime.”

The White House Earns Its Union Label

In addition to delaying and rewriting key ACA provisions and carving out a special subsidy for members of Congress, Obama’s latest constitutional violation will exempt unions from a fee the law imposes upon all large group health plans. That provision which appears in Section 1341 (b)(1)(A)  establishes a reinsurance program to compensate insurers on exchanges in the individual market if they are hit with higher than expected costs to cover those with pre-existing conditions. This will come from insurers and self-insured employers who pay in proportion to the number of people they cover. The target is to raise $25 billion during 2014, amounting to $63 per covered employee. The union exemption would kick in for 2015 and 2016.

As reported in a Wall Street Journal editorial, “The unions hate this reinsurance transfer because it takes from their members in the form of higher premiums and gives to people on the exchanges.”

The union exemption deal will require that insurers who aren’t fully reimbursed by fees along with non-exempted self-insured employers will have to pay more to make up the shortfall. How will they make that up? How else but by passing on higher costs to their customers? The Department of Health and Human Services has confirmed that the fee for other non-exempt plans will be higher as a result.

Responding to union pressure, an exemption buried on page 72,340 of the December 2 Federal Register states: “Our continued study of this issue leads us to believe that this provision may reasonably be interpreted in one of two ways – it may be interpreted to mean that self-insured, self- administered plans must make reinsurance contributions, or it may be interpreted to mean that such plans are excluded from the obligation…upon further consideration of the issue, we believe the statutory language can reasonably be read…”

Yet as Betsy McCaughey points out in an Investor’s Business Daily piece, while Taft-Hartley plans self -insure and self-administer, the weasel-wording is a ruse. She writes:  “That’s a lie. The ACA’s reinsurance provision doesn’t use the word ‘self-insured’ or distinguish between plans that pay their own claims and plans that hire administrators.”

Here, “self-insured” refers to a business which pays directly for its workers’ policy costs and hires an insurer as a third-party administrator to process claims and manage care. “Self-administered” plans go one step farther and manage their benefits in-house. As the Wall Street Journal observes, other than collectively-bargained Taft-Hartley plans, “Almost no business in the real world still follows this old –fashioned practice”. Such insurance covers about 20 million union members, and about four out of five Taft-Hartley trusts.

Eleven Republican senators who see the exemption as blatant congressional circumvention and cronyism by the Obama administration to curry favor with political allies have introduced a bill called the “Union Tax Fairness Act” (S. 1724) to block it. Included are U.S. Senators Orrin Hatch (R-UT), John Thune (R-SD), Lamar Alexander (R-Tenn.), James Inhofe (R-OK), David Vitter (R-LA), Mike Enzi (R-WY), Ron Johnson (R-WS), John Barrasso (R-WY), Tim Scott (R-SC), Saxby Chambliss (R-GA), and Tom Coburn (R-OK).

Senator Hatch commented: Since the overwhelming majority of self-administered health insurance plans are run by unions, let’s call this what it is: a political payback by the administration to its union friends for backing this disastrous law. But the fact is, the White House doesn’t have the authority to change the law on its own and, as this bill makes clear, any attempt at a Big Labor carve-out from ObamaCare must be approved by Congress.”

Senator Thune said: “Unions should not be granted a special exemption from ObamaCare’s reinsurance tax just because the president fears further union backlash on his signature law. These unions agreed to pay this tax when they endorsed ObamaCare, but now that they are finding out what the law means for them and their plans, they want out. Rather than granting special backroom deals to political allies, the administration should support fairness for all by permanently delaying the law for every American.”

Senator Alexander added: The Obama administration should not reward its labor union friends and allies who helped pass the health care law by giving them a carve-out from the law’s worst provisions. This hefty reinsurance fee is one of the many job-killing taxes that helped pay for the passage of the law – the administration should be embarrassed that it would consider exempting their union cronies without providing similar relief to our nation’s employers and faith-based and charitable organizations.”

The unions weren’t the only cronies to get a special ObamaCare break. Insurers who went along with ACA from the beginning in order to expand markets from previously uninsured populations on the taxpayer dole didn’t want any of that same medicine for themselves.

Ten giant health insurance companies, including Blue Cross/Blue Shield, Cigna and Aetna, went to the White House and received waivers allowing them to impose yearly cap limits on health coverage they provide to their own employees. Under ObamaCare, companies which aren’t exempt are required to phase out caps on annual health care benefits by 2014.

Cigna Corp., the largest waiver exemption beneficiary, was allowed to cap benefits for its 265,000 employees. This exception was granted just slightly less than one month before its CEO David M. Cordani told attendees at a November 9, 2010 Reuters Health Summit: “I don’t think it’s in our society’s best interest to expend energy in repealing the law.”

Aetna was granted a waiver on October 1, 2010 allowing it to cap benefits for its 209,423 enrollees. The company’s CEO Mark Bertolini had previously expressed mixed feelings about the legislation. Writing in a March 2010 Op/Ed which appeared in the Hartford Courant shortly after it became law, he said: “When fully implemented, the new law will have a major effect on the market…Individuals and small employers will have more options and choices. The private sector will do what it does best: innovate to solve problems,”

The BCS Insurance Group which notes on their website “We are the premier source for insurance and reinsurance for Blue Cross and Blue Shield plans” received an ObamaCare waiver for its 115,000 enrollees. In fact three divisions of Blue Cross/Blue Shield reportedly received waivers. They include Excellus Blue Cross/Blue Shield (18,860 enrollees), Blue Cross/Blue/Shield of Tennessee (20,205 enrollees), and Mountain State Blue Cross/Blue Shield with 270 enrollees.

HHS waivers from oversight rules were granted to “Medigap” policy providers which exempts them from releasing and explaining health care payment rate increases. According to the Daily Caller, AARP, the largest of these, advocated for ObamaCare to include an attack on their biggest competitor, Medicare Advantage.

AARP was a driving force behind getting ObamaCare through Congress. They conducted a $121 million advertising campaign to push it, plus spent millions more lobbying for it on Capitol Hill. After President Obama called for $313 billion in Medicare cuts to fund his signature program, Medicare Advantage took the big hit.

Broken Premises

Don’t forget that ObamaCare would have encountered the same forgotten fate as HillaryCare had it not been for the support of big unions and insurers. Perhaps recall those throngs of United Federation of Teachers (UFT) and Service Employee International Union (SEIU) members picketing the Supreme Court in favor of its approval carrying signs that read “Protect Working Families, Protect the Law”.

And they already received gratitude. Immediately after the provisions took effect, unions requested and were granted 1,231 waivers exempting 543,812 of their employees compared with only 69, 813 non-union worker exemptions.

Continued in article

Jensen Comment
With most of the millions of signing up "affordable health care" getting free medical care under the expanded Medicaid programs or premiums subsidized by the government, it shouldn't end up as a surprise who will really pay for medical care in the future. That's becoming a no-brainer. Even clever millionaires such as students with trust funds are now eligible for free Medicaid health care.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm

 


How to Lie With Naive Politically Correct Estimates

"Affordable Care Act: 17 Million Can Get Subsidies," by Mary Agnes Carey, WebMD News from Kaiser Health News, November 5, 2013 ---
http://www.webmd.com/health-insurance/20131105/17-million-people-eligible-for-premium-subsidies-study-finds

Jensen Comment
Fraud is inevitable and cannot be prevented when it comes to giving out subsidies to to insured that are not legally entitled to such subsidies. Firstly, there's the $2 trillion underground economy where people are receiving income that even the IRS cannot detect --- those folks who work for unreported cash earnings. We're talking about millions of people who do not report any income to the IRS or greatly under report their incomes ---
http://www.cs.trinity.edu/~rjensen/temp/TaxNoTax.htm

Secondly, the 17 million reported above does not jive with the estimated 49.5% (of 130 million) of taxpayers who file tax returns but do not pay any income taxes. Some of them have incomes offset by credits such as credits for dependents, but its likely that the nearly all of 50% of taxpayers who pay no qualify, at least on paper, for subsidies ---
http://www.cs.trinity.edu/~rjensen/temp/TaxNoTax.htm

Most of those making more than $100,000 pay some income taxes. Bloomberg reports that 98% of those that pay no income taxes have less than $100,000 in earnings. Most are availing themselves of recent tax breaks such as energy credits, tax breaks from employer contributions to medical insurance, increased tax breaks for dependents, and deferred tax breaks such as breaks professors get for employer contributions to TIAA-CREF.

Watch the April 3, 2012 Bloomberg Video ---
http://www.bloomberg.com/video/89503501/

A family of four making less than $98,000 qualifies for a health insurance subsidy from the government.

Hence I think the 17 million estimate is wildly inaccurate unless tens of millions of those eligible for subsidies simply go uninsured because they cannot afford the deductibles even if the premiums with subsidies are affordable.

One added qualifier is the huge unknown (at least to me) number of Medicaid and Medicare recipients who are scoped out of the Affordable Health Care Act. Those on Medicaid do not pay income taxes. Most of those on Medicare do pay income taxes such that the sources of error in estimating the number of others who will actually claim subsidies under the Affordable Health Care Act is probably impossible to estimate within a 10 million range of error or more.

The enormous source of error that cannot be eliminated is that $2 trillion underground cash-only economy that takes place under the noses of the IRS enforcers of taxes.


"NBC News: "Obama Administration knew millions could not keep their health insurance," by Bob Beauprez, Townhall, October 30, 2013 ---
http://finance.townhall.com/columnists/bobbeauprez/2013/10/30/nbc-news-obama-administration-knew-millions-could-not-keep-their-health-insurance-n1733175 

When Obama repeatedly made the claim – "If you like your health plan; you can keep your health plan" – objective observers knew it wasn't so. This morning, the media is buzzing with evidence that Obama knew it was a lie, but deliberately kept spinning the same phony claim for years.

The shock in all this is not that Obama was lying; he has a well established record of that. It's that somebody has uncovered the evidence; the smoking gun. The following is the NBC News account of the mess du jour for the White House and ObamaCare.

Our sources deeply involved in the Affordable Care Act tell NBC NEWS that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.”

None of this should come as a shock to the Obama administration….

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

Continued in article

 


"5 Lies the Democrats Told To Sell Obamacare," by John Hawkins, Townhall, June 4, 2013 --- Click Here
http://townhall.com/columnists/johnhawkins/2013/06/04/5-lies-the-democrats-told-to-sell-obamacare-n1612356?utm_source=thdaily&utm_medium=email&utm_campaign=nl

. . .

It sounded great.

Of course, it also sounds great when a Nigerian prince offers to give you millions of dollars to help him get money into the United States. Unfortunately, those Nigerian princes with the funny names won't make you any richer, just as Presidents with funny names won't improve your health care. They'll just tell you lies like these.

1) Obamacare will cut the cost of your health care. If only. When Obamacare goes into effect next year, many Americans can expect STEEP increases in the cost of health care.

President Obama (promised)...that the cost of insurance would go down “by $2,500 per family per year.” ...In fact, the average 25 and 40-year-old will pay double under Obamacare what they would need to pay today, based on rates posted at eHealthInsurance.com (NASDAQ:EHTH). More specifically, for the typical 25-year-old male non-smoker, the average Obamacare “bronze” exchange plan in California will cost between 64 and 117 percent more than the cheapest five plans on eHealth. For 40-year-old male non-smokers, it’s between 73 and 146 percent more.

2) Obamacare will not increase the deficit. Calling for a massive new government program to cut costs is sort of like moving to Death Valley for the reduced air conditioning bills. Alas, it's not so.

Obamacare will increase the long-term federal deficit by $6.2 trillion, according to a Government Accountability Office (GAO) report released today.

Senator Jeff Sessions (R., Ala.), who requested the report, revealed the findings this morning at a Senate Budget Committee hearing. The report, he said, “confirms everything critics and Republicans were saying about the faults of this bill,” and “dramatically proves that the promises made assuring the nation that the largest new entitlement program in history would not add one dime to the deficit were false.”

President Obama and other Democrats attempted to win support for the health-care bill by touting it as a fiscally responsible enterprise. “I will not sign a plan that adds one dime to our deficits — either now or in the future,” Obama told a joint-session of Congress in September 2009. “I will not sign it if it adds one dime to the deficit, now or in the future, period.”

You mean Obama lied to us AGAIN? Who would have ever guessed?

3) "If you like your doctor, you will be able to keep your doctor. Period." Soon, many Americans will be happy if they can find A DOCTOR, much less THEIR DOCTOR.

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

 

The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

Even if doctors do not quit their jobs over the ruling, America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.

What good is health care, even the bad health care we'll get through Obamacare, if you can't find a doctor to see you when you're sick?

4) Obamacare will create jobs. That would be true if you added "...at the IRS" to the end of it, but companies have already begun to move millions of workers from full to part time to avoid punitive new costs under Obamacare.

Retailers are cutting worker hours at a rate not seen in more than three decades — a sudden shift that can only be explained by the onset of ObamaCare’s employer mandates.

 

Nonsupervisory employees logged an average 30.0 hours per week in April, the shortest retail workweek since early 2010, Labor Department data out Friday show.

…This reversal doesn’t appear related to the economy, which has been consistently mediocre. Instead, all evidence points to the coming launch of ObamaCare, which the retail industry has warned would cause just such a result.

...One way for employers to minimize the costs of providing “affordable” coverage to modest-wage workers is to shift more work to part-time, defined as less than 30 hours per week under ObamaCare.

So not only are they going to get crummy health care, they're getting their hours cut back, too. Thanks, Obama!

5) If you like your health care plan, you'll be able to keep it. According to Obama, even though the government is about to come crashing into the health care market like a Blue Whale bellyflopping into a pond, it isn't going to have any impact at all on the insurance companies that were already swimming along. Why, if you like your own insurance, then there is nothing to worry about because you can keep it.

Yet, just last week Fox News reported,

New health insurance rules under ObamaCare could lead to a host of personal insurance plans being canceled as early as this fall, a scenario expected to cause consumer confusion.

 

Under the federal overhaul, those policies that cannot meet new insurance plan standards may be discontinued. This means individuals, and some small businesses, that rely on those plans will have to find new ones.

The goal is to ensure that most insurance policies offer a basic set of coverage, as part of the Obama administration's plan to cover most of the nation's 50 million uninsured.

Yet it also seems to run afoul of one of the president's best-known promises on the law: "If you like your health care plan, you'll be able to keep your health care plan."

In fact, state insurance commissioners largely are giving insurers the option of canceling existing plans or changing them to comply with new federal requirements. Large employer plans that cover most workers and their families are unlikely to be affected.

The National Association of Insurance Commissioners says it is hearing that many carriers will cancel policies and issue new ones because administratively that is easier than changing existing plans.

..."You're going to be forcibly upgraded," said Bob Laszewski, a health care industry consultant. "It's like showing up at the airline counter and being told, 'You have no choice, $300 please. You're getting a first-class ticket, why are you complaining?'"

On a personal note, as someone who buys his own insurance, the cost of my policy has gone up $50 a month since Obamacare passed and I expect it to be cancelled this fall, but I guess it's a small price to pay for us little people if it allows Barack Obama to feel like he finally accomplished something "historic."

Obamacare hasn't fully taken effect yet, but when it does, it's only going to get worse. Everything from death panels to unimaginably long waits for surgeries to bureaucrats denying effective, relatively common, currently in use treatments because they are "too expensive" are all coming down the pike. Obamacare is too much of a disaster to truly fix; so the best thing we can do right now is let this nightmare become reality, let people see how bad it is and then insist on a repeal or bust. Either the Democrats live with the disaster they've inflicted on the American people at the ballot box long term or they do the right thing and allow us to repeal this monstrosity before it does even more damage to our country.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


"ObamaCare's Troubles Are Only Beginning:  Be prepared for eligibility, payment and information protection debacles—and longer waits for care," by Michael J. Boskin, The Journal of Accountancy, December 15, 2013 ---
http://online.wsj.com/news/articles/SB10001424052702304403804579260603531505102?mod=djemEditorialPage_h

The White House is claiming that the Healthcare.gov website is mostly fixed, that the millions of Americans whose health plans were canceled thanks to government rules may be able to keep them for another year, and that in any event these people will get better plans through ObamaCare exchanges. Whatever the truth of these assertions, those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond. Here's why:

The "sticker shock" that many buyers of new, ACA-compliant health plans have experienced—with premiums 30% higher, or more, than their previous coverage—has only begun. The costs borne by individuals will be even more obvious next year as more people start having to pay higher deductibles and copays.

If, as many predict, too few healthy young people sign up for insurance that is overpriced in order to subsidize older, sicker people, the insurance market will unravel in a "death spiral" of ever-higher premiums and fewer signups. The government, through taxpayer-funded "risk corridors," is on the hook for billions of dollars of potential insurance-company losses. This will be about as politically popular as bank bailouts.

The "I can't keep my doctor" shock will also hit more and more people in coming months. To keep prices to consumers as low as possible—given cost pressures generated by the government's rules, controls and coverage mandates—insurance companies in many cases are offering plans that have very restrictive networks, with lower-cost providers that exclude some of the best physicians and hospitals.

Next year, millions must choose among unfamiliar physicians and hospitals, or paying more for preferred providers who are not part of their insurance network. Some health outcomes will deteriorate from a less familiar doctor-patient relationship.

More IT failures are likely. People looking for health plans on ObamaCare exchanges may be able to fill out their applications with more ease. But the far more complex back-office side of the website—where the information in their application is checked against government databases to determine the premium subsidies and prices they will be charged, and where the applications are forwarded to insurance companies—is still under construction. Be prepared for eligibility, coverage gap, billing, claims, insurer payment and patient information-protection debacles.

The next shock will come when the scores of millions outside the individual market—people who are covered by employers, in union plans, or on Medicare and Medicaid—experience the downsides of ObamaCare. There will be longer waits for hospital visits, doctors' appointments and specialist treatment, as more people crowd fewer providers.

Those with means can respond to the government-driven waiting lines by making side payments to providers or seeking care through doctors who do not participate in insurance plans. But this will be difficult for most people.

Next, the Congressional Budget Office's estimated 25% expansion of Medicaid under ObamaCare will exert pressure on state Medicaid spending (although the pressure will be delayed for a few years by federal subsidies). This pressure on state budgets means less money on education and transportation, and higher state taxes.

The "Cadillac tax" on health plans to help pay for ObamaCare starts four years from this Jan. 1. It will fall heavily on unions whose plans are expensive due to generous health benefits.

In the nearer term, a political iceberg looms next year. Insurance companies usually submit proposed pricing to regulators in the summer, and the open enrollment period begins in the fall for plans starting Jan. 1. Businesses of all sizes that currently provide health care will have to offer ObamaCare's expensive, mandated benefits, or drop their plans and—except the smallest firms—pay a fine. Tens of millions of Americans with employer-provided health plans risk paying more for less, and losing their policies and doctors to more restrictive networks. The administration is desperately trying to delay employer-plan problems beyond the 2014 election to avoid this shock.

Meanwhile, ObamaCare will lead to more part-time workers in some industries, as hours are cut back to conform to arbitrary definitions in the law of what constitutes full-time employment. Many small businesses will be cautious about hiring more than 50 full-time employees, which would subject them to the law's employer insurance mandate.

On the supply side, medicine will become a far less attractive career for talented young people. More doctors will restrict practice or retire early rather than accept lower incomes and work conditions they did not anticipate. Already, many practices are closed to Medicaid recipients, some also to Medicare. The pace of innovation in drugs, medical devices and delivery is expected to slow significantly, as higher taxes and even rationing set in.

The repeated assertions by the law's supporters that nobody but the rich would be worse off was based on a beyond-implausible claim that one could expand by millions the number of people with health insurance, lower health-care costs without rationing, and improve quality. The reality is that any squeezing of insurance-company profits, or reduction in uncompensated emergency-room care amounts to a tiny fraction of the trillions of dollars extracted from those people overpaying for insurance, or redistributed from taxpayers.

The Affordable Care Act's disastrous debut sent the president's approval ratings into a tailspin and congressional Democrats in competitive districts fleeing for cover. If the law's continuing unpopularity enables Republicans to regain the Senate in 2014, the president will be forced to veto repeated attempts to repeal the law or to negotiate major changes.


It is exceptionally difficult -- for all practical purposes, impossible," writes Eberstadt, "for a medical professional to disprove a patient's claim that he or she is suffering from sad feelings or back pain. In other words, many people are gaming or defrauding the system. This includes not only disability recipients but health care professionals, lawyers and others who run ads promising to get you disability benefits. Between 1996 and 2011, the private sector generated 8.8 million new jobs, and 4.1 million people entered the disability rolls.
Michael Barone, "Men Find Careers in Collecting Disability," --- Click Here
http://townhall.com/columnists/michaelbarone/2012/12/03/men_find_careers_in_collecting_disability?utm_source=thdaily&utm_medium=email&utm_campaign=nl
 
Jensen Comment
 Even after one or more spine surgeries it is virtually impossible to determine whether remaining pain is real or faked. I can claim first hand that after 15 spine surgeries and metal rods from neck to hip that my wife's suffering is real. However, I know of at least two instances where the disability careers are faked in order to get monthly lifetime disability payments and access to Medicare long prior to age 65. This seems to be one of the unsolvable problems in society that becomes even more problematic when a disability career is easier to enter than a job-like career.


Two  Ivy League Professors Slugging It Out in a Political Arena

Harvard History Professor Niall Ferguson --- http://en.wikipedia.org/wiki/Niall_Ferguson
Princeton Economics Professor Paul Krugman --- http://en.wikipedia.org/wiki/Paul_Krugman

"Kinds Of Wrong," by Paul Krugman, The New York Times, August 21, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/21/kinds-of-wrong/

Looking at the comments on my Niall Ferguson takedown (see Ezra Klein, Matthew O’Brien, James Fallows, and Noah Smith for more), I found my memory jogged about a point I’ve been meaning to make about the nature of error in economics.

It seems to me that when readers declare that some piece of economics commentary is “wrong”, they often confuse three different notions of wrongness, which are neither intellectually nor morally equivalent.

First, there’s the ordinary business of expressing a view about the economy that the reader disagrees with – e.g., “Krugman is wrong, because the government can’t create jobs”; or, if you prefer, “Casey Mulligan is wrong, because we’re suffering from demand problems, not supply problems.” Obviously it’s OK to say things like this, and sometimes the criticism is correct. (I’m not wrong, but Mulligan is!) But equally obviously, there’s nothing, er, wrong about being wrong in this sense: people will disagree, and that’s legitimate.

Second, and much less legitimate, is the kind of wrongness that involves making assertions that are logically or empirically indefensible. I’d put the Cochrane/Fama claims that government spending can’t increase demand as a matter of accounting in this category; this is a basic conceptual error, which goes beyond mere difference of opinion. And economists who are wrong in this sense should pay a professional price.

That said, I don’t think it’s realistic to expect the news media to be very effective at policing this kind of wrongness. If professors with impressive-sounding credentials spout nonsense, it’s asking too much of a newspaper or magazine serving the broader public to make the judgment that they actually have no idea what they’re talking about.

Matters are quite different when it comes to the third kind of wrongness: making or insinuating false claims about readily checkable facts. The case in point, of course, is Ferguson’s attempt to mislead readers into believing that the CBO had concluded that Obamacare increases the deficit. This was unethical on his part – but Newsweek is also at fault, because this is the sort of thing it could and should have refused to publish.

Now, I don’t expect a publication that responds to daily or weekly news to do New Yorker-style fact checking. But it should demand that anyone who writes for it document all of his or her factual assertions – and an editor should check that documentation to see that it actually matches what the writer says.

Continued in article

 

"Unethical Commentary, Newsweek Edition," by Paul Krugman, The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/

There are multiple errors and misrepresentations in Niall Ferguson’s cover story in Newsweek I guess they don’t do fact-checking — but this is the one that jumped out at me. Ferguson says:

The president pledged that health-care reform would not add a cent to the deficit. But the CBO and the Joint Committee on Taxation now estimate that the insurance-coverage provisions of the ACA will have a net cost of close to $1.2 trillion over the 2012–22 period.

Readers are no doubt meant to interpret this as saying that CBO found that the Act will increase the deficit. But anyone who actually read, or even skimmed, the CBO report (pdf) knows that it found that the ACA would reduce, not increase, the deficit — because the insurance subsidies were fully paid for.

Now, people on the right like to argue that the CBO was wrong. But that’s not the argument Ferguson is making — he is deliberately misleading readers, conveying the impression that the CBO had actually rejected Obama’s claim that health reform is deficit-neutral, when in fact the opposite is true.

More than that: by its very nature, health reform that expands coverage requires that lower-income families receive subsidies to make coverage affordable. So of course reform comes with a positive number for subsidies — finding that this number is indeed positive says nothing at all about the impact on the deficit unless you ask whether and how the subsidies are paid for. Ferguson has to know this (unless he’s completely ignorant about the whole subject, which I guess has to be considered as a possibility). But he goes for the cheap shot anyway.

Continued in article

Jensen Comment
The CBO assumes that the requirement (just upheld by a Supreme Court decision) that all people in the United States have health insurance or otherwise will have health insurance premiums deducted from their tax refunds that will fund the added cost of covering current poor people needing subsidies for health insurance coverage. This is what Krugman means above when he assumes "the insurance subsidies are fully paid for." This is why the Affordable Health Care Act (ACA) tried to get states to raise the number of people receiving state subsidies for Medicaid. About half the states, however, are refusing to along with the expanded coverage under Medicaid. This means that more higher-end low income people will depend on the ACA "subsidies" instead of Medicaid coverage from federal and state Medicaid funding.

It seems to be a matter of semantics whether these tax return add-ons are a tax or not, but Krugman (probably rightfully) ignores this matter of semantics. But since about half the taxpayers in the U.S. pay no income taxes and over 90% of them are below the median in earnings it's not clear whether enough insurance premiums expected to be collected will really be collected. The CBO may have been planning on an economic recovery that perhaps will never materialize in this new era of global competition with Asia. The CBO expectations of lower unemployment may not materialize (currently there are nearly 13 million unemployed people not counting the many who've simply given up looking for work or received fraudulent Social Security lifetime disability awards). The required subsidies in reality may greatly exceed the added premiums "tax" collected. But nobody, including the CBO, knows what deficits will become.

Also it's not at all clear that the CBO correctly estimated health care claims given the double-digit inflation in the cost of medical services. This is the real Achilles Heel of the Affordable Health Care Act. The costs of actually providing the promised services in the future may greatly exceed expectations.

What may be more subject to dispute is how accurate the CBO is on estimating future costs of bringing on people who have prior conditions that prevent them from currently being able to obtain health care coverage. I'm definitely in favor of providing affordable coverage to these people with prior conditions. But I think the eventual coverage costs will exceed CBO estimates since many of them need high-cost organ transplants and other very expensive medical services.

Professor Krugman has a very loyal crowd of liberal followers who seldom disagree with his liberal politics.
The comment of NS
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/
 

I am very surprised by the hysterical reaction of many readers to Krugman's comment. The point of the argument is what the HBO report says. Does Ferguson lie about the HBO report in his Newsweek article? Either Ferguson or Krugman is correct. I would expect readers disagreeing with Krugman to provide quotations from the HBO report showing that he is wrong and that Ferguson is right.

Instead of that I see a lot of ideological delirium in too many of the comments.

NS, Paris, France

 

Comment of Laurie Wick
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/

I cancelled my subscription to Newsweek today. I do not need this kind of uninformed blather in my home. If I feel the need to read/hear totally unfactual, biased reporting, I can just turn on FOX news at any hour of the day or night. Which I will never do.

Laurie Wick

Jensen Comment
Actually, since Tina Brown became editor, Newsweek became a liberal feminist magazine. Niall Ferguson's column is only there for tokenism. The Ferguson cover story is most likely a desperate attempt to recover the millions of conservative subscribers who've defected since Tina Brown took over. One of the recent cover's of Newsweek accuses Candidate Romney of "being a Wimp." Are you sure you want to cancel Newsweek Laurie?

The Comment of J. Philip
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/

FTA: "health reform that expands coverage requires that lower-income families receive subsidies to make coverage affordable. "

And, exactly,. Mr. Krugman, where do you think those subsidies are gonna come from? You can continue to carry Obama's water that's what you get paid to do, but the rest of us know a TAX when we see one.

J. Phillip

Closing Jensen Comment
I wish the Democrats had rammed a national health care plan down our throats in that short window of time 2008-2010 when they controlled the entire executive and legislative branches of the federal government. Instead we ended up with a bastardized public-private ACA that pleases neither the left nor the right. I am inclined to believe that the ACA will always have insurance premiums falling way short of costs of delivering medical services. Whether or not this adds to the deficit is simply a matter of accounting gimmicks the familiar governmental accounting shell game ---
http://www.trinity.edu/rjensen/Theory02.htm#GovernmentalAccounting

Bob Jensen's threads on the ACA are at
http://www.trinity.edu/rjensen/Health.htm


Paul Ryan on the Affordable Health Care Act --- http://www.youtube.com/watch?v=zPxMZ1WdINs

The larger reality is that Medicare cannot and will not continue as it is, as the President used to admit. A sampler of his rhetoric from the town-hall summer of 2009: "Mark my words," he declared in Grand Junction, Colorado, "Medicare in about eight to nine years goes into the red. . . . It is going broke." He added in Portsmouth, New Hampshire, that "What is truly scary—what is truly risky—is if we do nothing" because Medicare is "unsustainable" and "running out of money." In Belgrade, Montana, he said the program must be reformed "to be there for the next generation, not just for this generation."What he rarely mentions is how he plans to fix Medicare under ObamaCare. First the government will do things like arbitrarily commanding providers to deliver the exact same benefits except for $716 billion less. When that doesn't work, as it surely won't, the feds will take control of the case-by-case decisions currently made between patients and doctors and substitute the judgment of technocrats. (See what's already happening in Massachusetts, "RomneyCare 2.0," August 6.)
"The Mediscare Boomerang," The Wall Street Journal, August 16, 2012 ---
http://professional.wsj.com/article/SB10000872396390444772404577587464183295348.html?mod=djemEditorialPage_t&mg=reno64-wsj

 


It's Unethical as it Gets in the Whitehouse
"Axelrod's ObamaCare Dollars Emails suggest the White House pushed business to the presidential adviser's former firm to sell the health-care law," by Kimberly A. Strassel, The Wall Street Journal, June 21, 2012 ---
http://professional.wsj.com/article/SB10001424052702304765304577480871706139792.html?mod=djemEditorialPage_t&mg=reno-wsj

Rewind to 2009. The fight over ObamaCare is raging, and a few news outlets report that something looks ethically rotten in the White House. An outside group funded by industry is paying the former firm of senior presidential adviser David Axelrod to run ads in favor of the bill. That firm, AKPD Message and Media, still owes Mr. Axelrod money and employs his son.

The story quickly died, but emails recently released by the House Energy and Commerce Committee ought to resurrect it. The emails suggest the White House was intimately involved both in creating this lobby and hiring Mr. Axelrod's firm—which is as big an ethical no-no as it gets.

Mr. Axelrod—who left the White House last year—started AKPD in 1985. The firm earned millions helping run Barack Obama's 2008 campaign. Mr. Axelrod moved to the White House in 2009 and agreed to have AKPD buy him out for $2 million. But AKPD chose to pay Mr. Axelrod in annual installments—even as he worked in the West Wing. This agreement somehow passed muster with the Office of Government Ethics, though the situation at the very least should have walled off AKPD from working on White-House priorities.

It didn't. The White House and industry were working hand-in-glove to pass ObamaCare in 2009, and among the vehicles supplying ad support was an outfit named Healthy Economy Now (HEN). News stories at the time described this as a "coalition" that included the Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association, and labor groups—suggesting these entities had started and controlled it.

House emails show HEN was in fact born at an April 15, 2009 meeting arranged by then-White House aide Jim Messina and a chief of staff for Democratic Sen. Max Baucus. The two politicos met at the Democratic Senatorial Campaign Committee (DSCC) and invited representatives of business and labor.

A Service Employees International Union attendee sent an email to colleagues noting she'd been invited by the Baucus staffer, explaining: "Also present was Jim Messina. . . . They basically want to see adds linking HC reform to the economy. . . . there were not a lot of details, but we were told that we wd be getting a phone call. well that call came today."

The call was from Nick Baldick, a Democratic consultant who had worked on the Obama campaign and for the DSCC. Mr. Baldick started HEN. The only job of PhRMA and others was to fund it.

Meanwhile, Mr. Axelrod's old firm was hired to run the ads promoting ObamaCare. At the time, a HEN spokesman said HEN had done the hiring. But the emails suggest otherwise. In email after email, the contributors to HEN refer to four men as the "White House" team running health care. They included John Del Cecato and Larry Grisolano (partners at AKPD), as well as Andy Grossman (who once ran the DSCC) and Erik Smith, who had been a paid adviser to the Obama presidential campaign.

In one email, PhRMA consultant Steve McMahon calls these four the "WH-designated folks." He explains to colleagues that Messrs. Grossman, Grisolano and Del Cecato "are very close to Axelrod," and that "they have been put in charge of the campaign to pass health reform." Ron Pollack, whose Families USA was part of the HEN coalition, explained to colleagues that "the team that is working with the White House on health-care reform. . . . [Grossman, Smith, Del Cecato, Grisolano] . . . would like to get together with us." This would provide "guidance from the White House about their messaging."

According to White House visitor logs, Mr. Smith had 28 appointments scheduled between May and August—17 made through Mr. Messina or his assistant. Mr. Grossman appears in the logs at least 19 times. Messrs. Del Cecato and Grisolano of AKPD also visited in the spring and summer, at least twice with Mr. Axelrod, who was deep in the health-care fight.

A 2009 PhRMA memo also makes clear that AKPD had been chosen before PhRMA joined HEN. It's also clear that some contributors didn't like the conflict of interest. When, in July 2009, a media outlet prepared to report AKPD's hiring, a PhRMA participant said: "This is a big problem." Mr. Baldick advises: "just say, AKPD is not working for PhRMA." AKPD and another firm, GMMB, would handle $12 million in ad business from HEN and work for a successor 501(c)4.

A basic rule of White House ethics is to avoid even the appearance of self-dealing or nepotism. If Mr. Axelrod or his West Wing chums pushed political business toward Mr. Axelrod's former firm, they contributed to his son's salary as well as to the ability of the firm to pay Mr. Axelrod what it still owed him. Could you imagine the press frenzy if Karl Rove had dome the same after he joined the White House?

Continued in article


"Study: Obama's Health Care Law Would Raise Deficit," SmartPros, April 10, 2012 ---
http://accounting.smartpros.com/x73682.xml

Reigniting a debate about the bottom line for President Barack Obama's health care law, a leading conservative economist estimates in a study to be released Tuesday that the overhaul will add at least $340 billion to the deficit, not reduce it.

Charles Blahous, who serves as public trustee overseeing Medicare and Social Security finances, also suggested that federal accounting practices have obscured the true fiscal impact of the legislation, the fate of which is now in the hands of the Supreme Court.

Officially, the health care law is still projected to help reduce government red ink. The Congressional Budget Office, the government's nonpartisan fiscal umpire, said in an estimate last year that repealing the law actually would increase deficits by $210 billion from 2012 to 2021.

The CBO, however, has not updated that projection. If $210 billion sounds like a big cushion, it's not. The government has recently been running annual deficits in the $1 trillion range.

The White house dismissed the study in a statement late Monday. Presidential assistant Jeanne Lambrew called the study "new math (that) fits the old pattern of mischaracterizations" about the health care law.

Blahous, in his 52-page analysis released by George Mason University's Mercatus Center, said, "Taken as a whole, the enactment of the (health care law) has substantially worsened a dire federal fiscal outlook.

"The (law) both increases a federal commitment to health care spending that was already unsustainable under prior law and would exacerbate projected federal deficits relative to prior law," Blahous said.

The law expands health insurance coverage to more than 30 million people now uninsured, paying for it with a mix of Medicare cuts and new taxes and fees.

Blahous cited a number of factors for his conclusion:

- The health care's law deficit cushion has been reduced by more than $80 billion because of the administration's decision not to move forward with a new long-term care insurance program that was part of the legislation. The Community Living Assistance Services and Supports program raised money in the short term, but would have turned into a fiscal drain over the years.

- The cost of health insurance subsidies for millions of low-income and middle-class uninsured people could turn out to be higher than forecast, particularly if employers scale back their own coverage.

- Various cost-control measures, including a tax on high-end insurance plans that doesn't kick in until 2018, could deliver less than expected.

The decision to use Medicare cuts to finance the expansion of coverage for the uninsured will only make matters worse, Blahous said. The money from the Medicare savings will have been spent, and lawmakers will have to find additional cuts or revenues to forestall that program's insolvency.

Under federal accounting rules, the Medicare cuts are also credited as savings to that program's trust fund. But the CBO and Medicare's own economic estimators already said the government can't spend the same money twice.

Continued in article

 


Freakonomics
"Here’s Why Health Care Costs Are Outpacing Health Care Efficacy," by Stephen J. Dubner, Freakonomics.com, April 18, 2011 ---
http://www.freakonomics.com/2011/04/18/heres-why-health-care-costs-are-outpacing-health-care-efficacy/

In a new working paper called “Technology Growth and Expenditure Growth in Health Care” (abstract here, PDF here), Amitabh Chandra and Jonathan S. Skinner offer an explanation:

In the United States, health care technology has contributed to rising survival rates, yet health care spending relative to GDP has also grown more rapidly than in any other country.  We develop a model of patient demand and supplier behavior to explain these parallel trends in technology growth and cost growth.  We show that health care productivity depends on the heterogeneity of treatment effects across patients, the shape of the health production function, and the cost structure of procedures such as MRIs with high fixed costs and low marginal costs.  The model implies a typology of medical technology productivity:  (I) highly cost-effective “home run” innovations with little chance of overuse, such as anti-retroviral therapy for HIV, (II) treatments highly effective for some but not for all (e.g.  stents), and (III) “gray area” treatments with uncertain clinical value such as ICU days among chronically ill patients.  Not surprisingly, countries adopting Category I and effective Category II treatments gain the greatest health improvements, while countries adopting ineffective Category II and Category III treatments experience the most rapid cost growth. Ultimately, economic and political resistance in the U.S. to ever-rising tax rates will likely slow cost growth, with uncertain effects on technology growth.

This paper strikes me as sensible, explanatory, and non-ideological to the max. It would be nifty if the people who work in Washington read it, and thought about it, and maybe even acted on it. (And it would be nifty if the Knicks beat the Celtics too, but I’m not holding my breath for either outcome …)

Here’s a very good paragraph from the paper:

The science section of a U.S. newspaper routinely features articles on new surgical and pharmaceutical treatments for cancer, obesity, aging, and cardiovascular diseases, with rosy predictions of expanded longevity and improved health functioning (Wade, 2009). The business section, on the other hand, features gloomy reports of galloping health insurance premiums (Claxton et al., 2010), declining insurance coverage, and unsustainable Medicare and Medicaid growth leading to higher taxes (Leonhardt, 2009) and downgraded U.S. debt (Stein, 2006). Not surprisingly, there is some ambiguity as to whether these two trends, in outcomes and in expenditures, are a cause for celebration or concern.

And the authors offer good specific examples of what they built their argument on, noting the …

Continued in article


"The Truth About Health Care Reform and the Economy:  Separating economic fact from economic myth," by Veronique de Rugy, Reason Magazine, April 15, 2011 --- http://reason.com/archives/2011/04/15/the-truth-about-health-care-re

Myth 1: Health care reform will reduce the deficit.

Fact 1: Health care reform will increase the deficit.

The Patient Protection and Affordable Care Act includes many provisions that have nothing to do with health care: the CLASS act, a student loan overhaul, and many new taxes. These provisions don't change the health care system. They just raise money to pay for the new law. Strip them away and the law’s actual health care provisions don't lower the deficit—they increase it!

The chart below uses data from Congressional Budget Office (CBO) to clarify the fiscal consequences of health care reform.

. . .

As you can see, from 2012 to 2021, the Congressional Budget Office estimates that the health care act will reduce deficits by $210 billion (note that this estimate differs from the widely cited $143 billion figure used during the lead-up to the passage of the act). During this same time period, however, the actual health care reform provisions of the law will increase deficits by $464 billion.

Of course, one should not evaluate the health care legislation on its fiscal impacts alone. In theory we should get some fiscal benefits. But the key question is how they net out. Still, no matter what you think about the benefits of the health care legislation, it is incorrect to claim that health care reform will save money. It won’t.

Myth 2: The U.S. health care system is a free-market system.

Fact 2: Roughly half of all U.S. health care is currently paid for by the government.

. . .

Even in the absence of the health care reform law, government programs including Medicare and Medicaid already fund almost half of American health care. Roughly a third of the remaining expenditures are funded by private insurers—mainly through subsidized and highly regulated employee plans. Not exactly a free market.

As this chart shows, state and federal entities make up over half of the health insurance market. Of course, the Patient Protection and Affordable Care Act will only increase the share of government involvement in the health care market.

Myth 3: Medicare spending increases life expectancy for seniors. Reductions in Medicare spending will therefore reduce their life expectancy.

Fact 3: Increases in life expectancy for seniors are due to increased access to health care, not to Medicare.

While Medicare spending has certainly decreased seniors’ out of pocket health care expenses (by 1970, Medicare reduced out of pocket expenses by an estimated 40 percent relative to pre-Medicare levels), the program’s effect on mortality is much less clear.

. . .

Continued in article


"Mayberry OMG:  Those false ads cost taxpayers $3.5 million," The Wall Street Journal, March 25, 2011 ---
|http://online.wsj.com/article/SB10001424052748704604704576220640964310506.html#mod=djemEditorialPage_t

President Obama met with the winner of the "save award" in the Oval Office the other day, the contest for federal employees who find ways to make government more efficient. Trudy Givens, of Portage, Wisconsin, suggested that the feds stop mailing out paper copies of the Federal Register (available online since 1994) to the provinces. Her good idea will cut about $4 million a year in printing and postage.

We don't work for the government, but here's our "save" suggestion: How about not spending some $3.5 million to deceptively promote ObamaCare?

It turns out it cost the Health and Human Services Department $2.78 million to buy airtime for three cable TV ads last year, featuring Andy Griffith praising the new entitlement. The "Matlock" eminence rendered his services pro bono, but Porter Novelli didn't. The media consulting firm racked up 668 billable hours and earned $404,384.40 producing the spots, according to documents released by the outside GOP advocacy group Crossroads GPS through the Freedom of Information Act.

At least Porter Novelli didn't charge taxpayers for fact-checking. Among Mr. Griffith's many deceptive claims, he tells his fellow seniors that their Medicare benefits won't change (they will, most immediately in Medicare Advantage) and that ObamaCare strengthens the program's finances (it doesn't, according to the chief Medicare actuary). Lovable ol' Andy of Mayberry then says "that new health-care law sure sounds good" to him, in a transparent bid to win over senior voters in advance of the 2010 election.

The next time the President wants to run misleading ads ahead of an election, he might hit up the Democratic Party or use his bully pulpit, rather than passing the bill to taxpayers. Meantime, an Administration functionary says in a new promotional Web video for the save award—how much did that one cost to produce?—that "Something that seems relatively small if replicated over the full length of the federal government can really result in substantial savings."

How about we go one better and save several trillion dollars by repealing a health-care bill that Americans still hate despite Sheriff Andy's endorsement?


"PolitiFiction True 'lies' about ObamaCare," The Wall Street Journal, December 23, 2010 ---
http://online.wsj.com/article/SB10001424052748703886904576031630593433102.html?mod=djemEditorialPage_t

So the watchdog news outfit called PolitiFact has decided that its "lie of the year" is the phrase "a government takeover of health care." Ordinarily, lies need verbs and we'd leave the media criticism to others, but the White House has decided that PolitiFact's writ should be heard across the land and those words forever banished to describe ObamaCare.

"We have concluded it is inaccurate to call the plan a government takeover," the editors of PolitiFact announce portentously. "'Government takeover' conjures a European approach where the government owns the hospitals and the doctors are public employees," whereas ObamaCare "is, at its heart, a system that relies on private companies and the free market." PolitiFact makes it sound as if ObamaCare were drawn up by President Friedrich Hayek, with amendments from House Speaker Ayn Rand.

This purported debunking persuaded Stephanie Cutter, a special assistant to the President. If "opponents of reform haven't been shy about making claims that are at odds with the facts," she wrote on the White House blog, "one piece of misinformation always stood out: the bogus claim . . ." We'll spare you the rest.

PolitiFact's decree is part of a larger journalistic trend that seeks to recast all political debates as matters of lies, misinformation and "facts," rather than differences of world view or principles. PolitiFact wants to define for everyone else what qualifies as a "fact," though in political debates the facts are often legitimately in dispute.

For instance, everyone can probably agree that Medicare's 75-year unfunded liability is somewhere around $30.8 trillion. But that's different from a qualitative judgment, such as the wisdom of a new health-care entitlement that was sold politically as a way to reduce entitlement spending. But anyway, let's try to parse PolitiFact's ObamaCare reasoning.

Evidently, it doesn't count as a government takeover unless the means of production are confiscated. "The government will not seize control of hospitals or nationalize doctors," the editors write, and while "it's true that the law does significantly increase government regulation of health insurers," they'll still be nominally private too.

In fact—if we may use that term without PolitiFact's seal of approval—at the heart of ObamaCare is a vast expansion of federal control over how U.S. health care is financed, and thus delivered. The regulations that PolitiFact waves off are designed to convert insurers into government contractors in the business of fulfilling political demands, with enormous implications for the future of U.S. medicine. All citizens will be required to pay into this system, regardless of their individual needs or preferences. Sounds like a government takeover to us.

PolitiFact is run by the St. Petersburg Times and has marketed itself to other news organizations on the pretense of impartiality. Like other "fact checking" enterprises, its animating conceit is that opinions are what ideologues have, when in reality PolitiFact's curators also have political views and values that influence their judgments about facts and who is right in any debate.

In this case, they even claim that the government takeover slogan "played an important role in shaping public opinion about the health-care plan and was a significant factor in the Democrats' shellacking in the November elections." In other words, voters turned so strongly against Democrats because Republicans "lied," and not because of, oh, anything the Democrats did while they were running Congress. Is that a "fact" or a political judgment? Just asking.

As long as the press corps is nominating "lies of the year," ours goes to the formal legislative title of ObamaCare, the Patient Protection and Affordable Care Act. For a bill that in reality will raise health costs and reduce patient choice, the name recalls Mary McCarthy's famous line about every word being a lie, including "the" and "and."


"Bachmann Exposes $105 Billion Secret," by Phyllis Schlaffy, Townhall, March 15, 2011 ---
http://townhall.com/columnists/phyllisschlafly/2011/03/15/bachmann_exposes_$105_billion_secret

When ObamaCare was passed by the Senate on Christmas Eve of 2009, senators had less than 72 hours to compare a 383-page package of amendments to the 2,074-page bill. Public outrage over backroom deals (such as the Cornhusker Kickback and the Louisiana Purchase) led to the election of Scott Brown in Massachusetts.

Democrats then cooked up a plan to link the now-2,409-page Senate-passed ObamaCare bill to dozens of amendments contained in a separate 150-page Budget Reconciliation bill that could pass both houses by a simple majority. That's when then-Speaker Nancy Pelosi famously told the then-Democratic majority, "We have to pass the bill so that you can find out what is in it."

When President Obama signed ObamaCare into law, that set in motion a series of funding triggers and money transfers that add up to $105,464,000,000 in pre-authorized appropriations that are scheduled to be paid up through FY2019. In laymen's language, that means writing postdated checks that are guaranteed to be paid out over the next eight years.

This money was divided into dozens of smaller amounts so the big total would not be apparent. For example, Section 2953 of ObamaCare included a pre-funded appropriation of $75 million a year for five years to "educate adolescents" in "adult preparation subjects" such as "stress management" and "the development of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects."

Section 4101(a) of ObamaCare prefunded $200 million a year over four years for the construction of school-based health centers. In Section 4002, a total of $17,750,000,000 will be deposited over 10 years to a discretionary account controlled by the HHS secretary (currently Kathleen Sebelius), who may spend that money "to provide for expanded and sustained national investment in prevention" and to "help restrain the rate of growth in private and public sector health care costs."

Continued in article

Also see http://townhall.com/columnists/terryjeffrey/2011/03/16/congress_must_stop_$1055_billion_in_automatic_obamacare_spending


White did President Obama turn down IBM's offer to, for free, to detect medical fraud?
Video:  Did White House Snub Fraud Fighter?

http://news.yahoo.com/video/politics-15749652/did-white-house-snub-fraud-fighter-22352314

Is Medicare a "Medicare is a good example of a government program that is highly efficient?"

-----Original Message-----
From: AECM, Accounting Education using Computers and Multimedia [mailto:AECM@LISTSERV.LOYOLA.EDU] On Behalf Of Peters, James M Sent: Thursday, September 23, 2010 10:37 AM

To: AECM@LISTSERV.LOYOLA.EDU
Subject: Re: accounting basics

I think it is time to push back against all this anti-government rhetoric that just isn't based on observed evidence. Whether goverments work best or markets work best is a function of the task to be performed and the nature of the product. Governments have proven they can provide better health insurance and health care than the private sector. Medicare is a good example of a goverment program that is highly efficient and spends 97% of your tax dollars on health care while private sector firms spend only 70% to 75% of your premium dollars on health care. Some firms reach 80%, but they are the exception. Government run hospitals in the US are now rated as among the best, if not the best in the nation. The Veterans Hospitals have better records of treatment success and lower costs that the vast majority of private hospitals.

Market advocates seem to forget free market theory. Free markets only work when certain, rather restrictive conditions are met. Among the most frequently violated are equal power and knowledge among all market participants. Even Adam Smith in the Wealth of Nations advocated a strong role for governments in keeping markets free. When conditions are right, markets work brilliantly. However, (a rhetorical question) how many market in the industrialize world really meet the conditions of truly free markets? My answer is very few.

Governments do some things much better than markets. The key is recognizing the market conditions that lead to government advantage and letting governments handle those areas. Auditing is a prime candidate for government intervention because of no auditor can truly be objective when they are being paid by the client. The markets cannot function properly in auditing because the true customer, the general public, isn't a party to the transaction. Audits aren't just for the current owners, they are for perpsective owners as well, which means the general public. The general public needs to be represented at the table when auditors are hired.

The other key is to recognize that governments fail when people fail to be informed voters. All governments, like all markets, are not made equal. Some work better than others. In democracies, the effectiveness of the government is a function of the involvement and knowledge of the electorate. Thus, we are all responsible for our own government's success and failures. The fact that America seems to have a disfunctional government right now is that we have a disfunctional electorate that seems to enjoy mindless shouting matches over informed policy dialog. Other nations don't suffer from this disease.

Let's all join John Stewart in Washington DC for the "Return Sanity to America" rally. It is a start to building a government that can live up to its potential.

Jim

September 23, 2010 reply from Bob Jensen

Hi Jim,

If this is your idea of "observed evidence" then I've no hope for you in the academy. For one thing a good academic would be more precise about definitions like “better health care.” For example, some other nations come out “better” in infant mortality because they throw away very premature small babies and don’t count them into survival rates. What does “better” mean in terms of who invents the latest and greatest medications to fight cancer?

Medicare, for example, is one of the least-efficient government programs that arguably has the worst internal accounting controls of all other government programs except, possibly, the defense program. An "efficient" program would have stellar internal controls preventing fraud and error.

President Obama repeatedly asserts that "Medicare and Medicaid are largest deficit drivers" ---
http://www.politifact.com/truth-o-meter/statements/2009/jun/25/barack-obama/obama-says-medicare-and-medicaid-are-largest-defic/

And Medicare is not a very good example of "government" efficiency since the private sector delivers virtually all the medical services. The Medicare service providers are notoriously inefficient by prescribing billions of dollars in unneeded services, medications, non-existent medical equipment, and lifetime disability benefits to crooks that are not disabled.

I don't care to continue on in the AECM with debates over extreme political dogma since this is truly outside what subscribers expect from the AECM. They wanted to learn more about the PwC re-branding and the future of auditing/assurance services. I doubt that they want to hear a rant about joining a Glenn Beck-bashing by Jon Stewart in Washington DC. Most of us do not support the extremes of Beck or Stewart and certainly do not want the AECM to be a rallying call for either extreme. That is not in the mission of the AECM.

Also I see no need to censor the other subscribers of the AECM if they happen to disagree with Jim Peterson’s political dogma. Even if I were a Glenn Beck supporter (which I’m not) I would not urge AECM subscribers to join me in Beck’s big Washington DC rally (where you would never find me).

It’s a free country, and I suspect you will be among the Glenn Beck bashers at Jon Stewart’s rally for liberals. But I don’t think you should plead with AECM subscribers to join you in this political burning of Beck’s books.

Bob Jensen

 

 


In 2009 President Barack Obama is engineering a universal health care bill by appealing to the with blatant and deceitful estimates of costs in a muddled up system of inclusions of social services that are only remotely linked to health care (such as marriage counseling).

Note that I’m not in favor of repealing the recent legislation. But I am in favor of adding a public option so long as taxation and insurance premiums are added to fully cover the annual costs of health insurance. And let's stop the BS on the left and on the right side of this debate.

Some of the blatant lies are as follows:

 

The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

So, you can’t try to seek alternatives to lawsuits if you’ve actually done something to implement alternatives to lawsuits. Brilliant! The trial lawyers must be very happy today!

While there is debate over the details, it is clear that medical malpractive lawsuits have some impact on driving health care costs higher. There are likely a number of procedures that are done simply as a defense against future possible litigation. Recall this from the Washington Post:

“Lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits, congressional budget analysts said today — a substantial sum that could help cover the cost of President Obama’s overhaul of the nation’s health system. New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but would also spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin Hatch (R-Utah).”

Longtime readers will recall that we caught Kristof playing similar games with statistics back in January 2005, when he claimed that the U.S. infant-mortality rate was worse than communist Cuba's and much worse than European rates. We pointed out that a central reason U.S. rates are high is that American physicians make heroic efforts to save extremely premature infants, who nonetheless have a mortality rate in excess of 50%. In other countries, these babies are simply discarded and not even counted in the statistics.
Wall Street Journal Editors Newsletter, November 6, 2009

Sampling Only

President Obama tried to sell his health care overhaul in prime time, mangling some facts in the process. He also strained to make the job sound easier to pay for than experts predict.

Note: This is a summary only. The full article with analysis, images and citations may be viewed on the above Fact Check Websites.



Updates on August 31, 2010

"Go To the Back of the CLASS," by Ed Feulner, Townhall, August 17, 2010 ---
http://townhall.com/columnists/EdFeulner/2010/08/18/go_to_the_back_of_the_class

In Washington, politicians often give their bills clever names designed more to obscure than to reveal.

Consider the CLASS Act. It sounds like yet another federal attempt to meddle in local schools. Instead, it stands for “Community Living Assistance Services and Support.”

CLASS was a little-noticed part of the massive Obamacare bill that the president signed in March. It’s supposed to provide affordable long-term care insurance to American workers. In reality, it creates another entitlement likely to increase our exploding federal deficit.

Starting next year CLASS is scheduled to begin enrolling people and collecting premiums. If CLASS was a normal insurance program, it would invest these premiums to build reserves. These reserves would later be tapped to provide benefits for those individuals in need of long-term care services.

But CLASS doesn’t work that way.

Similar to Social Security, all premiums that CLASS collects will be spent immediately. Its trust fund will be filled with government IOUs. Since participants need to pay five years of premiums before they’re eligible to collect any benefits, a sizeable amount of short-term revenue will be raised from CLASS. This aspect was especially useful when lawmakers were trying to find tricks to reduce the projected cost of Obamacare. By including the revenues from CLASS, politicians were able to pretend they’d reduced the cost of the bill by $70 billion.

But even Uncle Sam can’t spend your money twice. It’s impossible to spend the money today on government programs and invest the money to fund eventual benefits.

Eventually 2017 will arrive. That’s when CLASS starts paying benefits. It’s difficult to predict how soon after that the program would dive into the red and pay out more in benefits than it collects in premiums. Actuaries at the Centers for Medicare & Medicaid Services estimate it could be as soon as 2025.

Continued in article

 


Updates on October 31, 2010


"Say NO to Government Subsidies For Frivolous Litigation," by Lisa A. Ricard, Townhall, October 6, 2010 ---
http://townhall.com/columnists/LisaARickard/2010/10/05/say_no_to_government_subsidies_for_frivolous_litigation

Taxes are a major topic of debate in Washington right now. Faced with a massive federal deficit, some politicians have proposed raising taxes on individuals and businesses, despite the obvious negative effects of tax increases on economic growth and job creation. Yet at the same time, some in Washington are actually considering the creation of a new special interest tax break that will hurt economic growth, increase the deficit and fuel increased civil litigation.

The plaintiffs' bar and its allies in Congress and the administration are pushing for the adoption of a nearly $1.6 billion tax deduction for trial lawyers who take contingency fee cases. This proposed deduction would essentially provide a U.S. government subsidy to plaintiffs' lawyers to increase the number of frivolous lawsuits.

For several years, the plaintiffs' bar has been attempting to push this proposed tax break through Congress. With Congress so far unwilling to act, plaintiffs' lawyers have decided on a new approach and are now aggressively lobbying the Treasury Department to bypass Congress and create the deduction through administrative action.

The tax deduction would impose direct costs on the federal government and American taxpayers. According to the Congressional Budget Office, this trial lawyer subsidy would cost nearly $1.6 billion over ten years, all during a time of record federal deficits.

But these direct costs represent just a fraction of the proposal's potential damage. The contingency fee tax break would, in effect, subsidize ever more costly, frivolous litigation against American businesses. By some estimates, the tax deduction could subsidize as much as 40 percent of the initial plaintiffs' expenses for certain cases. With the federal government paying for such a large percentage of the up-front costs of lawsuits, plaintiffs' lawyers will be emboldened to take on the most speculative and frivolous litigation.

And in these troubled economic times, the last thing America needs is more frivolous lawsuits. As a percentage of gross domestic product, the United States spends more than twice as much on litigation as any other industrialized nation, a cost that reached $254.7 billion in 2008 according to a report by Towers Perrin.

Continued in article



December 31, 2015

Finding and Using Health Statistics --- http://www.nlm.nih.gov/nichsr/usestats/index.htm

Bob Jensen's threads on economic statistics and databases ---
http://www.trinity.edu/rjensen/Bookbob1.htm#EconStatistics


Obama's Whoppers on the ACA --- Click Here
http://townhall.com/columnists/donaldlambro/2015/07/08/obamas-whoppers-will-bite-him-in-the-end-and-the-democrats-too-in-2016-n2022375?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=


Cadillac Medical  Insurance Plan --- https://en.wikipedia.org/wiki/Cadillac_insurance_plan

"St. Paul, MN schools may adjust health plans to avoid 'Cadillac tax'," By Josh Verges, TwinCities.com, July 22, 2015 ---
http://www.twincities.com/education/ci_28522319/st-paul-schools-may-adjust-health-plans-avoid

St. Paul Public Schools employees are likely to see their health benefits curtailed as the school district looks to avoid financial penalties set to begin in 2018.

The Affordable Care Act's "Cadillac Tax" provision will charge employers an excise tax on high-cost plans -- 40 percent on every dollar over $10,200 on individual and $27,500 on family plans.

Jeni Simon, a consultant with Aon Hewitt, told school board members Tuesday that companies already are redesigning their health plans in order to avoid paying the tax. A survey found 92 percent of U.S. employers expect their health plans to change by 2018, and 47 percent said they'll be significantly different.

"This could be crippling financially for an organization," Simon said.

The school district has generous health plans that haven't changed in 10 years, Simon said. Among the options for getting under the tax cap are eliminating spousal coverage or flexible savings accounts, or charging higher co-pays or deductibles.

Continued in article


"This Is How Easy It Is to Scam Obamacare:  Federal auditors duped healthcare.gov 11 out of 12 times," by John Tozzi, Bloomberg, July 16, 2015 ---
http://www.bloomberg.com/news/articles/2015-07-16/this-is-how-easy-it-is-to-scam-obamacare?cmpid=BBD071615_BIZ

When healthcare.gov opened in late 2013, it was so crippled by technical problems that critics questioned whether people would be able to sign up for coverage. Now, it may actually be too easy to enroll.

That’s according to a new government audit, presented in testimony from the Government Accountability Office, delivered at a Senate Finance Committee hearing on Thursday. When federal auditors tried to apply for insurance coverage and tax credit subsidies using fictitious applicants, they succeeded 11 out of 12 times. Here are some highlights from the GAO’s undercover investigation:

Fake applicants got through on the phone

The auditors couldn’t get coverage for fake applicants just by going online, because the website couldn’t verify their identities. But investigators successfully completed the fake applications on the phone and got coverage for almost all of them. In the one enrollment that didn’t succeed, the applicant declined to give a Social Security Number, though other cases that had missing or invalid SSNs were approved.

Continued in article

Jensen Comment
Millions of workers in the underground cash economy not only do not pay in income taxes many of them most likely are also getting 100% subsidies for health insurance or are fraudulently on Medicaid. Literally all big government programs are big piñatas for fraudsters.


"Did Senators Commit Health Insurance Fraud? Did Senators and their staff pretend to be “small businesses” to get subsidies?" by Joe Schoffstall," The Wall Street Journal, July 17, 2015 ---
http://www.wsj.com/articles/notable-quotable-obamacare-1437171835?tesla=y

. . .

“The Affordable Care Act (ACA), better known as Obamacare, required that members of Congress and their staff enroll in individual plans through the healthcare exchanges created by the law,” the group said in a press release. “As open enrollment approached in 2014, members and staff realized that by enrolling as individuals, they would no longer receive generous taxpayer-funded contributions to help pay their insurance premiums as they had for decades under the Federal Employees Health Benefits Program. They would instead only qualify for subsidies if their household income was less than 400 percent of the federal poverty level, just like millions of other Americans that had to purchase insurance in the individual market.”

The group notes that senators worked with the White House and the Office of Personnel Management for guidance on how to enroll in the Small Business Health Options Program in order to skirt any obstacles.

On October 2, 2013, the Office of Personnel and Management (OPM) used a federal regulation to deem Congress a small business despite its having more than 12,000 employees and dependents.

Continued in article

Jensen Comment
Surely you don't believe our beloved senators could commit fraud.


"The New York Times notices that ObamaCare is causing insurance rates to soar," by Robert Laurie, Canada Free Press, July 6, 2015 ---
http://canadafreepress.com/article/73517

There have been plenty of stories about the ways in which ObamaCare is driving up healthcare costs. All across the country, we’ve seen double digit insurance rate hikes and soaring premiums. It’s nothing new, and conservatives have been warning that this would be the case since long before the unpopular law was rammed down America’s throat.

However, acknowledgement of ObamaCare’s failure usually comes from either right-leaning news sources, or insurance industry watchdogs.  We don’t often get it from the far-left paper of record, The New York Times:

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

  Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.

Huh.  That’s weird. I thought ObamaCare was supposed to lower rates across the board.  Didn’t the President promise that the average household would see their premiums decline by something on the order of $2500.00? Certainly the New York Times must be shocked to discover that these claims were bald-faced lies, and that conservatives were right all along.

Continued in article


"How the Affordable Care Act Is Reducing Competition Five big insurers seem set to become three, as Aetna buys Humana and Anthem eyes Cigna. Thanks, ObamaCare," by Scott Gottlieb, The Wall Street Journal, July 5, 2015 ---
http://www.wsj.com/articles/how-the-affordable-care-act-is-reducing-competition-1436136236?tesla=y

The urge to merge is sweeping managed health care. Aetna announced Friday a $37 billion deal to acquire Humana. Anthem and Cigna are in merger talks and could be next. The national for-profit insurers are on an anxious mission to consolidate. These combinations will sharply reduce competition and consumer choice, as five big insurers shrink, probably, to three.

This trend is a direct consequence of ObamaCare, reflecting the naïveté of its architects and the fulfillment of their myopic vision. For Aetna, the deal is aimed at expanding its footprint in Medicare Advantage, a business that has become more financially attractive now that ObamaCare caps profits in the individual and group insurance markets.

. . .

But now almost every co-op is financially underwater, on the hook for federal loans that amount to more than 100% of the total value of their capital and surplus. Some—like Arizona’s Meritus Mutual Health Partners—are nearing 1,000%, according to rating agency A.M. Best.

All but five co-ops had negative cash flow heading into the end of last year, according to Standard & Poor’s, and nine had medical-loss ratios above 100%, including Iowa’s CoOportunity Health, which has declared bankruptcy. During the last half of 2014 the Health and Human Services Department had to bail out six co-ops with $356 million in emergency funding.

Continued in article

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


"Scotus Fuctus on Obamacare Roberts arrogates god-like powers to himself," by Shikha Dalmia, Reason Magazine, June 25, 2015 ---
http://reason.com/blog/2015/06/25/justice-roberts-plays-god-with-obamacare

"The Supreme Court’s Obamacare Decision Is Already Worth $3 Billion For Insurers," by Leah Libresco, Nate Silver's 5:38 Blog, June 25, 2015 ---
http://fivethirtyeight.com/datalab/the-supreme-courts-obamacare-decision-is-already-worth-3-billion-for-insurers/ 

 

Externalities of Aging (More Disease and More Entitlements Expense)
World's Population Is Getting Sicker, Study Shows ---
http://www.webmd.com/news/20150608/worlds-population-is-getting-sicker-study-shows

Entitlements Actuarial  Lies
A trillion lie here and a trillion lie there and pretty soon you're talking about an unsustainable future covered up by lying in politics.

Entitlements --- http://en.wikipedia.org/wiki/Entitlement

Harvard, Dartmouth:  Social Security forecasts have been too optimistic — and increasingly biased ---
http://hotair.com/archives/2015/05/09/harvard-dartmouth-social-security-forecasts-have-been-too-optimistic-and-increasingly-biased/


The Government Not Exactly Sure Where $3 Billion in Obamacare Subsidies Went --- Click Here
http://townhall.com/tipsheet/katiepavlich/2015/06/16/the-government-has-no-idea-where-3-billion-in-obamacare-subsidies-went-n2013393?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=

. . . Three billion dollars of hard earned tax money you've been sending to subsidize other people's healthcare plans
1) went to the wrong people
2) was paid out in the wrong amounts.

An Inspector General audit of the Department of Health and Human Services revealed today that Obamacare subsidies handled by the agency have been completely unorganized, disfunctional and misplaced. Why? Because HHS never implemented a system to ensure the subsides would be secure, distributed in the right amounts and sent to those who are eligible to receive them. More from the Washington Free Beacon

"[The Centers for Medicare and Medicaid Services] CMS's internal controls did not effectively ensure the accuracy of nearly $2.8 billion in aggregate financial assistance payments made to insurance companies under the Affordable Care Act during the first four months that these payments were made," the OIG said.

"CMS's system of internal controls could not ensure that CMS made correct financial assistance payments," they said.

The OIG reviewed subsidies paid to insurance companies between January and April 2014. The audit found that CMS did not have a process to "prevent or detect any possible substantial errors" in subsidy payments.

The OIG said the agency did not have a system to "ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts."

In response to the audit, CMS said they issued a regulation to
change their accounting methods.“CMS takes the stewardship of tax dollars seriously and implemented a series of payment and process controls to assist in making manual financial assistance payments accurately to issuers,” they said.

More directly from the report about what was found: 

We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS:

-relied on issuer attestations that
-did not ensure that advance CSR payment rates identified as outliers were appropriate,
-did not have systems in place to ensure that financial assistance payments were made on
behalf of confirmed enrollees and in the correct amounts,
-did not have systems in place for State marketplaces to submit enrollee eligibility data for
fina
ncial assistance payments, and
-did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.

The internal control deficiencies that we identified limited CMS’s ability to make accurate payments to QHP issuers. On the basis of our sample results, we concluded that CMS’s system of internal controls could not ensure that CMS made correct financial assistance payments during the period January through April 2014.

 

According to the Inspector General, the audit was conducted "to determine whether CMS’s internal controls were effective to ensure the accuracy of financial assistance payments to QHP issuers made during the first 4 months that these payments were made." 

Continued in article

 


"Hospitals Expected More of a Boost From Health Law Expansion of Medicaid hasn’t had the financial impact that was anticipated," by Christian Weaver, The Wall Street Journal, June 3, 2015 ---
http://www.wsj.com/articles/hospitals-expected-more-of-a-boost-from-health-law-1433304242?KEYWORDS=Hospitals

The health law’s expansion of Medicaid in many states hasn’t benefited nonprofit hospitals in those states as expected, according to a new report by Moody’s Investors Service.

Hospitals in the mostly blue states that expanded Medicaid were largely expected to benefit from fewer unpaid bills and more paying customers, but that hasn’t generally translated into better operating margins or cash flow, Moody’s found.

Performance improved across the board—including in the mostly Republican-led states that opted out of the law’s Medicaid expansion—as the economy gained steam last year and unemployment declined.

In expansion states, hospitals’ unpaid bills fell 13% on average last year compared with 2013, the report found. But, their 2014 operating margins didn’t increase any more than hospitals in the 22 states that have sat out the expansion, the report shows.

“Clearly, reducing bad debt is positive, but it is not this silver bullet,” said Daniel Steingart, a Moody’s analyst and author of the report. He said the findings call into question “a narrative out there that Medicaid expansion has lowered bad debt and that is driving [financial] improvements at hospitals.”

Continued in article

Jensen Comment
When I lived in San Antonio, over $1,000 of my property tax billing went to the Bexar County Hospital to cover charity medicine and bad debts of people who were treated but did not pay for the treatments. As a rule there's at least one hospital in larger cities, usually the largest non-profit hospital, that receives local tax dollars to contribute toward the hospital's bad debts.

Obamacare's promise of relieving the burden of local taxpayers for charity medicine turned into another one of the lies. Indeed there are fewer bad debts due to expanded Medicaid coverage such that more Federal dollars are pouring into hospitals who accept Medicaid patients. However, the bad news is that Medicaid only covers (according to the article) about half the cost of treating Medicaid patients in hospitals. This leaves hospitals with tow choices. Provide lower-cost care or ask for more dollars from local taxpayers to cover the added losses of the expanded Medicaid coverage.

It turns out that states who refused to expand Medicaid coverage are better off for having refused.


"Overhead costs exploding under ObamaCare, study finds," by Sarah Ferris, The Hill, May 27, 2015 ---
http://thehill.com/policy/healthcare/243188-overhead-costs-exploding-under-obamacare 

Five years after the passage of ObamaCare, there is one expense that’s still causing sticker shock across the healthcare industry: overhead costs.

The administrative costs for healthcare plans are expected to explode by more than a quarter of a trillion dollars over the next decade, according to a new study published by the Health Affairs blog.

The $270 billion in new costs, for both private insurance companies and government programs, will be “over and above what would have been expected had the law not been enacted,” one of the authors, David Himmelstein, wrote Wednesday.

Those costs will be particularly high this year, when overhead is expected to make up 45 percent of all federal spending related to the Affordable Care Act. By 2022, that ratio will decrease to about 20 percent of federal spending related to the law.

 

The study is based on data from both the government’s National Health Expenditure Projections and the Congressional Budget Office. Both authors are members of Physicians for a National Health Program, which advocates for a single-payer system.

"This number – 22.5 percent of all new spending going into overheard – is shocking even to me, to be honest. It’s almost one out of every four dollars is just going to bureaucracy," the study's other author, Steffie Woolhandler, said Wednesday.

She said private insurers have been expanding their administrative overhead despite some regulations from the Obama administration to control those costs, such as the medical loss ratio, which requires a certain amount of premium dollars to be spent directly on healthcare. She argues that a better approach would be a type of Medicare-for-all system.

The extra administrative costs amount to the equivalent of $1,375 per newly insured person per year, the authors write.

Continued in article


Cadillac Tax --- http://en.wikipedia.org/wiki/Cadillac_insurance_plan
President Obama exempted trade unions for political purposes

From the CFO Journal's Morning Ledger on May 26, 2015

Good morning. A provision of Obamacare set to take effect in 2018 will slap a hefty tax bill on employee health plans that exceed certain cost thresholds, and that has CFOs looking at a range of alternatives, from scaling back current offerings to eliminating the plans altogether, CFO Journal’s Kimberly S. Johnson and Maxwell Murphy report.

“To me, it’s a penalty for giving our employees a generous benefits package,” said Action Environmental Group Chief Financial Officer Brian Giambagno. Action Environmental briefly considered doing away with employee health coverage altogether to save money. “I’d be lying if I said we haven’t had that discussion,” said Mr. Giambagno.


"Obamacare Exchanges on Life Support," by Michelle Malkin, Townhall, May 15, 2015 ---
http://townhall.com/columnists/michellemalkin/2015/05/15/obamacare-exchanges-on-life-support-n1999097?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=

. . .

The miraculous, efficient, cost-saving, innovative 21st-century government-run "marketplaces" were supposed to put the "affordable" in Obama's Affordable Care Act. Know-it-all bureaucrats were going to show private companies how to set up better websites (gigglesnort), implement better marketing and outreach (guffaw), provide superior customer service (belly laugh), and eliminate waste, fraud and abuse (LOLOLOL).

You will be shocked beyond belief, I'm sure, to learn that Obamacare exchanges across the country are instead bleeding money, seeking more taxpayer bailouts and turning everything they touch to chicken poop.

Wait, that's not fair to chicken poop, which can at least be composted.

"Almost half of Obamacare exchanges face financial struggles in the future," The Washington Post reported last week. The news comes despite $5 billion in federal taxpayer subsidies for IT vendors, call centers and all the infrastructure and manpower needed to prop up the showcase government health insurance entities. Initially, the feds ran 34 state exchanges; 16 states and the District of Columbia set up their own.

While private health insurance exchanges have operated smoothly and satisfied customers for decades, the Obamacare models are on life support. Oregon's exchange is six feet under -- shuttered last year after government overseers squandered $300 million on their failed website and shady consultants who allegedly set up a phony website to trick the feds. The FBI and the U.S. HHS inspector general's office reportedly have been investigating the racket for more than a year now.

In the People's Republic of Hawaii, which has been a "trailblazer" of socialized medicine for nearly four decades, the profligate state-run exchange demanded a nearly $30 million cash infusion to remain financially viable after securing $205 million for startup costs. The Hawaii Health Connector accidentally disconnected hundreds of poor patients' accounts and squandered an estimated 8,000 hours on technological glitches and failures. Enrollment projections were severely overinflated like a reverse Tom Brady scandal. After failing to secure a bailout, Hawaii announced this week that its exchange would be shut down amid rising debt.

Continued in article

 


"Massachusetts’ Botched Obamacare Exchange Build May Have Been Illegal As Well As Incompetent," by Peter Suderman, Reason Magazine, May 12, 2015 ---
http://reason.com/blog/2015/05/12/masachusetts-botched-obamacare-exchange

Report finds that state misled federal officials about progress on the $135 million project.

When Obamacare’s health insurance exchanges officially launched in October, 2013, one of the worst performers was, somewhat ironically, located in the one state that already had a functioning health insurance exchange: Massachusetts. The state had been running its own online insurance portal for years as part of RomneyCare, the coverage expansion that would become the model for Obamacare. But the exchange the state already had in place, while functional, didn’t have all of the features required by Obamacare. A total overhaul was required.

But when Obamacare’s exchanges went live, the upgrade turned out to be a downgrade. Despite years of administrative planning and development, funded largely by $135 million federal grants, the Massachusetts Health Connector basically didn’t work at all during the first open enrollment period. Repair efforts stalled, and eventually the entire thing was scrapped so that the state could start all over again on yet another new exchange. The original tech contractor, CGI (which also worked on the botched federal exchange) was fired from the project, and a new team was brought in to start over.

It’s been clear for a while now that the project was massively mismanaged, but it now looks increasingly as if development of the exchange may have involved illegality as well as incompetence.

Not only did the officials in charge of the exchange botch the job, they are now accused of having intentionally misrepresented their progress (or lack thereof) to federal officials. A stinging report released yesterday by the Pioneer Institute, based on official contemporaneous audit reports by an outside consultant and unnamed “whistleblowers” who were interviewed by the report’s author, Josh Archambault, alleges that state officials lied to federal overseers about progress on the project and cheated on a key federal connectivity test, employing what was essentially a dummy system in order to cover for work that had not yet been completed.

Continued in article

Bob Jensen's Fraud Updates --- http://www.trinity.edu/rjensen/FraudUpdates.htm


Brookings: The Patient Protection and Affordable Care Act (links to hundreds of studies) ---
 
http://www.brookings.edu/research/topics/affordable-care-act


"One-Third Drop Obamacare in California," by Michael Reagan, Newsmax, April 26, 2015 ---
http://www.newsmax.com/MichaelReagan/obamacare-covered-california-health-insurance/2015/04/26/id/640791/

. . .

The truth is (there’s that word again), over one–third of Covered California policyholders dropped their insurance altogether.

Attkisson contends this is one of the worst retention rates in the nation. And for those poor souls who are still at the mercy of Covered California, the situation doesn’t get any better, 84 percent of the policyholders will be paying increased premiums in 2015.

Continued in article


From the CFO Journal's Morning Ledger on April 27, 2015

Pharmaceutical companies buy rivals’ drugs, then jack up the prices
http://www.wsj.com/articles/pharmaceutical-companies-buy-rivals-drugs-then-jack-up-the-prices-1430096431?mod=djemCFO_h
More pharmaceutical companies are buying up drugs they see as undervalued, and then raising their prices. The WSJ’s Jonathan D Rockoff and Ed Silverman report that the trend is one of a number of tactics being employed by pharmaceutical firms. Companies also regularly raise prices of their own older medicines while demanding high fees for new treatments, driving up the cost of drugs in the process. Since 2008, branded-drug prices have increased 127%, compared with an 11% rise in the consumer price index, according to drug-benefits manager Express Scripts Holding Co.


"The ObamaCare Effect: " by Marty Makary, The Wall Street Journal, April 19, 2015 --
http://www.wsj.com/articles/the-obamacare-effect-hospital-monopolies-1429480447?tesla=y

. . .

Today’s frenzy of hospital mergers and physician practice acquisitions is giving hospital systems even greater leverage to inflate opaque “charge-master” medical bills that even hospitals are sometimes unable to itemize sensibly. With no mechanism to allow free-market forces to keep prices in check, this translates into higher health-insurance deductibles and copays for insured Americans, and in the case of Medicare and Medicaid, higher taxes.

When you’re the only game in town, you call the shots. That is one reason California Attorney General Kamala Harris is insisting on “strong conditions” before approving Prime Healthcare Services’ $843 million takeover of the six-hospital Daughters of Charity Health System. Prime is a hospital management company operating 34 acute-care hospitals in 10 states.

Ms. Harris required Prime to continue operating four Daughters’ facilities as acute-care hospitals with emergency services over the next 10 years. She also required that all six hospitals remain in the state’s Medi-Cal program, maintain charity care benefits at their historical levels, and continue providing essential health services such as reproductive health care.

Those conditions only begin to address the concerns surrounding such a merger. A San Bernardino, Calif., court recently held a Prime hospital, Chino Valley Medical Center, in contempt for needlessly admitting patients through the emergency room. On a national level, physician groups bought by large hospital systems are often prodded to send patients for ambulatory surgery and diagnostic procedures to the departments of their parent hospital, which may charge more than other outpatient centers the doctor might prefer.

A study of more than 150 hospital-owned and physician-owned organizations published last October in the Journal of the American Medical Association found that patient costs are 19.8% higher for physician groups in multi-hospital systems compared with physician-owned organizations.

The Affordable Care Act did not repeal antitrust laws. The Federal Trade Commission prevailed in three litigated hospital mergers in the last three years, and in 2014 it won its first-ever litigated case challenging a health-system acquisition of a physician group. But these victories are few. The great majority of mergers occur with little if any public debate about how they will effect prices or patients.

U.S. Oncology, for example, boasts more than 1,000 oncologists in its network and serves nearly 20% of all U.S. cancer patients. In 2010 it was acquired by McKesson Corp., one of the largest U.S. drug distributors, in what some called a savvy move to get cancer doctors and the drugs they prescribe under the same roof. Specialty hospitals are also sprouting around the country, even franchising, exemplified by the rapid spread of the MD Anderson Cancer Center, which aims to have a center within three hours of every American. But is it wise to have one corporation in charge of cancer care for an entire state or region?

Advocates say such expansion brings standardized care and clinical trials to more of the population, but it also results in an undeniable homogenization that may limit options for patients. If management decides that its doctors can only use one chemo drug for a particular cancer, or if the central leadership elects to not adopt a new surgical technology system-wide, will patients be told about the other options?

As a busy surgeon, I have serious concerns about the race to consolidate America’s hospitals because of the risk that very large organizations may govern without valuing the wisdom of their front-line employees. Already many doctors are frustrated by the electronic medical records, strategic planning and hospital processes that they feel have marginalized their medical insights into their own patients.

We can encourage the good work of hospitals to create networks of coordinated care, while at the same time insist that hospitals compete on price and quality outcomes. Achieving this balance in the wake of the Affordable Care Act is critical to ensure that one-fifth of the U.S. economy functions in a competitive and competent market.

Dr. Makary is a surgeon at Johns Hopkins Hospital and professor of health policy at the Johns Hopkins Bloomberg School of Public Health. He is the author of “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care“ (Bloomsbury Press, 2013).

Jensen Comment
The word "frenzy" probably overstates the case. In rural areas, however, local hospitals already monopolize local markets in general care. What I see up here is MDs pulling out of primary care practices either by refusing ACA-insured patients or by returning to medical schools to further specialize. Our very best general surgeon just took a year off to return to medical school to further specialize. Chances of his returning to our hospital are zero.

What I see in primary care up here is much wider use of physicians' assistants and osteopathic privary care providers replacing the departing MD providers. ACA and Medicaid rates are driving MDs out of primary care. The only way to make primary care profitable is to make it more factory-like in efficiency in seeing patients.


"Overkill An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?" by Atul Gawande, The New Yorker, May 11, 2015 ---
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive.

I decided to do a crude check. I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Continued in a very long article

Jensen Comment
Twice my wife was sent from the ER to a night in intensive care when my own suspicions were that she really did not have to spend one night in the hospital let alone the very expensive ICU unit. I think that sometimes ER doctors in small hospitals support the ICU units and the CAT Scan or MRI Scan units beyond what is called for in the science  of medicine. It might be argued that such expensive prescriptions are shields against ambulance-chasing lawyers, but I think in many cases the small hospitals just need more revenues to support unused capacity investments.

"The ‘Michigan Model’ for Malpractice Reform A communication and resolution program reduced claims by 36%," by Allen Kachalia And Sanjay Saint, The Wall Street Journal, May 10, 2015 ---
http://www.wsj.com/articles/the-michigan-model-for-malpractice-reform-1431300074?tesla=y

Doctors have many tests and procedures to choose from when treating you. But is it possible to have too much of a good thing?

It is. Overuse and waste in medical care—which include ordering more tests and treatment than scientific evidence supports—make up as much as 30% of health-care spending according to a 2013 Institute of Medicine report. That’s approximately $750 billion a year, which we all pay for in premiums and taxes to support Medicare and other insurance programs.

A massive new effort to eliminate wasteful spending has begun. This year the Department of Health and Human Services announced plans to pay doctors and hospitals more for quality, not quantity. Private insurers are likely to follow suit.

We recently published findings in the Annals of Internal Medicine from a national survey of hospitalists—physicians who primarily treat patients in the hospital setting—that sheds some light on how medical tests and treatments are overused, and how often.

We asked hospital doctors to imagine two common patient scenarios—a cardiac evaluation before surgery and a patient who suddenly loses consciousness—and asked what they thought most of their colleagues in their hospital would do. Evidence-based guidelines exist for both scenarios.

More often than not, the hospital doctors said that their colleagues would choose the option that meant overuse of testing—not because of a lack of awareness of the guidelines, but to reassure themselves or their patients. This unwarranted testing and treatment can lead to medical complications.

Continued in article

The Texas Model
Texas voters initiated a change in the constitution that caps punitive damages.

"Canadian Malpractice Insurance Takes Profit Out Of Coverage," by Jane Akre, Injury Board, July 28, 2009 ---
Click Here
http://www.injuryboard.com/national-news/canadian-malpractice-insurance-takes-profit-out-of-coverage.aspx?googleid=267890  

The St. Petersburg Times takes a look at the cost of insurance in Canada for health care providers.

A neurosurgeon in Miami pays about $237,000 for medical malpractice insurance. The same professional in Toronto pays about $29,200, reports Susan Taylor Martin.

A Canadian orthopedic surgeon pays just over $10,000 for coverage that costs a Miami physician $140,000. An obstetrician in Canada pays $36,353 for insurance, while a Tampa Bay obstetrician pays $98,000 for medical malpractice insurance.

Why the difference?

In the U.S., private for-profit insurance companies extend medical malpractice coverage to doctors.

In Canada, physicians are covered through membership in a nonprofit. The Canadian Medical Protective Association offers substantially reduced fees for the same coverage, especially considering that their payout is limited by caps in Canada just as in some U.S. states.

In 1978, the Canadian Supreme Court limited pain and suffering awards to just over $300,000, circumventing the opportunity for a jury to decide on an award depending on the case before them.

Canadian Medical Protective Association

Here’s how it works.

Fees for membership vary depending on the region of the country in which the doctor works and their specialty. All neurosurgeons in Ontario will pay the same, for example. The number of claims they have faced for medical malpractice does not figure into their premium

"We don't adjust our fees based on individual experience; it's the experience of the group,'' says Dr. John Gray, the executive director, "That's what the mutual approach is all about, and it helps keep the fees down for everyone,” he tells the St. Petersburg Times.

If a doctor is sued, the group pays the claim and provides legal counsel.

In the U.S., the push has been on for limiting claims, no matter how egregious the medical malpractice. President Obama was booed in June when, before the American Medical Association, he said he would not limit a malpractice jury award.

"We got a crazy situation where Obama is talking about the cost of medicine but he said, 'I don't believe in caps,' " complains Dr. Dennis Agliano, past president of the Florida Medical Association. "If you don't have caps, the sky's the limit and there's no way to curtail those costs.''

But the importance of limiting jury awards may not play into the big picture on health care reform.

Malpractice lawsuits amount to less than one percent of both the Canadian and the U.S. healthcare system, meanwhile between 44,000 and 98,000 Americans die each year due to medical errors in hospitals alone, while 16 times as many suffer injuries without receiving any compensation, reports the group Americans for Insurance Reform.

Major Difference

In Canada, an injured patient is often required to pay for the initial investigation into his case. In the U.S. the contingency fee basis, usually in the range of 30 percent, allows the injured party to proceed without a financial downside.

In both the U.S. and Canada, the definition of medical negligence is that a duty of care was owed to the patient by the physician, there was a breach h of the standard of care and the patient suffered harm by the physician’s failure to meet that standard of care.

A bad outcome in itself is not the basis of a lawsuit.

The Canadian Medical Protective Association insures virtually all of the country’s 76,000 doctors, as opposed to the U.S. where private for-profit insurance companies cover physicians for medical malpractice.

In Canada, the median damaged paid in 2007 was $91,999 and judgments favored patients 25 times, doctors 70 times.

In the U.S., many physician groups are requiring patients to waive their rights to a jury trial, even though malpractice litigation accounts for just 0.6 percent of healthcare costs.

Public Citizen, the consumer group, charges that the facts don’t warrant the “politically charged hysteria surrounding medical malpractice litigation.”

For the third straight year, medical malpractice payments were at record lows finds the group in a study released this month. The decline, however, is likely due to fewer injured patients receiving compensation, not improved health safety.

2008 saw the lowest number of medical malpractice payments since the federal government’s National Practitioner Data Bank began compiling malpractice statistics. In 2008, payments were 30.7 percent lower than averages recorded in all previous years.

In the report titled, The 0.6 Percent Bogeyman, the nonprofit watchdog group states, “between three and seven Americans die from medical errors for every 1 who receives a payment for any type of malpractice claim.”

Public Citizen previously reported that about five percent of doctors are responsible for half of the medical malpractice in the U.S. that can result in permanent injury or death. #



Read more:
http://www.injuryboard.com/national-news/canadian-malpractice-insurance-takes-profit-out-of-coverage.aspx?googleid=267890#ixzz0W0Z71JOP

 

Jensen Comment
I'm in favor of fully-funded health care reform that completely nationalizes health insurance phased in reasonably with high tax pay-as-you-go restriction and strict cost-saving caps on punitive damage lawsuits. I really favor former Senator Bill Bradley's long-forgotten Canada-like proposal:

The bipartisan trade-off in a viable health care bill is obvious: Combine universal coverage with malpractice tort reform in health care. Universal coverage can be obtained in many ways — including the so-called public option. Malpractice tort reform can be something as commonsensical as the establishment of medical courts — similar to bankruptcy or admiralty courts — with special judges to make determinations in cases brought by parties claiming injury. Such a bipartisan outcome would lower health care costs, reduce errors (doctors and nurses often don’t report errors for fear of being sued) and guarantee all Americans adequate health care. Whenever Congress undertakes large-scale reform, there are times when disaster appears certain — only to be averted at the last minute by the good sense of its sometimes unfairly maligned members. What now appears in Washington as a special-interest scrum could well become a triumph for the general interest. But for that to happen, the two parties must strike a grand bargain on universal coverage and malpractice tort reform. The August recess has given each party and its constituencies a chance to reassess their respective strategies. One result, let us hope, may be that Congress will surprise everyone this fall.
Bill Bradley, "Tax Reform’s Lesson for Health Care Reform," The New York Times, August 30, 2009 ---
http://www.nytimes.com/2009/08/30/opinion/30bradley.html?_r=1


A $5,000+ surprise from the IRS?
"The ObamaCare Burden Some Americans are in for an especially bad tax season," by James Taranto, The Wall Street Journal, February 18, 2015 ---
http://www.wsj.com/articles/the-obamacare-burden-1424293227?tesla=y

. . .

“Janice Riddle got a nasty surprise when she filled out her tax return this year,” CNN.com reports:

The Los Angeles resident had applied for Obamacare in late 2013, when she was unemployed. She qualified for a hefty subsidy of $470 a month, leaving her with a monthly premium of $1 for the cheapest plan available.
Riddle landed a job in early 2014 at a life insurance agency, but since her new employer didn’t offer health benefits, she kept her Obamacare plan. However, she didn’t update her income with the California exchange, which she acknowledges was her mistake.
Now, she has to pay back the entire subsidy, which is forcing her to dip into her savings.
“I was blindsided that the subsidy has to be paid back,” said Riddle, adding she didn’t even use the coverage, which she had until she qualified for Medicare in October. “I’m in shock . . . but I have no choice. Do I want to argue with the IRS or the Obama administration?”

CNN reports that “between 4.5 million and 7.5 million taxpayers received subsidies,” and an earlier CNN report cites an H&R Block estimate that 3.4 million of them will end up owing the IRS money on the deal. Of course taxpayers who overestimated their income and thus underestimated their subsidies will be due a refund—but one suspects those with an unanticipated income squeeze were likelier to drop their insurance during the year, which means that in some cases they’ll owe the mandate tax.

 


"ObamaCare Pushes Colleges to Dump Student Health Plans," by John Merline, Investor's Business Daily, March 30, 2015 ---
http://news.investors.com/blogs-capital-hill/033015-745676-colleges-dump-student-insurance-plans-because-of-obamacare.htm

College professors and students keep suffering unexpected costly ObamaCare side effects. First, colleges started rolling back faculty hours to avoid the employer mandate, a development the American Association of Association of University Professors called "reprehensible."

Then Harvard professors complained when the college hiked their insurance costs because of "health care reform."

Now colleges are starting to dump their student insurance plans because of ObamaCare.

An AP story notes that four of New Jersey's 11 state public colleges have done so, as have three of Washington state's six, and that many more are likely to follow.

These colleges figure that, since students can get coverage elsewhere, they can just wash their hands of the problem. Those students who had been relying on their college insurance plans now must go to an ObamaCare exchange or onto Medicaid to get coverage.

The problem, as University of Wisconsin, Madison, student health insurance manager Richard Simpson notes, is that college plans are usually a good deal for students, with lower deductibles and more flexibility than cheap ObamaCare plans provide.

"Student plans provide gold or platinum level coverage at a bronze price," Simpson told AP.

So students forced into an exchange are likely to be worse off financially.

True, many of these students will qualify for Medicaid because they earn little or no money. But while getting more Americans dependent on government earlier in life might make the left happy, cramming people who previously had good coverage onto the failing Medicaid system is hardly a sign of progress.

Of course, the other option is for students to join the ranks of the uninsured, which no doubt many will choose.

Jensen College
Even though Obamacare may take away one of the alternatives college students have for healthcare (as described in the above article) for most of those students their college's health insurance plan was probably a bad deal in the first place. For those students who have little or no income to report to the IRS because they are full-time students, the ACA exchange studies provide them with virtually free health insurance which is obviously cheaper than what most of them paid for medical insurance under a college student plan.

The taxpayers are getting hit for those subsidies, but the students themselves have a sweeter deal unless they have enough taxable income to make the ACA subsidies irrelevant.

 


"Screwed by Seniors:  The people expected to pay for Social Security and Medicare can't afford it," by Veronique de Rugy, Reason Magazine, March 2016 ---
http://reason.com/archives/2015/02/06/screwed-by-seniors 

Remember Occupy Wall Street, when thousands across the country took to the streets, sleeping in tents to protest the ultra-rich 1 percent? The occupiers' frustration was real, but their ire was misdirected. They should have launched an Occupy the AARP movement instead.

Government policies that transfer cash from the relatively young and poor to the relatively old and wealthy are the real scandal. In 1970, Social and Medicare accounted for 20 percent of federal spending. They have since grown to 40 percent; by 2030, they will be more than half. And these numbers understate the level of federal spending for the elderly. According to the Centers for Medicare and Medicaid Services, some 28 percent of spending on Medicaid, a program designed to offer health care to families in poverty, goes to older Americans.

But these days, unlike in the era before Social Security and Medicare were created, most seniors are doing just fine, with various general indices of well-being all pointing to higher standards of living for the elderly. When Social Security was born in 1935, the average life expectancy was 65. Today, it's 78.8. In 1959, the U.S. Census Bureau found more than 30 percent of Americans 65 and older living below the poverty line. In 2013, the percentage had dropped to 9.5. According to a report by the Federal Interagency Forum on Aging-Related Statistics, the average net worth of Americans over the age of 65 increased by almost 80 percent between 1988 and 2008. Today's seniors are healthier, better educated, and richer than their predecessors.

Of course some seniors remain poor. But as the University of Chicago economist Bruce Meyer wrote in 2011, "Even over the past 10 years, those 65 and older with the lowest income are now living in bigger houses that are much more likely to be air conditioned and have appliances like a dishwasher and clothes dryer." And seniors aren't just doing well compared to previous generations; they're doing well relative to their younger counterparts.

In short, a group that's better off than ever before is receiving ever more generous benefits subsidized by younger, poorer Americans.

Looking at both consumption and income data to assess changes in living standards, Meyer and the Notre Dame economist James Sullivan find that Americans 65 and older have much lower poverty rates than most other demographic groups, and that these rates have fallen significantly faster for them than for other groups, too.

According to the Pew Research Center, as of 2009 "the typical household headed by an adult 65 or older had $170,494 in net worth, compared with just $3,662 for the typical household headed by an adult younger than 35." This is to be expected, since people generally accumulate assets and pay off debts as they grow older. But the authors were surprised to find that the gap has actually been widening. In 1984, when the Census Bureau began tracking these numbers, "the age-based wealth gap was 10:1. By 2009, it had ballooned to 47:1."

Sadly, this trend is not just a product of older Americans getting wealthier. Younger Americans are getting poorer. According to Pew, the net worth of households headed by people younger than 35 shrunk by 68 percent even as the net worth of households headed by people 65 and older grew by 42 percent. Meanwhile, a 2011 paper by Jeffrey Thompson of the University of Massachusetts Amherst and Timothy Smeeding of the University of Wisconsin–Madison shows that households whose head was under 34 were hit much harder during the recession than households headed by people in other age groups. Thompson and Smeeding also found that younger Americans recovered much more slowly from the damage.

And the situation will get worse as spending on Medicare and Social Security explodes. Without reforms today, vast tax increases will be needed to pay for the unfunded promises made to a steadily growing cohort of seniors.

Fortunately, numerous workable solutions are available to lawmakers. Way back in 2003, Cato Institute scholars Chris Edwards and Tad DeHaven listed several sensible reforms, including adding a system of personal savings accounts to Social Security, liberalizing Medical Savings Accounts, and making the latter permanent "to reduce health care costs by increasing competition between providers and making consumers more responsive to tradeoffs." These options are supposed to encourage families to save more, but also to use their money more responsibly and in a manner more consistent with their long-term needs. And since taxpayers remain in control of their cash, they can also pass it along if they don't use it all before they die—giving the next generation a head start when it comes to building assets.

In the September 2012 issue of reason, Reason TV's Nick Gillespie and I offered a more comprehensive option when we argued against having separate programs for the elderly and the poor. Because the important distinction is the inability to pay, not the age of the beneficiary, we suggested that "the most obvious, effective, and just approach is to end Social Security and Medicare and replace them with a true safety net that would help poor Americans regardless of age. To the extent that seniors qualify for income supplements, food stamps, and other transfer programs, they should be added to those rolls. They can also be added to Medicaid rolls (currently about 9 million seniors are so-called double-dippers, receiving benefits from both Medicaid and Medicare)."

Unfortunately, there is almost no appetite in Congress for even mild reforms of Social Security and Medicare. Most lawmakers won't touch entitlement programs, because older Americans vote. Driven by a desire to get re-elected, politicians refuse to reform the program at the core of our country's future fiscal woes.

Continued in article

Jensen Comment
In addition to paying seniors and the exploding population of people on Medicare that are declared disabled, taxpayers are on the hook for providing free medical services and medicines to the expanded (Obamancare) rolls of Medicaid.

Over a fourth of the California population is now getting totally free medical services and medicines under Medi-Cal.
California's Medi-Cal program for "poor" grows to 12 million. --
http://www.sacbee.com/entertainment/living/health-fitness/article10317917.html

Bob Jensen's threads on entitlements ---
http://www.trinity.edu/rjensen/Entitlements.htm


MediCal is California's Version of Medicaid free medical services for poor people. MedicCal also has a price-fixing program that is preventing many doctors and hospitals from providing services to patients insured by MediCal. This is an example of where price fixing either results in either having no goods and services or inferiors goods and service.

Over a fourth of the California population is now getting totally free medical services and medicines under Medi-Cal.
California's Medi-Cal program for "poor" grows to 12 million. --
http://www.sacbee.com/entertainment/living/health-fitness/article10317917.html

Since California embraced the federal health care overhaul, the state's Medicaid program for the poor has added more than 2.7 million people, a surprisingly high number that has left the state to grapple with making sure there are enough doctors to care for all of them.

Medi-Cal, the $95 billion joint federal-state program, covers 12 million people — nearly one in every three residents — for their doctor visits, hospital care, pregnancy-related services, as well as some nursing home care, making California the largest health care purchaser in the state.

The figure accounts for 17 percent of the nation's Medicaid enrollment, even though California has 12 percent of the U.S. population.

Lawmakers and advocates say the safety net program has grown so big, so fast that without major fixes, California won't be able to provide quality health care for its poor.

"Medi-Cal is turning into an empty promise with an insurance card," said Molly Weedn, a spokesman for We Care for California, a coalition of doctors, hospitals, health plans and labor unions pushing for higher payment rates. Democratic Sen. Ed Hernandez of La Puente and Assemblyman Rob Bonta of Alameda plan to introduce legislation Wednesday to raise rates.

Even though the federal government has injected billions into California, doctors and hospitals say the state continues to pay much less than private insurance or Medicare for medical services. That's meant fewer primary care doctors and specialists are willing to treat Medi-Cal patients.

According to the California HealthCare Foundation, a health care philanthropy based in Oakland, 76 percent of primary physicians accept new patients through private insurance, but only 57 percent accept new Medi-Cal patients.

The result is that more Medi-Cal patients are ending up in emergency rooms, which is more expensive and doesn't provide ongoing care for serious diseases and illnesses, according to We Care for California.

Dr. Marc Futernick, who directs emergency services at California Hospital in downtown Los Angeles, said one Medi-Cal patient with advanced colon cancer came into his emergency room four times in five weeks because he was unable to see an oncologist or get the chemotherapy treatments he needed.

"It's much worse than just a couple years ago," Futernick said.

As Democratic legislative leaders look for ways to spend more on social services, Gov. Jerry Brown and Republican lawmakers fret about the state's ability to pay for its commitments. Medi-Cal costs grew 4.3 percent from $17.8 billion last year to $18.6 billion this year, or 16 percent of the state's general fund. The program also faces spiraling costs for seniors and specialty drugs.

While the federal government will pay 100 percent of the costs for newly eligible Medi-Cal recipients until 2016, it will be phasing down to a 90 percent share in 2020. The Brown administration projects it will cost $1.7 billion more for the state to cover the 10 percent.

One way the Brown administration has proposed controlling costs is to limit Medi-Cal enrollment to certain times of the year, similar to open enrollment for private health plans.

Sen. Richard Pan, D-Sacramento, a doctor who has called for Medi-Cal reform, said it would be shortsighted if the state doesn't increase provider payments to save money in the long run. He said the state needs to improve coordination of care, set and measure performance standards for contracting health plans and better manage chronic illnesses to reduce hospitalization rates.

"How can we not afford this?" he asked.

Chris Perrone, director of health reform at the California HealthCare Foundation, said the state's enrollment success stems from its decision to make it easier for low-income people to enroll. For example, the state negotiated a waiver from the federal government to start covering low-income childless adults in a transitional program as early as 2010.

The expansion has helped Richard Olivares, a 33-year-old homeless man in Sacramento. He gained access to a cardiologist for heart spasms and a psychiatrist for schizophrenia, anxiety and anger management issues. Medi-Cal also covered a recent jaw surgery from a fight.

"It's really been a blessing because I have a heart problem and every time I get sick, I'm able to go and see a doctor," he said.

When Medi-Cal expanded last year under President Barack Obama's health reform plan, the state struggled to enroll people fast enough and counties reported being hobbled by a new web-based enrollment system that didn't always work. California's backlog reached as high as 900,000, prompting threats from the federal government and triggering a lawsuit from patients and health care advocates.

Under the expansion, a person can make up to $16,105 or 138 percent of the federal poverty level to qualify for Medi-Cal, or $32,913 for a family of four.

The state Department of Health Care Services, which oversees Medi-Cal, said the backlog has been "virtually cleared." The department declined multiple interview requests to The Associated Press to explain its plan for handling the caseload, which is expected to grow as more immigrants in the country without documentation will be eligible for state-funded health coverage under Obama's executive order not to seek deportation.

Read more here:
http://www.sacbee.com/entertainment/living/health-fitness/article10317917.html#storylink=cpy

"Medi-Cal a waiting game for many low-income Californians," by Tracy Seipel, San Jose Mercury News, February 7, 2015 ---
http://www.mercurynews.com/health/ci_27481258/obamacare-medi-cal-waiting-game-many-low-income 

Julie Moreno felt lucky to be among more than 2.7 million previously uninsured Californians to be added to Medi-Cal, the state's health care program for the poor.

Until she needed cataract surgery.

For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend's mother to have the procedure done elsewhere last February.

One year into the explosive, health law-induced growth of Medi-Cal, it appears one of the most alarming predictions of critics is coming true: The supply of doctors hasn't kept up with demand. One recent study suggests the number of primary care doctors in California per Medi-Cal patient is woefully below federal guidelines.

"If you're pregnant, you get help," Moreno said. "But if you're 49 and not pregnant, you have to wait for everything."

In fact, seven months after Moreno's surgery, her original surgeon's office called just to say they still couldn't fit her in.

At least 1.2 million Californians have signed up for a private insurance plan since enrollment began in October 2013 under the Affordable Care Act, better known as Obamacare. But it's Medi-Cal that has witnessed the largest growth -- 2.7 million since the controversial law opened the program up to many more recipients in January 2014.

By mid-2016, more than 12.2 million people -- nearly a third of all Californians -- will be on Medi-Cal, state health officials say.

Those officials continue to insist that the current delays to see a doctor and crowded emergency rooms are all part of to-be-expected growing pains. But many experts say the problems are so widespread they shouldn't be ignored.

"California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients," said Dr. Del Morris, president of the California Academy of Family Physicians, which represents many of the first-line doctors who treat Medi-Cal patients. "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"

Morris and other experts say the situation is about to get worse, in part because of Medi-Cal's health care reimbursement rates.

For years, the rates paid by Medi-Cal -- called Medicaid in the rest of the country -- have been among the nation's lowest. A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31. A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.

Even before the latest cuts, Medi-Cal doctors -- particularly specialists -- in California's rural areas often seemed nearly impossible to find. And the shortage of Medi-Cal physicians appears to be causing spikes in the number of Medi-Cal patients being treated in hospital emergency rooms around the state. Data from the Office of Statewide Health Planning and Development show that in the first three quarters of 2014, "treat and release" visits to emergency rooms by Medi-Cal patients jumped 30 percent from the same period the year before.

At least once a week at the MayView Community Health Center in Mountain View, the clinic is so swamped that it is forced to send Medi-Cal patients to hospital emergency rooms "because they cannot go anywhere else," clinic operations director Harsha Mehta said.

Since January 2014, Axis Community Health in Pleasanton has added about 1,700 new Medi-Cal patients to its five facilities that serve the Tri-Valley area, bringing the total to about 14,000. While 700 of those patients were already being treated at Axis before they enrolled in Medi-Cal, the overall jump in new patients is forcing Dr. Divya Raj, Axis' medical director, to hire more hard-to-find doctors.

A recent report by the California HealthCare Foundation that tried to determine if the state has enough doctors to handle the influx of Medi-Cal patients reinforces Raj's trepidation.

The report found the ratio of patients to full-time primary care doctors participating in Medi-Cal -- including family medicine physicians, general internists, pediatricians and ob/gyns -- was 35 to 49 physicians per 100,000 enrollees, well below the federal guidelines of 60 to 80.

"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."

Bait and Switch for Primary Care "Doctors"
Nationwide there was an enormous shortage of primary care doctors before Obamacare. Obamacare greatly increased the demand for such doctors, thereby, making the shortage much worse. This has led to nationwide bait and switch primary care that is similar to three of the medical clinics in Littleton, New Hampshire. Each clinic has one MD and one or more added "physicians assistants" who are not medical doctors but can examine patients and prescribe common medications.

The bait and switch part is that patients in each clinic are not allowed to see the MD at all or must wait much longer for an appointment to see the the MD. In the meantime they are encouraged to be examined by only the physicians assistant or to go to emergency rooms.

Another sad part of the bait and switch tactic is that many specialists such as those at the Dartmouth medical center will only see patients referred by an MD or osteopath. Without such referrals patients are not allowed to make appointments with such specialists such as dermatologists, psychiatrists, and surgeons.

One other clinic up here has a really lousy and uncaring foreign-trained MD and an osteopath. My primary care doctor is the osteopath. He seems pretty good to me, but then my medical needs are fairly simple and routine. Our Littleton Regional Hospital does have an outstanding emergency room, although it's not a trauma center and has to send a relatively large number of patients by helicopter to the Dartmouth medical center about 50 miles away.

Of course patients with serious problems have discovered how to get referrals. The go directly to emergency rooms and maybe wait the better part of a day to be examined. But they eventually leave with a referral to see a specialist provided that specialist will accept their insurance.

The huge problem in New Hampshire is that nearly half (slightly less this year) of the hospitals and specialists will not accept ACA insurance.


"How Obamacare Is Ruining Health Insurance," by John C. Goodman, Forbes, February 11, 2015 ---
http://www.forbes.com/sites/johngoodman/2015/02/11/how-obamacare-is-ruining-health-insurance/

The health insurance market is changing. And the changes are not good. Even before there was Obamacare, most insurers most of the time had perverse incentives to attract the healthy and avoid the sick. But now that the Affordable Care Act has completely changed the nature of the market, the perverse incentives are worse than ever.

Writing in Sunday’s New York Times Elizabeth Rosenthal gives these examples:

But aren’t these insurers worried that if they mistreat their customers, their enrollees will move to some other plan? Here’s the rarely told secret about health insurance in the Obamacare exchanges: insurers don’t care if heavy users of medical care go to some other plan. Getting rid of high-cost enrollees is actually good for the bottom line.

To appreciate how different health insurance has become, let’s compare it to the kind of casualty insurance people buy for their home or their cars.

Dennis Haysbert is the actor I remember best for playing the president of the United States in the Jack Bauer series, 24.  You probably know him better as the spokesman for Allstate. In one commercial he is standing in front of a town that looks like it has been demolished by a tornado. “It took only two minutes for this town to be destroyed,” he says. And he ends by asking “Are you in good hands?”

The point of the commercial is self-evident. Casualty insurers know you don’t care about insurance until something bad happens. And the way they are pitching their products is: Once the bad thing happens, we are going to take care of you.

Virtually all casualty insurance advertisements carry this message, explicitly or implicitly. Nationwide used to run a commercial in which all kinds of catastrophes were caused by a Dennis-the-Menace type kid. In a State Farm ad, a baseball comes crashing through a living room window. Nationwide’s “Life comes at you fast” series features all kinds of misadventures. And of course, the Aflac commercials are all about unexpected mishaps.

The Case Against Obamacare: An eBook From Forbes
Don’t be fooled. The new health law has disrupted coverage for millions, and driven up costs for millions more.

My favorite casualty insurer print ad is sponsored by Chubb. It features a man fishing in a small boat with his back turned to a catastrophe. He is about to go over what looks like Niagara Falls. Here’s the cutline: “Who insures you doesn’t matter. Until it does.”

Now let’s compare those messages to what we see in the health insurance exchange. Federal employees have been obtaining insurance in an exchange, similar to the Obamacare exchanges, for several decades. Every fall, during “open enrollment,” they select from among a dozen or so competing heath plans. In Washington, DC where the market is huge, insurers try to attract customers by running commercials on TV, in print and in other venues.

Continued in article

 

 


"How Obama’s $3 Trillion Health-Care Overhaul Would Work," by John Tozzi, Bloomberg Businessweek, January 26, 2015 ---
http://www.businessweek.com/articles/2015-01-26/how-obama-s-3-trillion-health-care-overhaul-would-work?campaign_id=DN012715

The Obama administration has announced plans to accelerate a shift in how the U.S. pays its $2.9 trillion annual health-care bill. Officials at Medicare, which covers one in six Americans, want to stop paying doctors and hospitals by the number of tests and treatments they do. Instead, the government wants to link payments to how well providers take care of patients, not just how much care they provide.

This transition is already under way. Millions of Americans are now covered in experimental programs created by the Affordable Care Act designed to reduce unnecessary care and incentivize doctors to focus on quality, not quantity. The administration wants to vastly expand such programs to include half of all Medicare payments by the end of 2018. Here’s what you need to know:

Growth has slowed in recent years. Since 2010, per capita health spending has increased at about the same rate as the U.S. economy, a historically low rate for American health spending. Even if that holds steady, 17¢ of every dollar spent in the U.S. goes to health care, far higher than in other countries that have health outcomes as good or better than America’s.

The government’s starting to change how it pays doctors and hospitals

After the Affordable Care Act was passed in 2010, the federal government started experiments with doctors and hospitals willing to try new payment models. One of the attempts to do this was a program called Accountable Care Organizations (ACOs), which would let medical providers share in the savings if they reduced the overall health-care costs for their Medicare patients. Now more than 7.8 million of Medicare’s 55 million beneficiaries get their care through such arrangements, up from zero in 2011.

The Obama administration would like to speed this up. Medicare wants 30 percent of all payments to go through models like ACOs by the end of next year, and 50 percent by the end of 2018, up from about 20 percent now. Other incentives already in place, such as penalties for hospitals when patients get readmitted, nudge providers to improve care, even if they’re still getting paid in a traditional fee-for-service system. The government wants 90 percent of all Medicare payments to include such incentives by the end of 2018.

It still has a long way to go

It’s hard to say precisely how much of the total $2.9 trillion in health spending flows through fee-for-service payments, but a safe answer is: most of it. Even hospitals participating in Medicare’s new payment experiments often get paid the old way by commercial insurers, for example. Those contradictory incentives can make it hard for hospitals to fully make the changes they need to care for patients more efficiently. “Can you create a situation ultimately where you’re treating fewer people in the hospital and doing fewer higher-reimbursement treatments? That’s a real risk,” Moody’s health-care analyst Dan Steingart told me this month. “If your contracts only pay you on a pure fee-for-service basis, you’re basically shooting yourself in the foot.”

This is the first time Medicare officials have set clear targets for how much spending they want to flow through new payment systems. The Obama administration said the goals should incentivize more doctors and hospitals to join, and give them some certainty that the switch to new payment methods is real. The government also wants private-sector buyers of health care to make the shift. A council of executives from the insurance and medical industries, as well as big employers such as Boeing and Verizon, will try to expand alternative payments.

We don’t know how well it will work

Medicare is trying a few experiments, including ACOs and bundled payments (which try to put limits around how much hospitals can charge for common procedures like knee and hip replacements). While economists and medical providers largely agree that ending the fee-for-service program is essential to containing health-care costs, the evidence for the new models isn’t really in yet. Medicare officials said they have no results on bundled payments yet. The early years of the ACO program have shown some savings, but a majority of ACOs for which Medicare has data have not generated savings yet.


Teaching Case on ACA Health Care Tax Issues
From The Wall Street Journal Weekly Accounting Review on February 6, 2015

The ACA and Other Changes to Watch Out for This Tax Season
by: Tom Herman
Feb 02, 2015
Click here to view the full article on WSJ.com
 

TOPICS: Individual Taxation

SUMMARY: Before firing off a 2014 income tax return, taxpayers should take some time to master a few important, but easily overlooked, deductions, credits and other breaks-including a few that were revived at the end of last year. Even if a taxpayer considers him or herself a tax wizard who loves studying the Internal Revenue Code, it's increasingly easy to make costly bloopers. Also, taxpayers should watch out for a few new wrinkles in 2015, notably those stemming from the Affordable Care Act. The article offers some areas that deserve extra attention.

CLASSROOM APPLICATION: This article offers insight on some areas of individual taxation, especially areas that have experienced recent changes.

QUESTIONS: 
1. (Advanced) What are the tax issues involving health insurance for 2014 tax returns? Will the changes affect all taxpayers, some, or just a few? Why is health insurance a part of tax returns?

2. (Introductory) What is the income ceiling for the Social Security tax? How could this be a problem for people who have more than one job?

3. (Advanced) How is income taxed if capital losses exceed capital gains? How does that differ from when capital gains exceed capital losses? How are gains and losses from a personal residence different from other capital gains and losses?

4. (Advanced) What is the standard deduction? How many taxpayers elect to claim it? What is the other alternative? Why do the majority of the taxpayers choose the option they choose?

5. (Introductory) What taxpayers should choose to deduct sales taxes? What is the other option?

6. (Introductory) What is the simplified calculation for the home office deduction? Why did the IRS develop this calculation? What is the other option?
 

Reviewed By: Linda Christiansen, Indiana University Southeast

Before firing off your 2013 income tax return, take some time to master a few important, but easily overlooked, deductions, credits and other breaks—including a few that were revived at the end of last year.
"The ACA and Other Changes to Watch Out for This Tax Season," by Tom Herman, The Wall Street Journal, February 2, 2015 ---
http://www.wsj.com/articles/the-aca-and-other-changes-to-watch-out-for-this-tax-season-1422849612?mod=djem_jiewr_AC_domainid

The complexity and questions that arise from the nation’s ever-changing tax laws are as certain as taxes themselves. So we introduce a new column, written by Tom Herman, a former tax columnist for The Wall Street Journal, that will look at developments affecting taxpayers and individual investors. We welcome your thoughts and questions about tax issues, big and small. Send them to reports@wsj.com.

Early birds, be careful.

Before firing off your ... income tax return, take some time to master a few important, but easily overlooked, deductions, credits and other breaks—including a few that were revived at the end of last year.

Even if you consider yourself a tax wizard who loves studying the Internal Revenue Code, it’s increasingly easy to make costly bloopers. Also, watch out for a few new wrinkles this year, notably those stemming from the Affordable Care Act.

Here are some areas that deserve extra attention:

HEALTH INSURANCE Get ready for some new lines on this year’s forms because of the Affordable Care Act. For most, this should be fairly simple. “The majority of taxpayers—more than three out of four—will simply need to check a box to verify they have health-insurance coverage,” the IRS says. Others will face trickier issues. Some may be eligible to claim an exemption from the coverage requirement. But those who don’t have qualifying coverage or who don’t qualify for an exemption will need to make “an individual shared responsibility payment.” Others may qualify for a “premium tax credit.” See irs.gov/aca for details. For some “this will be very complicated,” warns Mark Luscombe, principal federal tax analyst for Wolters Kluwer Tax & Accounting U.S.

SOCIAL SECURITY TAX Some people who worked for two or more employers last year may have paid too much in Social Security tax. The maximum amount that should have been withheld by all your employers for 2014 was $7,254. (That’s 6.2% of $117,000, the maximum amount of wages subject to the Social Security tax.) If you had too much withheld, you typically can claim the excess as a credit. See IRS Publication 17 for details.

INVESTMENT LOSERS Did you lose money on stocks, bonds and other investments you sold last year? Use your capital losses to offset capital gains. But what if your losses exceeded your gains? You can deduct as much as $3,000 a year ($1,500 for married taxpayers filing separately) of net losses against your wages and other ordinary income. Carry over excess losses into future years. Warning: You can’t deduct a loss on the sale of your personal residence.

IRA CHARITABLE TRANSFERS Late last year, lawmakers revived a provision that allowed many people age 70½ or older to transfer as much as $100,000 directly from an IRA to charity, tax-free, during 2014. The transfer counted toward the taxpayer’s required minimum distribution. You’re supposed to report your “qualified charitable distribution” on your return even if it’s tax-free. Just make sure you don’t put it on the wrong line. For example, if you file Form 1040, report your “QCD” on Line 15a. Don’t include any of that distribution on the line for “taxable amount” (Line 15b). Instead, write “QCD” next to the line.

HIGHER STANDARD About two out of every three returns typically claim the standard deduction. For 2014, the basic standard deduction is $12,400 for those married and filing jointly, or $6,200 if single or married and filing separately. There are additional amounts for people who were 65 or older, or blind. Before taking the standard deduction, check to see if you might be better off itemizing.

SALES TAXES Late last year, Congress revived a law that gives taxpayers who itemize an important choice: They can deduct either state and local income taxes paid in 2014—or their state and local sales taxes. (But they can’t deduct both.) The sales-tax option offers welcome relief for people in states with no income tax, such as Texas and Florida. But taxpayers in other states may benefit from taking the sales-tax deduction, says Mr. Luscombe, including those who paid large amounts of sales tax on major purchases such as cars or boats or those who reside in states with high sales-tax rates.

HOME OFFICE Many people who work at home don’t bother deducting their home-office expenses because the rules can be fiendishly complex and because of fears it would increase their chances of getting audited. But if you qualify to deduct home-office expenses, you may benefit from a simplified calculation method allowed by the IRS. Multiply the square footage of the home used for your home office (but not more than 300 square feet) by an IRS-approved rate of $5 a square foot. Thus, the maximum deduction in this case would be $1,500.

Mr. Herman is a writer in New York City. He was formerly The Wall Street Journal’s Tax Report columnist.

IRS ACA Health Insurance Site --- http://irs.gov/aca


"Tax Preparers Brace To Give Bad Health Law News," by April Dembosky, KQED and Jeff Cohen, WNPR, WebMD News from Kaiser Health News, January 21, 2015 ---
http://www.webmd.com/health-insurance/20150121/tax-preparers-brace-to-be-bearers-of-bad-health-law-news

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for Jackson Hewitt Tax Services.


And Yet in New Hampshire and Other States Upwards of Half the Hospitals are Refusing to Serve Patients with ACA insurance?
Why?

Answer One of the main reasons is that hospitals serving ACA patients get stuck with having to serve deadbeats who are behind in paying their insurance premiums. For 60 days doctors and lawyers must serve ACA patients that are behind over 30 days in paying insurance premiums such that insurance companies no longer have to pay their medical bills.

In the past people who defaulted on premiums became uninsured people who were treated in special facilities such as county hospitals funded by taxpayers. Now people who default on premiums get a 90-day grace period where insurance companies pay their medical costs for 30 days and the doctors and hospitals have to pay for their medical care for 60 days.

There's a 90-day grace period in the ACA where people who default on paying premiums are still covered for the first 30-days by the insurance company and the next 60 days by the doctors and hospitals providing the care is absolutely absurd. The insurance companies will simply pass on these bad debt losses (which may be enormous for surgeries and hospital confinements) into higher premiums for the people who pay their medical insurance billings.


"Supreme Court Battle Brewing Over Medicaid Fees," by Phil Galewitz, WebMD, January 12, 2015 ---
http://www.webmd.com/health-insurance/20150112/supreme-court-battle-brewing-over-medicaid-fees

Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection.

But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, she was finally able to get Nathaniel an appointment nearly a week later near their South Florida home. That was in 2005.

Last month, ruling in a lawsuit brought by the state’s pediatricians and patient advocacy groups, a federal district judge in Miami determined Nathaniel’s wait was “unreasonable” and that Florida’s Medicaid program was failing him and nearly 2 million other children by not paying enough money to doctors and dentists to ensure the kids have adequate access to care.

The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. In the past two decades, similar cases have been filed in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia– with many resulting in higher pay.

But while providers and patient advocates nationwide hailed the Florida decision, they are deeply worried about a U.S. Supreme Court case that they say could restrict their ability across the country to seek judicial relief from low Medicaid reimbursement rates.

The high court on Jan. 20 will hear a case from Idaho seeking to overturn a 2011 lower court order to increase payments to providers serving Medicaid enrollees with development disabilities. In the original case, five centers serving developmentally disabled adults and children argued that Idaho was unfairly keeping Medicaid reimbursement rates at 2006 levels despite studies showing that the cost of providing care had risen.

Idaho officials argue only the state and federal government should be able to set provider fees in Medicaid and all other “private parties,” including patients and providers, should not be able to use the court system to gain higher rates. Twenty-seven states and the Obama administration are supporting Idaho’s appeal, along with the National Governors Association.


"Tax Preparers Brace To Give Bad Health Law News," by April Dembosky, KQED and Jeff Cohen, WNPR, WebMD News from Kaiser Health News, January 21, 2015 ---
http://www.webmd.com/health-insurance/20150121/tax-preparers-brace-to-be-bearers-of-bad-health-law-news

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be much more complex for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for Jackson Hewitt Tax Services.

 


"What '60 Minutes' Didn't Say: Hospitals Will Charge You More Under Obamacare," by Avik Roy, Forbes, January 12, 2015 ---
http://www.forbes.com/sites/theapothecary/2015/01/12/what-60-minutes-didnt-tell-you-obamacare-will-drive-up-the-cost-of-hospital-care/

On Sunday evening, CBS’ 60 Minutes did a feature story on Steven Brill’s new book, America’s Bitter Pill, in which Brill complains that Obamacare didn’t do enough to tackle the exorbitantly high price of U.S. hospital care. “Obamacare does zero to change any of that,” says Brill. That’s not exactly right. What Brill—and CBS—don’t tell you—is that Obamacare is driving hospitals to charge you more than they already do.

The U.S. hospital industry is crony capitalism at its finest

Steven Brill, founder of The American Lawyer and Court TV took a starring role in the health care debate when he published the Time articleBitter Pill,” describing how hospitals charge extreme prices for ordinary care to the uninsured. For example, Sean Recchi, an uninsured lymphoma patient, went to MD Anderson Cancer Center, a world-renowned facility in Houston, to seek treatment. MD Anderson proceeded to charge him $283 for a $20 chest X-ray. They charged him more than $15,000 for blood tests costing a few hundred dollars. They charged him $13,702 for a dose of Rituxan, a lymphoma drug, for which the average U.S. hospital price is around $4,000. All told, Recchi’s course of treatment cost $83,900. Whatever he couldn’t pay was called “uncompensated care.”

MD Anderson is not struggling under the weight of bills unpaid by the uninsured. In 2010, MD Anderson recorded revenue of $2.05 billion and operating profits of $531 million. Brill recounted several other patients at other hospitals with similar stories.

This is a topic we’ve covered extensively at The Apothecary, and elsewhere: the U.S. hospital industry is the single largest example of crony capitalism in the history of civilization. In 2013, I wrote a piece for National Review calledAn Arm and a Legexplaining the problem.

To summarize: the average day spent in a U.S. hospital costs five times as much as it does in other industrialized countries. That’s not because U.S. hospitals use higher technology or better care. It’s because they charge more for the same technology and the same care. Because they can get away with it.

Obamacare subsidizes hospitals’ already-high prices

Thanks to federal intervention in the health care system—Medicare, Medicaid, and the employer tax exclusion—hospitals have been able to charge whatever they want for their services, knowing that the average consumer has no idea how much he’s paying, because he’s paying mostly through taxes and other indirect means.

In 2013, U.S. government entities—i.e., taxpayers—spent a half-trillion dollars subsidizing American hospitals. By 2021, thanks in part to Obamacare, that will grow to $800 billion a year. That’s more than twice what the military spends subsidizing the aerospace industry.

And here’s the thing. While Brill rightly criticizes Obamacare for not doing anything to bring down the cost of hospital care, he’s actually an ardent supporter of the law. And this is the fundamental problem with Brill’s thesis. Obamacare doesn’t merely not do anything to bring hospital costs down. It actively works to drive hospital costs upward, by doubling down on the incentives hospitals have to charge more to patients.

In every state, it’s the hospital industry that has been the principal lobbyist in support of Obamacare. Why? Because the law increases taxpayer subsidies of the hospital industry by around $400 billion per decade. In other words, it takes the currently high prices that U.S. hospitals charge and says “keep doing what you’re doing.”

If Obamacare had never passed, hospitals would have been under much more pressure to keep these costs down, because no one would be bailing them out if hospital care became increasingly unaffordable. The opposite, of course, has happened.

Obamacare encourages hospitals to increase their market power

The next thing Obamacare does is it encourages hospitals to merge, thereby giving hospitals even more market power to charge even higher prices. A study by Jamie Robinson of the University of California found that highly concentrated hospital markets–where one or two hospitals controlled most of the patient volume—hospitals charged an average of 41 percent more for common procedures than they did in more competitive markets.

Continued in article


The Health Care Market is Not a Market

"Video:  Inside ‘Bitter Pill’: Steven Brill Discusses His TIME Cover Story," Time Magazine, February 22, 2013 ---
http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/

Simple lab work done during a few days in the hospital can cost more than a car. A trip to the emergency room for chest pains that turn out to be indigestion brings a bill that can exceed the price of a semester at college. When we debate health care policy in America, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

Steven Brill spent seven months analyzing hundreds of bill from hospitals, doctors, and drug companies and medical equipment manufacturers to find out who is setting such high prices and pocketing the biggest profits. What he discovered, outlined in detail in the cover story of the new issue of TIME, will radically change the way you think about our medical institutions:

· Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer—Medicare—from even trying to negotiate the price of drugs.

· Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

· Cancer treatment—at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson—has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

· Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Brill concludes:

The health care market is not a market at all.
It’s a crapshoot. Everyone fares differently based on circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or protected only partially by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow knew the prices before they got billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers.

 

"Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

"Yes, Hospital Pricing Is Insane, But Why? Time magazine issues a 24,000-word memo on what we already knew," by Holman Jenkins Jr., The Wall Street Journal, March 1, 2013 ---
http://online.wsj.com/article/SB10001424127887323978104578334082993009730.html?mod=djemEditorialPage_h

Without diminishing the epic scope of Steven Brill's Time magazine piece about the U.S. health care system, he reiterates in lengthy detail perversities that are already well known, without offering a single useful insight on how it go that way, and even less on how to fix it.

Yet Mr. Brill, founder of CourtTV and American Lawyer magazine, author of books on terrorism and education, has written the longest piece in Time's history—24,000 words—so attention must be paid.

That health-care costs are inflated compared to what they would be in a reasonably transparent, competitive market (a point Mr. Brill never clearly makes) won't be a revelation. That hospitals allocate their costs to various items on their bills and price lists in ways that are opaque and arbitrary is not a new discovery either.

He finds it shocking that a hospital charging $1,791 a night won't throw in the generic Tylenol for free (instead charging $1.50 each). But this is to commit the reification fallacy of thinking there is some organic relationship between what a hospital charges for a particular item and what that item costs in the first place.

He dwells on the irrationality of hospitals charging their highest prices to their poorest customers, those without insurance. But he's also aware that these customers often pay little or nothing of what they are charged and hospitals reallocate the cost to the bills of other patients. He even notes that a hospital might collect as little as 18% of what it bills.

He vaguely gets that hospital price lists are memos for the file, to be drawn out and waved as a reference in negotiations with their real customers, the big health-care insurers, Medicaid, Medicare and other large payers.

The deals hammered out with these customers tend naturally to gravitate toward round numbers, leaving a hospital free to allocate its costs and profits to specific items however it wants. Mr. Brill may be offended that certain "non-profit" hospitals appear to be highly profitable. He probably wouldn't be happier, though, if they diverted their surplus revenues into even higher salaries and more gleamingly superfluous facilities.

"What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

Your time might be better spent reading Duke University's Clark Havighurst in a brilliant 2002 article that describes the regulatory, legal and tax subsidies that deprive consumers of both the incentive and opportunity to demand value from medical providers. Americans end up with a "Hobson's choice: either coverage for 'Cadillac' care or no health coverage at all."

"The market failure most responsible for economic inefficiency in the health-care sector is not consumers' ignorance about the quality of care," Mr. Havighurst writes, "but rather their ignorance of the cost of care, which ensures that neither the choices they make in the marketplace nor the opinions they express in the political process reveal their true preferences."

You might turn next to an equally fabulous 2001 article by Berkeley economist James C. Robinson, who shows how the "pernicious" doctrine that health care is different—that consumers must shut up, do as they're told and be prepared to write a blank check—is used to "justify every inefficiency, idiosyncrasy, and interest-serving institution in the health care industry."

Hospitals, insurers and other institutions involved in health care may battle over available dollars, but they also share an interest in increasing the nation's resources being diverted into health care—which is exactly what happens when costs are hidden from those who pay them.

Continued in article

Jensen Comment
Over a year ago Erika's Medicare-Anthem summary of charges for the month included an $11,376 charge for out patient surgery that was mistakenly billed to her account. We called our doctor who did the procedure in the hospital. Our doctor responded not to bother her or the hospital --- since Medicare-Anthem paid the entire bill it would not matter.

This bothered us since the woman (I assume it was a woman) may not have been eligible for Medicare-Anthem. So I phoned Medicare. Medicare said not to bother them and advised us to contact the hospital where the procedure took place. Any corrections should be made by the hospital and the doctor.

So I called the hospital's accounting office. They asked that I send in a copy of the Medicare-Anthem report. I hand-delivered the report to the the hospital accounting office --- which is miles from the hospital.

Over the ensuing year we waited for a corrected Medicare-Anthem report. Nothing! So I did a follow up visit to the hospital's accounting office. The feedback was that since Medicare-Anthem paid the bill there was no need to waste time correcting this item.

I keep thinking that some woman not eligible for Medicare got a windfall gain here. Who cares if it was Medicare-Anthem that got screwed?

Erika and I changed to a doctor that we like better. But we cannot change hospitals.

Moral of the Story
If the third party insurer gets billed mistakenly or pays too much nobody cares, least of all the doctors and hospitals who got reimbursed.

Question
Who is telling a lie?

Steven Brill wrote a long cover story for Time Magazine, In that story he describes having his team examine eight very complicated hospital bills from different hospitals. In every case they found that the bills were laced with errors and overcharges in favor of the hospital and possible frauds.
Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

The following week Stamford Hospital CEO Brian G. Grissler replied as shown, in part, below. Steven Brill's reply to Grissler, Time Magazine, March 18, 2013, Page 2.

Brian G. Grissler
". . . Brill refused to share the patient's name or the complete bill, so we are unable to answer those questions . . . "

Steven Brill Responds
"Stamford Hospital was shown the bill and never disputed its authenticity. I made clear in the article the hospital settled for cutting its bill entirely in half."

Jensen Comment
There are four possibilities behind this dispute:

  1. Brian Grissler could be lying through his teeth.

     
  2. Brian Grissler may not have thoroughly investigated the ultimate resolution of this bill by his staff.

     
  3. Steven Brill could be lying through his teeth.

     
  4. Steven Brill and Brian Grissler may not be discussing the same bill (although Brill claims he only picked one bill to examine from Stamford Hospital).

My vote is that Answer 1 above is probably the correct answer, but we most likely will never know.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


And Yet in New Hampshire and Other States Upwards of Half the Hospitals are Refusing to Serve Patients with ACA insurance?
Why?

Answer
One of the main reasons is that hospitals serving ACA patients get stuck with having to serve deadbeats who are behind in paying their insurance premiums. For 60 days doctors and lawyers must serve ACA patients that are behind over 30 days in paying insurance premiums such that insurance companies no longer have to pay their medical bills.

In the past people who defaulted on premiums became uninsured people who were treated in special facilities such as county hospitals funded by taxpayers. Now people who default on premiums get a 90-day grace period where insurance companies pay their medical costs for 30 days and the doctors and hospitals have to pay for their medical care for 60 days.

There's a 90-day grace period in the ACA where people who default on paying premiums are still covered for the first 30-days by the insurance company and the next 60 days by the doctors and hospitals providing the care is absolutely absurd. The insurance companies will simply pass on these bad debt losses (which may be enormous for surgeries and hospital confinements) into higher premiums for the people who pay their medical insurance billings.


Say What?
Harvard Faculty Upset Over Obamacare's Impact

http://townhall.com/tipsheet/guybenson/2015/01/06/single-tear-harvard-faculty-upset-over-obamacare-impact-n1938881?utm_source=thdailypm&utm_medium=email&utm_campaign=nl_pm&newsletterad=thpm1

"Harvard Ideas on Health Care Hit Home, Hard," by Robert Pearjan, The New York Times, January 5, 2015 ---
http://www.nytimes.com/2015/01/06/us/health-care-fixes-backed-by-harvards-experts-now-roil-its-faculty.html?_r=2

For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed. Continue reading the main story Related Coverage

Roberto Villacreses of Sunshine Life and Health Advisors with Darko Tomelic and Andrea Viteri recently at a Miami mall. Health Insurance Enrollment Strongest in Federal MarketplaceDEC. 30, 2014 Agents from Sunshine Life and Health Advisors helped customers sign up for health care in Miami this month. So Far, 6.4 Million Obtain Health Care Coverage for 2015 in Federal MarketplaceDEC. 23, 2014 Obama Administration to Investigate Insurers for Bias Against Costly ConditionsDEC. 22, 2014

The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”

In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven by health care reform,” in the form of the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.

Richard F. Thomas, a Harvard professor of classics and one of the world’s leading authorities on Virgil, called the changes “deplorable, deeply regressive, a sign of the corporatization of the university.”

Mary D. Lewis, a professor who specializes in the history of modern France and has led opposition to the benefit changes, said they were tantamount to a pay cut. “Moreover,” she said, “this pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent.”

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

Michael E. Chernew, a health economist and the chairman of the university benefits committee, which recommended the new approach, acknowledged that “with these changes, employees will often pay more for care at the point of service.” In part, he said, “that is intended because patient cost-sharing is proven to reduce overall spending.”

The president of Harvard, Drew Gilpin Faust, acknowledged in a letter to the faculty that the changes in health benefits — though based on recommendations from some of the university’s own health policy experts — were “causing distress” and had “generated anxiety” on campus. But she said the changes were necessary because Harvard’s health benefit costs were growing faster than operating revenues or staff salaries and were threatening the budget for other priorities like teaching, research and student aid.

In response, Harvard professors, including mathematicians and microeconomists, have dissected the university’s data and question whether its health costs have been growing as fast as the university says. Some created spreadsheets and contended that the university’s arguments about the growth of employee health costs were misleading. In recent years, national health spending has been growing at an exceptionally slow rate.

In addition, some ideas that looked good to academia in theory are now causing consternation. In 2009, while Congress was considering the health care legislation, Dr. Alan M. Garber — then a Stanford professor and now the provost of Harvard — led a group of economists who sent an open letter to Mr. Obama endorsing cost-control features of the bill. They praised the Cadillac tax as a way to rein in health costs and premiums.

Dr. Garber, a physician and health economist, has been at the center of the current Harvard debate. He approved the changes in benefits, which were recommended by a committee that included university administrators and experts on health policy.

In an interview, Dr. Garber acknowledged that Harvard employees would face greater cost-sharing, but he defended the changes. “Cost-sharing, if done appropriately, can slow the growth of health spending,” he said. “We need to be prepared for the very real possibility that health expenditure growth will take off again.”

But Jerry R. Green, a professor of economics and a former provost who has been on the Harvard faculty for more than four decades, said the new out-of-pocket costs could lead people to defer medical care or diagnostic tests, causing more serious illnesses and costly complications in the future.

“It’s equivalent to taxing the sick,” Professor Green said. “I don’t think there’s any government in the world that would tax the sick.”

Meredith B. Rosenthal, a professor of health economics and policy at the Harvard School of Public Health, said she was puzzled by the outcry. “The changes in Harvard faculty benefits are parallel to changes that all Americans are seeing,” she said. “Indeed, they have come to our front door much later than to others.”

But in her view, there are drawbacks to the Harvard plan and others like it that require consumers to pay a share of health care costs at the time of service. “Consumer cost-sharing is a blunt instrument,” Professor Rosenthal said. “It will save money, but we have strong evidence that when faced with high out-of-pocket costs, consumers make choices that do not appear to be in their best interests in terms of health.”

Harvard’s new plan is far more generous than plans sold on public insurance exchanges under the Affordable Care Act. Harvard says its plan pays 91 percent of the cost of services for the covered population, while the most popular plans on the exchanges, known as silver plans, pay 70 percent, on average, reflecting their "actuarial value.”

"None of us who protested was motivated by our own bottom line so much as by the principle,” Ms. Lewis said, expressing concern about the impact of the changes on lower-paid employees.

In many states, consumers have complained about health plans that limit their choice of doctors and hospitals. Some Harvard employees have said they will gladly accept a narrower network of health care providers if it lowers their costs. But Harvard’s ability to create such networks is complicated by the fact that some of Boston’s best-known, most expensive hospitals are affiliated with Harvard Medical School. To create a network of high-value providers, Harvard would probably need to exclude some of its own teaching hospitals, or discourage their use.

“Harvard employees want access to everything,” said Dr. Barbara J. McNeil, the head of the health care policy department at Harvard Medical School and a member of the benefits committee. “They don’t want to be restricted in what institutions they can get care from.”

Although out-of-pocket costs over all for a typical Harvard employee are to increase in 2015, administrators said premiums would decline slightly. They noted that the university, which has an endowment valued at more than $36 billion, had an unusual program to provide protection against high out-of-pocket costs for employees earning $95,000 a year or less. Still, professors said the protections did not offset the new financial burdens that would fall on junior faculty and lower-paid staff members.

Continued in article

 

 

 




December 31, 2014

The 5 Most Common Health Insurance Exemptions -- and Who Qualifies ---
http://news.yahoo.com/5-most-common-health-insurance-exemptions-qualifies-180857442.html

Cadillac Tax --- http://en.wikipedia.org/wiki/Cadillac_insurance_plan
Unions used their political connections to exempt themselves from the whopping Cadillac tax on luxury health plans
---
http://nypost.com/2010/01/15/unions-will-dodge-os-health-tax/

 


"Vermont bails on single-payer health care," by Sarah Wheaton, Politico, December 17, 2014 ---
http://www.politico.com/story/2014/12/vermont-peter-shumlin-single-payer-health-care-113653.html

. . .

Gov. Shumlin had missed two earlier financing deadlines but finally released his proposal. But he immediately cast it as “detrimental to Vermonters.” The model called for businesses to take on a double-digit payroll tax, while individuals would face up to a 9.5 percent premium assessment. Big businesses, in particular, didn’t want to pay for Shumlin’s plan while maintaining their own employee health plans.

“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”

And that was for a plan that would not be truly single payer. Large companies with self-insured plans regulated by ERISA would have been exempt. And Medicare also would have operated separately, unless the state got a waiver, which was a long shot.

Shumlin added that federal funds available for the transition were $150 million less than expected.

He also has a lot less political capital than before November. Shumlin, chairman of the Democratic Governors Association, still hasn’t even officially won his own reelection bid: The Legislature will settle the outcome of the November race in January because Shumlin failed to win more than 50 percent of the vote. He’s leading his Republican challenger by just a few thousand ballots.

And the substance of the plan isn’t its only politically problematic aspect. Gruber, now infamous for his blunt assessments of the Affordable Care Act and his remarks about “stupid” voters, was until recently a state consultant. Days after the election, video emerged of him dismissing criticism of Vermont’s plan in 2011 by asking, “Was this written by my adolescent children, by any chance?” State officials said they would cut off his contract.

Advocates of a single-payer plan said Shumlin should not be able to cast aside Act 48, the 2011 law that called for the creation of Green Mountain Care, without repealing it. A group planned to hold a rally in front of the statehouse on Thursday to protest his decision.

“The governor’s misguided decision was a completely unnecessary result of a failed policy calculation that he pursued without Democratic input,” the group Healthcare Is a Human Right Campaign said in a statement.

Jensen Comment
This is sad, because I was hoping that Vermont would lead the way for the other 49 states to adopt single-payer plans ---
http://www.trinity.edu/rjensen/Health.htm

One of Vermont's many problems with health care is that physicians are leaving the state due, in large measure, to Vermont's huge taxation of higher income professionals. This has already forced Vermont to use the medical doctors, clinics, and hospitals in bordering New Hampshire where there are no taxes on earned incomes and sales.

Vermont is also having a problem with loss of students in schools. Thus far efforts to close nearly-empty schools have failed. Purportedly there are some Vermont school districts that have more members on the school boards than children in the schools.


Question
Does anybody find it shocking that hospitals and other medical service providers overbill the third party insurance fraud pinata made up of Medicaid, Medicare, and medical insurance companies?

What is sad is when powerful politicians stand in the way of legal investigations for their big-donor friends.

"Probes Of Overbilling Run Into Political Pressure," by Christopher S. Stewart, The Wall Street Journal, December 12, 2014 ---
http://imarketreports.com/probes-of-overbilling-run-into-political-pressure.html

When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened.

Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official who oversees Medicare, Marilyn Tavenner, asking her to back down, according to documents reviewed by The Wall Street Journal. In a June 2012 letter to Ms. Tavenner, Rep. Jackson Lee said blocking payments had put the hospital at financial risk and “jeopardized” patients needing Medicare.

Weeks later, Ms. Tavenner, administrator of the Centers for Medicare and Medicaid Services, instructed deputies to restore most payments to the hospital even as the agency was cooperating in a criminal investigation of the facility, according to former investigators and documents. “These changes are at the direction of the Administrator and have the highest priority,” a Medicare official wrote to investigators.

About two months after that order, Riverside’s top executive was indicted in a $158 million fraud scheme. The hospital was barred from Medicare this May, and the CEO was convicted in October.

What happened at Riverside General Hospital shows how political pressure from medical providers and elected officials can collide with efforts to rein in waste and abuse in the nearly $600 billion, taxpayer-funded Medicare system. More than a dozen former investigators and CMS officials said in interviews that they faced questions from members of Congress about policy changes or punitive action affecting providers or individual doctors.

Ricky Sluder, a former senior investigator for a Medicare contractor who oversaw part of the Riverside investigation, said “it was extremely frustrating to stall an investigation to give some explanation to a lawmaker. It’s providers’ way of using political power.”

In an emailed statement, Medicare administrator Ms. Tavenner said the Riverside episode “reflected the tension between fraud prevention and access to care.” She said she wasn’t aware of the pending indictments and that her job required her to “balance two important policy goals” — saving taxpayer money and protecting Medicare’s beneficiaries.

A spokesman for Rep. Jackson Lee declined to comment.

Medicare has reported that during the 2013 fiscal year, waste, fraud and abuse accounted for an estimated $34.6 billion in improper payments to medical providers. CMS says it clawed back about $9 billion that year through audits and investigations.

Medicare hires contractors to enforce antifraud rules and fight improper billing. The contractors can suspend payments to doctors and hospitals and revoke billing privileges. They also can block some payments to review claims — called “prepayment review.”

Such actions can squeeze medical providers and even threaten to put them out of business. Medical providers sometimes seek help from elected officials. Politicians have a stake in such disputes: Health providers often provide jobs and valued services in their districts, and can be campaign contributors.

Continued in article

Question
What is the main difference between errors in hospital bills (in over 90% of the billings) and retail store scanned billings (in over 4% of the billings)?

Answer
Errors in hospital bills almost always favor the hospitals.
Retail store billing errors only favor the stores about half the time.

 

"The Accuracy of Scanned Prices, David Hardesty, Journal of Retailing, 2014 ---
http://www.sciencedirect.com/science/article/pii/S0022435914000244

4.08% of the prices picked up by retail-store scanners are wrong, about twice the error rate considered acceptable by the U.S. Federal Trade Commission, says a team led by David M. Hardesty of the University of Kentucky that studied more than 231,000 products scanned over 15 years in the state of Washington. Slightly less than half the errors were overcharges. An intriguing finding: Error rates are higher in affluent neighborhoods, suggesting that stores may be more careful about mistakes in areas where shoppers are more price-conscious, the researchers say.

Continued in article

The Health Care Market is Not a Market

"Video:  Inside ‘Bitter Pill’: Steven Brill Discusses His TIME Cover Story," Time Magazine, February 22, 2013 ---
http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/

Simple lab work done during a few days in the hospital can cost more than a car. A trip to the emergency room for chest pains that turn out to be indigestion brings a bill that can exceed the price of a semester at college. When we debate health care policy in America, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

Steven Brill spent seven months analyzing hundreds of bill from hospitals, doctors, and drug companies and medical equipment manufacturers to find out who is setting such high prices and pocketing the biggest profits. What he discovered, outlined in detail in the cover story of the new issue of TIME, will radically change the way you think about our medical institutions:

· Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer—Medicare—from even trying to negotiate the price of drugs.

· Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

· Cancer treatment—at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson—has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

· Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Brill concludes:

The health care market is not a market at all.
It’s a crapshoot. Everyone fares differently based on circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or protected only partially by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow knew the prices before they got billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers.

 

"Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

"Yes, Hospital Pricing Is Insane, But Why? Time magazine issues a 24,000-word memo on what we already knew," by Holman Jenkins Jr., The Wall Street Journal, March 1, 2013 ---
http://online.wsj.com/article/SB10001424127887323978104578334082993009730.html?mod=djemEditorialPage_h

Without diminishing the epic scope of Steven Brill's Time magazine piece about the U.S. health care system, he reiterates in lengthy detail perversities that are already well known, without offering a single useful insight on how it go that way, and even less on how to fix it.

Yet Mr. Brill, founder of CourtTV and American Lawyer magazine, author of books on terrorism and education, has written the longest piece in Time's history—24,000 words—so attention must be paid.

That health-care costs are inflated compared to what they would be in a reasonably transparent, competitive market (a point Mr. Brill never clearly makes) won't be a revelation. That hospitals allocate their costs to various items on their bills and price lists in ways that are opaque and arbitrary is not a new discovery either.

He finds it shocking that a hospital charging $1,791 a night won't throw in the generic Tylenol for free (instead charging $1.50 each). But this is to commit the reification fallacy of thinking there is some organic relationship between what a hospital charges for a particular item and what that item costs in the first place.

He dwells on the irrationality of hospitals charging their highest prices to their poorest customers, those without insurance. But he's also aware that these customers often pay little or nothing of what they are charged and hospitals reallocate the cost to the bills of other patients. He even notes that a hospital might collect as little as 18% of what it bills.

He vaguely gets that hospital price lists are memos for the file, to be drawn out and waved as a reference in negotiations with their real customers, the big health-care insurers, Medicaid, Medicare and other large payers.

The deals hammered out with these customers tend naturally to gravitate toward round numbers, leaving a hospital free to allocate its costs and profits to specific items however it wants. Mr. Brill may be offended that certain "non-profit" hospitals appear to be highly profitable. He probably wouldn't be happier, though, if they diverted their surplus revenues into even higher salaries and more gleamingly superfluous facilities.

"What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

Your time might be better spent reading Duke University's Clark Havighurst in a brilliant 2002 article that describes the regulatory, legal and tax subsidies that deprive consumers of both the incentive and opportunity to demand value from medical providers. Americans end up with a "Hobson's choice: either coverage for 'Cadillac' care or no health coverage at all."

"The market failure most responsible for economic inefficiency in the health-care sector is not consumers' ignorance about the quality of care," Mr. Havighurst writes, "but rather their ignorance of the cost of care, which ensures that neither the choices they make in the marketplace nor the opinions they express in the political process reveal their true preferences."

You might turn next to an equally fabulous 2001 article by Berkeley economist James C. Robinson, who shows how the "pernicious" doctrine that health care is different—that consumers must shut up, do as they're told and be prepared to write a blank check—is used to "justify every inefficiency, idiosyncrasy, and interest-serving institution in the health care industry."

Hospitals, insurers and other institutions involved in health care may battle over available dollars, but they also share an interest in increasing the nation's resources being diverted into health care—which is exactly what happens when costs are hidden from those who pay them.

Continued in article

Jensen Comment
Over a year ago Erika's Medicare-Anthem summary of charges for the month included an $11,376 charge for out patient surgery that was mistakenly billed to her account. We called our doctor who did the procedure in the hospital. Our doctor responded not to bother her or the hospital --- since Medicare-Anthem paid the entire bill it would not matter.

This bothered us since the woman (I assume it was a woman) may not have been eligible for Medicare-Anthem. So I phoned Medicare. Medicare said not to bother them and advised us to contact the hospital where the procedure took place. Any corrections should be made by the hospital and the doctor.

So I called the hospital's accounting office. They asked that I send in a copy of the Medicare-Anthem report. I hand-delivered the report to the the hospital accounting office --- which is miles from the hospital.

Over the ensuing year we waited for a corrected Medicare-Anthem report. Nothing! So I did a follow up visit to the hospital's accounting office. The feedback was that since Medicare-Anthem paid the bill there was no need to waste time correcting this item.

I keep thinking that some woman not eligible for Medicare got a windfall gain here. Who cares if it was Medicare-Anthem that got screwed?

Erika and I changed to a doctor that we like better. But we cannot change hospitals.

Moral of the Story
If the third party insurer gets billed mistakenly or pays too much nobody cares, least of all the doctors and hospitals who got reimbursed.

Question
Who is telling a lie?

Steven Brill wrote a long cover story for Time Magazine, In that story he describes having his team examine eight very complicated hospital bills from different hospitals. In every case they found that the bills were laced with errors and overcharges in favor of the hospital and possible frauds.
Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

The following week Stamford Hospital CEO Brian G. Grissler replied as shown, in part, below. Steven Brill's reply to Grissler, Time Magazine, March 18, 2013, Page 2.

Brian G. Grissler
". . . Brill refused to share the patient's name or the complete bill, so we are unable to answer those questions . . . "

Steven Brill Responds
"Stamford Hospital was shown the bill and never disputed its authenticity. I made clear in the article the hospital settled for cutting its bill entirely in half."

Jensen Comment
There are four possibilities behind this dispute:

  1. Brian Grissler could be lying through his teeth.

     
  2. Brian Grissler may not have thoroughly investigated the ultimate resolution of this bill by his staff.

     
  3. Steven Brill could be lying through his teeth.

     
  4. Steven Brill and Brian Grissler may not be discussing the same bill (although Brill claims he only picked one bill to examine from Stamford Hospital).

My vote is that Answer 1 above is probably the correct answer, but we most likely will never know.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm

 


From the CFO Journal's Morning Ledger on December 9, 2014

Workers to bear burden of ACA cost increases ---
http://blogs.wsj.com/cfo/2014/12/08/workers-to-bear-burden-of-aca-cost-increases/?mod=djemCFO_h

Workers in the U.S. should expect health care to take a bigger bite out of their paychecks next year, CFO Journal’s Vipal Monga reports. According to Bank of America Merrill Lynch, finance chiefs at U.S. companies expect the Affordable Care Act to increase healthcare costs next year, and the majority expect to pass that along to their employees.

Jensen Comment
There were only supposed to be savings for workers under the ACA. What went wrong?

"ObamaCare by the Numbers: Part 2," by John Cassidy, The New Yorker, March 2010 ---
http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html

. . .

Does Santa Claus live after all? According to the C.B.O., between now and 2019 the net cost of insuring new enrollees in Medicaid and private insurance plans will be $788 billion, but other provisions in the legislation will generate revenues and cost savings of $933 billion. Subtract the first figure from the second and—voila!—you get $143 billion in deficit reduction.

The first objection to these figures is that the great bulk of the cost savings—more than $450 billion—comes from cuts in Medicare payments to doctors and other health-care providers. If you are vaguely familiar with Washington politics and the letters A.A.R.P. you might suspect that at least some of these cuts will fail to materialize. Unlike some hardened skeptics, I don’t think none of them will happen. One part of the reform involves reducing excessive payments that the Bush Administration agreed to when it set up the Medicare Advantage program in 2003. If Congress remains under Democratic control—a big if, admittedly—it will probably enact these changes. But that still leaves another $300 billion of Medicare savings to be found.

The second problem is accounting gimmickry. Acting in accordance with standard Washington practices, the C.B.O. counts as revenues more than $50 million in Social Security taxes and $70 billion in payments towards a new home-care program, which will eventually prove very costly, and it doesn’t count some $50 billion in discretionary spending. After excluding these pieces of trickery and the questionable Medicare cuts, Douglas Holtz-Eakin, a former head of the C.B.O., has calculated that the reform will actually raise the deficit by $562 billion in the first ten years. “The budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed,” he wrote in the Times. “So fantasy in, fantasy out.”

Holtz-Eakin advised John McCain in 2008, and he has a reputation as a straight shooter. I think the problems with the C.B.O.’s projections go even further than he suggests. If Holtz-Eakin’s figures turned out to be spot on, and over the next ten years health-care reform reduced the number of uninsured by thirty million at an annual cost of $56 billion, I would still regard it as a great success. In a $15 trillion economy—and, barring another recession, the U.S. economy should be that large in 2014—fifty or sixty billion dollars is a relatively small sum—about four tenths of one per cent of G.D.P., or about eight per cent of the 2011 Pentagon budget.

My two big worries about the reform are that it won’t capture nearly as many uninsured people as the official projections suggest, and that many businesses, once they realize the size of the handouts being offered for individual coverage, will wind down their group plans, shifting workers (and costs) onto the new government-subsidized plans. The legislation includes features designed to prevent both these things from happening, but I don’t think they will be effective.

Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.

Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)

If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”

So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.

The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.

Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)

In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead.

Even if the government tried to impose additional sanctions on such firms, I doubt it would work. The dollar sums involved are so large that firms would try to game the system, by, for example, shutting down, reincorporating under a different name, and hiring back their employees without coverage. They might not even need to go to such lengths. Firms that pay modest wages have high rates of turnover. By simply refusing to offer coverage to new employees, they could pretty quickly convert most of their employees into non-covered workers.

The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it. According to the C.B.O., somewhere between eight and nine million workers will lose their group coverage as a result of their employers refusing to offer it. That isn’t a trifling number. But the C.B.O. says it will be largely offset by an opposite effect in which employers that don’t currently provide health insurance begin to offer it in response to higher demand from their workers as a result of the individual mandate. In this way, some six to seven million people will obtain new group coverage, the C.B.O. says, so the overall impact of the changes will be minor.

Continued in article

"Senate Bill Sets a Plan to Regulate Premiums," by Robert Pear, The New York Times, April 20, 2010 --- http://www.nytimes.com/2010/04/21/health/policy/21healt

. . .

Grace-Marie Turner, president of the Galen Institute, a research center that advocates free-market health policies, said the Democrats’ proposal was unlikely to succeed in lowering insurance costs.

“Capping premiums without recognizing the forces that are driving up costs would be like tightening the lid on a pressure cooker while the heat is being turned up,” Mrs. Turner said.

Mrs. Feinstein said her bill would close what she described as “an enormous loophole” in the new law. And she said health insurance should be regulated like a public utility.

“Water and power are essential for life,” Mrs. Feinstein said. “So they are heavily regulated, and rate increases must be approved. Health insurance is also vital for life. It too should be strictly regulated so that people can afford this basic need.”

The 6 Biggest Whoppers In Gruber's ObamaCare Comic Book ---
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm

. . .

What the reviewers failed to mention is that the book is also chock-a-block with misinformation and outright falsehoods about the law Gruber helped construct — many of which Gruber himself exposed later on. Among the most glaring:

• Gruber claims that for individuals and small firms qualifying for a tax credit, "this bill will lower your health care costs." But Gruber would later go on to tell several states the opposite. One of them was Wisconsin, where he said fewer than 6% would see lower premiums, and 41% would get hit with hikes of 50% or more. Meanwhile, millions learned that Gruber's claim was a fantasy last year, when they confronted ObamaCare's sky-high premiums after seeing their existing plans canceled.

• Gruber declares that the law doesn't raise taxes on anyone "with incomes below $200,000 per year." Yet several of the dozens of tax hikes stuffed into the bill hit the middle class, or soon will. Americans for Tax Reform counted seven big ones.

• In the section on the Cadillac tax, which depicts Gruber tooling around in a Caddy, he claims this tax would apply "only to the top few percent of health insurance plans" and would hit more only if premiums climb faster than inflation.

But in videotaped comments, Gruber explains that the tax was purposely designed to start small and then eventually hit all employer plans, "essentially getting rid of the exclusion for employer-sponsored plans."

• Gruber emphatically declares that ObamaCare will cut the federal deficit by $1 trillion over its second decade because "the deficit-reducing effects of this legislation grow over time."

But all the Congressional Budget Office said was that a "rough outlook" for ObamaCare's second decade resulted in deficit cuts "in a broad range of around one-half percent of GDP." And that assumed the law was enacted exactly as written, and worked exactly as predicted, both of which have already failed to come true.

When the Government Accountability Office ran the numbers using more realistic scenarios, it found ObamaCare adding significantly to the long-term deficit. The CBO, meanwhile, has given up making even short-term forecasts of ObamaCare's impact on the deficit.

• Throughout the book, Gruber cites CBO projections of ObamaCare's effects on premiums and coverage, calling it "the best independent source for evaluating bills like the ACA." What he doesn't mention is that when the CBO developed its health care forecasting model in 2007, Gruber had a role in creating it. It even credits Gruber for his "helpful comments and feedback ... throughout the model's development."

And in a 2011 paper, Gruber himself said that his own health care model "mirrors the CBO approach to modeling health reform."

• Gruber says that if the law's many cost-control measures work as expected, "the ACA will end up solving our cost problem in the U.S." But earlier this year Gruber told the Washington Post that it was "misleading" to say ObamaCare will save money. "The law isn't designed to save money," he said. "It's designed to improve health, and that's going to cost money."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


"Chuck Schumer: Passing Obamacare in 2010 Was a Mistake:  The Senate’s No. 3 Democrat says that his party misused its mandate," by Sarah Mimms, National Journal, November 25, 2014 ---
http://www.nationaljournal.com/congress/chuck-schumer-passing-obamacare-in-2010-was-a-mistake-20141125

Chuck Schumer upbraided his own party Tuesday for pushing the Affordable Care Act through Congress in 2010.

While Schumer emphasized during a speech at the National Press Club that he supports the law and that its policies "are and will continue to be positive changes," he argued that the Democrats acted wrongly in using their new mandate after the 2008 election to focus on the issue rather than the economy at the height of a terrible recession.

"After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs and built on the partial success of the stimulus, but unfortunately Democrats blew the opportunity the American people gave them," Schumer said. "We took their mandate and put all of our focus on the wrong problem—health care reform."

The third-ranking Senate Democrat noted that just about 5 percent of registered voters in the United States lacked health insurance before the implementation of the law, arguing that to focus on a problem affecting such "a small percentage of the electoral made no political sense."

The larger problem, affecting most Americans, he said, was a poor economy resulting from the recession. "When Democrats focused on health care, the average middle-class person thought, 'The Democrats aren't paying enough attention to me,' " Schumer said.

Continued in article

"Sen. Chuck Schumer: Obamacare Focused 'On The Wrong Problem,' Ignores The Middle Class" by  Avik Roy, Forbes, November 26, 2014 ---
http://www.forbes.com/sites/theapothecary/2014/11/26/sen-chuck-schumer-obamacare-focused-on-the-wrong-problem-ignores-the-middle-class/

Despite the enduring unpopularity of Obamacare, Congressional Democrats have up to now stood by their health care law, allowing that “it’s not perfect” but that they are proud of their votes to pass it. That all changed on Tuesday, when the Senate’s third-highest-ranking Democrat—New York’s Chuck Schumer—declared that “we took [the public’s] mandate and put all our focus on the wrong problem—health care reform…When Democrats focused on health care, the average middle-class person thought, ‘The Democrats aren’t paying enough attention to me.’”

Sen. Schumer made his remarks at the National Press Club in Washington. “Democrats blew the opportunity the American people gave them…Now, the plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed,” Schumer maintained. “But it wasn’t the change we were hired to make. Americans were crying out for the end to the recession, for better wages and more jobs—not changes in health care.”

“This makes sense,” Schumer continued, “considering 85 percent of all Americans got their health care from either the government, Medicare, Medicaid, or their employer. And if health care costs were going up, it really did not affect them. The Affordable Care Act was aimed at the 36 million Americans who were not covered. It has been reported that only a third of the uninsured are even registered to vote…it made no political sense.”

The response from Obama Democrats was swift. Many, like Obama speechwriters Jon Lovett and Jon Favreau and NSC spokesman Tommy Vietor, took to Twitter. “Shorter Chuck Schumer,” said Vietor, “I wish Obama cared more about helping Democrats than sick people.”

"Schumer’s Con Job for the Middle Class," by Peter Morici, Townhall, December 2, 2014 ---
http://finance.townhall.com/columnists/petermorici/2014/12/02/schumers-con-job-for-the-middle-class-n1925988?utm_source=thdaily&utm_medium=email&utm_campaign=nl 

Senator Charles Schumer, in a recent speech, stated President Obama and Democratic majorities in Congress were elected in 2008 to get the economy working for middle class families. Consequently, assigning extraordinary priority to passing the Affordable Care Act was a mistake.

In 2008, most middle class families had private insurance they liked; their incomes had been falling for about a decade.

The ACA was really part of Democrats’ agenda to assist the working poor—raising the minimum wage, and expanding Medicaid, food stamps, the earned-income tax credit, and higher education grants—while cozying up to big business to finance Democratic campaigns.

Schumer wants Democrats to advocate big government programs to cure middle class woes, and portray Republicans as servants of big corporate interests. He still embraces the ACA as sound policy, even though it made health care more expensive for many middle class families and it enriches Democratic contributors among top executives and shareholders in the health care industries.

That’s not surprising—Schumer championed the 2010 Dodd-Frank banking reforms.

Those made compliance with new mortgage and business lending regulations so cumbersome that many regional banks sold out to bigger banks—and lots of decently-paying jobs in smaller city banks were lost. In turn, with more deposits to invest, the Wall Street banks keep finding new scams—like rigging foreign currency markets and speculating in commodities—to keep funding multi-million dollar bonuses for New York executives and big campaign contributions to Democrats in the Senate and House.

Cozying up to big business—while championing the poor and offering lip service to the middle class—is what Democrats have done best lately.

President Obama’s favorite fund raising venue is the home of Comcast’s CEO, and his Administration has rewarded cable providers with little effort to curb abusive rates, which rise faster than inflation.

Now, the Treasury Department has decided telecom companies may count the wires to homes as real estate and qualify for lower corporate taxes—that’s the kind of special treatment Obama charges are the primary focus of Republicans lawmakers.

. . .

Democrats have blocked petroleum exploration off the Atlantic, Pacific and Eastern Gulf Coasts, Keystone and other pipeline and infrastructure projects. These limit U.S. oil supplies, enrich big multinational oil companies, and keep OPEC and Russian oil producers in business. In turn, those deny Americans good paying jobs and finance terrorism.

The new GOP congress should try to reverse those abusive policies. But each step of the way, the Senator from Wall Street will appear on Sunday talk shows to paint Republicans as servants of big business.

Oh what a flimflam man—the Senator from Wall Street wants to now present himself as champion of the middle class.

Peter Morici is an economist and business professor at the University of Maryland, and a national columnist

 

Jensen Comment
So what's wrong with the ACA?
Firstly it expanded the piñata for fraud --- Medicaid. Half the people on Medicaid in Illinois were found not to be eligible for Medicaid.  It's bad in most other states that just are paying for audits while the Federal government is paying the tab.

Secondly it's a windfall for ACA insurance companies since the Federal government guarantees their profits and promises taxpayer money if they begin to fail. In capitalism, business firms are supposed to take on financial risks.

Thirdly, the affordable policies have 40%-60% co-pays that essentially prevents insured people from going to doctors, medical clinics, and hospitals unless they are really, really sick because of what it costs them up front. Insurance companies love that, because they are selling insurance that people don't use as much as they should be using that insurance.

Fourthly, insurance companies love the ACA because paying for medical services and medications for people behind on the payments of their ACA premiums are passed on to doctors and hospitals after 30 days. Is it any surprise that so many doctors and hospitals are refusing to accepted patients with ACA insurance?

And the list of complaints against the ACS goes on and on --- See below!

"ObamaCare Has Been A Boon To Insurers, Not Patients, Investors Business Daily, December 2, 2014 ---
http://news.investors.com/ibd-editorials-obama-care/120214-728765-new-reports-show-obamacare-a-boon-to-insurers-but-not-patients.htm

Health Costs: Imagine a health reform plan that gives a boost to big insurance companies while leaving patients less able to pay their medical bills. Think progressives would cheer about it? They will if it's called ObamaCare.

Once upon a time Democrats championed ObamaCare as "taking on" big insurance while protecting families from big medical bills. So how are those promises working out?

A Gallup survey released late last week found that 33% reported putting off medical treatments this year "because of the cost you would have to pay."

That's higher than any time since Gallup starting asking this question back in 2001, and three points higher than it was last year — before ObamaCare's insurance regulations went into effect.

What's more, the share who put off treatment for a serious condition because of cost hit 22% this year, up from 17% when President Obama took office.

Even more interesting, the poll found that having insurance apparently offered less financial protection. The share of those with insurance who said they couldn't afford at least one medical procedure jumped from 25% in 2013 to 34% in 2014.

Gallup suspects part of the reason is the fact that ObamaCare plans deployed narrow networks and steep deductibles, which kept premium costs down but exposed patients to big health bills.

At the other end of the spectrum, ObamaCare appears to be a windfall for Big Insurance. Over the first three years the law was in effect, the insurance market actually got more concentrated, according to a new Government Accountability Office report.

Between 2010 and 2013, for example, the number of states where the top three insurers controlled 80% of the individual insurance market or more went from 30 to 38. The GAO data go only through 2013, and so don't fully account for changes in the market thanks to the ObamaCare exchanges.

But it's not as though ObamaCare has so far made any meaningful impact. A Kaiser Family Foundation study looked at seven states and found that it was pretty much a wash this year — some were more competitive, some less, others didn't change.

And a GAO report released earlier this year found that the biggest insurers either held on to or increased their market share in 40 states under ObamaCare. It also found that small insurers became increasingly rare.

Yes, there are more insurance companies competing for business in the exchanges in ObamaCare's second open enrollment season. But so far, the overall impact of the law has been to direct billions of taxpayer subsidies to insurance companies for benefits that don't seem to be trickling down to patients.


Question
What is the main difference between errors in hospital bills (in over 90% of the billings) and retail store scanned billings (in over 4% of the billings)?

Answer
Errors in hospital bills almost always favor the hospitals.
Retail store billing errors only favor the stores about half the time.

 

"The Accuracy of Scanned Prices, David Hardesty, Journal of Retailing, 2014 ---
http://www.sciencedirect.com/science/article/pii/S0022435914000244

4.08% of the prices picked up by retail-store scanners are wrong, about twice the error rate considered acceptable by the U.S. Federal Trade Commission, says a team led by David M. Hardesty of the University of Kentucky that studied more than 231,000 products scanned over 15 years in the state of Washington. Slightly less than half the errors were overcharges. An intriguing finding: Error rates are higher in affluent neighborhoods, suggesting that stores may be more careful about mistakes in areas where shoppers are more price-conscious, the researchers say.

Continued in article

The Health Care Market is Not a Market

"Video:  Inside ‘Bitter Pill’: Steven Brill Discusses His TIME Cover Story," Time Magazine, February 22, 2013 ---
http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/

Simple lab work done during a few days in the hospital can cost more than a car. A trip to the emergency room for chest pains that turn out to be indigestion brings a bill that can exceed the price of a semester at college. When we debate health care policy in America, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

Steven Brill spent seven months analyzing hundreds of bill from hospitals, doctors, and drug companies and medical equipment manufacturers to find out who is setting such high prices and pocketing the biggest profits. What he discovered, outlined in detail in the cover story of the new issue of TIME, will radically change the way you think about our medical institutions:

· Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer—Medicare—from even trying to negotiate the price of drugs.

· Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

· Cancer treatment—at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson—has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

· Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Brill concludes:

The health care market is not a market at all.
It’s a crapshoot. Everyone fares differently based on circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or protected only partially by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow knew the prices before they got billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers.

 

"Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

"Yes, Hospital Pricing Is Insane, But Why? Time magazine issues a 24,000-word memo on what we already knew," by Holman Jenkins Jr., The Wall Street Journal, March 1, 2013 ---
http://online.wsj.com/article/SB10001424127887323978104578334082993009730.html?mod=djemEditorialPage_h

Without diminishing the epic scope of Steven Brill's Time magazine piece about the U.S. health care system, he reiterates in lengthy detail perversities that are already well known, without offering a single useful insight on how it go that way, and even less on how to fix it.

Yet Mr. Brill, founder of CourtTV and American Lawyer magazine, author of books on terrorism and education, has written the longest piece in Time's history—24,000 words—so attention must be paid.

That health-care costs are inflated compared to what they would be in a reasonably transparent, competitive market (a point Mr. Brill never clearly makes) won't be a revelation. That hospitals allocate their costs to various items on their bills and price lists in ways that are opaque and arbitrary is not a new discovery either.

He finds it shocking that a hospital charging $1,791 a night won't throw in the generic Tylenol for free (instead charging $1.50 each). But this is to commit the reification fallacy of thinking there is some organic relationship between what a hospital charges for a particular item and what that item costs in the first place.

He dwells on the irrationality of hospitals charging their highest prices to their poorest customers, those without insurance. But he's also aware that these customers often pay little or nothing of what they are charged and hospitals reallocate the cost to the bills of other patients. He even notes that a hospital might collect as little as 18% of what it bills.

He vaguely gets that hospital price lists are memos for the file, to be drawn out and waved as a reference in negotiations with their real customers, the big health-care insurers, Medicaid, Medicare and other large payers.

The deals hammered out with these customers tend naturally to gravitate toward round numbers, leaving a hospital free to allocate its costs and profits to specific items however it wants. Mr. Brill may be offended that certain "non-profit" hospitals appear to be highly profitable. He probably wouldn't be happier, though, if they diverted their surplus revenues into even higher salaries and more gleamingly superfluous facilities.

"What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

Your time might be better spent reading Duke University's Clark Havighurst in a brilliant 2002 article that describes the regulatory, legal and tax subsidies that deprive consumers of both the incentive and opportunity to demand value from medical providers. Americans end up with a "Hobson's choice: either coverage for 'Cadillac' care or no health coverage at all."

"The market failure most responsible for economic inefficiency in the health-care sector is not consumers' ignorance about the quality of care," Mr. Havighurst writes, "but rather their ignorance of the cost of care, which ensures that neither the choices they make in the marketplace nor the opinions they express in the political process reveal their true preferences."

You might turn next to an equally fabulous 2001 article by Berkeley economist James C. Robinson, who shows how the "pernicious" doctrine that health care is different—that consumers must shut up, do as they're told and be prepared to write a blank check—is used to "justify every inefficiency, idiosyncrasy, and interest-serving institution in the health care industry."

Hospitals, insurers and other institutions involved in health care may battle over available dollars, but they also share an interest in increasing the nation's resources being diverted into health care—which is exactly what happens when costs are hidden from those who pay them.

Continued in article

Jensen Comment
Over a year ago Erika's Medicare-Anthem summary of charges for the month included an $11,376 charge for out patient surgery that was mistakenly billed to her account. We called our doctor who did the procedure in the hospital. Our doctor responded not to bother her or the hospital --- since Medicare-Anthem paid the entire bill it would not matter.

This bothered us since the woman (I assume it was a woman) may not have been eligible for Medicare-Anthem. So I phoned Medicare. Medicare said not to bother them and advised us to contact the hospital where the procedure took place. Any corrections should be made by the hospital and the doctor.

So I called the hospital's accounting office. They asked that I send in a copy of the Medicare-Anthem report. I hand-delivered the report to the the hospital accounting office --- which is miles from the hospital.

Over the ensuing year we waited for a corrected Medicare-Anthem report. Nothing! So I did a follow up visit to the hospital's accounting office. The feedback was that since Medicare-Anthem paid the bill there was no need to waste time correcting this item.

I keep thinking that some woman not eligible for Medicare got a windfall gain here. Who cares if it was Medicare-Anthem that got screwed?

Erika and I changed to a doctor that we like better. But we cannot change hospitals.

Moral of the Story
If the third party insurer gets billed mistakenly or pays too much nobody cares, least of all the doctors and hospitals who got reimbursed.

Question
Who is telling a lie?

Steven Brill wrote a long cover story for Time Magazine, In that story he describes having his team examine eight very complicated hospital bills from different hospitals. In every case they found that the bills were laced with errors and overcharges in favor of the hospital and possible frauds.
Bitter Pill:  Why Medical Bills Are Killing Us," Time Magazine Cover Story, March 4, 2013, pp. 16-65 (a very long article)  ---
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

The following week Stamford Hospital CEO Brian G. Grissler replied as shown, in part, below. Steven Brill's reply to Grissler, Time Magazine, March 18, 2013, Page 2.

Brian G. Grissler
". . . Brill refused to share the patient's name or the complete bill, so we are unable to answer those questions . . . "

Steven Brill Responds
"Stamford Hospital was shown the bill and never disputed its authenticity. I made clear in the article the hospital settled for cutting its bill entirely in half."

Jensen Comment
There are four possibilities behind this dispute:

  1. Brian Grissler could be lying through his teeth.

     
  2. Brian Grissler may not have thoroughly investigated the ultimate resolution of this bill by his staff.

     
  3. Steven Brill could be lying through his teeth.

     
  4. Steven Brill and Brian Grissler may not be discussing the same bill (although Brill claims he only picked one bill to examine from Stamford Hospital).

My vote is that Answer 1 above is probably the correct answer, but we most likely will never know.


"Medical Costs Drive Record High Number of Americans to Delay Treatment," by Sarah Jean Seman, Townhall, November 29, 2014 ---
http://townhall.com/tipsheet/sarahjeanseman/2014/11/29/medical-costs-drive-record-high-number-of-americans-to-delay-treatment-n1925200?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=

One in three Americans has delayed seeking medical treatment due to its high cost, according to a recent Gallup poll. This marks the highest percentage ever recorded in the 14-year history of the survey question.

Despite President Obama's dream of providing affordable health care coverage for all, fewer and fewer Americans are able to get the coverage they need. 

“Last year, many hoped that the opening of the government healthcare exchanges and the resulting increase in the number of Americans with health insurance would enable more people to seek medical treatment. But, despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure.”

Even Upper-class Americans (those making more than $75K) were deterred by health care costs. Between 2013 and this year, there was an 11 percent increase in treatment delay among wealthier Americans.

What's more, the costs are not merely discouraging people from running to the Doctor for every little sneeze and cough. The survey found that Americans are becoming increasingly more likely (22 percent) to put off treatment for a "very" or "somewhat serious" condition or illness. Twice the number recorded (11 percent) for non-serious conditions.

Even as time continues to reveal Obamacare's negative impact on Americans, the Obama Administration continues to relentless promote its product as being what's best for the American people.


"The Real Cost of “High-Priced” Drugs," by Michael Rosenblatt, Harvard Business Review Blog, November 17, 2014 --- Click Here
https://hbr.org/2014/11/the-real-cost-of-high-priced-drugs?referral=00563&cm_mmc=email-_-newsletter-_-daily_alert-_-alert_date&utm_source=newsletter_daily_alert&utm_medium=email&utm_campaign=alert_date

Jensen Comment
This still does not explain why the USA has to pay so much more for medications than other nations pay for the exact same products, which is why so many of my neighbors make a run for Canada to re-fill their prescriptions.

This still does not explain why the big pharmaceutical companies lobbied our whores in Washington DC to ban negotiating lower prices for Medicare D prescriptions.


Flackcheck Patterns of Deception ---
http://www.flackcheck.org/patterns-of-deception/affordable-care-act/?gclid=CMWP97rJhsICFWxk7AodCA8AqQ


"Audit reveals half of people enrolled in Illinois Medicaid program not eligible," by Craig Cheatham, KMOV Television, November 4, 2013 ---
http://www.kmov.com/news/just-posted/Audit-reveals-half-of-people-enrolled-in-IL-Medicaid-program-not-eligible-230586321.html?utm_content=buffer824ba&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer

"Medicaid Spending Has Exploded, And It Will Keep Rising Faster Than Expected

"Medicaid Spending Has Exploded, And It Will Keep Rising Faster Than Expected," by John R. Graham, Daily Caller, November 12. 2014 ---
http://dailycaller.com/2014/11/12/medicaid-spending-has-exploded-and-it-will-keep-rising-faster-than-expected/

According to the Centers for Medicare & Medicaid Services (CMS), spending on Medicaid, the jointly funded state-federal welfare program that provides health benefits to low-income people, increased 6.7 percent in 2013 to $449.5 billion. And it will keep growing at a fast rate.

In 2014, total Medicaid spending is projected to grow 12.8 percent because Obamacare has added about 8 million dependents. A large minority of states have chosen to increase residents’ eligibility for Medicaid by expanding coverage to adults making up to 138 percent of the federal poverty level.

Unfortunately, more states are likely to expand this welfare program. This is expected to result in a massive increase in the number of Medicaid dependents: From 73 million in 2013 to 93 million in 2024. Medicaid spending is expected to grow by 6.7 percent in 2015, and 8.6 percent in 2016. For 2016 to 2023, spending growth is projected to be 6.8 percent per year on average.

This comprises a massive increase in welfare dependency and burden on taxpayers. Further, official estimates often low-ball actual experience. This is because it is hard to grapple with how clever states are at leveraging federal dollars.

The Office of the Inspector General of the U.S. Department of Health & Human Services has just released a report that summarizes a decade of research on how states game the system to increase spending beyond that which the federal government anticipated.

The incentive lies in Medicaid’s perverse financing merry-go-round. In a rich state like California, for example, the federal government (pre-Obamacare) spent 50 cents on the dollar for adult dependents. So, if California spent 50 cents, it automatically drew 50 cents from the U.S. Treasury. And most states had a bigger multiplier. Which state politician can resist a deal like that?

Continued in article


Jonathan Gruber --- http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29#Controversies

. . .

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.[17][18][19] While he did disclose his HHS connections in an article for the New England Journal of Medicine, his oversight in doing this earlier was defended by Paul Krugman in The New York Times.[20]

One heavily-scrutinized part of the ACA reads that subsidies should be given to healthcare recipients who are enrolled "through an Exchange established by the State". Some have read this to mean that subsidies can be given only in states that have chosen to create their own healthcare exchanges, and do not use the federal exchange, while the Obama administration says that the wording applies to all states. This dispute is currently part of an ongoing series of lawsuits referred to collectively as King v. Burwell. In July 2014, two separate recordings of Gruber, both from January 2012, surfaced in which he seemed to contradict the administration's position.[5] In one, Gruber states, in response to an audience question, that "if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits",[21] while in the other he says, "if your governor doesn't set up an exchange, you're losing hundreds of millions of dollars of tax credits to be delivered to your citizens."[22] When these recordings emerged, Gruber called these statements mistaken, describing them as "just a speak-o — you know, like a typo".[21]

In November 2014, a series of four videos emerged of Gruber speaking at different events, from 2010 to 2013, about ways he felt the ACA was misleadingly crafted and marketed to get the bill passed; in several of these videos he specifically refers to American voters as ill-informed and "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage. Gruber said the bill's inherent "lack of transparency is a huge political advantage" in selling it.[23] The comments caused significant controversy.[24][25][26][27][28] In two subsequent videos, Gruber was shown talking about the decision (which he attributed to John Kerry) to have the bill tax insurance companies instead of patients, which he called fundamentally the same thing economically but more palatable politically. In one video, he stated that "the American people are too stupid to understand the difference" between the two approaches, while in the other he said that the switch worked due to "the lack of economic understanding of the American voter."[29] In another video, taken in 2010, Gruber expressed doubts that the ACA would significantly reduce health care costs, though he noted that lowering costs played a major part in the way the bill was promoted.[30]

"Academic Built Case for Mandate in Health Care Law," by Catherine Rampell, The New York Times, March 28, 2012 ---
http://www.nytimes.com/2012/03/29/business/jonathan-gruber-health-cares-mr-mandate.html?pagewanted=all&_r=1&

After Massachusetts, California came calling. So did Connecticut, Delaware, Kansas, Minnesota, Oregon, Wisconsin and Wyoming.

They all wanted Jonathan Gruber, a numbers wizard at M.I.T., to help them figure out how to fix their health care systems, just as he had helped Mitt Romney overhaul health insurance when he was the Massachusetts governor.

Then came the call in 2008 from President-elect Obama’s transition team, the one that officially turned this stay-at-home economics professor into Mr. Mandate.

Mr. Gruber has spent decades modeling the intricacies of the health care ecosystem, which involves making predictions about how new laws will play out based on past experience and economic theory. It is his research that convinced the Obama administration that health care reform could not work without requiring everyone to buy insurance.

And it is his work that explains why President Obama has so much riding on the three days of United States Supreme Court hearings, which ended Wednesday, about the constitutionality of the mandate. Questioning by the court’s conservative justices has suggested deep skepticism about the mandate, setting off waves of worry among its backers — Mr. Gruber included.

“As soon as I started reading the dispatches my stomach started churning,” Mr. Gruber said of the arguments on Tuesday, while taking a break from quizzing his son for a biology test. “Losing the mandate means continuing with our unfair individual insurance markets in a world where employer-based insurance is rapidly disappearing.”

Mr. Gruber, 46, hates traveling without his wife and three children, so he is tracking the case from his home in Lexington, Mass. There he crunches numbers and advises other states on health care, in between headbanging at Van Halen concerts with his 15-year-old son and cuddling with the family’s eight parrots. (His wife, Andrea, volunteers at a bird rescue center.)

If the court rules against the mandate, Mr. Gruber says he believes the number of newly insured Americans could fall to eight million from the projected 32 million. He insists that without a mandate, the law will result in a terrible spiral: only relatively sick Americans will choose to get insurance, leading premium prices to rise and causing the healthier of even those sick people to drop their insurance, sending prices higher and higher.

Some other economists quibble, though, with Mr. Gruber’s pessimistic assessment.

“My general thought about the mandate is if insurance is affordable and accessible, most people will buy it anyway,” said David Cutler, an economist at Harvard and longtime collaborator of Mr. Gruber’s.

Others, like Paul Starr, a Princeton sociologist, say they believe Mr. Gruber’s work does not account for how hard it will be to enforce the mandate.

“There is this groupthink about how important the mandate is,” Mr. Starr says. “Most people don’t understand or won’t acknowledge how weak the enforcement mechanism is.”

Mr. Starr said he thought Mr. Gruber in particular was overstating the effectiveness of the mandate because “it’s his baby.”

 That said, it is difficult for too many other experts to categorically refute Mr. Gruber’s work, since he has nearly cornered the market on the technical science behind these sorts of predictions. Other models exist — built by nonprofits like the RAND Corporation or private consultancies like the Lewin Groupbut they all use Mr. Gruber’s work as a benchmark, according to Jean Abraham, a health economist at the University of Minnesota and former senior economist in both the Obama and George W. Bush administrations.

“He’s brought a level of science to an issue that would otherwise be just opinion,” Mr. Cutler says. “He’s really the only person who has been doing all this careful modeling for so long. He’s the only person you can go to for that kind of thing, which is why the White House reached out to him in the first place.”

Mr. Obama had made health care reform a cornerstone of his campaign, and wanted to announce a credible proposal quickly after taking office. But members of the Obama administration’s transition team said they had inherited an executive branch that had vastly underinvested in modeling research on health care, especially compared to the technical modeling that had been done in areas like tax policy.

“Creating a good model from scratch would have taken months, maybe years,” said Lawrence H. Summers, who was the director of President Obama’s National Economic Council and had advised Mr. Gruber on his dissertation when they were at Harvard.

Mr. Gruber had already spent years researching government mandates, starting with his 1991 dissertation about how mandated employer benefits cut into workers’ wages.

He also did similar analyses, on a broader range of public policies for the Treasury Department in the Clinton administration from 1997-98. He was recruited by Mr. Summers, who was then deputy secretary of Treasury.

Then in 2001, after returning to M.I.T., Mr. Gruber received an e-mail from Amy Lischko, who was then an assistant commissioner in the Massachusetts healthy policy department under then-Gov. Jane M. Swift, a Republican.

She was familiar with his work, and contracted him to model some potential ways that Massachusetts could expand health insurance coverage.

“He certainly wasn’t as well known then as he is now in the health care arena,” said Ms. Lischko, now a professor at Tufts University School of Medicine. “We couldn’t exactly kick the tires on these kinds of models back then, but we knew he had done work on simulations before.”

Mr. Gruber calls himself a “card-carrying Democrat.” He and his wife host a “great quadrennial Democratic victory party” whether or not the Democratic candidate wins, he said. But given his reputation and relatively rare expertise, he still ended up working for two Republican governors in Massachusetts.

When Mr. Romney succeeded Ms. Swift in 2003, he proposed using an individual mandate to help the state achieve universal health care coverage. Mr. Gruber was again brought in to analyze the idea, which he had not formally modeled before.

“Romney saw it as a traditional Republican moral issue of personal responsibility, getting rid of the free riders in the system, not as much of an economic issue,” Mr. Gruber said. “Not only were the Republicans for it, the liberals hated it. People forget that.”

Mr. Obama had vehemently opposed an individual mandate before his election in 2008.

After the Massachusetts plan passed in 2006, Arnold Schwarzenegger, then the Republican governor of California, invited Mr. Gruber to Sacramento to help model a similar proposal.

“That was awesome,” Mr. Gruber says, his eyes widening at the memory. “I got to see the sword from Conan the Barbarian.”

The California proposal fell apart, but soon Mr. Gruber had a little cottage industry helping states model potential health system changes. He also serves on the Massachusetts board that oversees the state’s new health care exchanges.

Along with these credentials, Mr. Gruber’s position as an adviser to the influential Congressional Budget Office also left him perfectly positioned to advise the White House on health reform.

“The most important arbiter of everything was the C.B.O.,” said Neera Tanden, who was a senior adviser for health reform at the Department of Health and Human Services.

The C.B.O.’s assessment of a bill’s efficacy and costs strongly influences political debate, but the office does not publicly reveal how it calculates those numbers.

“We knew the numbers he gave us would be close to where the C.B.O. was likely to come out,” Ms. Tanden said. She was right.

After Mr. Gruber helped the administration put together the basic principles of the proposal, the White House lent him to Capitol Hill to help Congressional staff members draft the specifics of the legislation.

This assignment primarily involved asking his graduate student researchers to tweak his model’s software code. It was also almost entirely conducted from his home office, while his children were at school and then after they had gone to bed.

“If I wanted to be in Washington, I’d have taken a job in Washington,” he said. “I wanted to be around for my family.”

Even though he was brought in by the White House, Congressional staff members from both parties trusted him because he was seen as an econometric wonk, not a political agent. But soon his very involvement with the bill caused questions about his objectivity to be raised in the news media.

During and after the bill’s slog through Congress, he frequently spoke with reporters and wrote opinion pieces supporting the Affordable Care Act but did not always mention his role in helping to devise it.

He says he regrets not being more upfront about his involvement with the administration. But he does not apologize for publicly advocating the legislation, and continuing to do so — including through a comic book he wrote to explain the law.

Yes, I want the public to be informed by an objective expert,” he says. “But the thing is, I know more about this law than any other economist.”

The unintentional Obamacare Wrecking Ball Professor from MIT
MIT economist Jonathan Gruber is one of the foremost architects of Obamacare, having bragged that he "knows more about this law" than anyone else in his field. He's also emerged as an unintentional one-man wrecking ball against Obamacare, making public statements that have undermined the Obama administration's legal and political defenses of the president's signature domestic legacy.
http://www.townhallmail.com/zlzjrctbjjwkrbjbkbrptkgllfkllbftddpcqrwdbwmdms_wzvdnjvgdsn.html

"Watch Obamacare Architect Jonathan Gruber Explain Why "Lack of Transparency" Was Key to Passing the Health Care Law," by Peter Suderman, Reason Magazine, November 10, 2014 ---
http://reason.com/blog/2014/11/10/watch-obamacare-architect-jonathan-grube

. . .

It's even harder to believe now that he has admitted that he thinks it's fine to mislead people if doing so bolsters the policy goals he favors. It's really quite telling, about the law and also about Gruber. Gruber may believe that American voters are stupid, but he was the one who was dumb enough to say all this on camera.

Jensen Comment
Condoning the misleading of the public for political purposes by a scientist borders on fabrication of data and may be in violation of his university's (MIT) academic integrity policy.

Similar issues arose in the allegations against Phil Jones regarding integrity of his climate temperature recordings ---
http://en.wikipedia.org/wiki/Climatic_Research_Unit_email_controversy
Professor Jones stepped aside temporarily but was reinstated. Nevertheless these and similar allegations badly damaged the public's confidence in climate change data.

Jon Krosnick, professor of communication, political science and psychology at Stanford University, said scientists were overreacting. Referring to his own poll results of the American public, he said "It's another funny instance of scientists ignoring science." Krosnick found that "Very few professions enjoy the level of confidence from the public that scientists do, and those numbers haven't changed much in a decade. We don't see a lot of evidence that the general public in the United States is picking up on the (University of East Anglia) emails. It's too inside baseball."[139]

The Christian Science Monitor, in an article titled "Climate scientists exonerated in 'climategate' but public trust damaged," stated, "While public opinion had steadily moved away from belief in man-made global warming before the leaked CRU emails, that trend has only accelerated."[140] Paul Krugman, columnist for the New York Times, argued that this, along with all other incidents which called into question the scientific consensus on climate change, was "a fraud concocted by opponents of climate action, then bought into by many in the news media."[141] But UK journalist Fred Pearce called the slow response of climate scientists "a case study in how not to respond to a crisis" and "a public relations disaster".[142]

A. A. Leiserowitz, Director of the Yale University Project on Climate Change, and colleagues found in 2010 that:

Climategate had a significant effect on public beliefs in global warming and trust in scientists. The loss of trust in scientists, however, was primarily among individuals with a strongly individualistic worldview or politically conservative ideology. Nonetheless, Americans overall continue to trust scientists more than other sources of information about global warming.

In late 2011, Steven F. Hayward wrote that "Climategate did for the global warming controversy what the Pentagon Papers did for the Vietnam war 40 years ago: It changed the narrative decisively."[143] An editorial in Nature said that many in the media "were led by the nose, by those with a clear agenda, to a sizzling scandal that steadily defused as the true facts and context were made clear."

Jensen Comment
Professor Gruber's confession will similarly affect the public opinion of the way Obamacare was foisted on the public. This is not a proud moment in science or the life of a scientist and his university.


From the CFO Journal's Morning Ledger on November 6, 2014

Health insurers woo consumers in crowded market
http://online.wsj.com/articles/health-insurance-deadline-prompts-marketing-blitz-to-drum-up-business-1415202655?mod=djemCFO_h
Health insurers are unleashing a blizzard of ads, letters, live events and other efforts to reach consumers, as the industry ramps up for the reopening of the health law’s marketplaces on Nov. 15. Meanwhile, small-business owners test-driving the federal government’s new online health-insurance exchange report a mixed experience with the site ahead of its planned opening in 10 days.

Jensen Comment
Health insurance is currently a very good business for companies, because bad debts from people who do not pay contracted premiums are passed on to the doctors and hospitals after 30 days. In any case Obamacare promises guaranteed profits for insurance companies at taxpayer expense if necessary. This is not capitalism since one of the tenants of capitalism is that businesses take risks risks of losses and failure.

It's the doctors and hospitals that take the financial risks. In New Hampshire nearly half the hospitals refuse to admit patients with ACA insurance except in dire emergencies. Many doctors are turning patients away unless they have something other than ACA medical insurance.

Another good thing for insurers is that the deductibles have become so huge (40% to 60%) that insured people put off getting medical care until absolutely necessary --- thereby greatly reducing the number of claims to be processed and paid.

My point is that just to say that more people now have ACA health insurance is not saying a whole lot about the quality of health care that this insurance is buying. There will probably be gridlock for years in Washington DC for any attempts to bring quality health care to all citizens of the USA. I favor national health insurance, although national health insurance plans in most non-OPEC nations like Sweden, Denmark, and the UK are doing badly these days. I consider Canada to be an OPEC nation. Germany is doing better because it allows people to take on supplemental health insurance using their own savings.

The USA is now an one of the world's largest oil producers, but gridlock politics have all but destroyed possibilities for great health care for all citizens. It's one of the best nations for health care for people who can afford to pay for the services, including those lucky enough to be on Medicaid or Medicare.


Some national health plans economize by not funding medical and pharmaceutical research in anticipation that other nations will make the new discoveries. These and others also economize with delays in service, such as waiting what seems like forever for a new hip in Canada, Sweden, or Denmark. But there are some that have taken on new services (such as dialysis for the elderly) that are not adequately funded.

"Britain's Health System Is 'At Breaking Point' Over A $48 Billion Funding Black Hole," by Tomas Hirst, Business Insider, October 6, 2014 ---
http://www.businessinsider.com/nhs-is-at-breaking-point-over-a-30-billion-funding-black-hole-2014-10
Also see http://www.businessinsider.com/nhs-is-at-breaking-point-over-a-30-billion-funding-black-hole-2014-10#ixzz3FMwz0jBP

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


ACA Health Insurance Mandate for Employers in 2015 Causes New Obstacles and Challenges

From the CFO Journal's Morning Ledger on October 15, 2014

With the health law’s insurance mandate for employers set to kick in next year, companies are trying to avoid the law’s penalties while holding down costs, using strategies like enrolling employees in Medicaid, the WSJ reports. The law’s penalties, which can amount to about $2,000 per employee, take effect next year for firms that employ at least 100 people.

Insurance brokers and benefits administrators are pitching companies on strategies to keep a lid on expenses that exploit wrinkles in the law. The Medicaid option is drawing particular interest from companies with low-wage workers, brokers say.

Locals 8 Restaurant Group LLC, with about 1,000 workers, already offers health coverage, and next year plans to reduce some employees’ premiums so as to avoid running afoul of the law’s standard for affordability. It will also help eligible employees enroll in Medicaid, using a contractor called BeneStream Inc. Such maneuvers could fuel controversy as costs are shifted to taxpayers, but BeneStream said its business is growing rapidly.


From the CFO Journal's Morning Ledger on October 31, 2014

Small firms (under 50 employees) drop health plans ---
http://online.wsj.com/articles/small-firms-drop-health-plans-1414628013?mod=djemCFO_h
Small companies are starting to turn away from offering health plans, with many viewing the health law’s marketplace as an inviting and affordable option. Wellpoint Inc. said its small-business-plan membership is shrinking faster than expected and it has lost about 300,000 people since the start of the year, leaving a total of 1.56 million in small-group coverage. Other insurers have flagged a similar trend.

Modestly larger firms are moving more employees to part-time in order to drop coverage. Larger firms have a much more difficult time avoiding high penalties for dropping health plans.

From the CPA Newsletter on May 27, 2014

IRS sets high penalties for (large) companies that send employees to ACA health exchanges
According to an Internal Revenue Service ruling, employers that move employees to health insurance exchanges by reimbursing them for their premiums do not satisfy the requirements of the Affordable Care Act. Companies that send workers to the exchanges face a tax penalty of $100 a day, or $36,500 a year, per employee. The New York Times (tiered subscription model) (5/

Eventually, large employers may opt to pay the fine for not providing health insurance and leave their workers to get coverage in the exchanges. Doing so might even save them money.
"Obamacare Increases Large Employers' Health Costs," by Sally Pipes, Forbes, May 19, 2014 ---
http://www.forbes.com/sites/sallypipes/2014/05/19/obamacare-increases-large-employers-health-costs/

Employer-provided health insurance may not be long for this world. According to a new report from S&P Capital IQ, 90 percent of American workers who receive health insurance from large companies will instead get coverage through Obamacare’s exchanges by 2020.

For that, patients — many of whom no doubt like the insurance they currently have — can blame Obamacare. The law’s many mandates, fees, and taxes will increase health costs for large employers to the point that providing health benefits at work is financially unsustainable.

Consider some of Obamacare’s most burdensome new levies. For instance, one fee on group plan sponsors is intended to fund the Patient Centered Outcomes Research Institute (PCORI), a government-sponsored organization charged with investigating the relative effectiveness of various medical treatments. Medicare may consider the Institute’s research in the determining what sorts of therapies it will cover.

Set aside the fact that the government — as paymaster for half of the health care delivered in this country — will have a significant incentive to twist the findings of such research so that older, cheaper therapies seem just as effective as more expensive, cutting-edge ones.

Making matters worse, the federal government is forcing private firms to underwrite its dirty work. For plan years ending after September 30, 2013, and before October 1, 2014, employer sponsors must pay the feds a PCORI fee of $2 per covered life. And for plan years between October 1, 2014, and October 1, 2019, they’ll have to pay an amount adjusted for national health inflation.

Large employers also have to pay a Temporary Reinsurance Fee to help “stabilize” premiums in the individual insurance market. In an American Health Policy Institute (AHPI) survey of businesses with more than 10,000 employees, one company estimated that this fee could cost it $15.3 million from 2014 to 2016.

Then there’s the 40 percent excise tax on expensive insurance plans — those with premiums greater than $10,200 for individuals and $27,500 for families — which goes into effect in 2018. One company in the same survey said that this tax could cost it $378 million over five years.

Large employers like these cover 59 percent of private-sector workers, according to the Employee Benefit Research Institute. So many firms will likely face the same tax-motivated cost increases as these two.

Obamacare doesn’t just tax employers directly. Its many coverage mandates also raise the cost of benefits indirectly.

Effective 2015, the law’s employer mandate requires employers with 100 or more full-time employees to provide health insurance to full-timers or pay a fine. In 2016, those with 50 to 99 employees will have to follow suit. The law originally intended for both groups to comply with the mandate in 2014.

Obamacare also orders plans to cover adult children on their parents’ policies until they’re 26 years of age. This “slacker mandate” has already raised employer health insurance costs by 1 to 3 percent. One firm told AHPI that the mandate could cost it almost $69 million over ten years.

Obamacare also requires employer-sponsored health plans to cover 100 percent of preventive care services, such as immunizations, contraceptive care, and depression screening. One large employer reported that full coverage of contraceptive care on its own could cost $25.6 million over ten years.

It’s no wonder that large employers expect their health bills to escalate in the years to come. The AHPI survey revealed that Obamacare could increase their health costs by 4.3 percent in 2016, 5.1 percent in 2018, and 8.4 percent in 2023.

Those percentages equate to real dollars. Over the next ten years, Obamacare could cost large employers $151 billion to $186 billion. That’s about $163 million to $200 million in additional cost per employer — or $4,800 to $5,900 per employee — solely attributable to the health reform law.

Employers will likely pass along these costs to their workers. According to a recent Mercer survey, 80 percent of employers are considering raising deductibles — or have already done so.

Eventually, large employers may opt to pay the fine for not providing health insurance and leave their workers to get coverage in the exchanges. Doing so might even save them money.

The care for an employee with hemophilia, for example, can cost a company $300,000. That could end up being a lot more expensive than the $2,000 per-employee fine for not offering insurance.

Firms could also continue furnishing insurance to most of their workers — but nudge their costliest ones onto the exchanges by making the company insurance plan unattractive to them. A company could shrink its network of doctors, raise co-payments, or even offer a chronically ill employee a raise to opt out of the employer plan.

In so doing, the company would save money. The employee would be able to secure better coverage through the exchange. And if a raise covered the cost of the exchange policy, both parties would benefit.

Others in the exchange pool — and the taxpayers subsidizing them — won’t be so lucky. Exchange enrollees are already sicker than their counterparts outside the government insurance portals. Indeed, the exchange pool fills prescriptions for the sorts of specialty drugs associated with chronic disease at a rate that’s 47 percent higher than for folks outside the exchanges.

Adding even more high-cost individuals to the exchanges could cause insurers to hike premiums. And higher premiums require greater taxpayer subsidies. Already, the Congressional Budget Office projects that the federal government will spend $1.03 trillion on exchange subsidies and related spending from 2015 to 2024.

If employers dump their sickest employees into the exchanges, that number could go spiral even further upward.

Continued in article


Penalty for Opting Out of the Affordable Care Act Is Large ($12,240) and Growing ---
http://taxprof.typepad.com/taxprof_blog/2014/09/penalty-for-opting-out-of-affordable-care-act-.html


"Underinsured ACA enrollees strain community health centers," by Virgil Dickson, Modern Healtcare, September 25, 2014 ---
http://www.modernhealthcare.com/article/20140925/NEWS/309259947/underinsured-aca-enrollees-strain-community-health-centers 

Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say.

The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can't afford it.

So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have
to write it off as uncompensated care..

“People bought what they could afford and healthcare centers are in effect subsidizing these policies,” said José Camacho, executive director of the Texas Association of Community Health Centers.

There had been uncertainty about whether community health centers, which receive federal funding and serve 22 million Americans at 9,000 sites around the country, were allowed to offer sliding-scale fees to patients with private insurance plans. On Monday,
HHS released a guidance clarifying that the centers can offer these reduced fees to patients with incomes under 200% of the federal poverty level.

Of the 7.3 million people who purchased and paid for coverage on the federal and states exchanges for 2014, about 20% selected bronze-tier plans, which feature deductibles as high as $5,500 a person. Those plans lack a key affordability feature of silver plans, which generally have higher premiums. Under the Patient Protection and Affordable Care Act, people with incomes of up to 250% of the federal poverty level who buy silver plans
qualify for cost-sharing subsidies that reduce their out-of-pocket costs for care. Purchasers of bronze plans do not qualify for those subsidies.

While all health plans that comply with Obamacare standards must cover a range of primary-care and preventive services on a first-dollar basis, deductibles and coinsurance apply when patients are diagnosed and treated for sickness, injuries or chronic illness.

“With the Affordable Care Act, while the number of uninsured may be dropping, there's a new challenge in that there is now a huge cadre of underinsured people,” said Sara Rosenbaum, chair of the health policy department at George Washington University.

Continued in article


"US Census Data: Uninsured Rate…Increased in 2014?," by Guy Benson, Townhall, September 22, 2014 ---
http://townhall.com/tipsheet/guybenson/2014/09/22/us-census-bureau-number-of-uninsured-americansincreased-in-2014-n1894992?utm_source=thdaily&utm_medium=email&utm_campaign=nl

Wait, what? We've expressed a healthy skepticism of the administration's "official" enrollment numbers, and for good reason -- but even I must admit to being a bit flummoxed by the United States Census Bureau's new findings that America's uninsured population increased in 2014 over 2013.  That data, via Phil Kerpen:

Continued in article

 

"The Myth of ObamaCare's Affordability:  The law's perverse incentives will have the nation working fewer hours, and working those hours less productively," by Casey B. Mulligan, The Wall Street Journal, September 8, 2014 ---
http://online.wsj.com/articles/casey-b-mulligan-the-myth-of-obamacares-affordability-1410218437?tesla=y&mod=djemMER_h&mg=reno64-wsj

Whether the Affordable Care Act lives up to its name depends on how, or whether, you consider its consequences for the wider economy.

Millions of people pay a significant portion of their income for health insurance so they and their families can get good health care when they need it. The magnitude of their sacrifices demonstrates the importance that people ascribe to health care.

The Affordable Care Act attempts to help low- and middle-income families avoid some of the tough sacrifices that would be necessary to purchase health insurance without assistance. But no program can change the fundamental reality that society itself has to make sacrifices in order to deliver health care to more people. Workers and therefore production have to be taken away from other industries to beef up health care, or the workforce itself has to get bigger, or somehow people have to work more productively.

Although the ACA helps specific populations by giving them a bigger slice of the economic pie, the law diminishes the pie itself. It reduces the amount that Americans work, and it makes their work less productive. This slows growth in both personal income and gross domestic product.

In further expanding the frontiers of redistribution, the ACA reduces the benefits of employment for both employers and employees. Employers that don't provide health insurance are either subject to large penalties based on the number and types of employees that they have, or are threatened with enormous penalties when they get the opportunity to expand their business. About a quarter of the nation's employees, more than 35 million men and women, currently work for employers that don't offer health insurance. These tend to be small and midsize businesses with employees who already make less than the average American worker. The result of penalizing businesses for hiring and expanding is going to be less hiring and expanding.

Another sixth of the nation's employees—almost 25 million people—are in a full-time position that makes them ineligible for the law's new and generous assistance with health-insurance premiums and cost sharing. They are ineligible for subsidies simply because they are working full time and thereby eligible for their employers' coverage. Because the only ways for them to get the new assistance is to move to part-time status, find an employer that doesn't offer coverage, or stop working, we can expect millions of workers to make one or more of those adjustments.

Most people wouldn't give up working merely to qualify for a few thousand dollars in assistance. But it is a mistake to assume that nobody is affected by subsidies, because there are people who aren't particularly happy with working, planning to leave their job anyway, or otherwise on the fence between working and not working. A new subsidy is enough to push them over the edge or to get them to stop working sooner than they would have otherwise.

The law has effects that extend well beyond the employment rate and the average length of the workweek. People, businesses and entire sectors will jockey to reduce their new tax burdens or enhance their subsidies. Their adjustments to the new incentives will make our economy less productive and stifle wage growth, even among workers who have no direct contact with the law's penalties and subsidies.

The "29er" phenomenon is a good example of how the law harms productivity. Because ACA's "employer mandate" requires firms with 50 or more full-time workers to offer health plans to employees who work more than 30 hours a week, many employers and employees have adopted 29-hour work schedules. This is not the most productive way to arrange the workplace, but it allows employers to avoid the mandate and its penalties and helps the employees qualify for individual assistance.

All of this, and much more, exacerbates the societal problem that the economy cannot expand its health sector without giving up something else of value. A complex law like the ACA has a few provisions that encourage work, such as counting unemployment income against eligibility for health assistance. But the bulk of the law overwhelms them. The ACA as a whole will have the nation working fewer hours, and working those hours less productively.

I estimate that the ACA's long-term impact will include about 3% less weekly employment, 3% fewer aggregate work hours, 2% less GDP and 2% less labor income. These effects will be visible and obvious by 2017, if not before. The employment and hours estimates are based on the combined amount of the law's new taxes and disincentives and on historical research on the aggregate effects of each dollar of taxation. The GDP and income estimates reflect lower amounts of labor as well as the law's effects on the productivity of each hour of labor.

By the end of this decade, nearly 20 million additional Americans will have health insurance as a consequence of the law. But the ultimate economywide cost of their enrollments will be at least double what it would have been if these people had enrolled without government carrots and sticks; that is, if they had decided it was worth spending their own money on health insurance. In effect, people who aren't receiving assistance through the ACA are paying twice for the law: once as the total economic pie gets smaller and again as they receive a smaller piece.

The Affordable Care Act is weakening the economy. And for the large number of families and individuals who continue to pay for their own health care, health care is now less affordable.

Mr. Mulligan is a professor of economics at the University of Chicago and the author of the new e-book "Side Effects: The Economic Consequences of the Health Reform" (JMJ Economics, 2014).

"Unemployed by ObamaCare:  Three new Fed surveys highlight damage to the labor market," The Wall Street Journal, August 21, 2014 ---
http://online.wsj.com/articles/unemployed-by-obamacare-1408664211?tesla=y&mod=djemMER_h&mg=reno64-wsj

"The Full-Time Scandal of Part-Time America Fewer than half of U.S. adults are working full time. Why? Slow growth and the perverse incentives of ObamaCare," by Mortimer Zuckerman, The Wall Street Journal,  July 13, 2014 ---
http://online.wsj.com/articles/mortimer-zuckerman-the-full-time-scandal-of-part-time-america-1405291652?tesla=y&mod=djemMER_h&mg=reno64-wsj

There has been a distinctive odor of hype lately about the national jobs report for June. Most people will have the impression that the 288,000 jobs created last month were full-time. Not so.

The Obama administration and much of the media trumpeting the figure overlooked that the government numbers didn't distinguish between new part-time and full-time jobs. Full-time jobs last month plunged by 523,000, according to the Bureau of Labor Statistics. What has increased are part-time jobs. They soared by about 800,000 to more than 28 million. Just think of all those Americans working part time, no doubt glad to have the work but also contending with lower pay, diminished benefits and little job security.

On July 2 President Obama boasted that the jobs report "showed the sixth straight month of job growth" in the private economy. "Make no mistake," he said. "We are headed in the right direction." What he failed to mention is that only 47.7% of adults in the U.S. are working full time. Yes, the percentage of unemployed has fallen, but that's worth barely a Bronx cheer. It reflects the bleak fact that 2.4 million Americans have become discouraged and dropped out of the workforce. You might as well say that the unemployment rate would be zero if everyone quit looking for work.

Last month involuntary part-timers swelled to 7.5 million, compared with 4.4 million in 2007. Way too many adults now depend on the low-wage, part-time jobs that teenagers would normally fill. Federal Reserve Chair Janet Yellen had it right in March when she said: "The existence of such a large pool of partly unemployed workers is a sign that labor conditions are worse than indicated by the unemployment rate."

There are a number of reasons for our predicament, most importantly a historically low growth rate for an economic "recovery." Gross domestic product growth in 2013 was a feeble 1.9%, and it fell at a seasonally adjusted annual rate of 2.9% in the first quarter of 2014.

But there is one clear political contribution to the dismal jobs trend. Many employers cut workers' hours to avoid the Affordable Care Act's mandate to provide health insurance to anyone working 30 hours a week or more. The unintended consequence of President Obama's "signature legislation"? Fewer full-time workers. In many cases two people are working the same number of hours that one had previously worked.

Since mid-2007 the U.S. population has grown by 17.2 million, according to the Census Bureau, but we have 374,000 fewer jobs since a November 2007 peak and are 10 million jobs shy of where we should be. It is particularly upsetting that our current high unemployment is concentrated in the oldest and youngest workers. Older workers have been phased out as new technologies improve productivity, and young adults who lack skills are struggling to find entry-level jobs with advancement opportunities. In the process, they are losing critical time to develop workplace habits, contacts and new skills.

Most Americans wouldn't call this an economic recovery. Yes, we're not technically in a recession as the recovery began in mid-2009, but high-wage industries have lost a million positions since 2007. Low-paying jobs are gaining and now account for 44% of all employment growth since employment hit bottom in February 2010, with by far the most growth—3.8 million jobs—in low-wage industries. The number of long-term unemployed remains at historically high levels, standing at more than three million in June. The proportion of Americans in the labor force is at a 36-year low, 62.8%, down from 66% in 2008.

Part-time jobs are no longer the domain of the young. Many are taken by adults in their prime working years—25 to 54 years of age—and many are single men and women without high-school diplomas. Why is this happening? It can't all be attributed to the unforeseen consequences of the Affordable Care Act. The longer workers have been out of a job, the more likely they are to take a part-time job to make ends meet.

The result: Faith in the American dream is eroding fast. The feeling is that the rules aren't fair and the system has been rigged in favor of business and against the average person. The share of financial compensation and outputs going to labor has dropped to less than 60% today from about 65% before 1980.

Why haven't increases in labor productivity translated into higher household income in private employment? In part because of very low rates of capital spending on new plant and equipment over the past five years. In the 1960s, only one in 20 American men between the ages of 25 and 54 was not working. According to former Treasury Secretary Larry Summers, in 10 years that number will be one in seven.

The lack of breadwinners working full time is a burgeoning disaster. There are 48 million people in the U.S. in low-wage jobs. Those workers won't be able to spend what is necessary in an economy that is mostly based on consumer spending, and this will put further pressure on growth. What we have is a very high unemployment rate, a slow recovery and across-the-board wage stagnation (except for the top few percent). According to the Bureau of Labor Statistics, almost 91 million people over age 16 aren't working, a record high. When Barack Obama became president, that figure was nearly 10 million lower.

The great American job machine is spluttering. We are going through the weakest post-recession recovery the U.S. has ever experienced, with growth half of what it was after four previous recessions. And that's despite the most expansive monetary policy in history and the largest fiscal stimulus since World War II.

Continued in article


California's Proposition 45:  Will ObamaCare price fixing work in California?

"California's ObamaCare Fight," by Allysia Finley, The Wall Street Journal, September 15, 2014 ---
http://online.wsj.com/articles/political-diary-californias-obamacare-fight-1410807906?tesla=y&mod=djemMER_h&mg=reno64-wsj

One of the most expensive and contentious initiative campaigns in California this year pits progressive Democrats against the state's ObamaCare exchange. The progressives want to give the state insurance commissioner veto power over health-insurance rates while the exchange backers want to prevent ObamaCare from imploding.

State Insurance Commissioner Dave Jones decided to go to voters after unsuccessfully lobbying the legislature to give him authority to reject health insurance rate hikes. Backing him are progressive groups and San Francisco billionaire Tom Steyer, who say consumers need more protection from money-grubbing health-insurance companies.

Assisting insurers in their fight against the initiative, Proposition 45, are regulators for the state exchange Covered California. "It's going to end up hurting Californians, hurting consumers, increasing costs," declared Democratic exchange board member Susan Kennedy at a meeting last month. "And it will damage health-care reform, perhaps permanently, perhaps fatally, in California and I think perhaps nationally."

"I don't think this is the right law at the right time," added Diana Dooley, who is Gov. Jerry Brown's secretary of health and human services. "I feel very mother-bearish on protecting the investment we have made in implementing the Affordable Care Act."

They're afraid Prop. 45 will induce insurers to narrow their provider networks to minimize rate increases. The larger danger is that some insurers might drop out of the exchange if they can't raise rates enough to cover their costs. This would erode choice and quality of health insurance, and the collateral damage might incite a public backlash. So to ensure ObamaCare's promise of lower health costs, progressives may wind up sabotaging the country's best-run state exchange.

Note that the ObamaCare benefit mandates are mainly to blame for driving up individual health premiums by as much as 88% this year. While campaigning for Prop. 45, Mr. Jones has flogged the rate spikes and accused insurers of curtailing their rate increases this year in order to undercut the initiative.

The anti-Prop. 45 campaign is just gearing up—it has spent $1.7 million of its $36.7 million war chest—but it seems that all the kvetching has raised public skepticism of the initiative. A Field Poll last week showed 41% of voters favoring the initiative, down from 69% in early July. A third of voters remain undecided, which is twice as many as two months ago. Ballot measures typically need to be polling above 50% to stand a chance of passing.

Jensen Comment
Voters should look to the empty supermarkets in Venezuela before going to the polls in California to vote for price fixing.

Voters should also remember that hospitals, medical clinics, and doctors are not obligated to serve patients having ACA-exchange insurance. In New Hampshire nearly half the hospitals in the state refuse to honor ACA-exchange medical insurance. This is partly due to reimbursement rates as well as having to cover up to 60 days of free medical care for deadbeats who are bad debts in terms of ACA insurance premiums.

Price controls ala Proposition 45 in California may result greatly reduced quantity and quality of medical care for patients insured by California's ACA-exchanges.

One state to watch in this regard is Vermont.
Vermont is in the midst of trying to start up a state-funded insurance plan that will force all private sector medical insurance companies out of the current Vermont ACA exchanges. This is probably the closest movement toward a Canadian-styled public sector health insurance plan. In Canada the province taxpayers fund healthcare insurance, and coverage varies somewhat between provinces.

One problem in Vermont is that a state with only 500,000 people (counting babies) cannot figure out how to raise $1 billion in capital needed to get the state-exchange plan started. I do hope that Vermont will figure out a way in this regard. Another problem is that much of Vermont's taxpayer dollars for state-funded medical care will go out of state since Vermont is so dependent on specialist services from the bigger medical service providers in surrounding states such as the Hitchcock-Dartmouth Medical Center and the large medical centers in Boston.

Update
 

"Vermont bails on single-payer health care," by Sarah Wheaton, Politico, December 17, 2014 ---
http://www.politico.com/story/2014/12/vermont-peter-shumlin-single-payer-health-care-113653.html

. . .

Gov. Shumlin had missed two earlier financing deadlines but finally released his proposal. But he immediately cast it as “detrimental to Vermonters.” The model called for businesses to take on a double-digit payroll tax, while individuals would face up to a 9.5 percent premium assessment. Big businesses, in particular, didn’t want to pay for Shumlin’s plan while maintaining their own employee health plans.

“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”

And that was for a plan that would not be truly single payer. Large companies with self-insured plans regulated by ERISA would have been exempt. And Medicare also would have operated separately, unless the state got a waiver, which was a long shot.

Shumlin added that federal funds available for the transition were $150 million less than expected.

He also has a lot less political capital than before November. Shumlin, chairman of the Democratic Governors Association, still hasn’t even officially won his own reelection bid: The Legislature will settle the outcome of the November race in January because Shumlin failed to win more than 50 percent of the vote. He’s leading his Republican challenger by just a few thousand ballots.

And the substance of the plan isn’t its only politically problematic aspect. Gruber, now infamous for his blunt assessments of the Affordable Care Act and his remarks about “stupid” voters, was until recently a state consultant. Days after the election, video emerged of him dismissing criticism of Vermont’s plan in 2011 by asking, “Was this written by my adolescent children, by any chance?” State officials said they would cut off his contract.

Advocates of a single-payer plan said Shumlin should not be able to cast aside Act 48, the 2011 law that called for the creation of Green Mountain Care, without repealing it. A group planned to hold a rally in front of the statehouse on Thursday to protest his decision.

“The governor’s misguided decision was a completely unnecessary result of a failed policy calculation that he pursued without Democratic input,” the group Healthcare Is a Human Right Campaign said in a statement.

Jensen Comment
This is sad, because I was hoping that Vermont would lead the way for the other 49 states to adopt single-payer plans ---
http://www.trinity.edu/rjensen/Health.htm

One of Vermont's many problems with health care is that physicians are leaving the state due, in large measure, to Vermont's huge taxation of higher income professionals. This has already forced Vermont to use the medical doctors, clinics, and hospitals in bordering New Hampshire where there are no taxes on earned incomes and sales.

Vermont is also having a problem with loss of students in schools. Thus far efforts to close nearly-empty schools have failed. Purportedly there are some Vermont school districts that have more members on the school boards than children in the schools.


"Doctors Get Stuck with Bills for Deadbeat Obamacare Patients," by J.D. Tuccille, Reason Magazine, September 16, 2014 ---
http://reason.com/blog/2014/09/16/doctors-get-stuck-with-bills-for-deadbea

Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don't pay their insurance premiums. That's because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don't pay the price of their insurance. If the patients eventually make good, there's no problem. But if patients don't pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three.

The piece I wrote last July was theoretical. The notification letter I'm holding in my hand, addressed to my wife's pediatric practice, is reality. And reality costs, in this case, over $600. That's the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It's a balance that my wife might have to eat, or else try to collect herself.

Here's the letter, from which my wife redacted all identifying information before showing it to me.

Dear Practitioner:

Under the Patient Protection and Affordable Care Act (PPACA), if an individual purchases health insurance through the Individual Marketplace and receives a subsidy to assist with premiums, there is a three month grace period in which the individual can make premium payments. During this period, insurance companies may not disenroll members, issuers must notify providers as soon as practicable when an enrollee enters the grace period and, during the second and third months of the grace period, they are required to notify providers that claims incurred in the second and third months may deny if the premium is not paid.

The member referenced above purchased health insurance through the Marketplace and currently receives a subsidy to assist with premiums. This letter is a courtesy notification to make you aware that this member and any covered dependents are currently in the 3rd month of their grace period.

What this means to you

  • This claim was incurred during the second or third month of the member's grace period and was pended. All individual claims under this contract are also in the second or third month of their grace period.
  • Any additional claims incurred during the second and third month of the grace period may be pended until the full premium due is paid by the member.
  • If the premium is paid in full by the end of the grace period, and pended claims will be processed in accordance with the terms of the contract.
  • If premium is not paid in full by the end of the grace period, any claims incurred in the second and third months may be denied. If claims incurred in the second and third month are denied due to non-payment of premium, you may seek reimbursement directly from the member.

The American Medical Association (AMA) has more information about the grace period here, though the letter above covers the high points. Given the potentially high costs providers can face when the insurance coverage they process for patient care turns out to be more of a conditional suggestion than a firm guarantee, the AMA also offers physicians guidance, and urges them to enter into financial agreements with patients who receive subsidized care. The idea is to get them to promise to pay their own bills if they stiff the insurance company.

Of course, those patients promised to pay their insurance companies, too.

"Doctors Get Stuck with Bills for Deadbeat Obamacare Patients," by J.D. Tuccille, Reason Magazine, September 16, 2014 ---
http://reason.com/blog/2014/09/16/doctors-get-stuck-with-bills-for-deadbea

Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don't pay their insurance premiums. That's because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don't pay the price of their insurance. If the patients eventually make good, there's no problem. But if patients don't pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three.

The piece I wrote last July was theoretical. The notification letter I'm holding in my hand, addressed to my wife's pediatric practice, is reality. And reality costs, in this case, over $600. That's the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It's a balance that my wife might have to eat, or else try to collect herself.

Here's the letter, from which my wife redacted all identifying information before showing it to me.

Dear Practitioner:

Under the Patient Protection and Affordable Care Act (PPACA), if an individual purchases health insurance through the Individual Marketplace and receives a subsidy to assist with premiums, there is a three month grace period in which the individual can make premium payments. During this period, insurance companies may not disenroll members, issuers must notify providers as soon as practicable when an enrollee enters the grace period and, during the second and third months of the grace period, they are required to notify providers that claims incurred in the second and third months may deny if the premium is not paid.

The member referenced above purchased health insurance through the Marketplace and currently receives a subsidy to assist with premiums. This letter is a courtesy notification to make you aware that this member and any covered dependents are currently in the 3rd month of their grace period.

What this means to you

  • This claim was incurred during the second or third month of the member's grace period and was pended. All individual claims under this contract are also in the second or third month of their grace period.
  • Any additional claims incurred during the second and third month of the grace period may be pended until the full premium due is paid by the member.
  • If the premium is paid in full by the end of the grace period, and pended claims will be processed in accordance with the terms of the contract.
  • If premium is not paid in full by the end of the grace period, any claims incurred in the second and third months may be denied. If claims incurred in the second and third month are denied due to non-payment of premium, you may seek reimbursement directly from the member.

The American Medical Association (AMA) has more information about the grace period here, though the letter above covers the high points. Given the potentially high costs providers can face when the insurance coverage they process for patient care turns out to be more of a conditional suggestion than a firm guarantee, the AMA also offers physicians guidance, and urges them to enter into financial agreements with patients who receive subsidized care. The idea is to get them to promise to pay their own bills if they stiff the insurance company.

Of course, those patients promised to pay their insurance companies, too.

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


There's No Accounting for the Pricing Differences of Health Care Services
Why does an upper back MRI scan cost three times as much in one reputable Boston-area hospital as in a nearby reputable hospital?

"Price Tags On Health Care? Only In Massachusetts," by Martha Bebinger, WBUI, October 8, 2014 ---
http://www.webmd.com/health-insurance/ma/20141008/price-tags-on-health-care-only-in-massachusetts

Without much fanfare, Massachusetts launched a new era of health care shopping last week.

Anyone with private health insurance in the state can now go to his or her health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.

It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information in Massachusetts—nothing. Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.

Then two years ago, Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public. Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices by provider in consumer-friendly formats.

“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

There are caveats.

1.) Prices are not standard, they vary from one insurer and provider to the next. I shopped for a bone density test. The low price was $16 at Tufts Health Plan, $87 on the Harvard-Pilgrim Health Care site and $190 at Blue Cross Blue Shield of Massachusetts. Why? Insurers negotiate their own rates with physicians and hospitals, and these vary too. Some of the prices include all charges related to your test, others don’t (see No. 2).

2.) Posted prices may or may not include all charges, for example the cost of reading a test or a facility fee. Each insurer is defining “price” as it sees fit. Read the fine print.

3.) Prices seem to change frequently. The first time I shopped for a bone density test at Blue Cross, the low price was $120. Five days later it had gone up to $190.

4.) There is no standard list of priced tests and procedures. I found the price of an MRI for the upper back through Harvard Pilgrim’s Now iKnow tool. That test is “not found” through the Blue Cross “Find a Doc” tool.

5.) Information about the quality of care is weak. Most of what you’ll see are patient satisfaction scores. There is little hard data about where you’ll get better care. This is not necessarily the insurer’s fault, because the data simply doesn’t exist for many tests.

6.) There are very few prices for inpatient care, such as a surgery or an illness that would keep you in the hospital overnight. Most of the prices you’ll find are for outpatient care.

These tools are not perfect, but they are unlike anything else in the country. While a few states are moving toward more health care price transparency, none have gone as far as Massachusetts to make the information accessible to consumers. Tufts Health Plan Director of Commercial Product Strategy Athelstan Bellerand said the new tools "are a major step in the right direction.” Bellerand added: “They will help patients become more informed consumers of health care.”

Patients can finally have a sense of how much a test or procedure will cost in advance. They can see that some doctors and hospitals are a lot more expensive than others. For me, a bone density test would cost $190 at Harvard Vanguard and $445 at Brigham and Women’s Hospital.

The most frequent early users of the newly disclosed data are probably providers. Anthony says some of the more expensive physicians and hospitals react with, “I don’t want to be the highest priced provider on your website. I thought I was lower than my competitors.”

Anthony is hoping that will generate more competition and drive down prices.

“I’m just talking about sensible rational pricing, which health prices are anything but,” she added.

Take, for example, the cost of an upper back MRI.

“The range here is $614 to $1,800, so three times,” said Sue Amsel, searching “Now I Know,” the tool she manages at Harvard Pilgrim. “That to me is a very big range.” 

In this case, the most expensive MRI is at Boston Children’s Hospital and the lowest cost option is at New England Baptist, with no apparent difference in quality. 

“It’s not just for choosing. It’s primarily for getting you the information, about whatever you’re having done, so you can plan for it,” she said.

Most of us don’t have to plan for anything except our co-pay. But about 15 percent of commercial insurance plans have high deductible plans, in which patients pay the full cost of an office visit or test up to the amount of their deductible, and that number is growing.

Continued in article

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


"GAO: Where did ObamaCare’s $3.7B go?" by Sarah Ferris, The Hill, September 22, 2014 ----
http://thehill.com/policy/healthcare/218628-gao-where-did-obamacares-37b-go

The Obama administration has spent at least $3.7 billion to build and promote online marketplaces under the Affordable Care Act, but it can’t prove exactly where it all went, according to an audit released Monday.

Federal investigators said the Centers for Medicare and Medicaid Services (CMS) does not properly track certain data that public officials need in order to determine whether the healthcare law is working.

The government tracks its healthcare spending in an outdated records system that cannot easily respond to data requests such as salaries or public relations contracts in certain departments. Instead, officials rely on manually prepared spreadsheets that can take months to produce. 

Out of that data, “we were not able to determine the reliability of most of the information,” according to the report by the independent Government Accountability Office (GAO). 

CMS's processes are inconsistent with certain federal accounting and internal control standards,” the report states. To improve the system, the GAO recommends that CMS staff create new procedures to provide more timely and reliable information to the public. “Particularly for programs subject to a significant degree of public and congressional scrutiny,” the GAO reports. 

The report marks the third time in two weeks that a federal audit has criticized the rollout of ObamaCare.

The auditors pointed to one particularly troublesome area within CMS — its Center for Consumer Information & Insurance Oversight, which works largely with state governments. 

That agency could not verify its total costs of staff salaries, travel, polling or total advertising spent on ObamaCare. 

The investigation was requested by Rep. Dave Camp (R-Mich.), the outgoing chair of the House Ways and Means Committee. Camp released a statement criticizing the administration's financial tracking.

“After promising transparency and then ignoring repeated requests from Congress, we now find out that the administration is not even keeping track of how many taxpayer dollars are going out the door,” he said. “Worse yet, the administration won’t even account for how much it spent on public relations campaigns promoting their unpopular law.” 

The Department of Health and Human Services (HHS), which oversees the other agencies, defended its financial tracking system, which it described as “up-to-date.” 

The department argued it relies on an ad-hoc process only when responding to non-routine data requests, such as those from the GAO or Congress. 

HHS has endured heavy scrutiny from lawmakers, particularly over the last year. Members of Congress and their staff have sent hundreds of inquiries to HHS since the launch of ObamaCare. As a result, department officials have testified at more than 50 hearings and supplied 140,000 pages of documents.


"Big (60%) Minnesota insurer leaves Obamacare site," by Dan Mangan (CNBC), Yahoo Finance, September 16, 2014 ---
http://finance.yahoo.com/news/big-minnesota-insurer-leaves-obamacare-185046511.html

The "Blue Ox" of Minnesota Obamacare is calling it quits.

PreferredOne, the insurer that sold nearly 60 percent of all private health plans on Minnesota's Obamacare exchange, on Tuesday said it would leave that marketplace. PreferredOne's plans were the lowest-cost options on that exchange, known as MNSure.

PreferredOne cited the costs of doing business on MNSure as the reason for its surprising decision, saying that selling plans is "not administratively and financially sustainable going forward," according to KSTP.com, the website of that Minnesota TV News network.

"Our MNsure individual product membership is only a small percentage of the entire PreferredOne enrollment but is taking a significant amount of our resources to support administratively," a company statement obtained by KSTP said. "We feel continuing on MNsure was not sustainable and believe this is an important step to best serve all PreferredOne members."
 

The insurer's surprising move came just two months before the start of open enrollment in Obamacare plans for 2015 and a month before insurers are expected to release their plan rates for next year.

Read More CEO prescription for health care

PreferredOne's decision is likely to have significant effect not only on its current Obamacare enrollees, but also on people who will be shopping for plans for next year on the exchange, which is now left with just four insurers. The remaining players on the exchange are Blue Cross and Blue Shield, Health Partners, Medica and UCare.

PreferredOne's relatively low-priced plans on MNSure for the 2014 enrollment season were a big reason why 59 percent of the 47,902 people who bought health coverage on the exchange by mid-April selected the insurer.

Those customers now face the prospects of higher rates if they want to remain in those same plans next year, as is their option, while existing customers of other insurers and new customers in the market will have fewer price options from which to choose.

In a statement released Tuesday, MNSure noted that "all consumers currently enrolled through Preferred One will have continued coverage through their existing plan for the rest of 2014."

And the statement said that under state law, customers have the right to renew their current coverage for 2015, but "this mandate does not require it to be offered at the same price."

Read More 115K could lose Obamacare coverage

In a joint statement, MNsure's CEO, Scott Leitz, and Preferred One CEO Marcus Merz said, "Today Preferred One made the decision to not offer health plans through the health insurance exchange in 2015. Simply put, both organizations understand that MNsure is still an evolving partnership. This decision impacts 2015 enrollment."

"Consumers still have at least four, well-known, Minnesota-based carriers who are committed to providing important health coverage to Minnesotans through MNsure, including people who qualify for tax credits and public programs," the CEOs said.

Read More How to save on health care in retirement

"MNsure and Preferred One will work closely to minimize impact to current enrollees in a Preferred One Plan through MNsure."

PreferredOne is owned jointly by three medical providers in the Minneapolis-St. Paul area. The insurer is Minnesota's fifth largest by revenue, and will continue selling health plans outside of the Obamacare exchange.

-By CNBC's Dan Mangan.

Jensen Comment
I don't think the ACA is sustainable until state or federal government insurance exchanges replace those of the private sector. Keep tuned into Vermont where a serious effort is underway to opt out of private sector medical insurance for ACA exchanges.


Jensen Comment
What stands in the way of cutting health care cost in the USA relative to other nations. My answer to this is:

  • Lawyers who have found a gold mine in malpractice insurance (often fraudulent) lawsuits. Physicians and hospitals pay ten or more times as much in the USA for malpractice insurance than health providers in other nations. In part this is why the USA has 80?% more lawyers than other nations.
     
  • Relatives of terminally ill patients who refuse to sign off on dying patients as long as third-party providers (e.g., Medicare and Medicaid) pay all the enormous expenses of keeping dying people alive in hospitals.|
    The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009 ---
    http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
    All other nations are more sensible about costs and benefits of temporarily extending life at massive costs.
     
  • Medical care providers who fear making mistakes (for whatever reason) and over prescribe diagnostic and treatment tests and medications. The USA also spends much more than other nations on keeping premature babies alive.
     

The article below focuses on the medical care providers.

"What Really Stands in the Way of Cutting Health Care Costs?" Knowledge@Wharton, July 31, 2014 ---
http://knowledge.wharton.upenn.edu/article/really-stands-way-cutting-health-care-costs/

"A Medicare scam that just kept rolling: The government has paid billions to buy power wheelchairs. It has no idea how many of the claims are bogus," The Washington Post, August 16, 2014 ---
http://www.washingtonpost.com/sf/national/2014/08/16/a-medicare-scam-that-just-kept-rolling/

LOS ANGELES — In the little office where they ran the scam, a cellphone would ring on Sonia Bonilla’s desk. That was the sound of good news: Somebody had found them a patient.

When Bonilla answered the phone, one of the scam’s professional “patient recruiters” would read off the personal data of a senior citizen. Name. DOB. Medicare ID number. Bonilla would hang up and call Medicare, the enormous federal health-insurance program for those over 65.

BREAKING POINTS:

WHERE GOVERNMENT FALLS APART

Fourth in a series examining the failures at the heart of troubled federal systems.

She asked a single question: Had the government ever bought this patient a power wheelchair?

No? Then the scam was off and running.

“If they did not have one, they would be taken to the doctor, so the doctor could prescribe a chair for them,” Bonilla recalled. On a log sheet, Bonilla would make a note that the recruiter was owed an $800 finder’s fee. “They were paid for each chair.”

This summer, in a Los Angeles courtroom, Bonilla described the workings of a peculiar fraud scheme that — starting in the mid-1990s — became one of the great success stories in American crime.

The sucker in this scheme was the U.S. government. That wasn’t the peculiar part.

The tool of the crime was the motorized wheelchair.

The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they’d provided expensive wheelchairs to Medicare patients — who, in reality, didn’t need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair.

A lot of the time, Medicare was fooled. The government paid.

Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.

Now, the golden age of the wheelchair scam is probably over.

But, while it lasted, the scam illuminated a critical failure point in the federal bureaucracy: Medicare’s weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn’t until 15 years later that officials finally did enough to significantly curb the practice.

“If you play it right, you can make a lot of money quickly, stealing from Medicare,” said James Quiggle, of the nonprofit Coalition Against Insurance Fraud, recounting the lesson of the past decade and a half. “You can walk into the United States, with limited English skills, no knowledge of medicine, and — if you hook up with the right people, that know how to play the system like a Stradivarius — you can become an overnight millionaire.” Video: How to scam Medicare in 4 easy steps

‘I said I didn’t need it’

In the courtroom in Los Angeles, 42-year-old Olufunke Fadojutimi was on trial. Prosecutors alleged she’d run a wheelchair-scam operation out of an office-park suite in suburban Carson, Calif.

As these scams go, this one was medium-sized. It billed Medicare for about 1,000 power wheelchairs.

“I said I didn’t need it,” witness Heriberto Cortez, 73, testified on the stand. Cortez was recalling the day when a stranger — allegedly one of Fadojutimi’s patient recruiters — came to his house and offered him a wheelchair. He said no. She didn’t listen.

“She insisted,” Cortez said. “She said that they were giving the chairs away.”

Later in the trial, 71-year-old Rodolfo Fernandez testified that a woman showed up at his house in Los Angeles. The woman asked if he was on Medicare. He was.

The next day, she came back with a van. Other seniors were already inside.

“They took us to a clinic. They did an exam on us,” Fernandez recalled, translated speaking through a Spanish interpreter.

Authorities said the doctor at this clinic was in on the scam, too. He was paid to find the same problems, every time. The patient was too weak to use a cane. Or a walker. Or even a non-motorized wheelchair. Only a motorized wheelchair would do. Instead of making lame men walk, the doctor’s job was to make walking men lame — at least on paper. A surge in power wheelchairs and scooters paid for by Medicare

Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and scooters for 2.7 million people. Today, the federal government does not know how much of that money was actually paid to scammers.

Source: U.S. Centers for Medicare and Medicaid Services

In his testimony, Fernandez noted that the clinic was in a second-floor walk-up.

“I had to climb the stairs,” Fernandez said, in order for the doctor to proclaim him unfit to climb stairs.

After seeing the doctor, prosecutors said, both Cortez and Fernandez got power wheelchairs from Fadojutimi’s company. The company then sent Medicare the bills. Medicare paid.

Today, Cortez’s wheelchair sits in his garage, still wrapped in plastic from the factory. Fernandez’s wheelchair is occupied by an enormous stuffed animal wearing a Los Angeles Lakers hat.

“I put my little teddy bear on top of it,” Fernandez said, as jurors smiled at a photo of the bear in the chair. An overwhelmed system

Fraud in Medicare has been a top concern in Washington for decades, in part because the program’s mistakes are so expensive. In fiscal 2013, for instance, Medicare paid out almost $50 billion in “improper payments.” These were bills that, upon further reflection, contained mistakes and should not have been paid.

No one knows how much of that money was actually lost to fraud, and how much of it was caused by innocent errors.

The power-wheelchair scam provided a painful and expensive example of why Medicare fraud works so often. The fault lay partly with Congress, which designed this system to be fast and generous. And it lay partly with Medicare bureaucrats — who were slow to recognize the threat and use the powers they had to stop it. As a result, scammers took advantage of a system that was overwhelmed by its own claims and lacked the manpower and money to check most of those claims before it paid.

The scheme first appeared in the mid-1990s in Miami — a city whose mix of elderly people and professional scammers has always made it the DARPA of Medicare fraud, where bad ideas begin.

“The patients would be walking,” said one former Justice Department official, recalling investigations from that time. “And they’d have the wheelchair, a $2,500 wheelchair, sitting in the corner with stacks of [stuff] on it. And [investigators] would say, ‘Why do you have this?’ And they would say, ‘They told me I could have this, so I took it.’ ”

Fraudsters, they were learning, had invented a new twist on an old trick: the Medicare equipment scam.

The original equipment scam had sprung up in the 1970s, at a time when Medicare was young and criminals were still learning how to steal its money. Doctors, for example, could bill Medicare for exams they didn’t do. Hospitals could bill for tests that patients didn’t need.

The equipment scam was the poor man’s way in, an entry-level fraud that didn’t require a medical degree or a hospital.

Instead, the crooks only had to set up a “medical equipment” company and get access to the Medicare system. Then, they needed to learn a simple scheme, in which the fraudster would run the normal order of medical decision-making in reverse.

A legitimate medical-supply company, of course, must wait for a patient to see a doctor, then come looking for somebody to fill a prescription. But a fraudster starts with a prescription he wants to fill.

Then he goes looking for a patient and a doctor to foist it on.

By the 1990s, fraudsters had already perfected parts of this equipment scam. To find the patients, for instance, they had learned to use professional recruiters, called “marketers” or “cappers.”

These recruiters induced seniors to hand over their Medicare ID numbers. Sometimes, they just paid the patients a bribe. Other times, they talked them into giving the number up free. The government is offering free wheelchairs, but only for a limited time. If you don’t act now . . .

Most fraudsters had also learned to buy off a doctor or two, paying a set price for each bogus prescription. But some had also perfected a cheaper method.

They corrupted dead doctors instead.

“The Russian mob up in Brooklyn has been doing this for years. . . . They scour the obits. They find out when Doctor Morris has died. They immediately write to Medicare and they say, ‘Hi, I’m Doctor Morris, and I’m changing my address,' ” said Lewis Morris, a former top official at the Department of Health and Human Services’ office of the inspector general.

If it works, the dead doctor’s mail is delivered to the live crook. Including paperwork with the doctor’s Medicare ID number. “So the new Doctor Morris, Sammy Scumbag, starts writing scrip in the name of Doctor Morris,” Morris said. Recent reforms have lessened this problem.

The payoff of this whole scheme came when a scammer sent Medicare a bill. The bill would say that the bought-off doctor had prescribed some piece of equipment to the bought-off (or hoodwinked) patient.

The fraudster would say that he had supplied that thing. Now, he wanted Medicare to pay its share — usually, 80 percent of the price tag.

But what was the best kind of equipment to use?

Continued in article

Bob Jensen's Fraud Updates --- http://www.trinity.edu/rjensen/FraudUpdates.htm

Bob Jensen's universal health care messaging --- http://www.trinity.edu/rjensen/Health.htm


We're old enough to remember when advocates for the Affordable Care Act promised that it would "bend the cost curve" and reduce expensive hospital visits, particularly at emergency rooms. So far, the opposite is occurring.
James Freeman, "There Goes Another ObamaCare Argument," WSJ, August 6, 2014 ---
http://online.wsj.com/articles/there-goes-another-obamacare-argument-1407242712?tesla=y&mod=djemMER_h&mg=reno64-wsj

"A Simple Theory for Why School and Health Costs Are So Much Higher in the U.S.," by Andrew O’Connell, Harvard Business Review Blog, April 7, 2014 ---
http://blogs.hbr.org/2014/04/a-simple-theory-for-why-school-and-health-costs-are-so-much-higher-in-the-u-s/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29&cm_ite=DailyAlert-040814+%281%29&cm_lm=sp%3Arjensen%40trinity.edu&cm_ven=Spop-Email 

Jensen Comment
One reason higher education costs more in the USA is that more attempts are made to bring college education to everybody with nearby physical campuses such as community colleges and online degree programs from major universities. In Europe and most other parts of the world higher education is available only to a much smaller portion of the population. In Germany, for example, less than 25% of young graduates are admitted to college and opportunities for adult college education are much more limited than in the USA. Those other nations, however, often offer greater opportunities for learning a trade that does not require a college education.

There are many reasons health care costs more in the USA. One reason is that the USA is the world leader in medical and medication research. Another reason is that the USA imposes a costly private sector insurance intermediary where other nations offer insurance from a more efficient public sector.

Still another reason is that malpractice lawsuits are a legal punitive damages lottery in most parts of the USA such that hospitals and physicians must pay ten or more times as much for malpractice insurance relative to nations like Canada that restrict malpractice to actual damages only, leaving out the lottery for lawyers.

Still another reason is that the USA keeps extremely premature babies alive that other nations throw away. Even more expense if what Medicare spends on keeping people hopelessly and artificially alive, dying people that other nations let slip away without all the very costly artificial life extensions.

On November 22, 2009 CBS Sixty Minutes aired a video featuring experts (including physicians) explaining how the single largest drain on the Medicare insurance fund is keeping dying people hopelessly alive who could otherwise be allowed to die quicker and painlessly without artificially prolonging life on ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/

National Bureau of Economic Research: Bulletin on Aging and Health --- http://www.nber.org/aginghealth/

Leading ACA Act Blogs ---
http://www.zanebenefits.com/blog/15-best-health-reform-blogs

 

 


"Obamacare by the Numbers A state-by-state analysis of failed health care exchanges," by Peter Suderman, Reason Magazine, August/September 2014 ---
http://reason.com/archives/2014/07/01/obamacare-by-the-numbers


"The ObamaCare-IRS Nexus:  The supposedly independent agency harassed the administration's political opponents and saved its health-care law," by Kimberly Strassel, The Wall Street Journal, July 24, 2014 ---
http://online.wsj.com/articles/kim-strassel-the-obamacare-irs-nexus-1406244677?tesla=y&mod=djemMER_h&mg=reno64-wsj

One of the big questions out of the IRS targeting scandal is this: How can an agency that engaged in such political misconduct be trusted to implement ObamaCare? This week's Halbig v. Burwell ruling reminded us of the answer. It can't.

The D.C. Circuit Court of Appeals ruled in Halbig that the administration had illegally provided ObamaCare subsidies in 36 insurance exchanges run by the federal government. Yet it wasn't the "administration" as a whole that issued the lawless subsidy gift. It was the administration acting through its new, favorite enforcer: the IRS.

And it was entirely political. Democrats needed those subsidies. The party had assumed that dangling subsidies before the states would induce them to set up exchanges. When dozens instead refused, the White House was faced with the prospect that citizens in 36 states—two-thirds of the country—would be exposed to the full cost of ObamaCare's overpriced insurance. The backlash would have been horrific, potentially forcing Democrats to reopen the law, or even costing President Obama re-election.

The White House viewed it as imperative, therefore, that IRS bureaucrats ignore the law's text and come up with a politically helpful rule. The evidence shows that career officials at the IRS did indeed do as Treasury Department and Health and Human Services Department officials told them. This, despite the fact that the IRS is supposed to be insulated from political meddling.

We know this thanks to a largely overlooked joint investigation and February report by the House Oversight and Ways and Means committees into the history of the IRS subsidy rule. We know that in the late summer of 2010, after ObamaCare was signed into law, the IRS assembled a working group—made up of career IRS and Treasury employees—to develop regulations around ObamaCare subsidies. And we know that this working group initially decided to follow the text of the law. An early draft of its rule about subsidies explained that they were for "Exchanges established by the State."

Yet in March 2011, Emily McMahon, the acting assistant secretary for tax policy at the Treasury Department (a political hire), saw a news article that noted a growing legal focus on the meaning of that text. She forwarded it to the working group, which in turn decided to elevate the issue—according to Congress's report—to "senior IRS and Treasury officials." The office of the IRS chief counsel—one of two positions appointed by the president—drafted a memo telling the group that it should read the text to mean that everyone, in every exchange, got subsidies. At some point between March 10 and March 15, 2011, the reference to "Exchanges established by the State" disappeared from the draft rule.

Emails viewed by congressional investigators nonetheless showed that Treasury and the IRS remained worried they were breaking the law. An email exchange between Treasury employees in the spring of 2011 expressed concern that they had no statutory authority to deem a federally run exchange the equivalent of a state-run exchange.

Yet rather than engage in a basic legal analysis—a core duty of an agency charged with tax laws—the IRS instead set about obtaining cover for its predetermined political goal. A March 27, 2011, email has IRS employees asking HHS political hires to cover the tax agency's backside by issuing its own rule deeming HHS-run exchanges to be state-run exchanges. HHS did so in July 2011. One month later the IRS rushed out its own rule—providing subsidies for all.

That proposed rule was criticized by dozens of scholars and congressional members, all telling the IRS it had a big legal problem. Yet again, the IRS did no legal analysis. It instead brought in a former aide to Democratic Rep. Lloyd Doggett, whose job appeared to be to gin up an after-the-fact defense of the IRS's actions. The agency formalized its rule in May 2012.

To summarize: The IRS (famed for nitpicking and prosecuting the tax law), chose to authorize hundreds of billions of illegal subsidies without having performed a smidgen of legal due diligence, and did so at the direction of political taskmasters. The agency's actions provided aid and comfort to elected Democrats, even as it disenfranchised millions of Americans who voted in their states to reject state-run exchanges. And Treasury knows how ugly this looks, which is why it initially stonewalled Congress in its investigation—at first refusing to give documents to investigators, and redacting large portions of the information.

Administration officials will continue to use the IRS to try to improve its political fortunes. The subsidy shenanigans are merely one example. Add Democrats' hijacking of the agency to target and silence political opponents. What you begin to see are the makings of a Washington agency—a body with the power to harass, to collect, to fine, to imprison—working on behalf of one political party. Richard Nixon, eat your heart out.


"Obamacare: The Story So Far A linktastic round-up of Reason's coverage of the president's health care law," by Peter Suderman, Reason Magazine, July 1, 2014---
http://reason.com/archives/2014/07/01/obamacare-story-so-far

Reason has been covering the march toward health care reform for so long, we remember when the Affordable Care Act was just a glimmer in President Barack Obama’s eye. As the package of health care laws that would eventually become known as Obamacare stumbled through debate, passage, and early implementation, our crack team of writers and reporters was there, chronicling the twists, turns, and dramatic reversals. And now, in honor of our special Obamacare issue, we have stitched together that coverage into a single handy, linktastic narrative. Enjoy!

 

The Pre-Debate:

Barack Obama campaigned on the promise of health care reform, and the moment he was elected president the push for a major overhaul began. But how to reform the system? In December 2008, Ronald Bailey took a look at "Tom Daschle’s Plan for Health Care Rationing"—an unsparing assessment of the proposals of the president’s initial nominee to run the Department of Health and Human Services (HHS). Daschle’s big idea, a Federal Health Board, was supposed to produce health care savings by making comparative effectiveness determinations about different medical procedures. But Bailey concluded that the Fed Board "would be able to cut costs only by limiting access to care."

What might work better? In March 2009, Bailey argued that free markets can provide health security through "health status insurance"—basically, a form of life-long insurance against catastrophic changes in an individual’s current health level. "Creating and selling separate health-status insurance policies would mean that medical insurance companies would no longer have an incentive to offload sick people," he wrote. "Instead, because those with pre-existing conditions would have the funds to pay higher premiums, insurers would compete for their business."

The Debate, Part 1:

Before long, the push for health care reform was consuming Washington. President Obama, now settled into the Oval Office, was making it an early top priority, and congressional staffers were beavering away on options to expand coverage, often citing the health systems of European countries as models.

Continued in article

 


Huge Medicaid Fraud:  The Biggest Drain on State Budgets in Medicaid
The Biggest Drain in the Federal Budget is Medicaid, Medicare, and Social Security
"The Medicaid Black Hole That Costs Taxpayers Billions," by John Tozzi, Bloomberg Businessweek, June 23, 2014 ---
http://www.businessweek.com/articles/2014-06-23/the-medicaid-black-hole-that-costs-taxpayers-billions?campaign_id=DN062314

Here’s some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week.

Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through what’s known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. It has become more popular in recent years than the traditional “fee for service” arrangement, in which Medicaid programs reimburse doctors and hospitals directly for each service they provide.

Despite the growth of managed care in recent decades, officials responsible for policing Medicaid “did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims,” according to the Government Accountability Office, the investigative arm of Congress. The managed-care programs made up about 27 percent of federal spending on Medicaid, according to the GAO. The nonpartisan investigators interviewed authorities in California, Florida, Maryland, New Jersey, New York, Ohio, and Texas over the past 12 months.

Funded jointly by the federal government and the states, Medicaid provided health insurance to about 72 million low-income Americans at a cost of $431 billion last year, according to the report. By the Medicaid agency’s own reckoning, $14.4 billion of federal spending on Medicaid constituted “improper payments,” which include both overpayments and underpayments. That’s 5.8 percent of what the federal government spends on the program. The $14 billion figure doesn’t tally what states lose to bad payments.

The fraud risk for managed care is twofold. Doctors or other health-care providers could be bilking the managed-care companies, which pass on those fraudulent costs to the government. Or the managed-care companies themselves could be perpetrating schemes that cost taxpayers money and harm patients.

What does this look like in practice? New York Times reporter Nina Bernstein wrote a Dickensian report last month detailing the competition among managed-care companies in New York to find the most profitable Medicaid clients:

“Many frail people with greater needs were dropped, and providers jockeying for business bought, sold or steered cases according to the new system’s calculus: the more enrollees, and the less spent on services, the more money the companies can keep.

“Adult home residents, like those caught in the hotel, had long been victimized under the old fee-for-service Medicaid system, in which providers were paid for services rendered. Now, under managed care, they find themselves prey to new versions of old tactics, including intimidation to accept services they do not need.

“’They came like vultures—”Sign here, sign here!”—with their doughnuts and cookies,” recalled Robert Rosenberg, 61, who has a spinal disorder and Crohn’s disease, and, at 4 feet 4 inches tall, had waded through hip-high water to escape the flood at Belle Harbor Manor in Queens. ‘They coerced people. They told residents they would lose their Medicaid if they didn’t sign.’”

Even well-meaning managed-care companies may not have an incentive to stop fraud by medical providers, the GAO says. “If [managed-care organizations] are making payments that are too high, or have some waste, fraud, and abuse, sometimes those payments then get put into the calculation for next year’s rates,” says Carolyn Yocom, director of health care at the GAO and author of the report.

The Department of Health and Human Services, in a five-page written response to the GAO included with the report, says the agency periodically assesses states’ managed-care programs, promotes best practices, and offers training for state leaders. The agency’s “comprehensive reviews have identified findings and vulnerabilities related to managed care program integrity,” according to the response. The agency also noted that managed-care audits can be more complex than policing traditional Medicaid payments, so “states can benefit from more direct support.” A spokeswoman for the department declined provide additional comment.

Part of the problem is that Medicaid in general “has not traditionally been very transparent, nor has it been very easy to see where the money goes,” the GAO’s Yocom says. Managed-care arrangements are even more difficult to monitor. “The visibility of what happens is once-removed, because of the managed-care entity itself.”

Craziest of all, states aren’t required to audit the payments they make to managed-care companies, or the payments those companies make to medical providers. The GAO, in its drily ascerbic way, recommends they start.

Continued in article

Jensen Comment
An even bigger fraud arises when Medicaid coverage granted to people who are really not eligible for Medicaid.

"Audit reveals half of people enrolled in Illinois Medicaid program not eligible," by Craig Cheatham, KMOV Television, November 4, 2013 ---
http://www.kmov.com/news/just-posted/Audit-reveals-half-of-people-enrolled-in-IL-Medicaid-program-not-eligible-230586321.html?utm_content=buffer824ba&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer

The early findings of an ongoing review of the Illinois Medicaid program revealed that half the people enrolled weren’t even eligible.

The state insisted it’s not that bad but Medicaid is on the federal government’s own list of programs at high risk of waste and abuse.

Now, a review of the Illinois Medicaid program confirms massive waste and fraud.

A review was ordered more than a year ago-- because of concerns about waste and abuse. So far, the state says reviewers have examined roughly 712-thousand people enrolled in Medicaid, and found that 357-thousand, or about half of them shouldn't have received benefits. After further review, the state decided that the percentage of people who didn't qualify was actually about one out of four.

"It says that we've had a system that is dysfunctional. Once people got on the rolls, there wasn't the will or the means to get them off,” said Senator Bill Haines of Alton.

A state spokesman insists that the percentage of unqualified recipients will continue to drop dramatically as the review continues because the beginning of the process focused on the people that were most likely to be unqualified for those benefits. But regardless of how it ends, critics say it's proof that Illinois has done a poor job of protecting tax payers money.

“Illinois one of the most miss-managed states in country-- lists of reasons-- findings shouldn't surprise anyone,” said Ted Dabrowski.

Dabrowski, a Vice-President of The Illinois Policy Institute think tank, spoke with News 4 via SKYPE. He said the Medicaid review found two out of three people recipients either got the wrong benefits, or didn't deserve any at all.

We added so many people to medicaid rolls so quickly, we've lost control of who belongs there,” said Dabrowski.

Continued in article


"Doctors Think Emergency Room Visits Are Going To Explode Under Obamacare, by Brett LoGiurato, Business Insider, May 22, 2014 ---
 http://www.businessinsider.com/obamacare-emergency-room-visits-study-2014-5#ixzz32TW12uwS

One of the major selling points of the Affordable Care Act was its theoretical potential to reduce costly emergency room visits, given the law's access to coverage. 

But a new survey shows that so far under the healthcare law, more people are going to the emergency room. The survey, conducted by the American College of Emergency Physicians, found that since Jan. 1 — the day coverage went into effect for millions of Americans — 46% of emergency physicians have experienced jumps in patients. Half that percentage reported a decrease, and 27% of physicians said the influx has stayed about the same.

And even though it was one of the points President Barack Obama and Democrats used to sell the law ahead of its passage, doctors said they've been expecting this all along.

"We told you this was going to happen. We don't mind that it has. But we'd sure appreciate some support," Howard Mell, a spokesman for the ACEP and an emergency care physician, told Business Insider on Wednesday. 

Emergency physicians only expect it to get worse over the next few years. Eighty-six percent of emergency physicians expect there to be a slight or "great" increase in the amount of visits to their departments over the next three years. Moreover, 77% of these doctors think their facilities are not prepared for the expected influx of patients.

Emergency care physicians also expect payments for ER visits to sharply reduce. They think access to emergency care will improve overall, but that doesn't mean quality care will follow — a plurality of emergency physicians expect the ACA to have a negative effect on quality and patient safety. 

Part of the increase can be expected. Emergency room use is a covered benefit, and when people get insurance, the use of those benefits would be expected to increase somewhat.

But here's the problem: Though the healthcare law has helped get more people insured, it doesn't guarantee care. ACEP says there is an overall shortage of primary care doctors.

 

Many of the millions who qualified for coverage under the expansion of the federal Medicaid program could also be out of luck, since many primary care doctors do not accept Medicaid patients. Because Medicaid coverage pays so little, it is the main problem, whereas more than 8 million people signed up for private insurance through exchanges established by the law.

The Obama administration said the study comes too soon to draw any long-term conclusions. 

"This survey, looking at only the first three months of coverage, cannot speak to the long-term effects of expanded coverage, which will be shaped by our continuing efforts to help people use their new primary care and preventive care benefits and to invest in innovative approaches aimed at improving our nation’s system of primary care," a Department of Health and Human Services told Business Insider in a statement.

Still, according to the Association of American Medical Colleges, there will be a shortage of about 30,000 too few primary care physicians to keep up with patient demand next year. And the problem is expected to grow — over the next decade, according to the study, primary care physicians will rise by only 7%.

Combined with the fact the American population is getting older — a 36% increase in the American population over 65 — ACEP is warning the U.S. is on something of a "collision course."

"Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care," said Alex Rosenau, the president of ACEP. 

"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."

A classic example of where the problem continues to manifest is with a patient who has asthma but waits until an emergency to seek coverage. As Mell explains, a primary care doctor should be able to solve the health problem in its infancy — for example, prescribing an inhaler to an asthma-inflicted patient. Instead, the patient will wait until they have an asthma attack. That means $50-$100 worth of medicine becomes thousands of dollars in emergency care.

Some health-policy experts think much of the increase can be mitigated by educating patients about their healthcare options. Many people who just gained insurance for the first time are simply used to routinely going to the emergency room for their healthcare needs.

"Part of the need in this new environment is to teach people who have not had insurance at all or very often in the past how best to use it and the best ways to access care," said Linda Blumberg, a senior fellow at the Urban Institute. "That is, they need help to understand the importance of identifying and using a usual source of care outside of the ER for non emergent situations."

Continued in article


From the CFO Journal's Morning Ledger on May 27, 2014

Health-law costs snarl union contract talks
Labor talks nationwide are becoming more challenging as unions and employers butt heads over who should pick up the tab for new costs associated with the Affordable Care Act
, the WSJ reports. Coverage for dependent children up to age 26 is already an issue, but future costs, like a tax on premium health plans that starts in 2018, are also coming up. Labor experts say the law doesn’t take into account that health benefits have been negotiated over decades, and that rewriting plans to meet end requirements can affect wages and other labor terms.

Jensen Comment
Many firms like Walgreen have already dropped employee health insurance plans.

On a separate matter, the Obama Administration recently ruled that salary increases to replace employer-funded  medical insurance contributions with ACA private exchange plans will not be tax deductible.  This complicates payroll and tax accounting for business firms.  Of course this will not matter to government agencies and other non-profit organizations since they do not seek tax deductions..

From the CFO Journal's Morning Ledger on October 31, 2014

Small firms drop health plans ---
http://online.wsj.com/articles/small-firms-drop-health-plans-1414628013?mod=djemCFO_h
Small companies are starting to turn away from offering health plans, with many viewing the health law’s marketplace as an inviting and affordable option. Wellpoint Inc. said its small-business-plan membership is shrinking faster than expected and it has lost about 300,000 people since the start of the year, leaving a total of 1.56 million in small-group coverage. Other insurers have flagged a similar trend.

From the CPA Newsletter on May 27, 2014

IRS sets high penalties for companies that send employees to ACA health exchanges
According to an Internal Revenue Service ruling, employers that move employees to health insurance exchanges by reimbursing them for their premiums do not satisfy the requirements of the Affordable Care Act. Companies that send workers to the exchanges face a tax penalty of $100 a day, or $36,500 a year, per employee. The New York Times (tiered subscription model) (5/

"I.R.S. Bars Employers From Dumping Workers Into Health Exchanges," by Robert Pear, The New York Times, May 25, 2014 ---
http://www.nytimes.com/2014/05/26/us/irs-bars-employers-from-dumping-workers-into-health-exchanges.html?_r=0 

Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums, but the Obama administration has squelched the idea in a new ruling. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day — or $36,500 a year — for each employee who goes into the individual marketplace.

The ruling this month, by the Internal Revenue Service, blocks any wholesale move by employers to dump employees into the exchanges.

Under a central provision of the health care law, larger employers are required to offer health coverage to full-time workers, or else the employers may be subject to penalties. Many employers — some that now offer coverage and some that do not — had concluded that it would be cheaper to provide each employee with a lump sum of money to buy insurance on an exchange, instead of providing coverage directly.

But the Obama administration raised objections, contained in an authoritative question-and-answer document released by the Internal Revenue Service, in consultation with other agencies.

Continued in article

IRS Ruling Prohibits Employers from Dumping Workers into Exchange May 27, 2014

The Obama administration is out with a new rule