Category: New Health Care Law

Broad Coalition Calls For Congress Not To Hand Health Insurers’ Losses To Taxpayers

JRGrahamUnitedHealth Group’s proposal (threat? promise?) to withdraw from Obamacare’s health insurance exchanges, and the failure of Obamacare’s COOPs are both events which NCPA has been predicting for a long time (see here and here).

Two years ago, we identified Obamacare’s “risk corridors” as a vehicle through which the Administration would expose taxpayers to unlimited liability for insurers’ losses in Obamacare. Due to our research and testimony, Congress prevented this exposure last December.

What with the exchanges unravelling so quickly, we are not surprised to learn that lobbyists are pressuring Congress to restore unlimited liability. We joined a broad-based coalition to write a letter to Congress urging the current policy be maintained.

Obamacare must be completely renegotiated from root to branch. Just handing taxpayers’ money to insurers for losses they incur will not solve the problem.

Read the entire letter here.

Work & Employment Down, Sleep & Socializing Up: Obamacare’s “Slacker Mandate”

sleeping-womanWhat with Obamacare’s health insurance exchanges unraveling pretty quickly, Americans might be excused for having forgotten one of Obamacare’s first intrusions: The “slacker mandate.” This was the provision that requires employer-based health plans to cover “children” on their parents’ plans until they are 26.

It took effect in 2010. The results are in, according to a new study published by the National Bureau of Economic Research:

If, as suggested by prior work, the provision reduced the amount of time young adults work, the question arises, what have these adults done with the extra time?

The extra time has gone into socializing, and to a lesser extent, into education and job search. Availability of insurance and change in work time appear to have increased young adults’ subjective well-being, enabling them to spend time on activities they view as more meaningful than those they did before insurance became available.

(Gregory Dolman & Dhaval Dave, “It’s About Time: Effects of the Affordable Care Act Coverage Mandate on Time Use,” NBER Working Paper No. 21725, November 2015.)

Large Insurer May Exit Exchange: The Exchange System is Collapsing Under its Own Weight

I reported earlier this week that the Obamacare Marketplace is slowly failing. Three days later the largest health insurer in America, UnitedHealth Group, announced it expects to lose $500 million on exchange plans next year and may exit the market in 2017.

Why Does Obamacare Over Invest in Spanish Customer Service?

The Center for Medicare & Medicaid Services (CMS) has started to publish its weekly reports on Obamacare enrollment via the federally facilitated exchanges.

A little over half a million people have selected a plan for the third open season. What is interesting is the exchanges’ overinvestment in Spanish capabilities. We first noted this last January.

The Snapshot reports that the average wait on the phone for a Spanish-speaking customer-service representative is 11 seconds, versus four minutes and 38 seconds for an English speaker. That’s 25 times longer. 52,023 of the 741,112 calls (seven percent) were in Spanish.


Peak Obamacare? We’re Almost There

money-burdenThe administration has released a report estimating that enrolment in Obamacare will reach only 9.4 million to 11.4 million at the end of 2016. Back in 2010, when the law was passed, the Congressional Budget Office estimated exchange coverage would be 21 million next year (Table 4).

Why the come down? Obamacare has a miserable take-up rate: Few who do not get significant subsidies sign up. Even worse, many of those who sign up at open enrolment cannot afford the premiums and drop out. Indeed, 15 percent of Obamacare beneficiaries who signed in 2015’s open season (which ended in February) were gone by the end of June. (The New York Times has just published interviews with some struggling to pay their premiums and maintain coverage.)

One year ago, I coined the term “Peak Obamacare” to describe this phenomenon. Although the administration’s cheerleaders have twice celebrated very high Obamacare enrolment during open season, the administration has finally decided to accept reality: We are on the verge of Peak Obamacare.

Congress Uses “Reconciliation” to Push Deficit-Funded Obamacare

Congressional Republicans are using a procedural tool called “reconciliation” to repeal a miniscule number of Obamacare provisions, according to Chris Jacobs of the Conservative Review:

Lost in the noise amidst Speaker Boehner’s resignation last week was the House of Representatives’ decision to begin moving its budget reconciliation bill. Earlier this spring, conservatives voted for the budget blueprint in both the hope and expectation that the reconciliation bill coming from that budget would be used to put full repeal of Obamacare on President Obama’s desk. But based on the newly released legislative proposals, those expectations have been disappointed.

Just as important, however, the Obamacare legislative proposals are limited to the following provisions:

  1. Repeal of the law’s auto-enrollment mandate for employers;
  2. Repeal of the Prevention and Public Health “slush fund;”
  3. Repeal of the individual mandate;
  4. Repeal of the employer mandate;
  5. Repeal of the tax on medical devices;
  6. Repeal of the “Cadillac tax” on high-cost employer health plans; and
  7. Repeal of the Independent Payment Advisory Board (IPAB).

That’s it. Under the proposed reconciliation instructions, a grand total of seven out of Obamacare’s 419 legislative sections—just over one percent of the law—would actually be repealed.

15 Percent of Obamacare’s Second Season Enrollees Were Gone by June 30

Obamacare’s second enrollment season closed around the end of February, with 11.7 million signed up. By March 31, that had dropped to 10.2 million who actually paid their first month’s premium. New data from the administration report that number dropped further to 9.9 million by June 30.

What is also notable is that the entire drop of paid enrollees occurred in states using the federal exchange, not state-based exchanges (for which enrolment stayed at 2.7 million). There is no word on whether the drop-outs got employer-based coverage, descended into Medicaid, or stayed uninsured. 423,000 were dropped by the administration because of lack of documentation of citizenship or immigration status.

A stable market? Not quite, I guess.

More than 40% of Employers will be Exosed to the Cadillac Tax in Coming Years

A controversial part of Obamacare imposes an excise tax on high cost health plans. Beginning in 2018, the so-called Cadillac Tax will impose a penalty of 40 percent of all costs in excess of $10,200 for employee-only coverage and $27,500 for family coverage. The threshold increases annually with inflation; that is regular inflation, not medical care inflation which rises at more than double the rate of general inflation.

Employers have a few options to avoid the tax. But all are things workers dislike, such as increasing cost-sharing, eliminating covered services, eliminating tax-free dollars for HSAs, HRAs and FSAs and adopting narrow networks.

The Kaiser Family Foundation looked at the proportion of firms offering health benefits plans that are expected to reach the threshold.




If you only look at large firms employing 200 workers or more, nearly half (46%) will have health plans subject to the tax in 2018. More than two-thirds (68%) will have health plans subject to the tax by 2028.

The tax exclusion for employee health insurance is worth approximately 40% to 45% (25% marginal tax rate, 15.3% payroll tax and maybe 5% state and local tax). What the Cadillac Tax does is impose a 40% tax on the excess costs over the threshold. What that basically means is the open-ended tax exclusion for employer sponsored health plans has been limited to $10,200 per individual and $27,500 per family.

Pro: Limiting the tax exclusion may encourage health plans to look for ways to reduce medical spending.

Con: Over time more and more people will be subject to the tax.

Should the Cadillac Tax be repealed?   Let me know what you think!

Electronic Health Records Harms the Doctor-Patient Relationship

By Lawrence N. Pivnick MD JD

A Texas Medical Liability Trust poll found that most of the patients interviewed said they wanted a physician who made them comfortable, to whom they could talk, one who actually listened to them. And they valued those attributes in their physician even more highly than his clinical acumen.

Commonwealth Fund’s Red Herring on Obamacare Risk Selection

One of this blog’s consistent themes is that Obamacare encourages insurers to seek to enroll health people in exchanges, and shun sick people. A new study from the Commonwealth Fund insists that is not the case, concluding that “insurers aren’t seeking lower-risk customers outside the ACA exchanges as some feared,” and “the ACA’s insurance reforms are working in the individual market.”

I will share the study’s conclusion, then explain the red-herring hypothesis it is meant to test: