Tag: "Health Reform"

Urban Institute: Kill the Employer Mandate

Caduceus with First-aid KitA new report from the Urban Institute urges the end of the employer mandate. The mandate has little effect on coverage: 251.1 million people would have health insurance if the employer mandate is fully implemented, versus 250.9 million if it were repealed. However, the mandate hurts low-income workers, by influencing some employer to cut back both hours and headcount:

Creating arbitrary thresholds (e.g., potential penalties for firms of 50 or more workers not providing coverage for employees typically working 30 or more hours per week) for financial requirements will change the employment decisions in some firms, and at least some workers will be adversely affected by them.

(Linda Blumberg, John Holahan, & Matthew Buettgens, Why Not Just Eliminate The Employer Mandate?)

Update: Federal Taxpayers Have Spent $655 Million on Three State Exchanges That Have Shut Down

Here’s the list:

Maryland                 $171,013,111

Massachusetts        $179,036,455

Oregon                    $305,206,587

Total                       $655,256,153

(Phil Kerpen, The Federalist). See previous posts here and here.

ObamaCare Will More than Double Profit Margins for Hospitals’ Emergency Departments

Think ObamaCare is all bad news for hospitals? Not according to a new study:

Physician and Nurse Pushing GurneyWe estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms.

(Michael Wilson & David Cutler, Health Affairs)

Only 25 Percent of Eligible, Unsubsidized, Applicants Selected a Policy

After five months of open enrollment, the final ObamaCare numbers are in:

  • Of 13.5 million eligible enrollees, 8 million (59 percent) “selected” policies on ObamaCare exchanges;
  • Of 4.8 million eligible enrollees who will not get subsidies, 1.2 million (25 percent) “selected” policies; and
  • Of 8.7 million eligible enrollees who will get subsidies, 6.8 million (77 percent) “selected” policies.

Although the report gives excruciating details of age, gender, and ethnic identities of the applicants, the Administration still declines to report how many of those who “selected” policies have paid premiums, claiming that only insurers themselves have this information.

Even If You Pay Your ObamaCare Fine, You Won’t Be Able To Choose Your Own Health Plan

According to Sarah Kliff, the Administration has made…”a decision that industry officials say could trigger yet another wave of cancellation notices.”

The administration is targeting a type of coverage called fixed benefit or indemnity insurance, which give patients a fixed sum of money whenever they visit the doctor or land in a hospital.

The new rule would mainly affect people who had chosen to pay the individual mandate, or who were exempt from the mandate, and who bought a fixed-benefit plan as a stopgap. The Obama administration is saying that they can’t do that unless they also buy a more comprehensive plan.

The Cost of Failure

American Commitment’s Phil Kerpen has calculated the cost in the five states that have closed or are at risk of closing their exchanges:


Why ObamaCare is Never Likely to be Popular

Jonathan Bernstein at Bloomberg View:

Caduceus with First-aid KitFor most of us, ObamaCare isn’t that visible, and the benefits often are the least visible part. The biggest winners are probably those on expanded Medicaid, and I’m confident many of them don’t know they were helped by ObamaCare. Don’t expect it to get better; it’s going to be less and less likely that people will identify the benefits they are receiving with “ObamaCare.” In five years, plenty of those in the exchanges won’t realize that under the old system they would have had a pre-existing condition that would have barred them from being insured. Even if they realize that such a restriction once existed, they almost certainly won’t realize that their minor medical condition would have qualified.

Given all that, once Republican opposition guaranteed that the ACA would be controversial it was likely that it would poll badly, even if it worked well — and even if it worked so well it couldn’t be repealed.

Employers Switch from Commercial Insurance to Self-Insured Plans

According to Citibank’s top ranked analyst Carl McDonald:

By our analysis, since 2002, risk enrollment at the publicly traded plans has fallen by over 14 million lives…The emergence of private exchanges that rely on a risk model (like the exchange product offered by Aon Hewitt) could help slow the loss of risk enrollment but the benefits of self-funding are so significant for many employers that we believe risk enrollment will continue to shrink.

Cooking the ObamaCare Stats?

caduceus_blogOut of the blue, the Census Bureau has changed how it counts health insurance — at the precise moment when ObamaCare is roiling the insurance markets.

Since 1987, the Current Population Survey, or CPS, has collected information on the health-insurance coverage status of Americans. The annual reports are widely cited because their large sample sizes improve accuracy, the data are gathered constantly, and they tease out state-by-state details. But this year the Census revamped the CPS household insurance questions, muddying comparisons between the pre- and post-ObamaCare numbers. The results of the new method will be disclosed this fall. (WSJ)

The Cost of ObamaCare Is Down 8%, but That May Not Be Good News

But so is access to doctors and hospitals in the plans offered on the health insurance exchanges.

A Congressional Budget Office report estimates lower federal spending (see the figure). The reason: Health plans in the exchanges look more like Medicaid than like employer-based coverage. Jason Millman reports:

The CBO report points out that it previously thought ObamaCare’s exchange plans would look more like employer-based coverage, but that hasn’t turned out to be the case so far — hence, the cheaper premiums. “The plans being offered through the exchanges this year appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans,” CBO wrote.

The CBO projects 42 million people will remain uninsured this year. In fact, the ACA will never cover more than 45% of the uninsured.