Economics, Health Care

What we learned about Obamacare today: Dec 17, 2013

1.) It’s less than a week until the December 23rd deadline for people to sign up for coverage starting January 1st. “About 1.9 million people have made it deep into the online process so far but have not yet selected coverage.”

2.) This morning President Obama met “with executives from leading technology companies, including Google, Microsoft and Apple, to solicit suggestions on the federal health care exchange website.” The 15 executives included “Apple CEO Tim Cook, Facebook COO Sheryl Sandberg, Twitter CEO Dick Costolo, Yahoo CEO Marissa Mayer, Google Executive Chairman Eric Schmidt and Microsoft Executive Vice President Brad Smith.”

3.) Should hospitals be allowed to pay Obamacare premiums? Louise Radnofsky and Christopher Weaver write that insurers are fighting hospitals trying to do just that. It seems “offers to help low-income people afford coverage could undercut economics of law,” and there is “contradictory guidance from HHS”:

Nonprofits, including some hospitals, say paying premiums would ensure coverage for people currently uninsured who can’t afford even a small monthly payment for health insurance. But insurers say they can’t make a profit unless the health-insurance exchanges created by the Affordable Care Act draw a balanced mix of healthy and sicker customers…. Help from nonprofits or hospitals could speed the arrival of less healthy customers into the exchanges, outpacing the arrival of younger, healthier people who might not cross paths with hospitals….

Hospitals making such payments would be fulfilling the law’s mission of extending coverage to millions of Americans, said Melinda Hatton, the American Hospital Association’s general counsel…. “It is a conflict of interest for hospitals and drug companies to pay patients’ premiums and cost-sharing for the sole purpose of increasing utilization of their services and products,” said Karen Ignagni, head of America’s Health Insurance Plans, the health-insurance industry’s trade group….

In late October… Kathleen Sebelius wrote a letter to a congressman stating that she didn’t consider plans sold through the insurance exchanges to be federal health-care programs, and so weren’t subject to rules that prevent health providers from giving subsidies or rebates to enrollees. But less than a week later, an HHS unit that is implementing the health law said it would “discourage” hospitals and other commercial entities from paying premiums. It asked insurers to reject such payments and warned that it would take further action if necessary.

4.) Eric Patashnik and Julian Zelizer give us “Five myths about the future of Obamacare.” Number 1: “Government programs never die.” Number 4: “Politicians decide the fate of laws.” Number 5: “Conflict over laws usually dies down.”

5.) Microsoft executive Kurt DelBene is succeeding Jeff Zients in leading the overhaul of HealthCare.gov. DelBene starts tomorrow and “has agreed to serve in this role for at least the first half of next year,” according to Kathleen Sebelius.  Here is Sebelius’ full statement announcing the news.

6.) The New York Times says there’s “A gap in the Affordable Care Act”:

The Affordable Care Act mandated that insurers cover dental care for children. Indeed, it was one of the 10 essential health benefits meant to set the bar for adequate health insurance. But pediatric dental care is handled differently from coverage of other essential benefits on federal and state exchanges…. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it.

Now experts are warning that the flawed implementation of this benefit on the exchanges could leave millions of children without access to dental care…. Tooth decay is the most common chronic childhood disease. Fourteen percent of children age 6 to 19 have untreated cavities, which can cause pain and, in rare cases, death…. Had pediatric dental insurance remained a mandatory purchase on the new insurance exchanges, as originally envisioned, roughly three million children would have gained coverage this way by 2018, according to an analysis by the dental association.

7.) State update: “45 states still haven’t hit 10% of enrollment goals for Obamacare.” The percent of the total enrollment goal achieved is 6.2% (this does not include new Medicaid enrollees), and the percent of enrollment period elapsed is 41.8%. If you would like to see this distributed across the states in map form, go here. Also look at Kaiser Health News’ state round-up here. Below are some of the various enrollment numbers:

* Illinois is at 7,043 out of a goal of 143,000 (4.9%).

* Minnesota has hit 4,478 out of a goal of 67,000 (6.7% achieved).

* In Oregon, they’re up to 730 out of a goal 237,000 (0.3% achieved).

* The states that have reached 10% of their enrollment goals are California (12.2%), Colorado (16.3%), Connecticut (43.5%), New York (23.0%) and Rhode Island (22.2); Kentucky is close (9.5).

8.) Slate has followed several people over the last few months as Obamacare has been rolled out. They recently checked in with these folks to see how the health law is working for them. Short answer is: “The website has improved, but the costs are all over the place.” For more detail, read each of their stories here in their own words.

9.) Here is a new ad from the Democratic Congressional Campaign Committee unveiled “in 44 competitive congressional districts highlighting the downsides of Republican calls to repeal the Affordable Care Act”:

10.) Politico says the “next Obamacare crisis” may be “small-business costs,” with “the biggest shocker” for small businesses hitting next October.

11.) Robert George writes on how the “contraceptive challenge exposes double standard”:

Last month, HHS cleared the way for patients to receive financial assistance from drug companies, when insurance won’t pay enough. It is hard to believe that this is the same agency litigating Sebelius v. Hobby Lobby and Conestoga Wood v. Sebelius before the Supreme Court. The Greens, an evangelical Christian family that owns Hobby Lobby, and the Hahns, a Mennonite family that owns Conestoga Wood, offer employee health coverage that complies with the Affordable Care Act in every way but one: Faith forbids them from paying for contraceptives that can cause early abortions, such as the morning-after pill. Because they do not cover four of 20 FDA-approved contraceptives, HHS seeks crippling penalties on their businesses.

The government has other ways of providing contraceptives. For instance, by creating a tax credit or expanding its own contraceptive distribution or allowing drugmakers to assist patients directly. HHS has rejected these options. Pharmaceutical company assistance is good enough for HIV drugs, but not for contraceptives. Insurers can charge prohibitively high “co-insurance” rates for MS drugs, but the abortion-causing drugs must be free….

It is not as if the Obama administration refuses to grant exceptions. To keep the president’s illusory promise that “if you like your health care plan, you can keep it,” HHS exempted insurance companies from dozens of rules, including the mandate, if they would renew old plans for an additional year. In short, if an insurance company doesn’t provide coverage for expensive drugs because it will make coverage seem cheaper, fine. If a plan doesn’t cover birth control because canceling non-compliant insurance plans would be politically embarrassing, fine too.

12.) If you’d like to read the confidential training manual for Obamacare navigators, go here. The document was uploaded online and is viewable by the public, despite the warning at the bottom of each page which reads “This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.”

13.) The House Oversight and Government Reform Committee released a report on the Obamacare navigators yesterday, titled “Risks of Fraud and Misinformation with ObamaCare Outreach Campaign: How Navigator and Assister Program Mismanagement Endangers Consumers.” Read the report below:
Navigator Report Update Final 12-13-13.pdf

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