Economics, Health Care

What we learned about Obamacare Feb 21-24, 2014

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1.) This past Friday the CMS published a report on the “impact on premiums for individuals and families with employer-sponsored health insurance from the guaranteed issue, guaranteed renewal, and fair health insurance premiums provisions of the Affordable Care Act.” The report was requested by Speaker Boehner as part of the 2011 Budget Control Act and due 90 days after enactment of that law (it is two years late). Here’s a snippet:

Once the new premium rating requirements go into effect, it is anticipated that the small employers that offer health insurance coverage to their employees and their families would have average premium rates. Therefore, we are estimating that 65 percent of the small firms are expected to experience increases in their premium rates while the remaining 35 percent are anticipated to have rate reductions. The individuals and families that receive health insurance coverage from their small employer generally contribute a portion of the premium. For this analysis, if the employer premium increases, it is assumed that the employee contribution will rise as well. Similarly, if the employer premium is reduced, the employee contribution is assumed to decrease. This results in roughly 11 million individuals whose premiums are estimated to be higher as a result of the ACA and about 6 million individuals who are estimated to have lower premiums. There is a rather large degree of uncertainty associated with this estimate.

2.) The Washington Post fact checks “Obama’s claim that 7 million got ‘access to health care for the first time’ because of his Medicaid expansion” and gives it four Pinocchios:

He seems to be falling into the same trap as other Democrats, and some reporters, by assuming that everyone in the Medicaid list is getting health insurance for the first time because of the Affordable Care Act. But that number is nowhere close to 7 million. It could be as low as 1.1 million (Avalere) or as high as 2.6 million (Gaba.) If one wanted to be generous, one could include people coming out of the woodwork, even though they would have been covered under the old law, but no one is really sure what that figure is. In any case, no matter how you slice it, it does not add up to 7 million.

3.) AEI’s Chris Conover says “Obamacare will cost 2.9 million or more jobs a year.” He adds, “When all is said and done, nearly 3 million will lose their jobs with over 500,000 of these (18%) representing involuntary job losses (workers fired).” Here’s a basic breakdown of those numbers- read the article for a full explanation of them:

4.) The Washington Post reports “Health care law’s small-business marketplace not attracting many small businesses”:

Small-business owners, who were supposed to gain more choices and cheaper rates from the new online-health-insurance portals, have been slow to select plans through marketplaces since the rollout started last fall. In part, some say, that is because luring employers to the marketplaces has taken a back seat to fixing technical problems and recruiting individuals and families.

As a result, businesses in many states have been left with an online-shopping portal that is only partially functional — if they have one at all…. In the District….[m]ore than 5,000 people have signed up for private insurance plans through the individual portal. At the same time, fewer than 300 individuals have purchased a plan offered by their small business on the city’s new exchange, even though nearly 10,000 employers have created an online profile allowing them to shop for coverage.

5.) “Obamacare stats still hard to nail down,” says Politico:

The truth is, nobody has a good, real-time fix on how successful the Affordable Care Act has been in reducing the ranks of the uninsured. The Obama administration hasn’t been able to say how many of the 3.3 million people who have signed up for private health insurance coverage, or of the 6.3 million who have been determined eligible for Medicaid, were actually uninsured before — and health care experts aren’t sure yet, either. There have been a couple of surveys, and at least one state — New York — has been keeping track of how many people were uninsured when they applied for coverage. But their answers are so wildly different that all we can say is, it’s either a tiny minority that were uninsured, or it’s most of them. Want to narrow that down? You’ll just have to wait…. The search for real, trustworthy numbers shows just how hard it is to track how many uninsured people are gaining health coverage in anything close to real time, and even harder to link those changes directly to the ACA….

“We’re not really going to know very accurately for a long time,” said Joe Antos, a health care expert at the conservative American Enterprise Institute…. So when will we know more? The Urban Institute should have results in April from its Health Reform Monitoring Survey, which should be able to measure how health coverage patterns shifted from March 2013 to this March.

6.) The University of Notre Dame has been “once again rejected in battle over birth control”: “A federal appeals court on Friday ruled against the University of Notre Dame in a case over parts of the federal health care law that forces it to provide health insurance for students and employees that covers contraceptives. The U.S. 7th Circuit Court of Appeals in Chicago upheld a federal judge’s earlier ruling that denied the Roman Catholic school’s request for a preliminary injunction that would prevent it from having to comply with the birth control requirement as the university’s lawsuit moves forward.”

7.) “Obamacare website encourages the incarcerated to enroll in Medicaid,” according to The Weekly Standard:

Nearly five months after the launch of, the federal government’s flagship Obamacare exchange added a new informational page aimed at a captive audience: the incarcerated.  The new page, which went live with little fanfare over the weekend, is designed to tell those currently serving sentences in prison or jail all they need to know about the Obamacare marketplace. Although private insurance may not be purchased through the insurance exchanges by such individuals, the website may be used to apply for Medicaid.  While Medicaid will not pay the cost of care while incarcerated, those seeking coverage are told that signing up now “may help you get needed care more quickly after you’re released.”

The page is entitled “What do incarcerated people need to know about the Marketplace?”  Only those serving sentences upon conviction are considered incarcerated for purposes of the Marketplace, not those locked up pending disposition of charges.

8.) There are “More cuts to Medicare benefits on the way,” writes AEI’s Scott Gottlieb:

Get ready for more cuts to private Medicare plans, and more fired doctors, as insurers are forced to cheapen provider networks, and benefits. That’s the upshot from the announcement by the Centers for Medicare and Medicaid Services that 2015 Medicare Advantage rates will be cut as much as a whopping 8%, once new reductions get baked into the program’s baseline….The total reduction is the sum of a dozen different adjustments.…[some] cuts are a direct result of Obamacare. One of those Obamacare cuts is a 2% reduction to the rates that CMS pays to the Medicare Advantage plans for each beneficiary they enroll. Previously, these health plans were paid a premium on the amount of money that each beneficiary is estimated to cost under Medicare’s fee for service program. Under Obamacare, the Medicare Advantage plans are brought into parity with FFS Medicare…. Another piece of the 8% reduction comes from the fee Obamacare imposes on health plans. Starting in 2015, health plans are required to pay an $8 billion (non-tax deductible) fee that will be apportioned to the different insurers based on their share of the total risk-based premiums that the industry collects. This fee accounts for another .6% of the projected 8% cut.

9.) The article referred to above is “Public sector cuts part-time shifts to bypass insurance law”:

President Obama has twice delayed enforcement of the health care law’s employer mandate, which would subject larger employers to tax penalties if they do not offer insurance coverage to employees who work at least 30 hours a week, on average. But many public employers have already adopted policies, laws or regulations to make sure workers stay under that threshold. Even after the administration said this month that it would ease coverage requirements for larger employers, public employers generally said they were keeping the restrictions on work hours because their obligation to provide health insurance, starting in 2015, would be based on hours worked by employees this year. Among those whose hours have been restricted in recent months are police dispatchers, prison guards, substitute teachers, bus drivers, athletic coaches, school custodians, cafeteria workers and part-time professors.

10.) This Kaiser Health News round-up looks at how the private exchange is benefiting from the health law, while “some state-run marketplaces still” struggle. Articles include: “Private exchange sees surge in health care enrollment,” “As deadline nears, state insurance exchanges still a mixed bag,” and “Nevada’s health exchange director to resign.”

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