07.10.2014

#FullRepeal Daily Digest

The Wall Street Journal: What the HHS Reports on the Health Exchanges Didn't Cover

One HHS report examined data from federally run exchanges through Feb. 23 and from state exchanges through last December. Put another way, federal auditors tallied data from the months when the exchanges experienced middling to sluggish enrollment—not the periods when the greatest number of applications were completed.
The inspector general’s report indicates that federally run exchanges had 2.9 million data inconsistencies, of which only 1% had been resolved by late February. But those figures underestimate the number of inconsistencies from the 2014 open-enrollment period—and, unless data resolution has dramatically improved in recent weeks, probably also underestimate the number of inconsistencies still pending.
A separate inspector general’s report also released on Monday found that federally run exchanges, and state-run exchanges in California and Connecticut, in many cases lacked proper procedures for verifying applicant information. As a result, applications that should have been flagged for additional inconsistencies were not. Again, the scope of the verification problem is most likely understated.
When troubles became clear with the exchanges last fall, the focus on fixing immediate technical issues led to deferred work on verification systems. Overall, the reports expose another facet of the failures of HealthCare.gov—and the after-effects of last fall’s rollout could persist for some time.

The Wall Street Journal: How Proposals for Obamacare Subsidies in 2015 Could Cost Taxpayers

In its proposed rule and related guidance for the 2015 open-enrollment season, the administration made two key decisions about determining re-eligibility for insurance subsidies. First, the guidance indicates that the exchanges would request updated tax return information solely from the IRS to determine eligibility for 2015 subsidies. Currently, the exchanges determine eligibility using information from the Social Security Administration and other income data sources, as well as tax information.
Second, most individuals who do not respond to requests to update their information would remain eligible for subsidies in 2015 at the same amount they received this year. (Their subsidies would not increase because of higher age or any premium changes.) Only individuals whose incomes appear to vastly exceed the thresholds for subsidies—what’s likely to be a “very small” group, HHS said in its guidance–or those who did not authorize the exchanges to review tax return data would not automatically receive subsidies in 2015.
The administration is seeking to streamline the process to determine eligibility, but the HHS inspector general’s investigations found the existing processes to be largely ineffective. An HHS report last week noted nearly 1 million inconsistencies relating to income reporting on applications.
Because that includes only the federally run exchanges and only cases handled through Feb. 23, the number of inconsistencies is probably significantly understated. The inspector general’s office also found that HHS had resolved only about 1% of inconsistencies that occurred on the federal exchange between Oct. 1, 2013, and Feb. 23, though the health-reform law requires the department to resolve issues within 90 days.

Kaiser Health News: Feds Demand Medicaid Backlog Fixes by Six States

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states [AK, CA, KS, MI, MS and TN] until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage.
A Kaiser Health News analysis of 15 large states in June found that more than 1.7 million more were still waiting for their applications to be processed—with some stuck in limbo for as long as eight months.
The reasons for the problems include technological glitches that prevented the federal insurance marketplace from transferring data on applicants to state Medicaid agencies. Also, many states were unable to handle an enrollment surge because of inadequate staffing, their own computer problems and other issues.

Reason: No, 20 Million Haven't "Gained Coverage" Under Obamacare

A report in the New England Journal of Medicine tallies up the various ways that Obamacare has expanded health insurance coverage and estimates that a total of 20 million people have "gained coverage under the ACA" as of May 1.
…the sources used for this tally don’t offer the kind of precision necessary to be confident in the headline estimate. It’s not possible to pin down the exact number of people covered because of the law, but this figure is almost certainly overstated.

USA Today: 'Staggering' pain claims in Brooklyn stoke suspicion

A USA TODAY analysis reveals that some of Medicare's top-earning specialists are in the New York City borough and sharing thousands of Medicare patients in volumes much higher than the norm. In hundreds of cases, patients have seen several pain specialists on the same day, shuffling between therapists who have billed Medicare for tens of thousands of procedures. In one case, a chiropractor and an occupational therapist saw the same patients on the same day more than 11,000 times in 18 months.