Panic prompted ObamaCare lawlessness

Obama faced major reluctance on the part of  insurance companies to join and remain in the Health Insurance Exchange.  A last ditch agreement funded by what was yet to be approved congressional approval of a budgetary allotment.

Panic prompted ObamaCare lawlessness

By Doug Badger
The Hill, July 15, 2016

Senior Obama administration officials took a series of decisions beginning in late 2013 that ranged from the reckless to the illegal in an effort to keep insurers participating in health insurance exchanges.

A report issued last week jointly by the House Ways and Means and Energy and Commerce committees explores how the administration came to unlawfully funnel $7 billion in unappropriated money to insurers through a single ObamaCare program.

The program — known as cost-sharing reduction (CSR) — requires insurers to reduce deductibles and other out-of-pocket spending for certain low-income people who signed up for coverage through health insurance exchanges. In turn, the statute authorized the administration to seek an appropriation from Congress to reimburse insurers for the cost of providing these coverage enhancements.

The congressional report chronicles how the administration determined as early as 2010 that it needed an appropriation to make CSR payments to insurers. In April 2013, the president submitted a budget to Congress formally requesting the appropriation.

But in July, the Senate Appropriations Committee, then controlled by Democrats, expressly denied the president's request. Sometime after Congress refused to fund the program, the administration contrived the theory that it could spend money without an appropriation.

Senior officials at the Office of Management and Budget (OMB) drafted a legal memorandum during late 2013 declaring that the government could make billions in CSR payments to the insurance industry without congressional approval. The administration began making the unlawful payments in January 2014.

Although the administration continues to stonewall the congressional investigation into how it arrived at this decision, the committees have learned that several Treasury Department officials raised concerns about the OMB memo. Those officials were permitted to read the document, but were forbidden to make copies or take notes.

The administration has denied Congress even that courtesy, defying congressional subpoenas for copies of the OMB memorandum and other material relevant to the investigation. It has supplied them with a memorandum that Treasury Secretary Jack Lew signed in January 2014 directing his subordinates to begin making CSR payments. But that memorandum has been redacted to omit the department's legal justification.

The administration also has slapped a gag order on current and former employees, instructing them not to answer the committees' questions about the legality of the unappropriated spending.

The administration has good reason to stonewall. Its ostensive reason — that the legitimacy of the CSR payments is under review by the courts — is a smokescreen. The Supreme Court settled that matter in a 1929 case arising from the Teapot Dome Scandal, holding that congressional inquiries cannot be thwarted by ongoing litigation.

The administration's defiance has a much simpler explanation: Its actions have no legal basis. Even The New York Times has acknowledged that if the administration were permitted to continue spending unappropriated money, "it could have major — some might say huge — consequences for our constitutional democracy."

At least one federal judge agrees. In a lawsuit filed by the House of Representatives, Federal District Court Judge Rosemary Collyer in May ruled that the CSR payments were unlawful. The Justice Department has appealed Collyer's ruling.

My July 8 testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations showed how the government's unlawful spending on the CSR program fits into a broader pattern of malfeasance in ObamaCare implementation. That malfeasance includes decisions made during the first half of 2014 to unlawfully divert $3.5 billion to $4.5 billion from the Treasury to insurance companies through the "reinsurance" program. It also involves the attempt by the government to turn the law's "risk corridor" program into a new version of the Troubled Asset Relief Program (TARP), forcing taxpayers to cover losses resulting from bad business decisions made by insurance executives.

Those abrupt and unlawful policy reversals were occasioned by a serious miscalculation of demand for health insurance among relatively healthy people.

It turns out that millions don't want it, unless premiums are steeply discounted. ObamaCare does the opposite for people in relatively good health, requiring insurers to overcharge them for a product they may not want or need, while discounting premiums for those in poorer health.

The result is a dysfunctional "market" that attracts high-risk enrollees and repels low-risk ones, leaving insurers with a losing proposition: a pool of customers who are disproportionately older, less well and paying premiums that are too low to cover their medical bills.

When the consequences of this dysfunctionality dawned on the administration, panic set in, prompting a series of regulatory improvisations providing for the payment of billions in corporate subsidies to the insurance industry.

Although the administration is not especially fond of insurers (as the president demonstrated this week with his renewed embrace of the "public option"), the exchanges would collapse without them. To avoid the political embarrassment of insurers withdrawing en masse from the exchanges, it has chosen to supply them with unlawful payments and stonewall congressional inquiries into this misconduct.

The administration's actions raise concerns that transcend the fractious politics of ObamaCare: They are institutional and constitutional in nature. Institutional because Congress's core lawmaking and oversight functions are being effaced. Constitutional because its power of the purse is under legal assault.

In such circumstances, Congress cannot be passive. It must act to require the administration to follow the law.

Badger, a former White House and U.S. Senate policy adviser, is a senior fellow with the Galen Institute. This piece was adapted from his July 8 testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations.

Read the article in The Hill

Information provided to Health Train Express by Galen Institute

Covered California II

Enrollment for Covered California began one month ago, and will end on January 15, 2014. The online internet enrollment worked more smoothly and was easy to access. It functions fairly well and most of the time it proceeds without a hitch.

One problem I encountered was an inability to progress from {adding members}  to where the web page for adding new members. This attempt repeated itself a number of times when 'next' was selected. After several attempts the next page did appear, and the process proceeded without further difficulty.

The people who receive the 'best benefits/premium cost' are clearly in the Medi-Cal category if their income is at or below the poverty level. The web site performed fairly well with numerous pop-ups and drop down menu selection. Because of the relatively large number of selections and fields it was difficult to scan through deductibles, and/or co pays. The site allowed users to select and compare plans by checking the plans one wanted to compare.

The plans all have deductibles and co pays. The lower the premium the higher the copay and and deductible.  In many cases the insurance appears to be 'catastrophic coverage'  Common sense would make one wonder how many people could afford a deductible of $2500 to $10,000.

The financial algorithm was  designed by people who know little about health care or it's real expenses.  It seems the design was to fit health care into the budget process.

Jonathan Gruber, the principal economic adviser and designer is an expert in health economics at the macro level, and is no authority on patient care.  He has no medical experience or clinical credentials and is ignorant of patient-provider health process.  He had received numerous awards in healthcare economics.
Gruber has published more than 140 research articles (the majority of which were for NBER) and has edited six research volumes.^[11] He is a co-editor of the Journal of Public Economics, an associate editor of the Journal of Health Economics, and the author of Public Finance and Public Policy.^[12] In 2011, he wrote Health Care Reform: What It Is, Why It's Necessary, How It Works, a graphic novel delineating the Affordable Care Act, illustrated by Nathan Schreiber.^[2]

An allegation and video content of Gruber testifying in several resulted in an eruption of public outrage and discontent.

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.^[18][19][20] Paul Krugman in The New York Times^[21] argued that, although Gruber didn't always disclose his HHS connections, the times when he didn't were no big deal. 

In November 2014, a series of videos emerged of Gruber speaking about the ACA at different events, from 2010 to 2013, in ways that proved to be controversial. Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted and/or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.

Writings:

Gruber's published works include:

• On February 15, 2006, the Center on Budget and Policy Priorities published an article by Gruber entitled "The Cost and Coverage Impact of the President's Health Insurance Budget Proposals"^[13]
• In a December 4, 2008, New York Times op-ed, "Medicine for the Job Market", he claimed that expanding health insurance, even in difficult financial times would stimulate the economy.^[14]
• On February 9, 2011, the Center for American Progress published an article by Gruber titled "Health Care Reform Without the Individual Mandate," analyzing the health insurance coverage impacts of alternative policy options for encouraging purchase of health insurance under the Patient Protection and Affordable Care Act, including the mandate, a late penalty, and auto-enrollment.^[15]

Covered California web site illuminates the copay/deductible inverse relationship and premium subsidy.  The working of Obamacare  obfuscates the ACA bill which was passed by the Democratic party.  Very troubling is  it did not include Republcan legislators in the design process. 

Contrary to Obama's proclamations many patients did not keep their physician,or hospital. Nancy Pelosi's uncannily accurate comment 'we won't know what is in it until we pass it'. Jonathan Gruber's "stupid" must also mean 'congress' was too stupid as well.

Portions of this article are attributable to 

New York Times, Covered California (online enrollment)

Affordable Care Act------Silk Scarf or Pig's Ear ?

Silk Scarf or Pig’s Ear ?

President Obama and the Democrats insist that the Affordable Care Act is working and has increased the number of insured, yet most Americans do not like the law.

The question now is what kind of bang did we get?  

Figures from the Heritage Foundation in their Consumer Power  Report “Obamacare Squandered $1.2 Billion on Failed Exchanges

It all began when HBX was enrolling carriers for each state. At best it was a difficult sell with much arm-twisting   In Maryland, Mississippi, New Mexico, and South Dakota, officials had to beg and plead just to get one carrier into the state’s private market.

Continuing problems are ongoing in many state exchanges. There’s only one insurance carrier – Blue Cross Blue Shield – in West Virginia’s exchange.

Hawaii is another consensus pick, and some experts say the state might never be able to support its Obamacare exchange. Hawaii was near the bottom for total enrollment, signing up just 15 percent of its eligible population, and had the second-worst mix of young adults. The state’s exchange also suffers from the fact that Hawaii had a low uninsurance rate to begin with – meaning there’s a smaller pool of potential customers there, which makes the state less attractive to insurers. Hawaii’s “Health Connector” has signed up the smallest number of people of any state in the country and has no plans to finance their operations moving forward. Their current plan appears to be to all-but-close-up-shop and outsource all of the exchange functions to the state Department of Human Services. The state’s leading insurance company says it is time to pull the plug. Expect this one to be official any day now.

Health care analysts are also keeping an eye on premiums in Maryland, Mississippi, New Mexico, and South Dakota, where officials had to beg and plead just to get one carrier into the state’s private market.

The expected rise in premiums will vary greatly from state to state, smaller states with fewer enrollees and a bias toward older and sicker people will see sharp rises in premiums.  It’s impossible, though, to say with any certainty whether a particular state will see an above-average price increase next year.   Maryland, Mississippi, New Mexico, and South Dakota,  are among those HBXs to watch.   Minnesota’s exchange has been a disaster, and they recently brought in [Deloitte] on a nine-month $4.95 million contract to fix it. It is unclear whether they will be successful.

Vermont, the tiny state with giant ambitions to use Obamacare as a stepping stone to single-payer, government-run health care is still facing enormous problems dealing with its tiny population. They are using CGI, the same vendor that failed on the federal healthcare.gov, and have given them a deadline of July 2 to get the site working. It is unclear what Vermont will do if they fail to deliver by that date.

The total is $ 1.2 billion…..and it is not over, yet

FEDERAL HEALTH BENEFIT EXCHANGES: COVERED CALIFORNIA, BREAKING NEWS

Exchange enrollments at 3.3 million, big jump in January

By Paul Demko 

Posted: February 12, 2014 - 5:15 pm ET

Tags: Costs, HealthCare.gov, Insurance

(Story updated at 6:15 p.m. ET)

Nearly 3.3 million individuals signed up for private insurance plans through the state and federal exchanges during the first four months of the open enrollment period, HHS reported Wednesday. The total represents significant growth in January, but is still less than halfway toward the goal of 7 million enrollments by March 31.

State exchanges enrolled 1.4 million individuals through the end of January, while 1.9 million individuals signed up through the federal exchange, according to figures released by the CMS on Wednesday. The federal exchange, in particular, showed momentum in January: Nearly 40% of total enrollments through the federal HealthCare.gov website occurred last month. 

It's very, very encouraging news,” HHS Secreatary Kathleen Sebelius said on a call with reporters Wednesday.  

However the total numbers only show a small part of the enrollment issues.  Demographics vary widely from state to state in terms of age, health, and gender.

“We're seeing a growing population of Americans who are young, healthy and well covered, and these younger Americans are signing up in greater proportions,” Sebelius said.

A significant number of new enrollees are from those who had pre-existing policies cancelled at the end of 2013.

Catastrophic Options

Hardship Exemptions  (Qualifications)

However, in some states exchange customers continue to skew significantly older. In Ohio and Wisconsin, for example, only 21% of enrollees were between the ages of 18 and 34.

A gender discrepancy is also emerging, with women representing 55% of those seeking coverage. In some states, the gender imbalance is even more pronounced. Women account for 60% of signups in Oregon and 62% of exchange customers in Mississippi.

HHS also issued data for the first time on the type of plans being purchased on the exchanges. More than 60% of state and federal exchange customers opted for silver plans, which are designed to cover 70% of medical costs

Last week, the Congressional Budget Office reduced its estimate for how many people will sign up for coverage in 2014 from 7 million to 6 million, due in part to the rocky rollout of the federal exchange and continued problems with some state marketplaces. 

There is still no data available on how many individuals have actually made their first premium payment. Even after enrollment and premium payment it remains to be seen how many will find a suitable provider. Magnifying this issue in California is massive errors in the provider directory listing providers who will not accept Covered California.

A massive  deception has been built into Covered California. Policies called Blue Shield PPO (Silver  Plan) are not ordinary Blue Shield PPO plans.  Not only that but there is a difference between group PPO plans and Individual Family Plans (IFP).

I contacted a wel established medical group (Inland Empire)  (120 providers)  to inquire about their providers enrolled in Covered California. I was told tthey accept the group Blue Shield PPO, but NOT the IFP. 

This will come as a great shock to those enrolled in many Covered California plans.

Precautionary note:  Check with your chosen provider to ascertain if they accept your specific plan under Covered California. Covered Callifornia is a general term and means very little. Be certain to find if the specific plan that was signed up for is truly available.

Many patients will present to the doctor's office and find they do not have a provider.

Important News:  Covered California is updating it's Provider  Directory.  Check with your chosen provider to corroborate their participation.  Urgent Care Centers are also specific to a planBe certain your chosen provider is aa member of the medical staff of your chosen hospital.

The Health Benefit Exchanges say that enrollment can be changed until March 31.2014.  

Note: This article will be updated weekly.

Covered California Rates Plans It Sells

Sorcea:

 San Diego UT
 CMS

For many people enrolling in Covered California this may be their first time in many years to enroll in any health  insurance plan.  For some it may be the first time they have qualified to be insured.

The array of plans is overwhelming at best and the enrollment program (contrary to  President Obama's statemtn) is not user friendly (such as buying on Amazon.com).  In fact the process has been made more difficult by this attempt to make health care fit into a business model for shopping.

Health Insurance has been like no other, and labelling a web site to encourage enrollment as the "Market Place" demeans the process further.  It equates health along with such things as a meat packing plant, and a piece of steak.

Although statistics can be misleading and subject to interpretation , this attempt to rank plans is a starting point for 'newbies'.

Nevertheless in order to assuage critics of Obamacare by pretending to offer quality comparison Covered California has listed their 'ratings'.

Several articles have appeared, one in the San Diego Union Tribune,  which stated that the two plans in San Diego which  rated the highest were Kaiser Permanente, and  Sharp Health Plan. Sharp and Kaiser each got four stars, one better than Anthem Blue Cross and Blue Shield of California.  This applies specifically to the San Diego region.  This is a truly unique area in terms of Kaiser and Sharp Health Plan for which there is no equivalent plan in other regions of California.

There are several organizations that rate health insurers based upon selected criteria.

NerdWallet Health offers The Best Hospitals tool which includes the most recent hospital data available through Medicare. The data features the 100 most frequently performed inpatient procedures from over 3,200 hospitals across 50 states. This website offers a straight forward chart which ranks hospitals/plans

NerdWallet devised the Easy Index, which ranks each company as Easy!, Decent, or Painful, based on our experience calling each company and health plan data from the National Committee for Quality Assurance (NCQA’s Private Health Insurance Plan Rankings 2012-2013 and NCQA’s Medicaid Health Insurance Plan Rankings 2012-2013).  NerdWallet Health's ranking differ significantly from what Covered California rated.

The other organizations that rank healthplans and/or hospitals are:

     NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA         accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.

Hospital Consumer Assessment of  Health Care Providers and Systems (HCAHPS) is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay. These rankings appears at Data.Medicare.Gov

NerdWallet Health offers their criteria for ranking.
  
 This is a beginning for some. For many assessing co-pays, deductibles, and benefits will be more of a challenge, especially those on subsidized plans who were previously covered by Medi-caid.  It is unclear to me whether Medi-caid will upgrade their coverage, provider lists, or hospital eligibility.

Repeal the President’s Health Care Law

I wrote in several posts why Obama Care will be de-constructed by the American Culture for many reasons.  Eventually it will be re-constructed in a manner consistent with the American Cultual beliefs,  which will avoid intruding on basic Constitutionally guaranteed freedoms. (regardless of what the Supreme Court has ruled.

All early signs point to erosion of ObamaCare

    All Signs Lead to the Destruction of ObamaCare
    Vital Signs Diminishing for Obamacare Is Life Support Imminent?
    The Fears About IPABs in the Affordable Care Act
    Death Spiral ? Is this the Black Hole for the Affordable Care Act?
    Will the Affordable Care Act Overwhelm the Health System?

    ACO Expectations May be Unrealistic
   

Senator Orin Hatch has initiated a Legislative proposal has connected changes leading to a uniform health insurance system:


Title 1: Repeal the President’s Health Care Law
        Section 101: Repeal Obamacare
Title 2: Replace Obamacare With Sustainable, Patient-Centered Reforms
        Section 202: Create a New Protection To Help Americans With Pre-Existing Conditions
Section 203: Empowering Small Business and Individuals with Purchasing Power
Section 204: Empowering States With More Tools to Help Provide Coverage While Reducing Costs
Section 204: Expand and Strengthen Consumer Directed Health Care
Title 3: Modernize Medicaid to Provide Better Coverage and Care to Patients
        Section 301: Transition to Capped Allotment to Provide States with Predictable Funding and Flexibility
        Section 302: Reauthorize Health Opportunity Accounts To Empower Medicaid Patients
Title 4: Reducing Defensive Medicine Practices And Getting Rid of Junk Lawsuits
        Section 401: Medical Malpractice
Title 5: Increasing Price Transparency to Empower Consumers and Patients
        Section 501: Requiring Basic Health Care Transparency to Inform And Empower Patients
Title 6: Reducing A Distortion in the Tax Code That Increases Health Costs
        Section 601: Capping the Exclusion of An Employee’s Employer-Provided Health Coverage

There is no reason why employer group coverage cannot be continued with the caveat that it must conform to not banning pre-existing issues, and eliminating any cap on benefits.
Tax code issues regarding health benefits should not have a limit, nor require a threshold of income under which deductions can be claimed.
The IRS should be prevented from administering penalties, nor punish using a penalty and/or fine mechanism.

Taken together the aforementioned ideas will lead to an end result. Each section must be evaluated against a background of common sense without regard to self-interest in any part of the health system.

If we want a re-birth of our system we cannot drag along the dysfunctions present in our present system.
I would add the aspect of improving the health of our citizens.  This may not be properly measured by outcome studies based on reducing costs. The metrics need to be re-evaluated for that component of reform.

The underlying and most important goal is to improve access and quality of care. While Obamacare addresses costs, it does little if nothing to improve access. This challenge requires more funding for primary care physicians education and reassess certain specialties now included in primary care listings. Many internist are not primary care oriented, although considered PCP, nor are obstetricians/gynecologists.

ObamaCare is the Central Battle over the future Direction of our Country.

Richard Reece MD who blogs at Medinnovation has some profound quotes from Thornton Wilder. From it derives the title of this article. Thorton Wilder,  a quintessential American writer, the author of The Bridge of Saint Luis Rey, Our Town, The Skin of Our Teeth,  and the inspiration of Hello Dolly !.  

Some of you will disagree with our view of the Affordable Care Act.

Wilder was a true patriot – a believer that America had created the most dynamic,  creative,  individualistic, and freedom-loving nation on earth.   

ObamaCare is the central battle over the future direction of our country. It cannot stand. It is a looming disaster for patients- especially seniors- for our economy and for the future of health care in America. It will lead to rationing and government control over health are decisions. The quality of care will decline. Medical progress will slow. And the resulting third-rate health care system will likey bankrupt our country.  The federal government is already racing toward a budgetary train wreck, and ObamaCare will only speed us down the tracks.”

Fortunately ObamaCare as it now is written will self-destruct and in the next five years the American Culture will de-construct it.

      Paul Rosenberg in FreemansPerspective.com  in a blog post entitled “Why ObamaCare Will Not Conquer American Culture,” November 1, 2013, in which he says,”Americans expect to choose whenever they want.. Americans expect choices; it is built for individual changes, not collective changes.  This is the DNA of the culture, and no matter what political controlling th liberal ruleship, the culture will simply not fall.

Grace-Marie Turner, James Capretta, Thomas Miller, and Robert Moffitt,  Why ObamaCare is Wrong for America: How the New Health Care Law Drives up Costs, Puts Government in Charge of Your Decisions, and Threatens Your Constitutional Rights (Broadside, a Harper Collins Imprint, 2011) who say, “The passage of ObamaCare was deeply polarizing. Never before had Congress passed - and the president signed into law – such sweeping legislation that was so strongly opposed by so many Americans."  

author:

Physicians in particular with our ethic of privacy and one on one relationships with our patients will not be misled by this plan which does not justify the means toward an end. We all are adamant about an equitable health care for all.  But this is not the way.

Take heart my colleagues.....the deconstruction will take place by the very people who put it together.....or they will be gone......voted out of office.

Vital Signs Diminishing for Obamacare Is Life Support Imminent?

Moody's: Uncertain healthcare landscape leads to negative outlook 

for US health insurers

Global Credit Research - 23 Jan 2014

Insurance companies, long held in high ESTEEM in the finance world, because of their wide base of investment and astute leadership are beginning to feel the effects of ObamaCare even before they begin paying reimbursements to providers, hospitals, and enrolled providers.

Moody's Corporation is an essential component of the global capital markets, providing credit ratings, research, tools and analysis that contribute to transparent and integrated financial markets.

Moody's changed the outlook for US health insurers to negative from stable, as implementation of the Affordable Care Act (ACA)continues to create uncertainty for the industry, says Moody's Investors Service in its new industry outlook "US Healthcare Insurers: Outlook Changed to Negative from Stable."

The ACA—signed into law in March 2010—seeks to increase affordability of health insurance and expand both public and private insurance coverage through a number of mechanisms including exchanges, mandates and subsidies.Uncertainty over the demographics of those enrolling in individual products through the exchanges is a key factor in Moody's outlook change, says the rating agency. Enrollment statistics show that only 24% of enrollees so far are aged 18-34, a critical group in ensuring that lower claim costs subsidize the higher claim costs of less healthy, older individuals. This is well short of the original 40% target based on the proportion of eligible people in this cohort, says Moody's.

Looking forward, Moody's expects reduced net earnings margins of approximately 2% in 2014, compared to an average of 3% the previous year and smaller overall membership growth of approximately 1%, down from 3% in 2013, with company strategies continuing to focus on revenue and income diversification.

Still, these changing dynamics will have an uneven effect on insurers, as the impact of these factors will vary by market segment and geography. Moody's view continues to be that the larger and more diversified insurers will be better positioned, both financially and strategically, to meet the challenges facing the sector.

Earlier this week, the conservative American Action Forum released a report which found"that after accounting for subsidies and cost-sharing, 6 out of 7 uninsured, young adult households will find it financially advantageous to forego health coverage, and instead pay the mandate penalty and cover their own health care costs.

*A reader points out that there's a difference between a negative outlook and a formal downgrade, which is what I originally implied. A credit downgrade is likely, but has not yet occurred.

Nevrtheless the Perverse Incentives of the Obama Care Act (Affordable  Care Act) come into play to increase the shortfall of funding health insurance for all, with no limitations..

The American Action Forum prints a readable and understandable explanation of how ObamCare is supposed to work.

This short infographic illustrates the reverse logic for young people

Death Spiral ? Is this the 'Black Hole for the Affordable Care Act

A better title for this may be "Failure to Launch"

Our congress has launched a multi-stage rocket. Whether it will obtain a free standing orbit is open to question.
Stage I success is very much in doubt. The velocity may be inadequate to launch stage II and even if Stage II lights off the orbital insertion velocity will be insufficient to obtain an orbit.

The lack of success in the enrollment process due to the failures of healthcare.gov and other related items in enrollment of young people may be a fatal even in financing the entire initiative for the Affordable Care Act.

This enrollment was meant to offset the expanded coverage for older patients, and increased enrollment of previously uninsured due to income limitations, and patients with pre-existing conditions.

Those in the know are already talking about a 'bailout' for insurers amounting to billions of dollars.  Again, 'it's too big to fail".

Nancy Pelosi was correct, "We won't know what is in it until it is passed"  This is a hell of a way to run 1/6th of our economy.

Prominenrt voices are being raised in the credible media about these real risks. Even dome Democrats have lowered their flag, although there remain some demagoguery and social engineers who are attempting to hi-jack our freedoms and bankrupt our already insolvent government.

Let's face it, our government lies, not only about health care, and politics, but national security issues.

Keep and open mind, but verify what we are being told by our government.

Ideologues and Unrealistic Expectations

Comments from Gary Levin MD are underlined and italicized:

Today I am amazed at an enthusiastic article about the Affordable Care Act by Eugene Robinson from Tallahassee.com.

His unbridled enthusiasm in the face of many difficulties that have nothing to do with health care exemplifies those who designed this law and passed it without reading it.

Here are some of his unsubtantiated claims and perhaps 'wishful thinking'

Eugene Robinson:  Washington Post

"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 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."

1. The fight is not history, we are barely through round one and all the points go to the opponents of the ACA.

2. Six million Americans have not received coverage from the ACA. Registering is only the first step. It took me over ten hours of fumbling on the web site, and on hold via telephone. How many will be able to pay premiums by deadlines, or negotiate the difficult process of acquiring a provider. 

"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."

The upside of the ACA is that all previously uninsurable patients now are enrolled no matter what pre-existing condition they have A+++++.

Can the ACA be improved?  Most definitely. The argument should not be Republican against Democrat.  Political party does not immunize one against illness.

I wholly agree with Mr. Robinson's analysis regarding the eventual goal of a uniform health system.  To call it universal care is a misnomer.

"The real problem with the ACA, and let’s be honest, is that it doesn’t go far enough. The decision to work within the existing framework of private, for-profit insurance companies meant building a tremendously complicated new system that still doesn’t quite get the job done: Even if all the states were fully participating, only about 30 million of the 48 million uninsured would be covered.

Yes Obamacare does not go far enough, however that is not the principle flaw. There is no one principle flaw, if there are any that is the poor analysis  and proposed implementation of a major expenditure that will effect most businesses,  all patients, and our national budget, and come up short.  If we are intent, committed and dedicated to these goals then let's get it right (or mostly right the first time)

Obamacare does establish the principle that health care is a right, not a privilege — and that this is true not just for children, the elderly and the poor but for all Americans.

Throughout the nation’s history, it has taken long, hard work to win universal recognition of what we consider our basic rights

This is a political and philosophical statement, not about health care. We need to keep these issues separate.  I agree with him about the tenet that all people should have health care financing.

Our first step should be to put on hold further mandates while the act is re-evaluated. Repeal is not an option, however amendment is a reality and not an 'existential' argument.

Mr Robinson's  article is not objective, nor unbiased. He totally neglects the weaknesses of the law which will require amendments.  Placing the issue in terms of a 'battle' between political parties does disservice to dedicated professionals who have  been in the system,  and who were neglected during the planning process.

To ignored the flaws would be a fatal mistake, health care costs will soar and there will still be large gaps in the insured population

Contact Eugene Robinson ateugenerobinson@washpost.com.

Contact Gary Levin MD at gmlevinmd@digitalhealthspace.com