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Obamacare Shills Try Heroic Measures

01 Saturday Nov 2014

Posted by Nuetzel in Uncategorized

≈ 1 Comment

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ACA, Business Week, CHIP, Cronyism, Death Spiral, Employer Sponsored Plans, Forbes, Government Failure, Health Care Exchanges, Mandates, Medicaid, Obamacare, USA Today, Welfare Programs

obama-health-care

Die-hard Obamacare supporters are in full denial over the lousy results of the health care plan in its first year. They’re tone deaf, living a delusion. This piece from Forbes.com notes that the Affordable Care Act (ACA) has been an abject failure thus far on six of seven major counts, and even the one “success” is terribly blemished. Close to 90% of the increase in the number of insured is due to expansion in the Medicaid and state Children’s Health Insurance Program roles. Both of those welfare programs predate the ACA and certainly could have been expanded without Obamacare and its collateral damage to existing health plans and the health care industry. In fact, according to Business Week, less than half of physicians now accept Medicaid, so it’s not always easy for those “newly insured” individuals to gain access to actual care.

In fact, Medicaid patients are not the only ones with access problems. This USA Today article linked by Forbes notes that physicians are limiting the number of Obamacare exchange-covered patients they’ll accept. After the disastrous unraveling of the “if-you-like-your-plan-you-can-keep-it” fiction, it was revealed that many of the policies foisted upon the “previously-insured-but-no-longer” group through Obamacare exchanges offered severely limited provider networks. If you liked your doctor, you might well have lost your doctor.

For the majority who do not qualify for taxpayer subsidies under Obamacare, the health insurance premia on policies acquired on the exchanges have risen drastically. This problem is covered in the Forbes article. Far less expensive short-term plans are being offered by insurers as an alternative to Obamacare, but they are only renewable if the insured remains healthy. It is precisely these kinds of circumstances that might devolve into a death spiral for Obamacare: an increasingly sick risk pool and universal rating may lead to accelerating premium hikes for the exchange policies.

So, prospects for improvement under the ACA are quite bleak. We’ve seen a botched rollout of the Obamacare website, the chief enrollment vehicle, which is still problematic; a wrecked individual market with policies cancelled and replaced by coverage with limited provider networks; a medical device industry battered by new taxes; a negative impact on full-time employment as firms reduce hours to avoid coverage requirements; expanded welfare programs with a concomitant burden on taxpayers; increased emergency room utilization; physicians opting out due to inadequate reimbursement and high compliance costs; healthy individuals opting out and sick individuals opting in; higher premia with more increases on the way and the prospect of an insurance death spiral; and we’ve seen arbitrary exemptions carved out for various cronies of the Obama administration all along the way. Oh, and we’ve seen lies, delays, and every effort to back-load costs and front-load benefits, an implementation governed by political considerations rather than improving health care. The next shoe to drop is likely to be widespread cancellation of employer-sponsored coverage as the ACA coverage mandate hits employers in 2015.

Desperate propaganda continues to flow, but that can’t change the fact that Obamacare is terrible policy with results to prove it. Here is government failure.

More Obamacare Follies

31 Thursday Jul 2014

Posted by Nuetzel in Uncategorized

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ACA, adverse selection, crony capitalism, Don Boudreaux, Medicare, Megan McArdle, Obamacare, rent seeking

follies
Disconcerting news regarding the administration of the ACA just keeps on coming. The so-called “risk corridors” represent a bailout for health insurers for whom Obamacare premium revenue proves inadequate. Sure enough, but more interesting is how the Obama administration attempted to manipulate several provisions of the law on reimbursement in order to keep insurers happy after other changes with negative implications for their risk pools. In addition, when insurers expressed alarm about the “budget neutrality” of the corridors, the administration backtracked on that position. “… the administration had a choice: provide a bailout, or face the unpleasant prospect of having insurers price their products honestly.” The unfolding of these events is detailed in Emails Show Cozy Government- Insurer Alliance….

Don’t get too excited about the improvement in Medicare’s finances under the ACA. The chief actuary for the Centers for Medicaid and Medicare Services says that the ACA’s Medicare changes aren’t sustainable. Reimbursement rates under the ACA are inadequate barring “an unprecedented change in health care delivery systems and payment mechanisms.” In other words, an unlikely advance in productivity will be necessary in order to make Medicare’s finances work.

A few days ago, I posted about the Halbig vs. Sebelius District Court decision here, highlighting Jonathan Gruber’s one-time defense of the ACA’s rules that premium subsidies could be paid only on policies purchased on state exchanges. More recently, he claimed that the rule was not the intent of the legislation. Here are some further thoughts from Don Boudreaux on Gruber’s memory lapse, in which he links to a piece by Megan McArdle. Boudreaux:

The very claim that such a simple “mistake” infects the ACA calls into question the competence (or the incentives, or both) of elites, both political and intellectual, who seek ever more power for government.

Obamacare Web Weavers Tangled Again

27 Sunday Jul 2014

Posted by Nuetzel in Uncategorized

≈ 2 Comments

Tags

federal subsidies, Halbig vs. Sebelius, insurance exchanges, Jonathan Gruber, Obamacare

Speak-O 

Did Congress intend to deny subsidies to those purchasing health insurance on federal exchanges under Obamacare? The DC Circuit Court ruled that it did, based on the “plain language of the law,” in last week’s Halbig v Sebelius decision. Shikha Dalmia writes that the howls of protest from some ACA supporters are disingenuous at best, especially those from health economist Jonathan Gruber, who was a key player in designing the law. In 2012, his standard talking points included assertions about incentives for states built into the law. On at least three occasions, Gruber said that any state would be crazy not to set up its own exchange because that would deny its citizens the right to federal tax credits on premium costs. Obviously, Gruber did not anticipate the backlash against the ACA, as manifested (among other things) by 36 “crazy” states refusing to set up their own exchanges.  

Earlier this week, before proof of Gruber’s earlier statements had surfaced, he insisted to Chris Matthews that the “plain language” on this point in the ACA was something like a typo. Later, when the first Gruber video was revealed, he stated that his comment was mistaken, that it was a “speak-o.” Hahaha! Nice try.

Key legislators certainly knew that the state exchange requirement was built into the ACA, as this video of remarks from Max Baucus at a Senate Finance Committee hearing proves. Of course, many legislators might have missed this point, but the bill never went through a careful mark-up process, and of course some lawmakers, like Nancy Pelosi, felt that they had to “pass the bill to find out what’s in it.” Well, after all, should busy legislators be bothered to read a 1,400 page bill prior to a vote? 

Deductible Concept Sprung On Newly Insured

19 Saturday Jul 2014

Posted by Nuetzel in Uncategorized

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ACA, adverse selection, Deductible Shock, Obamacare, Unintended Consequences

image

No, the monthly premium on your Obamacare coverage does NOT cover your deductible and copayments. You’re still on the hook for those bills. Apparently, that reality comes as a shock to many of the newly insured. And apparently, that reaction was unexpected by the drafters of the ACA as well as HHS, the state exchanges, and various organizations involved in the implementation of Obamacare. So, many of the previously uninsured, intended as the chief beneficiaries of the ACA, are feeling disillusioned, even jilted, by the terms of their coverage. As if the poor risk profile of enrollees weren’t bad enough, and amid continuing doubts about whether those purchasing coverage under Obamacare are actually paying their premia, the confusion among this constituency is a bad omen for the sustainability of the program.

Time For OTC Contraceptives

02 Wednesday Jul 2014

Posted by Nuetzel in Uncategorized

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Contraceptives, Hobby Lobby, Obamacare, OTC, Prescription Drugs, Small Government, Vox

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Here are seven reasons birth control pills shouldn’t require a prescription, offered by Adrianna McIntyre in Vox. There is much concern over “access” to contraceptives in the wake of the Hobby Lobby decision. While any new concern is largely misplaced, the biggest impediments to access might well be the prescription status of these drugs and their cost. Making contraceptives available over-the-counter would do a great deal to reduce these problems while leaving everyone else with a clear conscience. In fact, it would greatly improve access for the uninsured, a group which will remain large despite the best intentions of Obamacare supporters. As the Vox article notes, physicians support the move to make contraceptives available OTC, and it is highly feasible politically, though support will be contingent on certain safeguards, such as restrictions on sales to minors. Otherwise, it is a classic “small government” solution.

Abortifacients and Hobby Lobby

01 Tuesday Jul 2014

Posted by Nuetzel in Uncategorized

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Abortifacients, ACA, Contraception Mandate, Corporate Form, Hobby Lobby, Obamacare, Supreme Court

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Some are apparently too lazy, propagandized or ignorant to understand the facts underlying the Supreme Court’s Hobby Lobby decision. But not too lazy to re-tweet or re-post unreliable information.

Here is what the decision means:

1) The decision was narrower than the sloppy memes and some media reports would have you believe. Of the 20 different contraceptives approved for use by the FDA, only four are affected by the decision. Hobby Lobby offers the other 16 through its employee health plan, and it will continue to offer them. The four it is no longer required to offer through its plan are so-called abortifacients, which destroy an already fertilized egg. The ruling does not imply that Hobby Lobby can avoid covering other “mandated benefits” under Obamacare, including the other 16 contraceptives. (In my view, however, the entire coverage mandate should be struck down as well, keeping employer-provided health care benefits a private contactual matter. The specifics of the mandate were not part of the ACA legislation. They were promulgated by bureaucrats at HHS for whom overreach has no meaning.)

2) In general, when individuals decide to associate or act under a corporate form, the corporation assumes the rights they possess as individuals. Human action taken under the corporate form does not involve a diminution of individual rights. Yet the left acts as if people have no rights when acting under the corporate form. Incorrect. Speech, religion — all rights that are granted to individuals under the Constitution are guaranteed to them whether they act as a corporate association or not.

3) The decision in Hobby Lobby applies only to closely-held corporations, the shares of which are not publicly traded. These are not the “faceless corporations” of popular infamy, but are often family-owned companies, associations of partners, or professional practices. Publicly-traded corporations are not affected by the ruling. Only privately-held corporations with more than 50 employees (under the original provisions of the ACA) are affected.

4) The decision does NOT interfere with womens’ rights to obtain most contraceptives. It means that the government cannot force Hobby Lobby to pay for abortifacients, and female employees have an unrestricted right to pay for abortifacients out of their own pockets. They are employed, after all. In addition, the ruling has nothing to do with coverage of abortion procedures that might be necessary when a mother’s life is at risk.

5) The government is not restricted, except as a possible matter of politics, from offering all women free access to abortifacients. It has not offered to do so, however. Therefore, under the 1993 Religious Freedom Restoration Act (RFRA), signed by President Clinton, the Court held that the government cannot impose any burden on private parties (including individuals organized as closely-held corporations) in violation of their religious beliefs if there is a less burdensome alternative available. The RFRA’s importance to the Hobby Lobby ruling is discussed here.

6) Some have accused Hobby Lobby’s owners of hypocrisy, since they sell goods imported from China, where abortion is often coerced by the state. And that might be hypocritical, but the only possible relevance to the case would be if the purchase of Chinese goods reflected on the sincerity of their religious beliefs. That is a litmus test that few would sanction. A beauty of private markets is that they tend to be impersonal, allowing individuals of different cultural practices and beliefs to trade peacefully with one another if they so desire. That has no bearing on the type of labor contract that Hobby Lobby may offer its own employees. In any case, the ruling applies more broadly than to Christian importers of Chinese goods.

Aside

Just Insurance? Or Unjust Insurance?

29 Sunday Jun 2014

Posted by Nuetzel in Uncategorized

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Tags

ACA, adverse selection, central planning, Obamacare, Risk Ratings

Ambulance

Voices from the left keep insisting that universal coverage and a single, all-inclusive risk pool is “just insurance,” and that anyone standing in opposition just “doesn’t understand insurance.” The argument is usually extended to the idea that all individuals must receive and pay for a comprehensive set of benefits, going far beyond any reasonable notion of catastrophic coverage. Proponents of this view advocate an extreme form of socialized health coverage that eliminates private choice and traditional risk-rating.

In a free society, individuals cannot be coerced into cross-subsidizing activities that might violate their religious convictions. It is hoped that this will be affirmed by the Supreme Court’s Hobby Lobby decision, likely to be issued this Monday.

Likewise, in a free society, individuals should not be forced to cross-subsidize private choices made by others. Preserving the right of individuals to purchase the benefits and coverage levels of their choice at reasonable premia (e.g., catastrophic care only or “wellness” features, no pregnancy coverage for senior citizens, risk-based pricing) is crucial. Providing care for high-risk individuals with pre-existing conditions need not involve a dismantling of the private health insurance market.

Of course, Obamacare has fallen short of the socialist “ideal,” either before or after all of the exceptions, delays, and waivers made by the administration and HHS. Its design, nevertheless, has had a destructive impact on the private insurance market, and the program is straining under the effort to provide high-risk coverage. In “Obamacare’s Prognosis Grows Dimmer,” Lanhee Chen discusses how adverse selection is playing out on the Obamacare exchanges. Based on the evidence available thus far, the exchanges appear to be laden with a high percentage of sick individuals. This is likely to lead to more premium shock for enrollees as we head into the mid-term elections.

A path toward providing effective coverage for pre-existing conditions is discussed in this article. It asserts that a solution hinges on the ability for individuals to make seamless transitions between employer-provided coverage and individual coverage, even with pre-existing conditions. Since that ability must apply nationwide, the authors also assert that there must be a role for federal funding of the high-risk pool of individuals making the transition to the individual market.

Government Failure: Quicksand For the Quixotic Left

30 Friday May 2014

Posted by Nuetzel in Uncategorized

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central planning, Obamacare, Technocracy

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Progressives have always placed great faith in the ability of government technocrats to correct perceived social ills and do economic planning. This attitude inevitably leads them to drift into elitism. The naive Left, on the other hand, really don’t think much about how the government will do it, but both groups dream the impossible. That’s the general theme of the essay at the link, with more specific application to Obamacare. The opening paragraph is fun:

“They had a dream. For almost a hundred years now, the famed academic-artistic-and-punditry industrial complex has dreamed of a government run by their kind of people (i.e., nature’s noblemen), whose intelligence, wit, and refined sensibilities would bring us a heaven on earth. Their keen intellects would cut through the clutter as mere mortals’ couldn’t. They would lift up the wretched, oppressed by cruel forces. Above all, they would counter the greed of the merchants, the limited views of the business community, and the ignorance of the conformist and dim middle class.”

To quote Tyler Cowan, “The technocratic utopia is not on the menu.” Worse yet, by tilting ever-more government (and taxpayer) resources at windmills, leftist initiatives displace and discourage private activity, the real engine of economic growth. Prosperity tends to solve social ills quite effectively.

I confess that I’ve ceded too much La Mancha to the Left in this post. Perhaps the Libertarian Capitalist is better cast in the role of Don Quixote, and many of us are severe critics of subsidized wind power!

The VA and Government-Run Health Care

29 Thursday May 2014

Posted by Nuetzel in Uncategorized

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ACA, IRS Penalties, Obamacare, The Onion, Veteran's Affairs, Waiting Lists

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With Obamacare already on thin ice with the public, the problems at the VA are reinforcing the disadvantages of government-run health care. And if ACA proponents consoled themselves that the law was merely a step toward the “inevitable” single-payer system, the VA monopoly should not inspire hope. As noted elsewhere, one of the biggest costs of socialized medicine is always in the wait, a cost which is absent from official accounting reports.

The VA debacle is very bad news for the Obama Administration, not because it is their fault, though they have known about the fraudulent waiting lists for at least a year. Instead, for Obamacare, it is a public relations nightmare, as noted in this article: “Most Important Casualty of Veterans Affairs Scandal Could Be Obamacare.”

In another disturbing development, fit for an honored place in the pantheon of dumb government incentives, a new IRS ruling holds that employers who “dump” employees onto the federal exchanges will be fined up to $36,500 per year per employee! Granting the employee a raise to pay the premium will not gain the employer a dispensation. Only by firing the worker can they avoid the penalty. This is discussed here.

Here’s some commentary from the Onion that gets right to the heart of the VA problem: VA To Improve Veterans’ Health Care With New $500 Million Waiting Room. See the photo above for The Onion artist’s rendering of the new VA waiting room.

Physician: Why Take Insurance?

30 Wednesday Apr 2014

Posted by Nuetzel in Uncategorized

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Mandates, Obamacare, Price Controls

Image

Bravo to Daniel Craviotto for penning A Doctor’s Declaration of Independence, appearing today on wsj.com. It’s a condemnation of Obamacare from a man who understands sound medicine. Like many physicians, he’s had it with mindless regulations that take time away from patients and and interfere with the application of medical expertise. And he’s had it with the distortions that are typical of price regulation. “So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?”

 

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