Charles Krauthammer: Congress should repeal the insurance company bailout
The Affordable Care Act already contains such a provision, buried deep in the monstrous bill.
First order of business for the returning Congress: The No Bailout for Insurance Companies Act of 2014.
Make it one line long: “Sections 1341 and 1342 of the Affordable Care Act are hereby repealed.”
End of bill. End of bailout. End of story.
Why do we need it? On Dec. 18, the chairman of the Council of Economic Advisers was asked what was the administration’s Plan B if, because of adverse selection (enrolling too few young and healthies), the insurance companies face financial difficulty.
Jason Furman wouldn’t bite. “There’s a Plan A,” he replied. Enroll the young.
But of course there’s a Plan B. It’s a government bailout.
Administration officials can’t say it for political reasons. And they don’t have to say it because it’s already in the Affordable Care Act, buried deep.
First, Section 1341, the “reinsurance” fund collected from insurers and self-insuring employers at a nifty $63 a head. (Who do you think the cost is passed on to?) This yields about $20 billion over three years to cover losses.
Then there is Section 1342, the “risk corridor” provision that mandates a major taxpayer payout covering up to 80 percent of insurance-company losses.
Never heard of these? That’s the beauty of passing a bill of such monstrous length. You can insert a chicken soup recipe and no one will notice.
Nancy Pelosi was right in her speech to a group of people who work in county governments: We’d have to pass the damn thing to know what’s in it. Well, now we have and now we know.
The whole scheme was risky enough to begin with – getting enough enrollees and making sure 40 percent are young and healthy. Obamacare is already far behind its own enrollment estimates. But things have gotten worse. The administration has been changing the rules repeatedly – with every scrimmag-line audible raising costs and diminishing revenue.
First, it postponed the employer mandate. Then, it exempted from the individual mandate people whose policies were canceled (by Obamacare). And for those who did join the exchanges, Health and Human Services Secretary Kathleen Sebelius is “strongly encouraging” insurers to – during the “transition” – cover doctors and drugs not included in their clients’ plans.
The insurers were stunned. Told to give free coverage. Deprived of their best customers. Forced to offer stripped-down “catastrophic” plans to over-30 clients (contrary to the law). These dictates, complained their spokesman, could “destabilize” the insurance market.
Translation: How are we going to survive this? Shrinking revenues and rising costs could bring on the “death spiral” – an unbalanced patient pool forcing huge premium increases (to restore revenue) that would further unbalance the patient pool as the young and healthy drop out.
End result? Insolvency – before which the insurance companies will pull out of Obamacare.
The Affordable Care Act is here to stay
By Eugene Robinson,
Now that the fight over Obamacare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.
The fight is history, you realize. Done. Finito. Yesterday’s news.
Any existential threat to the Affordable Care Act (ACA) ended with the popping of champagne corks as the new year arrived. That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges. Obamacare is now a fait accompli; nobody is going to take this coverage away.
There may be more huffing, puffing and symbolic attempts at repeal by Republicans in Congress. There may be continued resistance and sabotage by Republican governors and GOP-controlled state legislatures. But the whole context has changed.
Now, officials in states that refused to participate in Medicaid expansion will have to explain why so many of their constituents — about 5 million nationwide — remain uninsured when they could have qualified for coverage. More than 1 million of these needlessly uninsured Americans live in Texas, which is targeted by Democrats as ripe for inroads because of its rapidly changing demographics. Will Gov. Rick Perry (R) be forced to reconsider his Obamacare rejectionism? Or will he ultimately be remembered for speeding the state’s transition from red to blue?
Performance of the federal insurance exchange Web site, HealthCare.gov, will continue to improve, if only because the initial flood of applicants is bound to subside. Meanwhile, insurance costs and benefits in states that refused to set up their own exchanges will be compared with those in states that did. There will be questions about how the new law is performing — but no one will be able to pretend it does not exist.
The Morning Plum: The next battle over Obamacare
By Greg Sargent,
The Obama administration says it has turned a corner in the fight over the Affordable Care Act: the announcement of millions of new enrollees has allowed it to begin showcasing stories of people’s lives being improved by the law.
At the same time, Republicans are telegraphing their next attack: Sowing doubts about those same enrollment numbers (no matter what they actually show) to prove the law is an epic catastrophe.
GOP Rep. Eric Cantor is circulating a memo that says Republicans will vote on a proposal to require the government to notify people if personal info has been breached on HealthCare.gov. The administration says there have been no such breaches, and as Steve Benen notes, this could be about trying to scare people from enrolling more than anything else. Beyond this, though, note this from Cantor’s memo:
“In the coming weeks, we will continue to address other areas where greater transparency is demanded, including the disclosure of reliable and complete enrollment data.”
So expect votes on proposals to require the administration to provide more detail about enrollment numbers — who is paying for insurance, as opposed to merely enrolling — and the demographic mix of enrollees. These votes will be partly about reassuring the base that GOP leaders are still taking the fight to Obamacare, dammit!!!
Now, health reform advocates with an interest in seeing the law succeed care very much about seeing transparency when it comes to these numbers. Framed as a political attack coming from a party that wants to see the law fail, however, at what point does this kind of stuff get tuned out by voters as so much Beltway white noise?
Majorities will almost certainly continue to disapprove of the law deep into 2014. That’s real. However, the law may well mostly remain on probation for many voters — repeal will likely continue to be a minority position in most polls, particularly after the hangover of the initial rollout fiasco recedes. Dems will continue advocating for keeping and fixing the law, to put distance between themselves and its problems – in hopes of fighting Republicans to a draw over health care, to make 2014 about other issues.
Dems could well lose a lot of Senate seats next fall — whether it will be enough to tip the Senate is an open question — and perhaps Obamacare will be a leading reason why. But that will turn on how well the law works over time on multiple fronts, and people’s direct experience of it, not on short term skirmishes over enrollment targets. Other potential problems certainly loom. But at the same time, the number of beneficiaries will continue to mount. If the law works even moderately well, the alternative Dems hope for is also possible. As Brian Beutler explains, more and more voters may well ”know people whose lives are better as a result of Obamacare,” allowing Dem candidates to “regain confidence in their ability to run on a platform of keeping and improving it.”
The Obama administration says it has turned a corner in the fight over the Affordable Care Act: the announcement of millions of new enrollees has allowed it to begin showcasing stories of people’s lives being improved by the law.
At the same time, Republicans are telegraphing their next attack: Sowing doubts about those same enrollment numbers (no matter what they actually show) to prove the law is an epic catastrophe.
GOP Rep. Eric Cantor is circulating a memo that says Republicans will vote on a proposal to require the government to notify people if personal info has been breached on HealthCare.gov. The administration says there have been no such breaches, and as Steve Benen notes, this could be about trying to scare people from enrolling more than anything else. Beyond this, though, note this from Cantor’s memo:
“In the coming weeks, we will continue to address other areas where greater transparency is demanded, including the disclosure of reliable and complete enrollment data.”
So expect votes on proposals to require the administration to provide more detail about enrollment numbers — who is paying for insurance, as opposed to merely enrolling — and the demographic mix of enrollees. These votes will be partly about reassuring the base that GOP leaders are still taking the fight to Obamacare, dammit!!!
Now, health reform advocates with an interest in seeing the law succeed care very much about seeing transparency when it comes to these numbers. Framed as a political attack coming from a party that wants to see the law fail, however, at what point does this kind of stuff get tuned out by voters as so much Beltway white noise?
Majorities will almost certainly continue to disapprove of the law deep into 2014. That’s real. However, the law may well mostly remain on probation for many voters — repeal will likely continue to be a minority position in most polls, particularly after the hangover of the initial rollout fiasco recedes. Dems will continue advocating for keeping and fixing the law, to put distance between themselves and its problems – in hopes of fighting Republicans to a draw over health care, to make 2014 about other issues.
Dems could well lose a lot of Senate seats next fall — whether it will be enough to tip the Senate is an open question — and perhaps Obamacare will be a leading reason why. But that will turn on how well the law works over time on multiple fronts, and people’s direct experience of it, not on short term skirmishes over enrollment targets. Other potential problems certainly loom. But at the same time, the number of beneficiaries will continue to mount. If the law works even moderately well, the alternative Dems hope for is also possible. As Brian Beutler explains, more and more voters may well ”know people whose lives are better as a result of Obamacare,” allowing Dem candidates to “regain confidence in their ability to run on a platform of keeping and improving it.”
Missing a Cancer Diagnosis
By SUSAN GUBAR
Stories of misdiagnoses circulate throughout the testimonies of people contending with all sorts of cancers. Such errors, made by patients as well as doctors, bring in their wake a sense of betrayal, self-recrimination and anger. Should we accept them as inevitable?
Like many women, I misinterpreted the muted symptoms of ovarian cancer. Bloating, satiety, fatigue and constipation are often attributed to menopause, aging, indigestion, irritable bowel syndrome, depression, laziness or whining. My general practitioner prescribed half a cup of wheat bran, applesauce and prune juice every day. By the time a CT was ordered a year later, the cancer had progressed to an advanced stage that is treatable but not curable. I was furious at myself and upset with my doctor.
People leading active lives seem especially prone to dismissing subtle warning signs. The philosopher Gillian Rose declared, “I was so attuned to regular exercise of body and mind that I could easily take minor symptoms of ill-health in my stride.” Similarly, the physician and marathon runner Dr. Geoffrey Kurland deceived himself about symptoms of leukemia: “I now realize that for several months my body had been giving me warnings I had chosen to ignore, warnings that something was not right with me.”
Physicians are particularly likely to miss a cancer diagnosis in the case of young adults. According to S. Lochlann Jain’s book “Malignant,” “doctors often work under the misguided assumption that cancer is a disease of older people, leading to an immorally high number of delayed diagnoses and, in turn, the large proportion of late-stage cancers.” When she received a late-stage breast cancer diagnosis in her mid-30s, Professor Jain turned to the tort system because her doctor had first refused to biopsy a lump in her breast and then ordered a fine needle aspiration (rather than a more reliable core biopsy). A false negative deferred treatment.
One 2013 study, undertaken by the National Coalition on Health Care along with Best Doctors, Inc., found a disconnect between what cancer specialists assume to be the case about physician misdiagnosis and the facts of the matter. A majority of the 400 doctors in the study believed that from zero to 10 percent of patients are misdiagnosed; however, research indicates that the actual figure may be as high as 28 percent. I suspect that patients would put the percentage higher.
Maine panel calls for $10 million more for Medicaid
A state commission also proposes studying challenges facing long-term care in the state.
A Maine commission that studied long-term care facilities issued a final report Thursday calling for an additional $10 million in Medicaid funding in the coming fiscal year to help offset chronic reimbursement shortfalls for nursing homes and assisted-living centers.
Related headlines
The report from the Commission to Study Long-Term Care Facilities also includes recommendations and proposed legislation for further study of the various challenges facing long-term care because of Maine’s rapidly aging population.
The commission found that MaineCare, the state’s Medicaid program, underfunded allowable nursing home and assisted-living costs by $24 million in 2009, $22.5 million in 2010 and $29.4 million in 2011, according to BerryDunn of Portland, a consulting firm that specializes in Medicaid and reimbursement. The state paid $271.5 million in MaineCare reimbursements in 2011.
The commission also learned that delayed auditing of MaineCare cost reports by the Department of Health and Human Services intensifies financial pressure on nursing homes and assisted-living facilities. In late October, the DHHS had 174 cost reports from 2010 through 2012 that were waiting to be audited and accounted for about $8 million in unpaid MaineCare reimbursements.
In addition, an auditor’s review showed that problems with DHHS computer and accounting systems caused errors in payments to nursing homes and assisted-living facilities, reducing the amount of state and federal money available for government use by about $27 million at any given time.
The proposed legislation would direct the DHHS to correct the funding errors and fix the computer problems
Patients now put health law to use test
Implementing the reforms at this point falls to insurance companies and medical providers.
By Juliet Williams
The Associated Press
The Associated Press
SACRAMENTO, Calif. — After a troubled rollout, President Obama’s health care overhaul now faces its most personal test: How will it work as people seek care under its new mandates?
Most major pieces of the Affordable Care Act take full effect with the new year. That means people who had been denied coverage because of a pre-existing medical condition can book appointments and get prescriptions.
Caps on yearly out-of-pocket medical expenses will mean people shouldn’t have to worry about bankruptcy after treatment for a catastrophic illness or injury. And all new insurance policies must offer a minimum level of essential benefits, ranging from emergency room treatment to maternity care.
The benefits apply to individual policies as well as those offered through employers.
The burden for implementing the law now shifts to insurance companies and health care providers.
Dr. John Venetos, a Chicago gastroenterologist, said there is “tremendous uncertainty and anxiety” among patients who have been calling his office, some of whom believe they have signed up for coverage but have not received insurance cards.
“They’re not sure if they have coverage. It puts the heavy work on the physician,” Venetos said. “At some point, every practice is going to make a decision about how long can they continue to see these patients for free if they are not getting paid.”
Administration officials said this week that 2.1 million consumers have enrolled through the federal and state-run insurance exchanges that are a central feature of the Affordable Care Act.
Yet how many of those who signed up for health coverage on the exchanges will follow through and pay their premiums will not be known for a couple of weeks. People who signed up on the federal website have until Jan. 10 to pay premiums for coverage retroactive to Jan. 1, while consumers in some states have until Jan. 6.
Knowing health care prices is just the start. Now, act on them
Posted Jan. 03, 2014, at 12:35 p.m.
Maine’s health care world received a new dose of transparency on Jan. 1.
That’s when a new state law took effect requiring all health care practitioners to keep a list of the most frequently provided health care services and procedures and their prices. That means when you go to the doctor’s office, you can ask to see how much it might cost to get your blood drawn, your wart removed or to have your child examined.
This is a welcome change and comes after years of efforts to improve transparency of medical costs. In addition to the new law, Mainers seeking more information about the price of their health care could search the Maine Data Health Organization’s website, where users can find out how much certain procedures cost at different hospitals or compare by ZIP code. Or, for example, most insurers have a “ payment estimator” that allows members to find costs for procedures, doctor’s office visits, lab tests and surgery ahead of time.
The new law provides one more resource for patients or future patients. The price list must be available at providers’ offices, so people won’t necessarily have to search for the information online. And the prices listed — what people would pay if they had no insurance — are the simplest to understand. The ultimate cost for patients will depend on their particular insurance situation, but the lists provide a picture of the full price. They give a broader frame of reference, so patients can make more informed decisions about their health care, and so providers have an incentive to lower costs.
Now, consumers will have to use the price lists. They will also have to demand easier-to-decipher and readily available information about the value of procedures — which considers both price and quality.
It may not come as a surprise that few patients compare providers’ health care prices or look up costs before they go to the doctor. Catalyst for Payment Reform’s 2013 National Scorecard on Payment Reform, which was based on a national survey of health plans, found that while 98 percent of responding plans said they offer a cost calculator tool, only 2 percent of their members use them. Other studies have found varying use rates, but the fact remains that it can be tricky figuring out whether you’ll get high-quality care that is reasonable in price.
So doctor’s offices and hospitals will do well to publicize their price lists and make them easy to locate and use in person and online. Consumers might also be given a direct reason to act on the information; simply having data available is usually not enough.
Employers or insurers could use price data to develop incentives for consumers to seek better-value specialists or services. Change Healthcare, for example, rolled out a tool called Ways to Save Alerts, which are texts or emails that let a member know of a way to save money on his or her recurring medical purchases. In one case study, when 80 percent of employees received the alerts, 66 percent acted on them.
The legislation sponsored by Sen. Dick Woodbury, I-Yarmouth, that became law Jan. 1 introduces a little more transparency to Maine health care. For a long time, both insured and uninsured patients getting lab work done or seeking help at a hospital have had little idea about what the costs of their care would be. While health care cannot always be a consumer market, as patients do not have the training of doctors and knowledge about the scope of care necessary, there are many instances when cost information about procedures can be helpful.
Now patients will have to use the information, and employers, insurers and other groups that care about keeping health care costs low can provide incentives for patients to use that information along the way.
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