The Affordable Care Act is Coming Home to Roost

[Koko78]

If you like your religious beliefs, you can keep your religious beliefs. Period.

 

It's the right thing to do.

[3rdnlng]

If you like your religious beliefs, you can keep your religious beliefs. Period.

 

It's the right thing to do.

 

Period.

[DC Tom]

If you like your religious beliefs, you can keep your religious beliefs. Period.

 

It's the right thing to do.

 

To be perfectly clear, the administration - indeed, the "party of tolerance" - never made any such claim about religious freedom.

 

And if the administration's shown anything, it's that 1) the ACA is the penultimate law that trumps even the Constitution, and 2) presidential press statements are the ultimate law that trump every goddamn thing.

[B-Man]

It's Potemkin Villages all the way down: No, 2.1 million haven’t enrolled in Obamacare plans.

With President Obama’s health care law scheduled to begin in earnest when the new year kicks off, Secretary of Health and Human Services Kathleen Sebelius claimed on a Tuesday conference call that as of Dec. 28, “2.1 million people have enrolled in a private insurance plan” through the program.

 

Later in the call, Sebelius emphasized that enrollments wouldn’t be completed until individuals paid their first month’s premiums.

But HHS officials still won’t disclose how many of the 2.1 million they claim enrolled through the federal healthcare.gov website or one of the state-based exchanges actually paid for coverage.

 

Though Sebelius left the call before the question-and-answer session, Centers for Medicare and Medicaid Services spokeswoman Julie Bataille declined several times to provide payment information. . . .

 

Later in the call, CNN’s Jim Acosta asked Bataille if she could at least say with confidence that a “very high percentage” of those 2.1 million had paid.

 

Instead of answering in the affirmative, Bataille said, “We are confident that those consumers have selected a plan and know what the next steps are for them in terms of securing coverage.”

 

The Wall Street Journal reported on Tuesday that: “As of Monday, however, only about half of enrollees billed for plans offered by more than 100 insurers in 17 states had paid their first month’s premium, said Mark Waterstraat, chief strategy officer at Benaissance, a third-party billing firm that works for those insurers.”

 

It isn’t clear whether that figure is indicative of the story nationwide, and it’s true that insurers have opted to give individuals until at least Jan. 10 (in some cases longer) to pay their premiums for coverage beginning on Jan. 1.

 

But there’s no reason to believe Sebelius’s claims that 2.1 million have enrolled as of Dec. 28, and journalists shouldn’t report that 2.1 million enrolled until HHS releases data showing that 2.1 million paid for their plans.

 

During the call, Bataille also declined to provide a demographic breakdown of those who have selected a plan so far or say how many of the 2.1 million signing up for insurance were previously uninsured.

 

Demographic information is important, because it is vital for the exchanges to attract a critical mass of young and healthy enrollees to offset the costs of covering older and sicker participants in the program.

 

Also, because millions of Americans have received cancellation notices from insurers, analysts want to know whether the law resulted in a net gain of those who have private insurance. Knowing how many of the 2.1 million signing up were previously uninsured could help provide insight into the question.

If the numbers were good, they’d be telling us.

 

 

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[IDBillzFan]

If the numbers were good, they’d be telling us.

 

They better hope the numbers are low because the real issue is going to be all the people who show up to doctors, hospitals and pharmacies this month with a piece of paper they were supposed to print out as proof of enrollement. (Not proof of payment, mind you...but just proof of enrollment, which is supposed to be enough to get covered.)

 

Will doctors, hospitals and pharmacies provide services without proof they'll get reimbursed? Or will they turn people away? And what is the certified proof of coverage and how hard is it to counterfeit?

 

Will doctors and hospitals and pharmacies go under when they realize they've been doling out services that will not get reimbursed? Or will people in dire need of these services die when Obamacare holds up approval of the services they need, simply because no one has actual proof of their coverage?

 

This is only going to get uglier.

 

But I'm sure the Democrats thought all this through when they crafted and passed the law entirely on their own.

[DC Tom]

They better hope the numbers are low because the real issue is going to be all the people who show up to doctors, hospitals and pharmacies this month with a piece of paper they were supposed to print out as proof of enrollement. (Not proof of payment, mind you...but just proof of enrollment, which is supposed to be enough to get covered.)

 

Will doctors, hospitals and pharmacies provide services without proof they'll get reimbursed? Or will they turn people away? And what is the certified proof of coverage and how hard is it to counterfeit?

 

Will doctors and hospitals and pharmacies go under when they realize they've been doling out services that will not get reimbursed? Or will people in dire need of these services die when Obamacare holds up approval of the services they need, simply because no one has actual proof of their coverage?

 

This is only going to get uglier.

 

But I'm sure the Democrats thought all this through when they crafted and passed the law entirely on their own.

 

That's an easy one to solve: a patient not paying for their insurance is indicative of nothing - it could have been a fault at the federal government level (technical failure preventing transfer of data to the insurer), or at the insurer level (inability to use the provided data to bill the patient). Therefore, the only reasonable course of action is to assume that proof of enrollment is reasonable evidence of intent to pay - effectively, that the patient WOULD have paid, if the insurer had billed them. Therefore, the insurers will be required to honor the hospitals' claims for patients that present proof of enrollment, since it's ultimately their fault for having such inefficient billing practices.

 

Hell, I don't even think that's a legislative change. That falls under "regulating insurance," which means HHS would be well within its right making a unilateral announcement of such some Friday afternoon.

 

Don't think that'll happen? The executive branch has already put the insurance industry on the hook for bailing them out of their own incompetence and bad practices. What's one more executive diktat?

 

EDIT: note that that would also solve the problem of defining "enrolled": if the insurers have to cover everyone who put an insurance policy in their cart, regardless of whether or not they paid for it, then the government's "enrolled" numbers are the actual "insured" numbers. QED.

Edited January 1, 2014 by DC Tom

[Nanker]

Jeanne d'Arc at the siege of Orleans. Or Tamerlane's defeat of the Ottomans at Ankara. With Joe, it's tough to know which.

I'm pretty sure he meant the disposal of Ernst RÖhm.

[B-Man]

Obamacare: Never Speak of It Again

 

Universities probably shouldn’t be in the business of “banishing” words, as Lake Superior State University does at the start of every year, as least not if they want to keep up their pretensions about academic and intellectual freedom.

 

At any rate, LSSU’s 2014 list is now out, and “Obamacare” is on it. Here’s the apparent explanation:

Because President Obama’s signature healthcare law is actually called the Affordable Care Act. The term has been clearly overused and overblown by the media and by members of Congress.

 

 

But which is the bigger lie: “Obamacare” or “Affordable Care”?

 

 

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[Gary M]

 

It's funny when stereotypes self-confirm: Obamacare’s Pajama Boy: ‘I am a liberal ****.’

 

 

Found the real pajama boy

 

[John Adams]

I'l say it again. I've now spoken to 3 business owners (including me) who have had great success on the exchange. Better plan, better rates, easy to use website.

 

I know it's not popular to say anything positive about the ACA on here but if you pay for your health care in any way, you really should go to the ACA website and price shop. My buddy owns a 10 person business and will save thousands this year--and his employees will get much better healthcare--by jettisoning his current offering and paying his people more money that they can use to enroll themselves.

 

For me, my wife has a PPO plan at work that was costing our family $1800. No dental. We signed up for the platinum BCBS Personal Choice plan. Lower deductible. All our doctors in network. Large network (including PENN) and out of network costs and deductible reasonable. Dental plan. $1200/month.

 

I know there's a lot of knee-jerk frothing at the mouth going on in this thread but the exchange, at least so far, is pretty awesome. And if you think about it, it should be: It's opening up health care pricing to competition.

 

OK, B-Man, go back to frothing.

[Nanker]

Good for you John. Here's a ACA supporter's story who's not so fortunate.

There's lots of anecdotal evidence on both sides of the issue. We'll have to wait for the full weight to be felt and actual data to be compiled to be able to being to learn the effects of this law and how Americans are affected by them. Lord knows, the most transparent regime in American history has been less than forthcoming with any ACA data to this point. I'd say the NSA knows more about who's signed up than the dopes in the White House do. They're too busy imitating ostriches to bother working for the American people.

[John Adams]

Good for you John. Here's a ACA supporter's story who's not so fortunate.

There's lots of anecdotal evidence on both sides of the issue. We'll have to wait for the full weight to be felt and actual data to be compiled to be able to being to learn the effects of this law and how Americans are affected by them. Lord knows, the most transparent regime in American history has been less than forthcoming with any ACA data to this point. I'd say the NSA knows more about who's signed up than the dopes in the White House do. They're too busy imitating ostriches to bother working for the American people.

 

My point is this: If you're paying for your own insurance, go to the exchange and you might find a better deal. I did and I know of several others (in different states) who also did. Yes, it's my anecdote, but most people in this thread have no interest in believing that there is any benefit of the ACA that doesn't come at a high cost. I believe that the exchange was a good idea and in many areas, has opened up insurance to greater competition.

 

Again, I know it's unpopular to say anything positive about the ACA and most here won't hear me. Still, I encourage those paying for insurance to take a look--you might be surprised at what you find. Maybe it won't be as good as what you have, but maybe it will be better.

[DC Tom]

Anecdotes - even the sum total of them - are not and were never going to be the measure of the quality of this law.

[TheMadCap]

My point is this: If you're paying for your own insurance, go to the exchange and you might find a better deal. I did and I know of several others (in different states) who also did. Yes, it's my anecdote, but most people in this thread have no interest in believing that there is any benefit of the ACA that doesn't come at a high cost. I believe that the exchange was a good idea and in many areas, has opened up insurance to greater competition.

 

Again, I know it's unpopular to say anything positive about the ACA and most here won't hear me. Still, I encourage those paying for insurance to take a look--you might be surprised at what you find. Maybe it won't be as good as what you have, but maybe it will be better.

 

Quite possible. I have no doubts that in some cases, as you point out, it's going to be better for some folks. I just hope it doesn't go the other way for the majority. We shall see...

[Azalin]

but most people in this thread have no interest in believing that there is any benefit of the ACA that doesn't come at a high cost.

I don't think it's because most people in this thread have no interest in there being any benefit, I think it's more that most don't think there needs to be what is essentially a complete takover of the industry. if there are problems inherent in our health care/insurance industries, many believe that they're due to government getting involved in the first place.

[B-Man]

For all Obamacare’s troubles, at least Americans can rest assured that the reforms are going to ease the pressure on Emergency Rooms. Right?

 

Well, not according to a study published in Science, no. From the abstract:

In 2008, Oregon initiated a limited expansion of a Medicaid program for uninsured, low-income adults, drawing names from a waiting list by lottery. This lottery created a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design. Using the randomization provided by the lottery and emergency-department records from Portland-area hospitals, we study the emergency-department use of about 25,000 lottery participants over approximately 18 months after the lottery.

We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person

, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.

 

Okay, so it doesn’t reduce the use of ERs. But at least pushing huge numbers of Americans onto Medicaid will improve their healthcare outcomes. Right? Again: No, not really.

 

 

 

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Edited January 3, 2014 by B-Man

[IDBillzFan]

Yes, it's my anecdote, but most people in this thread have no interest in believing that there is any benefit of the ACA that doesn't come at a high cost.

 

And herein lies the problem with your argument: virtually no one here able to complete a full sentence has argued that there is no benefit of the ACA without a high cost. Anyone thinking for themselves knows there are not only some good benefits to the law, but that many of those benefits (pre-existing conditions, keeping your 26-year-old adult child on your plan) could have EASILY been provided WITHOUT passing this abortion of a law...let alone forcing you to purchase a product simply because you exist in this country.

 

What you don't want to do is pit your happy anecdotes against the unhappy ones because they will get crushed in very short order. All you need to do is read about the millions in California who have lost their coverage and are now paying more for less coverage and higher deductibles and you'll realize your stories are the exception and not the rule.

[3rdnlng]

 

 

My point is this: If you're paying for your own insurance, go to the exchange and you might find a better deal. I did and I know of several others (in different states) who also did. Yes, it's my anecdote, but most people in this thread have no interest in believing that there is any benefit of the ACA that doesn't come at a high cost. I believe that the exchange was a good idea and in many areas, has opened up insurance to greater competition.

 

Again, I know it's unpopular to say anything positive about the ACA and most here won't hear me. Still, I encourage those paying for insurance to take a look--you might be surprised at what you find. Maybe it won't be as good as what you have, but maybe it will be better.

 

What does this have to do with gay marriage though?

[birdog1960]

And herein lies the problem with your argument: virtually no one here able to complete a full sentence has argued that there is no benefit of the ACA without a high cost. Anyone thinking for themselves knows there are not only some good benefits to the law, but that many of those benefits (pre-existing conditions, keeping your 26-year-old adult child on your plan) could have EASILY been provided WITHOUT passing this abortion of a law...let alone forcing you to purchase a product simply because you exist in this country.

 

What you don't want to do is pit your happy anecdotes against the unhappy ones because they will get crushed in very short order. All you need to do is read about the millions in California who have lost their coverage and are now paying more for less coverage and higher deductibles and you'll realize your stories are the exception and not the rule.

it's too early to know if they are the exception and not the rule. i'm quite sure better, more comprehensive data will be available in 6 months and even better in 18 months. then if it looks good for the aca (and it likely will) you can all argue statistics as a reason for disbelief. the real issue here for most of you is "forcing you to purchase a product" as you stated. get over it. it's been judged constitutional. the aca is taking flak for every pre-existing condition in the existing health care mess plus those inherent in it's own design. today, drudge links to an article about a doctors office waiting on hold 2 hours for procedure preapproval before giving up. the company they were trying to talk to was BLUE CROSS. news flash: they've been foot dragging approvals for years. it's part of their strategy and has nothing to do with the aca. but now everytime there's a glitch in the very inefficient existing medical system it's blamed on the aca as if the problems never existed before it. a business owner complained to me about his employees inability to get a similar policy at the same pricing through the aca to what he had provid3ed him. on further questioning, that policy limited yearly benefits to 25K. when i posited that this was grossly inadequate, the guy said it was adequate "most of the time, for most people". the moral: much of what you're hearing described as terrible failings of the aca is exagerrated, incomplete and biased based on preconceived opposition to the ideals inherent in the bill.

[DC Tom]

http://www.nytimes.com/2014/01/04/us/politics/obama-administration-urges-court-to-reject-nuns-health-law-challenge.html?partner=rss&emc=rss&_r=1&

 

Slipped into this story about the Little Sisters of the Poor is this particularly beautiful gem:

 

The Obama administration argued on Friday that the Affordable Care Act did not really impose an “employer mandate.”

 

The birth control requirements “apply only if an employer offers a group health plan,” the administration said in its brief.

 

“Employers, however, are not required to offer group health plans in the first place,” the brief continued. “Large employers (those with more than 50 full-time-equivalent employees) face a potential tax if they do not provide coverage, but that gives them a choice between two legal options: provide a group health plan or risk payment of the tax.”

 

Oh...okay. So the employer mandate that was delayed now doesn't exist, because the alternative isn't a penalty but a tax. Never mind that the administration CALLED it the "employer mandate" when they delayed it (as recently as eight days ago), and repeatedly argued the "tax" was not a "tax" but actually a "penalty." (As recently as October 30 of this year, as far as I can see).

 

So their argument is a tax-exempt organization has to pay a tax (that they insist is a penalty) for a mandate that isn't a mandate.(that they insist is a mandate) only because because the tax isn't a penalty (even though they insist it is.)

 

I hope the courts throw out the administration's response simply on the premise that it's far too dishonest to take seriously.