Category: New Health Care Law

Zeke Goes Off the Rails

Ezekiel Emanuel, Rahm’s brother and one of the key ObamaCare advisors, has been on quite a roll lately. Consider some of the headlines just from the past few weeks or so –

  • “Insurance Companies as We Know Them Are About to Die” (New Republic)
  • “In Health Care, Choice is Overrated” (The New York Times)
  • “You Don’t Need a Doctor for Every Part of Your Health Care” (CNSNews write up of a Bill O’Reilly interview)
  • “Inside the Making of ObamaCare” (Wall Street Journal)
  • “Progress with Caveats: At least 12 million have received coverage directly through a provision of the law” (Wall Street Journal)

In every instance his message is that he knows better than you do what is good for you. He knows a better way to do insurance than you do, he knows that you don’t really need a choice of doctor or hospital, he knows that you don’t really need a doctor at all for most services, and he knows that “things are actually going well” for ObamaCare despite the fact that you and most Americans don’t like it.

One has to wonder what is going on with this guy. Why is he so confident in offending so many Americans? Either he is triumphant in the idea that what we think doesn’t matter anymore because Obama is firmly in control of our future, or he knows that ObamaCare is such a disaster that he can finally say any damned thing he wants because none of it will ever happen anyway.

There Are Five Losers for Every ObamaCare Winner

Duke University’s Chris Conover has examined who wins and who loses under ObamaCare. Losers include pretty much everyone: Medicare beneficiaries, Medicaid beneficiaries, employees, and self-insured.

His conclusion:

When all is said and done, were ObamaCare fully in place right now, 166 million of today’s population could reasonably count themselves as losers in various ways, while only 34.6 million would be lucky enough to count as winners. That’s a ratio of 4.8 losers for every winner — not a particularly good outcome for any policy initiative, much less a “signature” legislative initiative.

SDF

Is ObamaCare Discriminating Against the Disabled?

This is Gov. Bobby Jindal:

The federal government provides funds to states matching their Medicaid contributions. But ObamaCare includes a twist: The law provides a richer federal match for states’ coverage of childless adults than Medicaid programs receive for covering individuals with disabilities. I’ll say that again: ObamaCare prioritizes Medicaid coverage of childless adults over care for persons with disabilities. That’s a case of skewed priorities if I ever heard of one.

…[M]y proposed budget for this year directs $26 million in new funding to home and community-based services for elderly individuals and persons with disabilities. We’re focused on improving the quality of care, and giving individuals with disabilities more choices. We’ve already increased the number of individuals receiving home and community-based care by 5,000, and this year’s funding increase will ultimately reduce our waiting list for services by over 4,000.

But while we’re focused on improving the quality of care provided and reducing waiting lists for persons with disabilities, Liberals would rather our state use those resources to participate in ObamaCare’s Medicaid expansion. Liberal groups like MoveOn.org won’t say one word about caring for individuals with disabilities, or how ObamaCare prioritizes coverage of childless adults ahead of the most vulnerable — they just want to intimidate states into accepting ObamaCare’s massive new spending programs.

It’s Zeke vs Me

In the Wall Street Journal. In recognition of ObamaCare’s 4th anniversary. Guess which one of us lacks a sense of humor?

I write:

money-burdenFor the past 40 years real, per capita health-care spending has been growing at twice the rate of growth of real, per capita income. That’s not only true in this country; it is about the average for the whole developed world.

Clearly, this trend cannot go on forever. So what does ObamaCare do about that? It limits the government’s share of the costs while doing nothing to protect individuals or their employers.

The law restricts the growth of total Medicare spending, the growth of Medicaid hospital spending and (after 2018) the growth of federal tax subsidies in the health-insurance exchanges to no more than the rate of growth of real GDP per capita plus about one half of 1%. This means that as health-care costs become more and more of a burden for the average family, people will get less and less help from government — to pay for insurance the government requires them to buy!

Zeke Emanuel with a somewhat different point of view.

ObamaCare’s Risk Corridor “Bailout” Just Got Bigger — Much Bigger

Last Friday, the Administration quietly released 280 pages of rules that, among other things, increased ObamaCare’s risk corridors:

We propose to implement an adjustment to the risk corridors formula…Such an adjustment could increase a QHP issuer’s risk corridors ratio if administrative expenses are unexpectedly high or claims costs are unexpectedly low, thereby increasing risk corridors payments or decreasing risk corridors charges. We propose to raise the administrative cost ceiling by 2 percentage points, from 20 percent to 22 percent. We also propose to increase the profit margin floor in the risk corridors formula (currently set at 3 percent, plus the adjustment percentage, of after-tax premiums). Such an adjustment could increase a QHP issuer’s risk corridors ratio if claims costs are unexpectedly high, thereby increasing risk corridors payments or decreasing risk corridors charges. We propose to raise the profit margin floor by 2 percentage points, from 3 percent to 5 percent. (p. 56)

The table below shows an insurance plan with $10 million cost target versus $11 million of allowable costs. Actual medical claims are $8.8 million. Using the formula for calculating its payout from the risk corridor, allowing 20 percent of administrative costs, the plan gets a $410,000 “bailout” (panel A). If it can add administrative costs up to 22 percent of allowable costs, the payout increases to $635,641 — an increase of 55 percent (panel B).

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Related Posts:

ObamaCare Risk  Adjustment: Moving the Goalposts.

The “3 Rs”: Understanding the Death Spiral in the ObamaCare Exchanges.

A Snapshot of the Health Care Workforce

Smiling NurseHow is the health care workforce changing under ObamaCare? This month’s jobs report from the Bureau of Labor Statistics gives us a snapshot of employment in health care versus the rest of the economy. The table below shows the details.

Despite the widely touted notion that ObamaCare is putting hospitals out of business, hospital employment barely budged from February 2013 through February 2014. There are still almost five million workers in hospitals, which are often the largest employer in any district. This makes them a political force to be reckoned with.

However, employment growth in health care has come from various ambulatory settings. This may be a good sign, if it indicates patients are using lower-cost outpatient care ― especially convenient clinics in shopping centers and pharmacies ― instead of over-priced hospital services. On the other hand, it could reflect increased demand for medical-office staff to deal with the unprecedented compliance requirements of ObamaCare.

ObamaCare’s Financial Management Platform Is Still Unbuilt

What difference does that make? A lot, according to the CMS explanation of why it just awarded a $91 million, one-year, no-bid contract to Accenture to complete the job:

rising…[W]ithout a Financial Management platform that accounts for enrollments and associated program costs (i.e. Advance Premium Tax Credits (APTC), Cost Sharing Reductions (CSR), payments to insurance plans, etc.), that integrates with the existing CMS Accounting platform (HIGLAS), the entire healthcare reform program is jeopardized by significantly increasing the following risks: (Emphasis mine)

  • Creating erroneous estimates of budgeted and projected payments associated with operating the FFM;
  • Inaccurate issuance of payments to health plans which could seriously put them at financial risk; potentially leading to their default and disrupting continued services and coverage to consumers;
  • Inaccurate forecasting of Risk Adjustment, Reinsurance, and Risk Corridor; potentially putting the entire health insurance industry at risk; and
  • Failing to support the end of the year reconciliation with IRS; leading to greater program costs for workarounds.

ObamaCare Tax Penalty: Families Could Owe Up To $11,000

TaxesThe Tax Policy Center has launched a Tax Penalty Calculator, which any individual can easily use to determine his or her ObamaCare tax liability. According to Roberton Williams:

If you don’t have approved insurance coverage by March 31 (and are not exempt from the requirement), the Affordable Care Act will hit you with a penalty on your 2014 income tax return. It is often said the tax is $95, but for many people it will be much more…For a single person who makes enough in 2014 to file a 1040, the penalty can be as little as $95 or as much as $3,600, depending on income. For families, the penalty is much larger: A couple with two children could owe between $285 and $11,000.

Zeke Speaks Out on McCain and Health Reform

Normally, I don’t think Zeke Emanuel has much to say that is both true and interesting. But this insider’s view of the making of ObamaCare is fascinating. Apparently there were people inside the White House who wanted to adopt John McCain’s approach to health reform. We ended up with only a timid step in that direction ― mainly so the president could save face after all the demagogic ads he ran attacking McCain during the campaign:

In 1954, the Internal Revenue Service created a tax exclusion for health insurance premiums, which is why health benefits offered through an employer aren’t subject to income or payroll taxes. This makes an additional dollar of health insurance (which isn’t taxed) more valuable than an additional dollar of wages (which is).

Economists — liberal and conservative alike — overwhelmingly denounce the tax exclusion. It drives costs higher while keeping wages down, it is regressive, and it is a major drag on the federal budget — lowering revenue by a whopping $250 billion a year.

During the 2008 presidential campaign, Senator John McCain proposed eliminating the exclusion and replacing it with a $5,000 tax credit to help families buy health insurance. The Obama campaign ran more than $100 million worth of ads pounding McCain, accusing the GOP nominee of “taxing health benefits for the first time ever.”

More from Steve Brill on the Tech Team that Saved ObamaCare

ap63460087062-8e31a0875fdd3a223001b0af4422d4403d18761a-s6-c30What Abbott could not find, however, was leadership. He says that to this day he cannot figure out who was supposed to have been in charge of the HealthCare.gov launch. Instead he saw multiple contractors bickering with one another and no one taking ownership for anything. Someone would have to be put in charge, he told Zients. Beyond that, Abbott recalls, “there was a total lack of urgency” despite the fact that the website was becoming a national joke and crippling the Obama presidency.

Time. HT: Austin Frakt.