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Tuesday, February 11, 2014

Health Care Reform Articles - February 11, 2014

Health Insurance Enforcement Delayed Again for Some Employers

By 
    WASHINGTON — The Obama administration announced Monday that it would again delay enforcement of a federal requirement for certain employers to provide health insurance to employees, giving medium-size companies extra time to comply.
    The “employer mandate,” which had already been delayed to Jan. 1, 2015, will now be phased-in beyond that date for some businesses with more than 50 employees. Businesses with fewer than 50 employees were already exempt.
    Under the Affordable Care Act, larger employers are generally subject to tax penalties if they fail to offer “minimum essential coverage” to full-time employees and their dependents.
    The administration laid out a three-tier approach.
    For larger employers with 100 or more employees (about 2 percent of employers): Seventy percent of employees must be offered coverage in 2015, and in later years at least 95 percent of employees must be offered coverage. Employers that do not meet these standards will be subject to tax penalties.
    For employers with 50 to 99 employees (about 2 percent of employers): Companies with 50 to 99 employees will have an extra year, until 2016, to provide coverage or pay tax penalties.For small businesses with fewer than 50 employees (about 96 percent of all employers): These companies will not be required to provide coverage or fill out any forms in any year.
    Valerie Jarrett, a senior adviser to President Obama, announced in blog post on July 2 that “we are giving businesses more time to comply.” No penalties would be assessed for 2014, she said.
    Members of Congress asked how the president could unilaterally waive provisions of the law. J. Mark Iwry, deputy assistant Treasury secretary for health policy, said the administration had broad “authority to grant transition relief” under a law that directs the Treasury secretary to “prescribe all needful rules and regulations for the enforcement” of tax obligations.
    This authority has often been used to “postpone the application of new legislation when immediate application would have subjected taxpayers to unreasonable administrative burdens or costs,” Mr. Iwry said.
    The announcement Monday followed numerous other steps by the administration to postpone and cushion the impact of the health care law.
    In mid-November, Mr. Obama asked insurers to reinstate policies being canceled because they did not comply with minimum coverage requirements of the law.
    A week later, the administration extended the initial deadline for people to sign up for coverage that starts in January. A few days after that, health officials announced a one-year delay in online enrollment for small businesses using the federal insurance exchange.
    The administration then moved the sign-up deadline for individuals to Dec. 23 and extended by one month, to the end of January, a special insurance program for people with serious illnesses.
    Kathleen Sebelius, the secretary of health and human services, announced on Dec. 19 that people facing the cancellation of individual policies could buy cheaper catastrophic coverage on the exchange and would be exempt from penalties if they went without insurance next year.


    Obamacare delay sparks new mandate fight
    By: Brett Norman and David Nather
    February 10, 2014 04:23 PM EST
    Once again, it’s employers who are getting a break from their Obamacare mandate – and that’s sure to increase the pressure on the Obama administration to delay the mandate for individuals, too.
    Regulations announced by the Obama administration Monday give two levels of delay to employers who would have had to cover their workers next year. Some businesses will get an extra year – until 2016. And the bigger businesses that do have to worry about the mandate will have it phased in over two years.
    It’s the second round of delays to the employer mandate, which will require all businesses with 50 or more full-time workers to provide health coverage or pay a fine. The mandate was originally supposed to start this year – until, under pressure from business groups, it got pushed back until 2015.
    Under the new rule, the Treasury Department said businesses with fewer than 100 workers would not be required to cover their workers in 2015 or face a fine. It gave bigger businesses with more than 100 workers extra time to ramp up coverage.
    (PHOTOS: Obamacare online glitches: 25 great quotes)
    It’s only the largest employers who will be affected, as the White House points out. The group that will get the delay until 2016 — businesses with between 50 and 100 workers — are just 2 percent of all employers in the country. And the businesses with more than 100 workers, the main ones that will feel the weight of the mandate, are another 2 percent of the nation’s employers, and many of those big companies already provide health insurance for workers.
    But the optics are still going to cause big headaches. Now that businesses are getting another break, the Obama administration will have to brace for the return of a huge political problem: the demands for regular people to get a break from their own fines if they don’t buy health coverage this year.
    It will be a major test of the new White House congressional operation — especially with the addition of Phil Schiliro, whom President Barack Obama brought back into the fold to coordinate Obamacare legislative strategy, including holding the line on repeal efforts.
    Most Americans still have to get health coverage this year or pay a fine, a source of political headaches as people struggled to sign up for coverage during the early website glitches. The federal enrollment website is working better now, but many Americans will still have to decide whether it’s better for them to sign up for coverage or pay the fine.
    Republicans have pushed the “fairness” line since the first delay: If businesses can get a break, why can’t individuals? They even forced a vote on the issue in the House last year, and the argument was so potent that 22 House Democrats voted to postpone the law’s individual mandate for a year.
    http://dyn.politico.com/printstory.cfm?uuid=1EF0D062-C8B4-481E-82C6-49A62D8B7739


    Changes and Delays to the Health Law

    Over the past year, the Obama administration has made a series of major changes to the health care law, many in response to the troubled rollout of Healthcare.gov.
    FEB. 7, 2013
    Announces a one-year delay in issuing rules to states for putting in place a “Basic Health Program,” a Medicaid-like plan for low-income adults who don’t qualify for Medicaid and may not be eligible for insurance subsidies.
    SPRING 2013
    Delays for one year the option to provide workers with a choice of health plans on the small business marketplace, limiting them to a single plan.Related article »
    JULY 2
    Announces a one-year delay in the requirement that larger businesses offer health coverage to their employees or face a penalty. Related article »
    SEPT. 26
    Announces a one-month delay in the opening of the small-business marketplace, setting the new start date at Nov. 1. Related article »
    OCT. 23
    Announces an adjustment of the individual mandate deadline, saying people must now sign up for a plan by March 31, instead of Feb. 15, to avoid tax penalties. Related article »
    NOV. 14
    Asks insurers to reinstate plans being canceled because they do not comply with minimum coverage requirements of the law. Related article »
    NOV. 22
    Extends the deadline to sign up for health coverage that takes effect on Jan. 1 by eight days (to Dec. 23) and delays the 2015 insurance enrollment period by a month, to Nov. 15, 2014, after the midterm elections. Related article »
    NOV. 27
    Delays for one year online enrollment in the small-business marketplace (until November 2014). The rollout had previously been delayed one month. Related article »
    DEC. 12
    Urges insurers to give consumers more time to make their first premium payments for coverage beginning Jan. 1. On Dec. 18, America's Health Insurance Plans, an industry trade group, says insurers will give them an extra 10 days, until Jan. 10, to pay their first premiums. Related article »
    DEC. 19
    Announces that people whose policies have been canceled will beallowed to buy catastrophic coverage and will be exempt from tax penalties for not having insurance in 2014. It also extends for one month an expiring federal program for people with cancer, heart disease and other serious illnesses. Related article »
    DEC. 23
    Establishes a 24-hour grace period for people trying to sign up for health coverage that takes effect on Jan. 1, citing delays due to high website traffic. This change effectively extends the deadline for coverage beginning Jan. 1 to Dec. 24. Related article »
    DEC. 24
    Announces that if people could show that they missed the deadline for coverage beginning Jan. 1 because of problems with Healthcare.gov, they might qualify for “a special enrollment period.” The administration did not say how long the period would last, but a spokeswoman said it was not providing “a blanket extension,” but was offering to provide “assistance to individuals on a case-by-case basis.” Related article »
    FEB. 10, 2014
    For employers with between 50 and 99 employees, delays for another year (until 2016) the requirement that they offer health coverage to their employees or face a penalty. Temporarily reduces the percentage of employees that larger companies are required to cover.
    http://www.nytimes.com/interactive/2013/12/20/us/politics/changes-and-delays-to-health-law.html

    The Good Jobs News on the Affordable Care Act

    Tuesday, 11 February 2014 09:47By Dean Baker, Truthout | News Analysis
    Leading Republicans, along with much of the media, went into a frenzy last week following the release of a Congressional Budget Office (CBO) report on the Affordable Care Act (ACA). The report assessed the likely impact of the ACA on employment and concluded it will lead to a reduction in the total number of hours worked by 1.5-2.0 percent when its effects are fully felt later in the decade.
    This reduction in hours is equivalent to 2.0-2.5 million fewer people working. This was quickly translated into a loss of 2.0-2.5 million jobs, which made Obamacare officially a jobs-killer in the eyes of the CBO. That's pretty powerful stuff, but it turns reality on its head.
    The CBO assessment was that because people could now get access to health insurance through the exchanges rather than having to get insurance through their jobs, many people might decide not to work or to work fewer hours. This voluntary reduction in work hours is one of the goals of Obamacare, it is not an unforeseen consequence.
    There are millions of people who struggle at their jobs with serious health conditions in the hope of reaching age 65 when they can qualify for Medicare. The exchanges will make it possible for many of these people to get insurance at prices they can afford, since insurers are not allowed to discriminate based on pre-existing conditions. As a result, some of these older workers will opt to either retire or to possible work fewer hours at a job that doesn't provide insurance. Giving people this option was one of the main goals of health care reform.
    Similarly, there are many workers with young children who would like to be able to either take time off from work to spend with their kids, or alternatively to work at a job part-time. However they may not have this option if their only way to afford insurance is by working at a full-time job. As a result of the ACA these people will work fewer hours.
    This also was also one of the goals of Obamacare. Advocates of health care reform thought it would be good if the parents of young children had the opportunity to work less to be with their kids, if that is what they choose to do.
    When CBO did its analysis and said that Obamacare would lead to some reduction in work hours, it was saying the ACA would have its intended effect. It was freeing people from health care related job-lock. This is a feature, not a bug.

    Drug Shortages Continue to Vex Doctors

    By 
    Despite efforts by the Obama administration to ease shortages of critical drugs, shortfalls have persisted, forcing doctors to resort to rationing in some cases or to scramble for alternatives, a government watchdog agency said on Monday. The number of annual drug shortages — both new and continuing ones — nearly tripled from 2007 to 2012.
    In recent years, drug shortages have become an all but permanent part of the American medical landscape. The most common ones are for generic versions of sterile injectable drugs, partly because factories that make them are aging and prone to quality problems, causing temporary closings of production lines or even entire factories.
    The analysis by the United States Government Accountability Office, released Monday, was required by a 2012 law that gave the Food and Drug Administration more power to manage shortages. The watchdog agency was designated to evaluate whether the F.D.A. had improved its response to the problem, among other things.
    The accountability office concluded that the F.D.A. was preventing many more shortages now than in the past — 154 potential shortages in 2012 compared with just 35 in 2010 — but that the total number of shortages has continued to grow. In 2012, the number of drugs in short supply, both new and long-term, was 456, the report said, up from 154 in 2007. Such drugs now include the heart medicine nitroglycerin, and cisatracurium, which is used to paralyze muscles during surgery and for patients on ventilators.
    “We are at a public health crisis when we don’t have the medicines to treat acutely ill patients and we don’t have the basics like intravenous fluids,” said Erin Fox, a drug expert at the University of Utah whose data was used in the analysis. The most acute shortage now is that of basic IV fluids, she said.
    Dr. Douglas C. Throckmorton, a senior F.D.A. official who deals with shortages, pointed out in testimony on Monday at a Congressional hearing on the matter that the number of new shortages declined in 2012 for the first time in a number of years, and that 2013 data indicated a similar downward trend. He said the agency, endowed with new powers under the 2012 law, has been able to manage shortages more aggressively.
    Manufacturers are now required to alert the agency of potential shortages before they happen. And agency officials have been careful when using their regulatory muscle.
    For example, in some cases where particles were found to be contaminating a drug that was in short supply, the agency allowed the company to filter the drug to avoid disrupting supplies instead of shutting down the production line altogether.
    What drives shortages is often a mystery. The drug industry rarely spells out the precise reason for a shortage, citing its need to protect competitive trade information.
    The 2012 law required that companies provide the F.D.A. with a general reason, but Ms. Fox said that it was often not specific enough to understand the particular causes of a shortage. Dr. Throckmorton said that two-thirds of the production disruptions that led to shortages were caused by quality problems and efforts to fix them.
    Economic factors are also a contributing factor. Narrow profit margins are making some drug companies reluctant to invest in fixing old production facilities. Changes in Medicare reimbursement and the role of group purchasing organizations, which buy drugs on behalf of hospitals, could also be contributing, by further reducing prices that producers get for the drugs.

    AOL Chief’s Words Leads to a Study in ‘I’m Sorry’

    By ANDREW ROSS SORKIN
    Was Tim Armstrong’s apology authentic?
    Last week, I wrote about the increasing tendency of leaders and executives to provide cheap apologies as an easy way to wash away problems. Dov Seidman, founder of LRN, a firm that advises companies on their cultures and how they can translate them into better performance, described the “I’m sorry” epidemic as “apology theater.” We pledged that we would begin tracking apologies and their aftermath.
    Almost on cue, a highly publicized case study arrived in the form of Mr. Armstrong, the chief executive of AOL.
    On an internal call last Thursday, Mr. Armstrong described recent changes in the company’s 401(k) program, which alters the way it matched employee contributions. The matching payment would come as one lump sum at the end of the year instead of in each pay period. In explaining the switch, he extolled the company’s benefits program and said that it would help save money amid rising health care costs.
    Then, he provided this example of those costs: “We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were O.K. in general,” according to a transcript provided by an AOL employee. “And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased health care costs, we made the decision, and I made the decision, to basically change the 401(k) plan.”
    With that, the Twittersphere was set aflame. The criticism came fast and furious.
    “I take issue with how he reduced my daughter to a ‘distressed baby’ who cost the company too much money. How he blamed the saving of her life for his decision to scale back employee benefits,” Deanna Fei, the mother of one of the babies and wife of an AOL employee, wrote on Slate. She is a novelist and the wife of Peter Goodman, an editor at AOL’s Huffington Post.
    “For me and my husband — who have been genuinely grateful for AOL’s benefits, which are actually quite generous — the hardest thing to bear has been the whiff of judgment in Armstrong’s statement, as if we selfishly gobbled up an obscenely large slice of the collective health care pie.”
    Nearly 2,000 comments poured in, cheering her on.
    http://dealbook.nytimes.com/2014/02/10/aols-error-leads-to-a-study-in-im-sorry/?_php=true&_type=blogs&hpw&rref=business&_r=0
    - Single payer anyone?



    In Arkansas, ‘Private Option’ Medicaid Plan Could Be Derailed

    By 
    LITTLE ROCK, Ark. — Last year, the Republicans who control this state’s Legislature devised a politically palatable way to expand Medicaid under President Obama’s health care law. They won permission to use federal expansion funds to buy private insurance for as many as 250,000 poor people instead of adding them to traditional Medicaid, which conservatives disparage as a broken entitlement program.
    But just as the idea is catching fire in other states with Republican or divided leadership — Iowa has adopted a version of the plan, and New Hampshire, Pennsylvania, Utah and other states are exploring similar avenues — Arkansas may abruptly reverse course, potentially leaving the 83,000 people who have signed up so far without insurance as soon as July 1.
    Facing pressure from conservative challengers in the May primary, several Republicans who supported the plan last year are now considering switching their vote when the Legislature votes to reauthorize its financing, possibly as soon as next week. The defection of just one Republican could kill the program, state officials said.
    “You’ve got a very small minority of people who can derail this,” said Gov. Mike Beebe, a Democrat who helped engineer the plan but will leave office at the end of the year because of term limits. He warned that ending the program would create an $85 million hole in his proposed budget — and devastate hospitals that were counting on the new federal funds.
    The threat to the Arkansas plan, known as the private option, underscores how the Affordable Care Act is an increasingly potent issue not just in congressional races, but also in state legislative contests. Though Republican legislative leaders support the plan, which would bring $915 million in federal funds to the state this year, any policy linked to the health care law remains anathema to many conservative voters.
    “Nobody at the State Capitol likes the Affordable Care Act,” said Representative Davy Carter, the Republican House speaker. “But you can’t ignore it and run from it. So we are dealing with the issue with the best interest of the state of Arkansas in mind.” Mr. Carter said he believed the program would survive, possibly with some changes to secure crucial votes.

    Democrats plan bill to kill embattled welfare study contract

    They say the first Alexander report was a skewed analysis the state can’t afford, but the DHHS chief insists it was accurate and useful.

    By Steve Mistler smistler@pressherald.com
    Staff Writer
    AUGUSTA — Democratic lawmakers said Monday that they’re submitting a bill that would nullify a $925,000 contract that the LePage administration entered into with a consultant to examine Maine’s welfare system.
    Gary Alexander, a former health and human services chief for Pennsylvania and Rhode Island, has been the subject of controversy since the administration announced in November that it had hired his firm, the Alexander Group. The contract, offered and awarded without competitive bidding, was signed Sept. 30.
    The criticism has increased since January, when Alexander delivered an analysis of the feasibility of expanding Maine’s Medicaid program. One national analyst said the report contained a $575 million calculation error. Others noted that the report doesn’t show any cost savings from expanding Medicaid.
    Democrats have said the contract is designed to validate the administration’s proposed welfare reforms and isn’t an independent analysis.
    In a news release Monday, the Democratic Party said the state cannot afford a skewed study when it faces an estimated $70 million budget shortfall for the fiscal year that ends June 30.
    “This is just one more in a tragic series of management errors from (Gov. Paul LePage) that is costing Maine taxpayers lots of money with little positive outcome,” said Rep. Richard Farnsworth of Portland, House chairman of the Legislature’s Health and Human Services Committee.
    Democrats contended that the administration used $185,000 in federal money designated for cash welfare benefits, known as Temporary Assistance for Needy Families, to pay Alexander. The entire study is funded with a mix of state general fund dollars and federal money.

    Sick Inside Our Broken Health System with that Old Familiar Terror in My Gut

    by Donna Smith
    I stepped up to the appointment check-in desk last Thursday as I prepared to have the CT scans needed to find out what the heck is going on with my body.  Many know I have been ill off and on since the day after Christmas, and I spent a week in the hospital after becoming so ill that dehydration was taking a toll on me. Doctors ordered lots of tests while I was in-patient and because the major symptoms have only been masked by meds and have not gone away, there is lingering concern about my cancer status, etc.  So I needed to be re-scanned to find out what is going on before we move forward with other care or treatment.
    Drinking the barium in preparation for the test was not much fun when I've been taking anti-nausea medication off and on for a month.  And I knew they'd also be starting an IV for more contrast dye to see as much of my belly as possible.  I was nervous.
    The woman at the check-in desk pulled up my record and first asked for my co-pay for the test -- $250, but then also asked if we wanted to make some progress on paying the now more than $2,000 I owe against my 2014 deductible and out-of-pocket costs.  I was instantly transported back to the terrified and angry places I have been so many times before when seeking health care has meant choosing between taking care of my health and hurting us financially.  My husband stared at me in disbelief and told the woman we would not be making payment on the $2,000.  We paid the $250.  As we walked back to the radiology area, I felt like leaving in shame.  I was ashamed of myself for needing care, ashamed of myself for not knowing how much the co-pay for the one test would be, and mostly ashamed of myself for not being wealthy enough to just take care of myself.
    My shame and terror lasted right through the time when I went in for the scan.  Then I started to get angrier about the system that does this to me over and over again.  We need improved and expanded Medicare for all for life -- a single standard of high quality care without financial barrier -- so no one ever again is more terrified and ashamed of a co-pay than he or she may be of finding cancer or some other serious illness brewing inside.  I don't want to see my husband's angry face in a medical waiting room.  I want to see him supporting me, comforting me when necessary and maintaining his own calm in the face of medical issues.  This is just such an awful system.  And the Affordable Care Act/Obamacare, as we all know, did not end these scenes from happening all over the country thousands of times every day.




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