Obamacare News of the Day

NBER (Casey Mulligan): The ACA: Some Unpleasant Welfare Arithmetic

• [under Obamacare] between six and eleven million workers would increase their disposable income by cutting their weekly work hours. About half of them would primarily do so by making themselves eligible for the ACA's federal assistance with health insurance premiums and out-of-pocket health costs, despite the fact that subsidized workers are not able to pay health premiums with pre-tax dollars. The remainder would do so primarily by relieving their employers from penalties, or the threat of penalties, pursuant to the ACA's employer mandate.
• Women, especially those who are not married, are more likely than men to have their short-term financial reward to full-time work eliminated by the ACA. Additional workers, beyond the six to eleven million, could increase their disposable income by using reduced hours to climb one of the "cliffs" that are part of the ACA's mapping from household income to federal assistance.

Politico: Health insurers have little info for first estimates of 2015 rates

• Companies are already starting to make estimates based on very limited information. In New Mexico, they’re setting preliminary 2015 rates despite not yet knowing who they’re on the hook to cover in 2014. “It was a challenge last year,” said Jim O’Connor, a principal with the actuarial firm Milliman, which helps insurers set their rates. “And we don’t have a whole lot more to go on this time around.”
• The key factor driving premiums of most employer-based insurance is medical claims. With so little detail on their new Obamacare customers, companies are falling back on proxies: demographic information such as age and gender, historical claims from the parts of the country where they operate, early prescriptions filled by their new enrollees that might indicate chronic conditions such as asthma or diabetes, and adjustments for the pent-up medical needs of the formerly uninsured
• Health plans in New Mexico had to file their rates on Monday, one of the first deadlines in the country. Of course, Monday was also the deadline for Obamacare’s first open enrollment period, which meant insurers were doing calculations even as thousands of new customers were still signing up.

Politico: Pelosi says ACA employer mandate stays

• House Minority Leader Nancy Pelosi on Sunday is dismissing reports of the suggestion by former White House press secretary Robert Gibbs that the employer mandate of Obamacare might not take effect.
• "Of all the things I want to say about the Affordable Care Act, Robert Gibbs' opinion, I don't know who his clients are or what his perspective is, but we are celebrating the fact that we have over 7 million who have signed up," she said. The various provisions of the law, she said, are "all integral." "This is an initiative that has strong pillars in it that relate to each other," Pelosi said.

Wall Street Journal: Some Democrats Fight Obama Over Medicare Lawmakers Ask Administration to Reject Move They Fear Could Undermine Private Plans for Seniors

• More than two dozen Democrats are fighting the Obama administration over planned cuts to private plans offered in Medicare, tied in part to the 2010 health overhaul, which could divide the party on health care in the run-up to this year's midterm elections.
• Other Democrats defend some of the cuts as needed changes. As part of the Affordable Care Act's roughly $700 billion in Medicare savings over 10 years, lower payments to Medicare Advantage insurers are supposed to bring them in line with spending under traditional Medicare. The health law used some of those savings to help pay for its expansion of insurance coverage.
• Since 2010, enrollment in the program has risen more than 30% to an all-time high of more than 15 million, who have seen their average premium fall by 9.8%, Ms. Sebelius said in February. The program has expanded as baby boomers have aged into Medicare and opted for the private plans.
• Democrats have also noted that Republican House Budget Committee Chairman Paul Ryan's budget, unveiled last week, says it will repeal the health law's policies, but incorporates the $700 billion of Medicare savings in its budget assumptions. The Wisconsin lawmaker has said Republicans would look to generate the law's revenue and savings another way when they overhaul the tax code.

Richmond Times Dispatch: Expanding Medicaid is crazy [Rep. Garrett is a GOP member of the VA Senate]

• …we don’t need to expand Medicaid; Medicaid expands itself. Here are the numbers: a 1,600 percent increase in Virginia’s Medicaid spending in 30 years. Twenty years ago, Medicaid was 6 percent of the budget; two years ago, Medicaid accounted for 21 percent (and this occurred while the budget itself was exploding). Simply put, Medicaid is the largest unfunded federal mandate there is.
• Medicaid is so fundamentally broken that expanding it would be like bailing out a sinking boat by adding water. Medicaid has been audited more than 60 times in 10 years because we know that the program is bleeding money.
• Democrats argue that we lose “federal tax dollars” if we don’t expand. This is flawed on several levels. The federal government is offering about $2 billion for Medicaid expansion. This money is guaranteed for a few years, and then goes away. Look at the billions taken from our seniors and Medicare to fund Obamacare. The “federal” money is temporary, the expanded program will continue. Reagan said “the closest thing to eternal life is a government program.” Once the “federal” money is gone, two things happen: (1) Virginians will have to make up the shortfall, and (2) those arguing for expansion will try increasing taxes, doubling down on a broken program.
  • The “federal” dollars argument also fails because taxpayers aren’t concerned whether their taxes were local, state or federal — they are only concerned about fewer dollars in their wallets. Virginia is 12th in terms of federal income taxes, paying more than $64 billion annually. When Obamacare lures us in using a short-term promise to return one thirty-second of that revenue, they’re bribing us with our own money!

Wall Street Journal: In Praise of Medical Scribes An old-fashion remedy for the ills of electronic record-keeping

• We often think that a complex problem (such as health care in the U.S.) requires a complex solution (ObamaCare). Yet some important issues that are not adequately addressed with the current health-care overhaul include decreased patient and physician satisfaction, reduced access to care, and the increasing cost of care. For instance, the electronic medical record-keeping that has been mandated as part of new health-care policy has complicated the lives of many physicians and led to substantial physician dissatisfaction.
• There is an inexpensive, market-based approach to addressing some of these problems: the use of medical scribes. Medical scribes are typically students with a college degree who are planning to go into the health-care profession. They perform multiple tasks under physician supervision including reviewing a patient's medical record, writing a note summarizing previous clinic visits and hospitalizations, finding and copying relevant test results, documenting the physician's findings and treatment recommendations about a patient's problems, typing instructions to the patient, entering billing codes and scheduling future visits, among other things.
• …When a scribe was used, physician productivity (measured as patients seen per hour) increased over 50%, and revenue to the clinic and affiliated health-care system increased markedly. Although the time spent in each patient's room was reduced by about 30%, the time in direct interaction with the patient (e.g., without the computer for entering patient information) increased significantly, and an independent assessment of physician-patient interaction was judged improved.
• Over the past two years, I have been using scribes for all my clinic visits. My patients either barely notice a scribe is in the examination room with me or comment on how they love having my undivided attention. I am now seeing over 30% more patients per hour than my colleagues who are not using scribes, staying on schedule, and finishing at the clinic on time. Patients calling to schedule a visit can see me much sooner than previously due to increased open slots on my schedule.

New York Times: Get Rid of the Individual Mandate [Reinhardt, the author, is a well regarded liberal health economist. However, the solution isn't to reconfigure a better mandate or incentive within Obamacare as he suggests– it's to repeal the law and expand choice and ownership over health care dollars]