08.12.2014

#FullRepeal Daily Digest

Investors Business Daily: ObamaCare Enrollment Is Shrinking, Top Insurers Say [it is too early to say with certainty, but it is at least plausible that actual Obamacare enrollments have fallen recently]

ObamaCare exchange statistics should clear up any doubt as to why the Obama Administration has been tight-lipped about enrollment since celebrating 8 million sign-ups in mid-April.
The nation's third-largest health insurer [Aetna] had 720,000 people sign up for exchange coverage as of May 20, a spokesman confirmed to IBD. At the end of June, it had fewer than 600,000 paying customers. Aetna expects that to fall to "just over 500,000" by the end of the year. That would leave Aetna's paid enrollment down as much as 30% from that May sign-up tally.
Cigna said that it expects its individual market customers, including more than 100,000 in the exchanges, to "move from 300,000 down to 280,000 in that range," Cigna CEO David Cordani said in a conference call. Other major insurers danced around questions about attrition on recent earnings conference calls, but none denied that it was occurring.
[RELATED] The New York Times: Medicaid Rolls Are Growing Even in States That Rejected Federal Funds [many people who were sold a brave new world of robust Obamacare coverage are finding that they're confined to a disastrous government program with a decades long track record of poor results]
- Data from Medicaid released Friday show that enrollment jumped in most states that did not expand their programs, including Georgia (16 percent), Montana (10 percent), Idaho (9 percent) and Florida (7 percent). Altogether, enrollment in Medicaid and the Children’s Health Insurance Program in the states that didn’t make any changes has gone up by 975,000. The reason is a phenomenon that health experts like to call the “welcome mat effect” or the “woodwork effect,”...

The Hill: ObamaCare premiums slated to rise by an average of 7.5 percent [analysis done by the Health Research Institute at PricewaterhouseCoopers]

Overall, the highest average price increases under ObamaCare so far have come in Indiana, where some consumers will see prices rise by 15.4 percent. The biggest average savings were found in Oregon, where premiums will drop an average of 2.5 percent in 2015.
"The average individual monthly premium for next year, before any subsidies are applied, is $384," Connolly wrote. "And insurance commissioners get a chance to weigh in on rates before fall enrollment."

The Wall Street Journal: Small Firms Hit by Big Changes in Health Coverage

Several thousand of the nation's smallest business owners—sole proprietors and the self-employed—were kicked off their small-business plans by carriers earlier this year. That is because new guidelines define "employers" as having at least two full-time employees, not including a spouse, in order to be eligible for group plans.
In all, more than 78% of the estimated 28 million small businesses in the U.S. have no employees, according to the Small Business Administration. These business owners must now seek coverage as individuals, or face fines.

Philly.com: With health law, ERs still packed Emergency-room visits have increased at many hospitals. A shortage of primary-care doctors is one reason.

An online study by the American College of Emergency Room Physicians found that nearly half of its members have seen a rise in visits since Jan. 1 when ACA coverage began. A resounding 86 percent of the physicians said they expect that number to continue growing.

MedPageToday: Regulators Shrug at Docs' Network Concerns [a news source from a physician's perspective]

If you are confused about which health networks your practice is listed in among those on your state's health insurance exchange, you might be pleased to know that state insurance regulators are revising a model rule addressing the need for "adequate" networks of providers. Unfortunately, however, ending your confusion about whether you're in or out of a particular network isn't a top priority for the regulators.

NCPA: Debate over Sovaldi is Misleading

Much has been made of the $84,000 price tag for the Hepatitis C treatment Sovaldi [Democrats and some GOP members are already concocting ways to make this more "affordable"], a groundbreaking new drug from Gilead Sciences that can cure Hepatitis C. According to the head of the health insurers' trade association, the drug is simply too expensive.
Sovaldi appears wildly expensive because the drug requires one big upfront cost. In the long run, however, the $84,000 drug can prevent far more expensive medical costs that would otherwise occur.
- As reported by the New York Times, more than half (60 percent) of Hepatitis C patients end up with chronic liver disease, while one-fifth have cirrhosis.
- While not all Hepatitis C patients will need one, a liver transplant can cost up to $600,000.
…liver disease can develop over two or three decades. In 2015 and 2016, patients can expect to see medical costs rise by 0.7 percent each year due to patients (an estimated 80,000 per year) taking advantage of the new drug. But starting as early as 2017, spending growth should begin to fall slightly as long-term costs are averted. Despite these long-term gains...insurers remain concerned about the price of the drug. Because so many Americans routinely change their insurance, many insurers are loathe to pay out large sums of money that may not save them costs in the long-run.
[As author John Graham explains] the answer to such a problem is health status insurance which doesn't last just one year and change from job to job, but it would allow people to insure against future chronic illnesses. This creates incentives to detect and remedy health problems before they become threatening and expensive.

Texas Tribune: Feds: Texas Responsible for Misspent Medicaid Dollars

Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims.
For nearly five years, the Texas Medicaid and Healthcare Partnership (TMHP), a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control: Between 2003 and 2010, Texas Medicaid payments for orthodontic services grew by more than 3,000 percent — from $6.5 million to $220.5 million — while program enrollment only grew 33 percent. By 2012, federal and state auditors found that the contractor’s actions had opened the door to a “massive Medicaid fraud scheme” that cost taxpayers hundreds of millions of dollars.

Politico Pro: Consumers' next Obamacare challenge: Tax forms

If consumers thought logging on to HealthCare.gov was a headache, sorting through complex forms ahead of tax deadline day 2015 is their next big Obamacare challenge. The health care law’s benefits are rolling out, but its major math problems start next year as the IRS tries to ensure that millions of Americans are correctly calculating their benefits and that those who don’t have coverage are penalized unless they qualify for an exemption.
That means much new paper-shuffling between now and April 15, which could be especially confusing for low- and middle-income Americans unaccustomed to lots of reporting to the IRS.The insurance exchanges and employers must send consumers details about their health plan and benefits or exemptions in time for them to file a tax return. If any of that information is delayed or wrong, tax refunds could be delayed.