Health Care Law Recasts Insurers as Obama Allies
By ROBERT PEAR
WASHINGTON — As Americans shop in the health insurance marketplace for a second year, President Obama is depending more than ever on the insurance companies that five years ago he accused of padding profits and canceling coverage for the sick.
Those same insurers have long viewed government as an unreliable business partner that imposed taxes, fees and countless regulations and had the power to cut payment rates and cap profit margins.
But since the Affordable Care Act was enacted in 2010, the relationship between the Obama administration and insurers has evolved into a powerful, mutually beneficial partnership that has been a boon to the nation’s largest private health plans and led to a profitable surge in their Medicaid enrollment.
The insurers in turn have provided crucial support to Mr. Obama in court battles over the health care law, including a case now before the Supreme Court challenging the federal subsidies paid to insurance companies on behalf of low- and moderate-income consumers. Last fall, a unit of one of the nation’s largest insurers, UnitedHealth Group, helped the administration repair the HealthCare.gov website after it crashed in the opening days of enrollment.
Insurers and the government have developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal Treasury to insurers each year,” said Michael F. Cannon, director of health policy studies at the libertarian Cato Institute.
So much so, in fact, that insurers may soon be on a collision course with the Republican majority in the new Congress. Insurers, often aligned with Republicans in the past, have built their business plans around the law and will strenuously resist Republican efforts to dismantle it. Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.
Law in the Raw
by Linda Greenhouse - New York Times
Nearly a week has gone by since the Supreme Court’s unexpected decision to enlist in the latest effort to destroy the Affordable Care Act, and the shock remains unabated. “This is Bush v. Gore all over again,” one friend said as we struggled to absorb the news last Friday afternoon. “No,” I replied. “It’s worse.”
What I meant was this: In the inconclusive aftermath of the 2000 presidential election, a growing sense of urgency, even crisis, gave rise to a plausible argument that someone had better do something soon to find out who would be the next president. True, a federal statute on the books defined the “someone” as Congress, but the Bush forces got to the Supreme Court first with a case that fell within the court’s jurisdiction. The 5-to-4 decision to stop the Florida recount had the effect of calling the election for the governor of Texas, George W. Bush. I disagreed with the decision and considered the contorted way the majority deployed the Constitution’s equal-protection guarantee to be ludicrous. But in the years since, I’ve often felt like the last progressive willing to defend the court for getting involved when it did.
That’s not the case here. There was no urgency. There was no crisis of governance, not even a potential one. There is, rather, a politically manufactured argumentover how to interpret several sections of the Affordable Care Act that admittedly fit awkwardly together in defining how the tax credits are supposed to work for people who buy their health insurance on the exchanges set up under the law.
Q and A: For Supreme Court, a Case of Economics and Politics
By ROBERT PEAR
WASHINGTON — When the Supreme Court on Friday agreed to hear a new challenge to the Affordable Care Act, it caused concern for many people who support the law, which has provided health insurance to more than 10 million. The challenge poses a threat to the law, according to defenders of President Obama’s policies.
In 2012, Chief Justice John G. Roberts Jr. sided with the more liberal justices in upholding a central provision of the law, which requires most Americans to have health insurance or pay a tax. The latest case, King v. Burwell, involves another provision of the law, which offers federal subsidies to help people buy insurance that many would otherwise be unable to afford. Here are preliminary answers to some of the many questions raised by the Supreme Court’s action.
Q. What is this case about?
A. The plaintiffs, residents of Virginia, are challenging the government’s authority to pay premium subsidies there. Virginia is one of three dozen states in which federal officials operate a public marketplace, or exchange, for the sale of insurance under the Affordable Care Act. Under a literal reading of the law, they say, subsidies are available only in states that established their own exchanges. The law, they note, authorized subsidies specifically for insurance bought on “an exchange established by the state.” By contrast, the White House and its allies argue that Congress intended to make the subsidies available in all states. And some judges have agreed. “The plain text of the statute, the statutory structure and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally facilitated exchanges,” said Judge Paul L. Friedman of the Federal District Court here. In January, he rejected a legal challenge to the subsidies in a separate case involving the same legal issue.
Q. What happens to people who are receiving subsidies?
Some Hiccups, but Federal Health Exchange Website Is in Good Health
By ROBERT PEAR
WASHINGTON — The Obama administration said Sunday that 100,000 people had submitted applications for health insurance on the first day of open enrollment, and it offered practical advice to consumers who had been locked out of their accounts.
Sylvia Mathews Burwell, the secretary of health and human services, cited the 100,000 applications as evidence that the refurbished website for the insurance marketplace was working for most users.
“The vast majority of people coming to the site were able to get on and do what they were intending to do,” Ms. Burwell said on the NBC program “Meet the Press.”
By contrast, when the website for the federal exchange went live on Oct. 1, 2013, it was virtually impossible to use. Government documents later obtained by congressional investigators showed that only six people managed to enroll on that first day, and that the total climbed to 248 on the next day.
Open enrollment for coverage in 2015 began on Saturday. Consumers had already been able to see health insurance options available on the federal exchange for five days. The opportunity for such “window shopping” took pressure off the HealthCare.gov website on Saturday, officials said.
Health Care’s Next Test: Getting More to Enroll
By ABBY GOODNOUGH and ROBERT PEAR
WASHINGTON — President Obama’s Affordable Care Act will face a substantial new test starting Saturday, when the second enrollment period for buying health insurance under the law begins and proponents embark on a three-month mission to persuade millions more Americans to sign up.
Officials running the revamped online insurance exchanges are promising a smoother enrollment experience this time, after spending heavily on website overhauls and simplifying the application process. Outreach groups are rolling out different strategies, from holding “pop-up” enrollment events at shopping malls to bluntly emphasizing the tax penalties that many Americans will face if they fail to get coverage. And the Obama administration is redoubling efforts to sign up young adults, members of minority groups and rural residents, who remain disproportionately uninsured.
But the current enrollment period brings with it complications. It will last only three months — half the length of the initial one, which ran from October through March. And this time, the insurance exchanges will be juggling two roles: signing up new customers, many of whom may be resistant or hard to reach, and trying to ensure that the seven million people who enrolled for 2014 remain covered.
Cost of Coverage Under Affordable Care Act to Increase in 2015
WASHINGTON — The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent — unless they switch plans.
The data became available just hours before the health insurance marketplace was to open to buyers seeking insurance for 2015.
An analysis of the data by The New York Times suggests that although consumers will often be able to find new health plans with prices comparable to those they now pay, the situation varies greatly from state to state and even among counties in the same state.
“Consumers should shop around,” said Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal insurance exchange serving three dozen states. “With new options available this year, they’re likely to find a better deal.” She asserted that the data showed that “the Affordable Care Act is working.”
Obamacare’s premiums are going up — at the same rate as everyone else’s
HealthCare.gov has reopened for business. For the next month, Americans obtaining health coverage through the Affordable Care Act (ACA) marketplaces face an open-enrollment period during which they can shop for, select and switch insurance plans.
Americans want to know if these plans are affordable, and whether the ACA is slowing the growth of the cost of health care in the United States. To look at the early reviews, the news isn’t good. “Cost of Coverage Under Affordable Care Act to Increase in 2015,” was the headline on a front-page New York Times article on Saturday. A Washington Post analysis determined that HealthCare.gov users will have more choices than last year, “but the options usually will be costlier.” Stories from other news outlets highlighting ACA’s higher costs include those found here and here.
Not surprisingly, Republican critics of the ACA have seized upon these reports as more evidence of its disappointments. “This year, many who like their plan will likely have to pay more to keep it,” said Sen. Orrin G. Hatch (R-Utah).
All of these conclusions are accurate. The estimates are fuzzy, but the consensus is that premiums will be rising across the country for the typical marketplace customer. Based upon data released last week by the U.S. Department of Health and Human Services, the Kaiser Family Foundation estimates that premiums will increase in the average county by 2 percent (for mid-range plans in the “silver” category) to 4 percent (for lower-cost “bronze” plans). In its analysis of the same data, the New York Times determined that silver plan premiums would rise 4 to 5 percent. Widely reported estimates by the Avalere Health consulting firm similarly found premiums rising 3 to 4 percent.
Why Shopping Is So Important in Health Enrollment
In September, we looked at early rate information and concluded that people who bought plans on the Affordable Care Act marketplaces this year should go back and shop again before renewing.
Now final data from a majority of states makes that recommendation even stronger.
The system is set up to make it easy for people who bought a plan last year to stay in that plan. People who don’t take active steps before Dec. 15 will be automatically renewed. But an Upshot analysis of rate data from the McKinsey Center for U.S. Health System Reform finds that many people who renew will face big price increases, while much better deals are available for similar plans.
Of course, switching plans has its costs — in many cases, it means changing doctors and drug lists. It also may mean mastering new deductibles, co-payments and other benefit structures. But it’s clear that if price is the most important thing, most Americans who bought the most popular plan in 2014 would be better off switching to something new for 2015.
The tough choice before consumers — between a price hike and the inconveniences of switching — is a consequence of the Affordable Care Act’s reliance on competition to control health insurance prices. The law encourages insurance companies to compete on price to keep premiums low.
Where Federal Health Exchange Rates Will Rise
In about a fifth of the counties in states using the federal insurance exchange, premiums for the lowest-priced silver plans will increase by 10 percent or more. But rates for the same plans will decrease in all of Maine, Montana and New Hampshire, and most parts of Mississippi and South Dakota.
Affordable Care Act Supporter Ignites Fury With a Word: ‘Stupid’
WASHINGTON — Three years ago, as President Obama fought for re-election, his team was more than happy to have Jonathan Gruber, a well-known Massachusetts Institute of Technology professor, mouthing off.
Mr. Gruber, a health care expert who helped develop Mitt Romney’s health care plan in Massachusetts and later was a consultant for Mr. Obama’s Affordable Care Act, was no stranger to the pundit circuit, and repeatedly called attention to the similarities between the two plans — a politically helpful fact for the Obama 2012 campaign.
“They’re the same bill,” Mr. Gruber declared once, adding an expletive before the word “bill.”
But now, Mr. Gruber’s bluntness is clearly less appreciated by those in the West Wing, thanks to the emergence of a series of videos that show Mr. Gruber calling the American public “stupid” and suggesting that the president’s health care law passed by fooling Americans about how it works.
“This bill was written in a tortured way to make sure C.B.O. did not score the mandate as taxes,” Mr. Gruber said in October 2013, referring to the Congressional Budget Office. “Lack of transparency is a huge political advantage. And basically, call it the ‘stupidity of the American voter’ or whatever, but basically that was really, really critical to getting the thing to pass.”
The White House was quick to reject Mr. Gruber’s comments. Josh Earnest, the president’s press secretary, said he disagreed “vigorously with that assessment,” and insisted that the “process associated with the writing and passing and implementing of the Affordable Care Act has been extraordinarily transparent.
The Policy at the Heart of the Jonathan Gruber Controversy
The controversy this week around the comments of a health economist, Jonathan Gruber, about President Obama’s health law has centered on his most explosive remarks, captured on video, about the “stupidity of the American voter” and the suggestion that the law was passed dishonestly. It was those blunt remarks that have Republicans in Congress talking about a new round of hearings to assail the law and, one imagines, a man who helped create its intellectual architecture.
But beyond his inflammatory comments, what substantive policy point was Mr. Gruber trying to make about the design of the Affordable Care Act, and how does it fit in with what is now the health care law of the land?
Referring to the Congressional Budget Office, Mr. Gruber said in an academic panel discussion last year (a tape of which surfaced this week): “This bill was written in a tortured way to make sure the C.B.O. did not score the mandate as taxes. If C.B.O. scored the mandate as taxes, the bill dies.”
The line between what constitutes federal taxes or spending and what doesn’t is often debatable. If the government requires coal companies to pay lifetime health benefits for their employees, does that count as federal spending? What about federal rules requiring businesses to install (sometimes costly) ramps for wheelchair access?
What exactly was Gruber’s role in the creation of the health law?
What was Jonathan Gruber’s role in putting together the Affordable Care Act?
That question has been hotly debated in light of recently circulated remarks that the MIT economics professor made about the “stupidity of the American voter” and the “lack of transparency” that was required to secure the passage of the health-care law.
President Obama is the latest to play down Gruber’s involvement. “The fact that an adviser who was never on our staff expressed an opinion that I completely disagree with in terms of the voters is not a reflection on the actual process that was run,” he said Sunday.
While it is probably overstating things to describe Gruber as an “architect” of the law, as so many recent reports have, he was also no ordinary adviser — as evidenced by the fact that he was paid nearly $400,000 by the administration for his work.
And his advice was important at critical moments when the bill’s survival was in jeopardy.
One of those times was July 20, 2009.
Four days before, Congressional Budget Office Director Douglas Elmendorf had declared that the bills that were going through the legislative process in the House and Senate would fail to bring the “fundamental change” necessary to bring down health costs over the long run. Elmendorf’s pronouncement struck at one of the basic rationales for the whole endeavor of overhauling the nation’s health-care system, even as opposition was building on the right.
Gruber was among a small group of economists that the president summoned to the Oval Office to meet with him and Elmendorf. The other two were former CBO director Alice Rivlin and Harvard University health economist David Cutler. They pored over the bill to look for other, more credible ways to wring out savings.
Drawing on that conversation, Obama met the following day with moderate "Blue Dog" Democrats, who had been holding up the bill in the House. He urged them to revisit an idea that had previously been rejected by committee chairmen on Capitol Hill. It would take from Congress the power to set Medicare reimbursement rates — a major driver of overall health-care costs — and put it in the hands of an independent board. That, many analysts believed, could be a “game changer.” It also remains one of the most controversial elements of the new law.
Obama dismisses renewed criticism of health-care law in wake of Gruber video
BRISBANE, Australia — President Obama dismissed renewed criticism of his signature health-care law Sunday and disputed an assertion from a former adviser involved in its creation who said the administration had deceived lawmakers.
Jonathan Gruber, an economist, suggested last year that the legislation passed in part because of the “stupidity of the American voter” and a “lack of transparency” in its funding mechanisms.
“I just heard about this,” Obama said at a news conference after wrapping up two days of meetings with world leaders here at the Group of 20 summit. “. . . The fact that some adviser who never worked on our staff expressed an opinion that I completely disagree with, in terms of the voters, is no reflection on the actual process that was run.”
It was the first time Obama had weighed in on the comments, which became public after he left Washington for a week-long trip to Asia.
Study Finds Alternative to Anti-Cholesterol Drug
By GINA KOLATA
For the first time since statins have been regularly used, a large study has found that another type of cholesterol-lowering drug can protect people from heart attacks and strokes.
The finding can help millions at high risk of heart attacks who cannot tolerate statins or do not respond to them sufficiently. And it helps clarify the role of LDL cholesterol, the dangerous form. Some had argued that statins reduced heart attack risk not just by lowering LDL levels but also by reducing inflammation. The new study indicates that the crucial factor is LDL, and the lower the levels, the better.
The six-year study, reported Monday at the annual meeting of the American Heart Association, involved 18,000 people who had had heart attacks or episodes of chest pain so severe they went to a hospital. They were randomly assigned to take a statin or a combination of a statin and the alternative drug to further reduce LDL levels.
Both groups ended up with very low LDL levels — those taking the statin, simvastatin, had an average LDL of 69, and those taking simvastatin and the other drug, ezetimibe, or Zetia, in a combination pill sold as Vytorin, had an average LDL of 54. No clinical trial had ever asked what happened when LDL levels get below 70 because, said Dr. Robert Califf, a Duke cardiologist and the study chairman, “many people were nervous about going this low and imagined a lot of possible toxicities.”
Statins lower LDL by preventing it from being made. Ezetimibe lowers LDL by preventing cholesterol from being absorbed in the gut.
The drugs were so effective that there were few cardiac events among the participants, but eventually a difference emerged. There were 6.4 percent fewer cardiac events — heart disease deaths, heart attacks, strokes, bypass surgeries, stent insertions and hospitalizations for severe chest pain — in those assigned to take Vytorin. The amount corresponded to what was predicted from the extra degree of cholesterol lowering with the combination drug.
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