05.21.2014

#FullRepeal Daily Digest

The Los Angeles Times: Federal funds earmarked to offset Affordable Care Act insurer losses

The Obama administration has quietly adjusted key provisions of its signature healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money. The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall's congressional elections. Administration officials for months have denied charges by opponents that they plan a "bailout" for insurance companies providing coverage under the healthcare law.
Obama administration officials said the new regulations would not put taxpayers at risk. "We are confident this three-year program will not create a shortfall," Health and Human Services spokeswoman Erin Shields Britt said in a statement. "However, we want to be clear that in the highly unlikely event of a shortfall, HHS will use appropriations as available to fill it."
[RELATED] Washington Examiner: CMS says it will use 'other sources of funding' to finance health insurer bailout, if needed

CATO: How VA Hospitals Are a Government-run Disaster

Earlier this month, the American Legion called for Secretary of Veterans Affairs Eric Shinseki to resign. No doubt Gen. Shinseki was asleep at the switch. But the problem goes well beyond an incompetent cabinet secretary or a few corrupt local bureaucrats.
Nobel Prize-winning economist and New York Times columnist Paul Krugman has long touted the VA system as the epitome of government-run healthcare. “Exhibit A for the advantages of government provision [of healthcare] is the veterans administration, which runs its own hospitals and clinics, and provides some of the best-quality healthcare in America at far lower cost than the private sector,” Krugman claims.
And he is right … at least about the VA being exhibit A for government healthcare. Like all single-payer health systems around the world, the VA controls costs by imposing a “global budget” — a limit to how much it can spend on care. Thus year-to-year funding varies according to the whims of Congress, not according to what consumers want or are willing to spend.
With tens of thousands of wounded soldiers returning from the wars in Iraq and Afghanistan, the demand for care is rising dramatically. Enrollment in VA services has increased by 13% from 2007 to 2012. Despite a 76% increase in expenditures ($24 billion) over that period, the program still suffers from chronic budget problems. In fact, the Congressional Budget Office estimates that it would require as much as a 75% increase in inflation-adjusted funding for the VA to treat all veterans. When resources can’t meet demand in a given year, the VA does what other single-payer systems do: It rations.
Even accessing the system can be a major problem. Currently, the case-processing backlog exceeds 344,000 claims. Although the VA says it has a policy of processing claims within 125 days, it actually takes an average of 160 days for a veteran to gain access to his health benefits. Moreover, the VA itself estimates that it has at least a 9% error rate in processing claims. Outside groups claim the error rate is much higher.
Appealing a VA decision can be an even more arduous process. A veteran who takes an appeal through all available administrative steps faces an average wait of 1,598 days, according to VA figures for 2013. Moreover, because funding decisions are determined through the political process rather than by patient preference, the money is often misallocated. VA hospitals with low utilization rates are built or kept open not out of need, but because they reside in the districts of powerful congressional committee leaders. At the same time, other hospitals without political clout are overflowing.

The Wall Street Journal: Don't Stop Thinking About ObamaCare More problems, and arguments, lie ahead

President Obama keeps insisting the debate over ObamaCare is "over." That declaration, wish, exhortation or command does not correspond with reality. A new Politico poll of voters in "hotly contested areas"--states and congressional districts thought to have competitive Senate or House contests--finds that 60% "say they believe the debate over the law is not over," whereas only 39% "echo the president's position" that the "debate has effectively concluded."
Of course the vast middle ground of "modify the law without repealing it" is terra incognita. It is as accurate as Burns's formulation ["Forty-eight percent of respondents endorsed repeal, versus 35 percent who wanted to modify the law without repealing it and just 16 percent who said it should be left unchanged."], and no less precise, to say that those who want to leave the law as it is are outnumbered more than 5 to 1 by those who want to repeal or change it.
There's an additional ambiguity: What does it mean to leave the law "unchanged" when the Supreme Court has already struck down parts of it and the administration has declined to follow or enforce others? That's not a salient question for immediate electoral purposes; in terms of voting intention, "left unchanged" can be taken as a statement of support for the Democrats. But even if the statutory language proves resistant to any effort at modification, there will be a new administration after 2016. That could mean more discretionary (or extralegal) changes and perhaps the end of ObamaCare as we know it.
"ObamaCare as we know it" is also an ambiguous turn of phrase, to say the least, for what do we know of ObamaCare? A few provisions are relatively straightforward, such as the expansion of Medicaid eligibility (in those states that have gone along with it) and the mandate that family insurance plans cover 23-, 24- and 25-year-old children of policyholders. But the whole of ObamaCare is an insanely complicated scheme that even experts are still struggling to understand. "We have to pass the bill so that you can find out what is in it--away from the fog of the controversy," then-Speaker Nancy Pelosi famously said in March 2010. We'll be finding out for many years to come, and there's no reason to think that "fog" will ever lift.
[RELATED] Commentary: We're Still Talking About ObamaCare Because Obama Designed It That Way

Washington Examiner: Mike Pence sides with hospital lobbyists in Medicaid fight

Expanding Medicaid by millions of individuals translates into more revenue for hospitals. This is an especially sensitive issue because Obamacare imposed cuts on Disproportionate Share Hospital payments, which are sent to hospitals that serve a large number of low-income patients. The theory behind the cuts was that the expansion of Medicaid would reduce hospitals' uncompensated care costs. In states that don't expand Medicaid, however, hospitals will have to absorb those cuts, and they won't have the offsetting benefit of more federal money.
Though hospitals will be asked to start making contributions to help finance the Pence plan after two years, the article explains, “hospitals as a whole will receive more benefits than they’ll incur in costs” under the plan. “Is this overall, the totality of this, is this still a good deal? Yeah,” said Brian Tabor, a lobbyist who led the hospitals' negotiations, according to the article.

The Federalist: Don't Worry, Obamacare Premiums Are No Big Deal [a tongue in cheek title which unwraps a Vox article understating why Obamacare premium are increasing]

So what does all of this mean for premium increases under the Obama regime? In spite of [Vox's] Ms. Kliff’s blinders, we know for a fact that requiring richer benefits raises costs, and Obamacare requires coverage of many benefits that no state has ever required before. We know for a fact that other regulations such as community rating and guaranteed issue dramatically raises costs, and Obamacare requires the entire country to do that. And we know for a fact that attracting the sick and repelling the healthy will cause premiums to skyrocket. While the jury is still out, almost every intelligent analyst believes that is what is happening (and what will continue to happen) under Obamacare.

NCPA: The Numbers Are In: Obama Failed to Recruit "Young Invincibles" Into ObamaCare

President Obama declared that 35 percent of enrollees in the exchanges are under the age of 35. However, his statement is a piece of lawyerly evasion, as first identified by Glenn Kessler of the Washington Post.
Under 35″ includes children, and that is not who is needed in the exchanges. Most of them would have enrolled with their parents in a family health plan. Those minors add very little to the premium of a family plan. The young people needed in the exchanges are the so-called “Young Invincibles”, who are between the ages of 18 through 34. These comprise only 28 percent of enrollees in ObamaCare — almost one third fewer than the 40 percent needed.