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Wednesday, October 2, 2013

Health Care Reform Articles - October 2, 2013


Government Shuts Down in Budget Impasse




WASHINGTON — A flurry of last-minute moves by the House, Senate and White House late Monday failed to break a bitter budget standoff over President Obama’s health care law, setting in motion the first government shutdown in nearly two decades.
The impasse meant that 800,000 federal workers were to be furloughed and more than a million others would be asked to work without pay. The Office of Management and Budget issued orders shortly before the midnight deadline that “agencies should now execute plans for an orderly shutdown due to the absence of appropriations” because Congress had failed to act to keep the federal government financed.
After a series of rapid-fire back and forth legislative maneuvers, the House and Senate ended the day with no resolution, and the Senate halted business until later Tuesday while the House took steps to open talks. But Harry Reid, the Senate majority leader, dismissed as game-playing the House proposal to begin conference committee negotiations.
“We will not go to conference with a gun to our heads,” he said, demanding that the House accept the Senate’s six-week stopgap spending bill, which has no policy prescriptions, before negotiations begin.
The Obama administration and the Republican-controlled House had come close to failing to finance the government in the past but had always reached a last-minute agreement to head off a disruption in government services.
In the hours leading up to the deadline, House Republican leaders won approval, in a vote of 228 to 201, of a new plan to tie further government spending to a one-year delay in a requirement that individuals buy health insurance. The House proposal would deny federal subsidies to members of Congress, Capitol Hill staff, executive branch political appointees, White House staff, and the president and vice president, who would be forced to buy their health coverage on the Affordable Care Act’s new insurance exchanges.
But 57 minutes later, and with almost no debate, the Senate killed the House health care provisions and sent the stopgap spending bill right back, free of policy prescriptions. Earlier in the day, the Senate had taken less than 25 minutes to convene and dispose of a weekend budget proposal by the House Republicans.
“They’ve lost their minds,” Mr. Reid said, before disposing of the House bill. “They keep trying to do the same thing over and over again.”

Conservatives With a Cause: ‘We’re Right’




WASHINGTON — Senator Claire McCaskill, Democrat of Missouri, was the first to take to the Senate floor to publicly pose a question gnawing at an increasing number of lawmakers and ordinary citizens alike as the deadline for a government shutdown neared: Has Congress gone completely crazy?
“It’s very hard from a distance to figure out who has lost their minds,” said Ms. McCaskill immediately after the Senate on Monday rejected a Republican plan to not finance the government unless Democrats agreed to delay the new health law. “One party, the other party, all of us, the president.”
Senator Harry Reid, the Nevada Democrat and majority leader, had his own colorful, if somewhat skewed, metaphor about why much of the government was about to grind to halt in a take-no-political-prisoners fight over what is essentially a simple six-week funding bill, attributing it to the emergence of a “banana Republican mind-set.”
Mr. Reid’s language was evocative, and the implication was serious. With Democrats controlling the White House and Senate and with millions of dollars spent getting the health care law to the starting line, what gives House Republicans the idea that they can triumph in their push to repeal, or at least delay, the Affordable Care Act when so many veteran voices in their party see it as an unwinnable fight?
“Because we’re right, simply because we’re right,” said Representative Steve King, Republican of Iowa, one of the most conservative of House lawmakers. “We can recover from a political squabble, but we can never recover from Obamacare.”
Representative Raúl Labrador, Republican of Idaho and one of the original proponents of the so-called Defund Obamacare movement, was similarly sanguine. “We can always win,” he said Monday afternoon, as he jogged up the stairs to a closed-door conference meeting, where House Republicans gathered to plot their next move.
Representative Pete Sessions, Republican of Texas and chairman of the House Rules Committee, hinted that Republicans were unlikely to give up without at least another round since they see their campaign against the health care law as something of a higher quest. And many, if not most, people they talk to — colleagues, friendly constituents, activists, members of advocacy groups — reinforce that opinion, bolstering their belief that they are on the right side not just ideologically, but morally as well.
“This isn’t the end of the road, guys,” Mr. Sessions said with a grin. “This is halftime.”
The distance between the House and the White House has never seemed greater.
ACA Countdown: Expect Low Pay for Docs in Exchange Plans

WASHINGTON -- Provider payments under health plans sold through the Affordable Care Act's health insurance marketplaces may be "significantly" lower than reimbursements from commercial plans, initial indications suggest.
National physician groups are concerned the rates are so low that their members won't sign on to participate in ACA marketplace plans, and there will be no doctors to treat those newly covered patients.
A representative of one primary care provider organization, speaking to MedPage Today on background, said some rates were 70% lower than traditional preferred provider network plans, adding that plans were trying to make provider rates as low as possible to keep premiums equally low.
"Initial hearsay information is that payment rates being offered by [marketplace] plans are quite low in at least some of the states," a federal affairs representative for a second primary care provider group said. "What that means is that fewer providers will sign up."
Health insurers are approaching community providers, hospitals, and clinics with Medicaid rates and starting negotiations with providers at that level, Lon Sprecher, chief executive of Dean Health Plan in Madison, Wis., told MedPage Today. Dean Health Plan and its owner SSM Health Care in St. Louis operate health plans, clinics, and hospitals in Missouri, Illinois, Oklahoma, and Wisconsin.
"The theory that they use is, 'Well, you're seeing these patients already. They're probably Medicaid or uninsured, so Medicaid reimbursement-plus would either be status quo or better than what the provider is receiving,' " Sprecher said.

US employers slashing worker hours to avoid Obamacare insurance mandate

Guardian readers shared their experiences of retailers announcing they would no longer provide healthcare for part-time employees. Photograph: Getty
Avita Samuels has worked at the Mall of America in Minneapolis for the last four years, juggling a sales job with her studies in political science and law at the University of Minnesota. The 24-year-old has been the top sales associate for the last three years and works between 29 and 35 hours a week. But over the past few months, she said, she has watched as friends working in stores around her have their hours and benefits slashed – and she's worried that she will be next.
Forever 21, the clothing store, told staff last month in a memo leaked to the press that it planned to cut hours and reclassify some full-time workers as part- time. The move, which the company denied had anything to do with President Barack Obama's health reforms, the Affordable Care Act (ACA), will nevertheless help it avoid a mandate under the legislation requiring companies with 50 or more employees to offer those working 30 hours a week or more health insurance. Earlier this month, Seaworld, which operates 11 entertainment parks across the US, capped hours for part time workers at 28, down from 32, according to the Orlando Sentinel.
Other retailers, such as Trader Joe's and Home Depot have said they will no longer provide medical coverage for part-time employees, and will shift them instead to the public healthcare exchanges which open Tuesday, 1 October. Some employers have said their health costs will rise as a result of various provisions of the ACA, which takes full effect in 2015, when larger companies have to provide health benefits to full time workers or pay a $2,000 per-person fine.
The trend has caused fears among low-paid workers living on the breadline that they will be hit twice – by having their hours and thus earnings cut and by having to pay more for healthcare. Based on what she said is happening in the stores around her, Samuels is concerned she too will have her hours cut and with it her eligibility for company healthcare under the ACA.
"It's a really scary situation," said Samuels, who earns $9.25 an hour and is trying to reduce a student loan debt of close to $50,000. She currently receives subsidised healthcare through her university, but it runs out next year, when she had hoped her employer healthcare would kick in.
"Technically, I should be eligible," she said. "But at least 20 stores around me have cut hours. I live paycheck to paycheck. I have credit card debts. It's a balancing act. I'm afraid I won't be able to afford healthcare."
As one of the nation's lowest-paid workers, with little job security, Samuels is not alone in her fears that she may be worse off when the ACA takes full effect.
http://www.theguardian.com/world/2013/sep/30/us-employers-slash-hours-avoid-obamacare


The insurance exchanges at the core of President Obama’s health care law began operation Tuesday, with federal, state and insurance industry officials watching closely, unsure of what to expect from the rollout.
Most predictions have been for a trickle of new customers at first, with polls showing that many Americans remain uncertain about the purpose of the exchanges and unconvinced that the law will help them. The exchanges are online markets where people can shop for health plans and see if they qualify for federal subsidies.
Despite months of feverish preparation, few officials are sure the exchanges have overcome a range of problems that have plagued the system in many states, including with Spanish-language versions, subsidy calculators and programs to enroll small businesses.
Monday morning, healthcare.gov, the federally run exchange, posted an error message saying high volume had slowed the system. “Please wait here until we send you to the login page. Thanks for your patience!” the message read. A state-run exchange in Maryland also posted a message saying it was “experiencing connectivity issues” and asking visitors to return at noon.
Nor can officials do more than guess how many of the tens of millions of people who are supposed to buy private coverage through the exchanges will do so in time to meet the law’s Jan. 1 deadline for obtaining insurance.
The stakes are immense for Mr. Obama, whose signature achievement is the 2010 law that is supposed to push the United States closer to universal health care. Defending the law in the 2012 campaign, he defeated a Republican opponent, Mitt Romney, who vowed to repeal it.
A trouble-plagued launching, accompanied by the complaints of frustrated consumers, could undermine political support for the law, while tepid participation by the uninsured could weaken its financial underpinnings, which depend on the largest possible number of people paying into the system. The logistics of the new online system are daunting, relying on links to government records to verify citizenship and eligibility for subsidies, and to thousands of different coverage combinations offered by insurers.

MILLIONS FLEE OBAMACARE


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