Top 10 Failures of ObamaCare After Six Months

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by JBeukema, Sep 23, 2010.

  1. JBeukema
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    Top 10 Failures of ObamaCare After Six Months - HUMAN EVENTS
     
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  2. Zander
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    Zander Platinum Member

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    ObamaCare was good for one thing - it started the Tea Party Movement.
     
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  3. Greenbeard
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    Greenbeard Gold Member

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    Double-digit increases of 1-9%, eh? Yes, premiums are always going to go up. The price of milk is always going to go up. The key is to decrease the rate of increase with time so that premiums aren't always rising faster than incomes (and thus eating up an ever larger share of the national income). There are two general strategies for doing this: 1) indiscriminately limit access, slash spending, cut treatments, and limit care; or 2) improve the way health care is delivered, addressing the vast inefficiencies that characterize our system.

    The former is faster but doesn't have particularly good outcomes for health, nor is it popular. The latter takes time because systemic improvement can't be conjured overnight. You'll have to weight the pros and cons of these approaches for yourself. The ACA, however, takes the latter approach to cost control. Which means it's in it for the long haul.

    This is a bit backwards. The number they use here comes from the federal rule itself, in which the high-end estimate that one-third of grandfathered plans will relinquish that status each year (leading to a cumulative ~69% giving up grandfathered status by the end of 2013) is derived. But that isn't "to meet the regulations," it's because those employers choose to make changes to the plans (e.g. in terms of cost-sharing) that cause them to lose grandfathered status.

    Using these estimates, if employers value grandfathering enough that they are willing to allow premiums to increase by three percent more than their otherwise intended level (or can make changes to benefits other than cost-sharing that achieve a similar result), then 14 percent of small employers and 11 percent of large employers would relinquish grandfather status if they made the same changes in 2011 as they had in 2009. Adding in the employers who would relinquish grandfather status because they change issuers, the Departments’ lower bound estimate is that approximately 21 percent of small employers and 13 percent of large employers will relinquish grandfather status in 2011.​

    That an employer can and will change insurance issuers at some point shouldn't be a shock. But a failure of ACA? That's a stretch.

    The statement "national budget deficit is worse" is defended using an opinion poll of what "voters nationwide" believe will happen? Moving on.

    No, more children aren't uninsured. No one is dropping existing policies; what certain insurers are doing in certain states (though not all) is refraining from issuing new policies.

    But this is certainly the first item in the list that actually looks like a failing of the ACA. Child-only policies are a cash crop for insurers; some insurers are now losing interest in that limited market now that they can't necessarily underwrite themselves to a profit on the backs of those kids.

    And therein lies a legitimate criticism of the ACA. It retains the private insurance market as the centerpiece of the payment side of our system. The profit motive remains the driver of many key decisions, even when that logically leads to limiting access for children.

    There's actually widespread support for repealing the 1099 provision. But paygo rules require that the repealing legislation contain offsets to cover the revenue that would've been collected under that provision of ACA. The Senate could only muster 56 votes for the more popular 1099 repeal bill, which isn't enough to make things happen.

    There's no reference to ACA here. But it's interesting to note that the survey in that link found:

    Most respondents agreed that health care coverage remains an important tool to attract and retain employees. More than eight out of ten employers (85%) said that health care benefits will either continue to be just as important, or more important, in the future. ​

    CBO didn't add $115 billion of discretionary spending to the tab; as they clarified:

    CBO’s discretionary baseline, which assumes that 2010 appropriations are extended with adjustments for anticipated inflation, already accounts for much of the potential discretionary spending under PPACA.​

    If you look at the recent national spending estimates from CMS actuaries, you'll see only two years this decade in which spending grows appreciably faster than under prior law: 2010, as high risks pools open across the nation, and 2014, as tens of millions of the uninsured join the ranks of the uninsured (in 2015 and 2016 it's very slightly higher).

    [​IMG]

    After that, spending slowly starts falling (that is, 3 years after the law goes full into effect). These projections only go to 2019 (i.e. 5-6 years after the coverage expansions begin) but that's right about where the cost growth is really going to start falling, as the CMS actuaries wrote:

    Enrollment shifts associated with the Affordable Care Act coverage expansions are projected to continue, contributing to continuing relatively faster spending growth rates through 2016. Thereafter, spending growth is projected to decelerate more substantially as a result of Affordable Care Act–mandated reductions to Medicare provider payment updates and the excise tax on high-cost insurance plans starting in 2018.​

    A substantial deceleration of spending growth is generally something people are eager to see.

    Medicare Advantage plans are given more money from the government than traditional Medicare plans but that doesn't mean reducing those additional payments means less money flowing to beneficiaries. The reason, as Austin Frakt has shown, is that the vast majority of those overpayments doesn't result in additional value for beneficiaries.

    Payment to MA plans has gone way up since 2003. Did the payment increase largely benefit beneficiaries or not? This is a current political and policy debate, about which much has been written in the media (both traditional and blogospheric). It turns out the answer is known and quantifiable. My work (with Steve Pizer and Roger Feldman) shows that for each additional dollar spent by the federal government (taxpayers) on the program since 2003, just $0.14 of it can be attributed to additional value (consumer surplus) to beneficiaries (see also: findings brief).

    What do we make of the other $0.86? That goes to the insurance companies but doesn’t come out “the other end” in the form of value to beneficiaries. In part it is accounted for by the costs of the additional benefits and in part it is captured as additional insurer profit.

    So, do higher MA payments produce little value to beneficiaries, as Obama claims, or are the benefits they fund important to maintain, as Republicans would have us believe? The balance of the evidence is on Obama’s side. In fact, it is a landslide: for each dollar spent, 14% of the value reaches beneficiaries and 86% of it goes elsewhere (profit or cost).​

    Medicare Advantage premiums are going down next year for beneficiaries, by the way.

    I'm not sure where the racial component of this one came from. That said, the suggestion here is that you're better off being uninsured than being on Medicaid. I guess it makes sense for this to turn into another "rah, rah, uninsurance!" piece.

    Unless they're for opening up private premium assistance to everyone. It would make the law significantly more expensive but it would do away with Medicaid.

    From shortly after it passed, we have:

    If their representative votes with Republicans to defeat the bill, 34 percent say they would be less likely to re-elect that member, 31 percent say they would be more likely to vote for the member, and 34 percent say it makes no difference.

    But if their member of Congress votes with Democrats to pass the legislation, 36 percent say they would be less likely to re-elect that member, 28 percent say they would be more likely to vote for the member, and 34 percent say it makes no difference.

    Translation: "There is no easy place right now in the health care debate," says McInturff, the GOP pollster. ​

    Is there a more recent poll indicating radically different voting influences?
     
    Last edited: Sep 23, 2010
  4. RDD_1210
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    RDD_1210 Forms his own opinions

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    I guess it's a shame that there is no heaven.
     
  5. rdean
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    rdean rddean

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    The year Obama took office, insurance rates rose 29% and the number one cause of bankruptcies was "medical bills".

    Republicans look back on this and say, "Ahh, the good old days, miss me yet?"
     
  6. CrusaderFrank
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    CrusaderFrank Diamond Member

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    What does reporting all purchases over $600 to the IRS have to do with health Care?
     
  7. Trajan
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    Trajan conscientia mille testes

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    shusshhh:eusa_shhh: we have the dem house defender of the faith depositing more boiler room gobbledygook.....you're supposed to be convinced now.
     
  8. Trajan
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    Trajan conscientia mille testes

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    sure why not, I'll play a round-

    How Seniors Will Pay for ObamaCare

    In many areas, Medicare Advantage enrollees will lose about one-third of their health insurance benefits. The cuts will finance new subsidies for younger people.

    Today marks the six-month anniversary of the enactment of the Patient Protection and Affordable Care Act, widely known as ObamaCare. It is a day when the first significant round of benefits kicks in, and the Obama administration is taking every opportunity to tout them to the American public.

    Insurers, we are being told, will no longer be able to impose annual limits or lifetime caps on benefits, and they will face a higher standard before than can drop anyone's coverage. Children will be guaranteed access to insurance, regardless of health condition. And there is more to come in the future.

    Yet the administration is strangely silent about who will bear the cost of these benefits. Search the government's own health-reform website and you'll get the idea that the whole thing is one big free lunch.

    The reality is that the cost of ObamaCare will be quite high for some people. By 2017, thousands of people in Dallas, Houston and San Antonio will be paying more than $5,000 a year in lost health-care benefits to make ObamaCare possible, according to a study published this month by Robert Book at the Heritage Foundation and James Capretta at the Ethics and Public Policy Center. For some New York City dwellers, the figure will exceed $6,000 a year. Unfortunate residents of Ascension, La., will pay more than $9,000 in lost benefits.

    Who are these people? Are they the rich and the comfortable—the folks presidential candidate Barack Obama told us could afford to pay for health reform? Are they people who have excessively profited during a recession that's caused hardships for so many? Are they the ones who gained the most from the Bush tax cuts?

    None of the above. According to the Book/Capretta study, the people getting hit with these very expensive tabs live in predominately low-income households. They are disproportionately minorities. They have trouble paying their own medical bills.

    These are the enrollees in Medicare Advantage plans, health plans operated by private insurers (Cigna, Aetna, United Health, etc.) that provide extra benefits to the elderly and the disabled on top of standard Medicare coverage. The price they will pay for health reform will be a double whammy: less spending on Medicare coupled with reduced subsidies for their Medicare Advantage plans. In many areas, Medicare Advantage enrollees will lose about one-third or more of their health-insurance benefits.

    Despite its popularity, conventional Medicare is actually a lousy health-insurance plan. It doesn't cover most drugs and it leaves beneficiaries exposed to thousands of dollars in potential out-of-pocket expenses. To protect themselves, most seniors purchase additional coverage known as "Medigap" insurance (either from an employer or purchased directly) and buy drug coverage (Medicare Part D) as well.

    Many low-income seniors, however, have trouble paying three premiums to three plans, and all too often they find a decent Medigap plan unaffordable. For these retirees (about one in every four Medicare beneficiaries) Medicare Advantage plans have been a godsend. They have been able to enroll in comprehensive health plans that resemble the coverage many nonseniors have—often with no extra premium.

    The hostility of the White House and many congressional Democrats toward these health plans is hard to explain. Ostensibly, they do everything President Obama says he wants to accomplish with health reform. They provide subsidized coverage to low- and moderate-income people who could otherwise not afford it. They have no pre-existing condition limitations, and some plans actually specialize in attracting and caring for patients with multiple illnesses. They provide an annual choice of plans.

    On measures of quality and efficiency, they also score well. According to a study published in June by America's Health Insurance Plans (a trade group that represents Medicare Advantage insurers):

    • Medicare Advantage enrollees had 33% more doctor visits (presumably representing more primary care), yet experienced 18% fewer hospital days and 10% fewer hospital admissions than conventional Medicare patients.

    • They had 27% fewer emergency-room visits, 13% fewer avoidable admissions, and 42% fewer readmissions.

    Other studies report similarly impressive results.

    This is not to say that the Medicare Advantage programs could not be improved. Right now, almost all the enrollees are in HMOs. Very few have a health savings account plan. And there is no practical way for the chronically ill to manage their own budgets. By contrast, the Medicaid disabled—as part of pilot programs that have been in force for a decade—can hire and fire the people who provide them with services, and use any money they save to purchase other medical care.

    Some complain that the government has been paying Medicare Advantage plans about 13% more than what would have been spent under conventional Medicare. This is partly explained by the influence of members of Congress who represent rural areas that would not otherwise be able to support these plans. In any event, these "overpayments" allow members to get about $825 in extra benefits each year, including lower out-of-pocket payments and better coverage for drugs, preventive care, and chronic disease care.

    According to a report published in April by the administration's own Medicare Office of the Actuary, about 7.4 million people who would have been enrolled in Medicare Advantage plans in 2017 will lose their coverage completely. Those who are able to retain their coverage will lose significant benefits. These cuts are financing lavish subsidies for health insurance for young people at about the same income level as the seniors who are being penalized.

    To those economic libertarians who view this as an entitlement wash, don't be misled. Many of the seniors losing their health plans will enroll in taxpayer-funded Medicaid, in addition to Medicare. The rest will be on the steps of Capitol Hill in the near future asking to have their benefits reinstated.

    John C. Goodman: How Seniors Will Pay for ObamaCare - WSJ.com
     
  9. JBeukema
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    Those poor vets @ the VA...
     
  10. NYcarbineer
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    NYcarbineer Diamond Member

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    Sorry, there are no rightwingers in Heaven.

    In fact, that's why they call it Heaven.
     
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