05.20.2014

#FullRepeal Daily Digest

Reuters: Obama allies revive push for Obamacare CEO

A group of healthcare experts close to the White House is urging the Obama administration to appoint a new chief executive officer to oversee Obamacare's online health insurance exchanges and safeguard the next open enrollment period that begins in six months. The recommendation, in a report due to be released by the Washington-based Center for American Progress think tank, calls for a major shakeup within the U.S. Department of Health and Human Services, which presided over last year's disastrous rollout of the federal market portal, HealthCare.gov.
The idea would be to take the exchanges out of the current bureaucracy and put them in the hands of a CEO with private-sector experience who could run them as true e-commerce sites. The CEO would answer only to President Barack Obama and his intended new health secretary, Sylvia Mathews Burwell.
The idea is not new. Reform advocates, including CAP pressed the same idea on the White House after HealthCare.gov's October crash, the first in a series of setbacks that posed a political challenge for Obama and his Democratic allies. The administration opted instead for a more narrowly defined health technology czar to rescue the site.

Washington Examiner: Get ready for big bailouts for insurers under Obamacare

During his first run for the presidency in 2008, President Obamablasted the influence of insurance lobbyists and vowed to take on the industry if elected. Yet as president, he passed a health care law that funnels more than $1 trillion in subsidies to insurers, and fines Americans who do not purchase their products. And on Friday, the Obama administration relented to pressure by the insurance industry, vowing to use additional taxpayer dollars to help bail out insurers from losses racked up as part of his health care law.
The issue concerns a provision in Obamacare known as the risk corridors program, which was designed to stabilize insurance premiums in the early years of the law's implementation. Essentially, the idea was to have insurers who do better than expected pay money into a fund within the Department of Health and Human Services that would then be used to finance payments to other insurers who rack up larger-than-expected losses.
The aim was to encourage insurers to sell plans on the law’s new exchanges by reassuring them that they wouldn’t be stuck with major losses if the risk pool turns out to be sicker and thus more expensive than expected. But in the event of industry-wide losses (in which payments to HHS are swamped by claims from insurers), the program could turn into a costly bailout of insurers by taxpayers.
On Friday afternoon, buried within 435 pages of regulations dumped by the CMS, officials quietly backed off their assurances that the program would be budget-neutral. Though the CMS still insists that the expectation is that the program will have more than enough money to fund itself, the agency left open the possibility of more funding if it was not.
“In the unlikely event of a shortfall for the 2015 program year, HHS recognizes that the Affordable Care Act requires the secretary to make full payments to issuers,” the regulation reads. “In that event, HHS will use other sources of funding for the risk corridors payments, subject to the availability of appropriations."
[RELATED] Morning Consult: Republicans Pick New 'Insurer Bailout' Fight

The Los Angeles Times: Growing evidence points to systemic troubles in VA healthcare system

Three years ago Edward Laird, a 76-year-old Navy veteran, noticed two small blemishes on his nose. His doctor at the Veterans Affairs hospital in Phoenix ordered a biopsy, but month after month, as the blemishes grew larger, Laird couldn't get an appointment. Laird filed a formal complaint and, nearly two years after the biopsy was ordered, got to see a specialist — who determined that no biopsy was needed. Incredulous, Laird successfully appealed to the head of the VA in Phoenix. But by then, it was too late. The blemishes were cancerous. Half his nose had to be cut away. "Now I have no nose and I have to put an ice cream stick up my nose at night ... so I can breathe," Laird said. "I look back at how they treated me over the years, but what can I do? I'm too old to punch them in the face."
The VA's internal documents show that the troubled agency has known since at least 2008 that employees manipulate the scheduling system to mask delays in care — what a 2010 memo called "gaming strategies." That memo, written by a VA deputy undersecretary, listed more than a dozen "inappropriate scheduling practices" at medical facilities dating to 2008.
Two years later, in 2012, a Government Accountability Office report concluded that the VA's reporting on its medical appointment wait times was "unreliable," outdated, easily manipulated and in need of complete overhaul. "The bottom line," said Draper, who was part of the GAO review team, "is that no one really knows how long veterans are waiting to receive care."

Oregonian: Thousands have not paid premiums for Cover Oregon health policies, placing coverage at risk

More than 81,000 people went through through Cover Oregon – either through paper or electronic applications—to select a private health plan. Of those, 5,000 havealready cancelled policies or been terminated for lack of payment. Thousands more have not yet paid their first-month's premiums, meaning their have not completed their enrollment, according to carriers.
Cover Oregon allowed consumers with qualifying incomes to access tax credits and other subsidies. Moda Health dominated sales through the exchange, with 40,000 policies sold covering about 55,000 people, including dependents.
Moda spokesman Jonathan Nicholas said "more than 80 percent" of people who used Cover Oregon have paid their first premium, but declined to be more specific. Other insurers gave ratios ranging between 66 percent to 80 percent of consumers who followed through with payments. For instance, people used Cover Oregon to buy 1,500 PacificSource policies but of those only 992 have so far paid their first month's premiums.