Friday, November 22, 2013

Political Damage Control - Delaying Obamacare Round II Until AFTER the 2014 Vote....

from CNN
Washington (CNN) -- After the many bumps, ruts and roadblocks the Affordable Care Act has run into, health officials in Washington have decided to delay open enrollment in Obamacare -- not this year, but a year down the road.

The Department of Health and Human Services wants to give insurers, consumers and engineers more time to avoid the first go-round's site crashes, coverage train wrecks and cost surprises.

It has moved the start of next year's open enrollment from October 15 to November 15 and extended the sign-up period from roughly seven weeks to eight, an HHS official, who spoke on condition of anonymity, told CNN.

The change will not affect this coverage year, which begins January 1, 2014.

The postponement "will give issuers the benefit of more time to evaluate their experiences during the 2014 plan year and allow them to take into account those who may enroll late, including young adults, before setting 2015 rates," the official said.

Young adults are less likely than their older counterparts to take out a health insurance policy, but even without that issue, enrollment in Obamacare has been minute overall, particularly via the federal sign-up website

Exact numbers are hard to pin down in the 36 states using the site. But as of November 2, just 26,794 people had enrolled in the states.

CNN's current tally for this group stands at less than 45,000 enrollees, but that's based on just a handful of states that have provided updates.

In the 14 states running their own sign-up methods, the numbers look better but still dismal. At least 133,000 people had enrolled at last count.

Many more have taken advantage of the expansion of Medicaid. Sticker shock The health department hopes that the added time will encourage insurers to get coverage details right and make their plans more affordable, while consumers have more time to flush the the devil out of the details.

Some consumers were not only hit with high premiums during the rollout but also with deductibles above flood stage. People picking the bronze plan, which has the lowest premiums, will shell out about $5,000 before insurers foot the bills.

Even then, policy holders will cover plenty out of pocket, like doctor visits, lab tests and medications.

"All we ever heard about Obamacare is that it would lower our deductibles and premiums," said Jennifer Slafter, 40 of Mabel, Minn.

"That's just not what's happened." Slafter and her husband, Steve, are scrambling to find affordable care for themselves and their two children.

The exchange's Blue Cross Blue Shield plan was $1,087 a month with a $6,000 deductible, while a Medica plan was $877 a month with a $12,700 deductible.

Both are steeper than their current plan.

Battle ahead As a side effect, the enrollment delay could also give everyone more time to contend with the political battle over Obamacare and whatever changes to the Affordable Care Act that might result.

Republicans on Capitol Hill have distributed a digital playbook among their ranks to align talking points against Obamacare.

The strategy memo is titled "Because of Obamacare ... I lost my insurance," and includes propaganda videos, fliers and social media posts.

The American people are handing President Obama a beating over the many glitches in the rollout of the ACA, with his approval ratings in polls bouncing down a staircase from one low point to the next.

Obamacare is even less popular.
So that the policy cancellation notices and huge price INCREASES don't hit right before the election.

Monday, November 18, 2013

The Health Care Cavalry Has Arrived!

From the office of U.S. Rep Andy Harris and The Dagger:
Washington, D.C. – Over 73,000 Marylanders have seen their health insurance plans terminated because of the President’s health reform law. Now the President is unilaterally changing the law to try to allow them to keep their plan for an additional year. If the insurance companies in Maryland who cancelled policies decide to extend them, Congressman Andy Harris, M.D. is calling on Maryland Insurance Commissioner Therese M. Goldsmith to expedite the review of those extensions to ensure individuals will be able to keep their plans on January 1st.

Congressman Andy Harris, M.D. released the following statement:

“The President promised Americans that if they liked their plan they could keep it. The President’s proposal today is too little too late, but now the Maryland Insurance Commissioner must expedite the review of any policy extensions offered so that those who have plans and like them can keep them. I have heard from many constituents who liked their policies, but are losing them and can’t afford the dramatically higher prices of plans offered in the exchange. The Maryland Insurance Commissioner must do all she can to prevent this harm from occurring.”

Thursday, November 14, 2013

Do we Live Under the Rule of Law? Or the Rule of a Man?

Under heavy pressure by congressional Democrats to fix Obamacare, President Barack Obama announced Thursday that the administration will allow insurance companies to keep individual customers on their existing plans for an additional year, even if the plans don't meet the law's standards.

The president's plan does not require the insurance companies to take back the Americans they kicked off, but does give them the option of taking the customers back if they want. The government will inform state insurance commissioners that they have permission to allow insurers to offer the out-of-date private plans for an additional year. It's up to them whether to allow them to continue or not.

Obama has been caught between two problems of his administration’s own making: millions of cancellations of individual health care coverage despite his pledge that “if you like your plan, you can keep it” and a botched federal website that was supposed to allow Americans to buy new insurance.

"I completely get how upsetting this can be for a lot of Americans," a contrite Obama told reporters Thursday afternoon. "Americans whose plans have been cancelled can choose to enroll in the same kind of plan."

The cancellations, estimated to affect up to 7 million Americans, are due to new standards in Obamacare that insurance companies are required to meet. Those who received cancellations were expected to go onto the new federal insurance marketplace — which has been plagued by tech problems since its Oct. 1 rollout — and purchase coverage there. About 5 percent of insured Americans get their insurance on the individual market.

But it remains unclear whether insurance companies will rescind the cancellations they’ve already handed out, since the Obama administration is not requiring them to do so. And the extension is only for one year, so the fix only delays the fact that many Americans will not be able to keep their current insurance under Obamacare.

The administration argues that many of the cancelled plans were sub par and that many people can buy better insurance for cheaper on the federal marketplace. The law significantly overhauled the individual insurance market, prohibiting plans that kick people off if they become sick or hiking premiums due to illness, among other reforms.

Obama said he believes the Affordable Care Act will work, but admitted the rollout of the exchanges has been bad. "We fumbled the rollout of this health care law," he said. The president added that he was not informed that the glitches in were so extensive and crippling — he believed they were minor and not systemic before Oct. 1. With his second term — and his legacy — in the balance, Obama frequently seemed deflated, almost defeated, light-years away from his soaring “audacity of hope” or the “fierce urgency of now” that powered his eager first term.

Things will get better, he promised, “if we can just get the darn website working and smooth this thing out.”

“I make no apologies for us taking this on because somebody, sooner or later, had to do it,” the president said. “I do make apologies for not having executed better over the last several months.”

And he offered worried and angry congressional Democrats — many of whom fear Obamacare will prove a potent Republican weapon in the 2014 mid-term elections — a kind of “I feel your pain” moment.

“There is no doubt that our failure to roll out the ACA smoothly has put a burden on Democrats, whether they're running or not, because they stood up and supported this effort through thick and thin, and, you know, I feel deeply responsible for making it harder for them rather than easier for them,” he said. “We’re letting them down.”

But he took more personal responsibility for the botched rollout than he has before in public.

“There have been times where I thought we, you know, got slapped around a little bit unjustly. This one's deserved, all right? It's on us,” he said.

After promising on Oct.1 that buying insurance on the federal website would work “the same way you’d shop for a plane ticket on Kayak or a TV on Amazon,” a more chastened Obama acknowledged that “buying health insurance is never going to be like buying a song on iTunes.”

He denied any deliberate attempt to mislead the public or that he was hasty in rolling out the website even as internal tests showed it would fail.

“I'm accused of a lot of things, but I don't think I'm stupid enough to go around saying, ‘this is going to be like shopping on Amazon or Travelocity,’ a week before the website opens, if I thought that it wasn't going to work,” he said.

As he closed the press conference, Obama dug for a more upbeat, combative message.

“Part of this job is, the things that go right, you guys aren't going to write about. The things that go wrong get prominent attention; that's how it's always been. That's not unique to me as president, and I'm up to the challenge,” he said.

Democrats crafted a bill that would require insurance companies to keep on the millions of customers, pressuring Obama to fix it. Sen. Mary Landrieu, the bill's sponsor, said in a statement she appreciated the president's announcement and would continue to "support legislation to fix this problem."

Republicans, meanwhile, have pounded away at Obama’s false promise and failed website to hammer home their message that the president is neither honest nor a competent manager.

"There is no way to fix this," Republican House Speaker John Boehner said. "I am highly skeptical that they can do this administratively."

Obama's statement is part of an all-out push to rescue the law. The White House was to host Senate Democrats later in the day, while chief of staff Denis McDonough was expected on Capitol Hill to reassure House Democrats.


Earlier this week, former President Bill Clinton advised President Obama to "honor the commitment" he made and to allow Americans to keep their health care plans, if they like them. That was a central promise Obama made when he sold Obamacare, but one that turned out not to be true when Obamacare began to be implemented last month.

"So I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they got," Clinton in an interview released Tuesday.

Now President Obama is taking Clinton's advice and trying to honor that commitment. In remarks today at the White House today, Obama said, "I completely get how upsetting this can be" lose insurance plans that I promised Americans would be able to keep. "To those Americans, I hear you loud and clear."

But there's a catch with president's proposed solution. The president is not proposing that the law be changed to allow all health insurance plans grandfathered into Obamacare's eligibility requirements.

No, instead the White House is saying that it will use "enforcement discretion" to allow illegal health insurance plans to be able to still be sold.
That is, the Obama administration will not enforce the penalty on individuals for not having eligible health insurance plans and they'll allow the insurance companies to still sell so-called bad plans -- plans they technically can't sell under Obamacare.

"Under the White House’s approach, the Department of Health and Human Services will notify the nation’s state insurance commissioners that they have federal permission to allow consumers who already have such insurance policies to keep them through 2014," reports the Washington Post.

He'll also be forcing insurance companies to help advertise for Obamacare by letting customers know that there's an Obamacare marketplace where they can purchase (or get subsidized) health care coverage.

Obama's proposal is an extra-legal solution to a big problem for millions of Americans around the country.

"I don't see within the law how they can do this administratively," said Speaker John Boehner in a press conference on Capitol Hill. "No one can identify anything the president could do administratively to keep his pledge that would be both legal and effective."

The proposed White House fix so that Obama can honor his commitment is also likely to create more problems and to further distrust the American people have for this administration, which makes law based on what it chooses to enforce while sidestepping the constitutional process that is in place.

Indeed, there's another problem. As Texas senator Ted Cruz says, the president cannot fix an unfixable law. "We cannot 'fix' Obamacare. The damage has been done, as millions of Americans have already been made to pay higher premiums and lose their jobs, wages, and health care plans," Cruz said today.

President Clinton famously dismissed Obama's candidacy for president of the United States by saying, "Give me a break. This whole thing is the biggest fairy tale I have ever seen."

With Obama's reliance on "enforcement discretion," it would now seem that Clinton had a point -- and that the "fairy tale" continues.

Hey Marylanders... Got Insurance?

From the Office of U.S. Rep Andy Harris and The Dagger:
Washington, D.C. – Today, the Department of Health and Human Services released the information on the number of people who have enrolled in the health insurance marketplaces. In Maryland, only 1,284 individuals have selected a plan on the health insurance marketplace between October 1 and November 2nd. That number pales in comparison to the over 73,000 people who have seen their plans terminated.

“The website sign up process has been an embarrassment, but the real train wreck of the President’s health plan is for the 73,000 families who lost their insurance,” said Rep. Andy Harris, M.D. “The President made three promises: if you liked your plan you could keep it, if you liked your doctors you could keep them, and the price for family health insurance would be $2,500 less per year. All three are turning out not to be true,”

According to an October 12, 2013, Baltimore Sun article, Maryland officials claimed 1,121 people signed up in the first 10 days. If that number was accurate, that means less than 8 people were able to sign up each day for the remainder of the reporting period. At that rate, it would take more than 295 years to sign up all of Maryland’s 800,000 uninsured.

Friday, November 8, 2013

If You Like it, You can Keep it. Period

from McClatchy DC
WASHINGTON — Even as President Barack Obama sold a new health care law in part by assuring Americans they would be able to keep their insurance plans, his administration knew that tens of millions of people actually could lose those their policies.

“If you like your private health insurance plan, you can keep your plan. Period,” Obama said as he pitched the plan, the unqualified promise he made repeatedly.

Yet advisers did say in 2010 that there were large caveats and that anyone whose insurance plan changed would lose the promised protection of being able to keep existing plans. And a report in 2010 said that as many as 69 percent of certain employer-based insurance plans would lose that protection, meaning as many as 41 million people could lose their plans even if they wanted to keep them and would be forced into other plans. Another 11 million who bought their own insurance also could lose their plans. Combined, as many as 52 million Americans could lose or have lost old insurance plans.

Some or much of that loss of favored insurance is driven by normal year-to-year changes such as employers changing plans to save money. And many people could end up with better plans. But it is not what the president pledged.

Caught in the firestorm of his broken promise, Obama on Thursday apologized.

“I am sorry that they are finding themselves in this situation based on assurances they got from me,” he told NBC News Thursday evening. “We’ve got to work hard to make sure that they know we hear them and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this.”

The shifting narrative started as Obama worked to sell the entire health care overhaul to a skeptical nation and Congress. To win support from those who already had insurance, he made the promise that no one who liked their plan would lose it. The key was that millions of plans would be “grandfathered” in the new law, thus protected from any new requirements.

Yet as insurance companies started notifying hundreds of thousands this fall that their current policies were being canceled in preparation for new ones, it became clear that many were not guaranteed to keep their plans.

The White House and Congress have focused on cancelations of plans in the individual market, where people buy their own policies.

Obama insisted anew Thursday that the problem is limited to people who buy their own insurance. “We’re talking about 5 percent of the population who are in what’s called the individual market. They’re out there buying health insurance on their own,” he told NBC.

But a closer examination finds that the number of people who have plans changing, or have already changed, could be between 34 million to 52 million. That’s because many employer-provided insurance plans also could change, not just individually purchased insurance plans

Administration officials decline to say how many employer-sponsored plans could change. But those numbers could be between 23 million to 41 million, based on a McClatchy analysis of estimates offered by the Department of Health and Human Services in June 2010.

Obama aides did acknowledge around the time the law was enacted in 2010 that some people could lose their coverage if their plans changed after the law was passed. Those people would in turn receive what the administration described as superior coverage. But in the years since the law’s passage, HHS officials have downplayed that consequence of the hard-fought law.

“If health plans significantly raise co-payments or deductibles or significantly reduce (them) . . . they’ll lose their grandfather status and their customers will get the same full set of consumer protections as new plans,” Health and Human Services Secretary Kathleen Sebelius said at a June 15, 2010, news conference.

Many changes in the old insurance plans could trigger the loss of the protected status. Regulations issued by HHS state that the grandfathered status would be lost if the policies eliminate coverage for a particular condition, reduce the annual dollar limit on benefits, increase co-payments by as little as $5 or 15 percent, or increase out-of-pocket maximums by more than 15 percent or premiums by more than 5 percent.

Later in June 2010, Sebelius’ department published estimates in the Federal Register that 39 percent to 69 percent of employers’ fully insured plans would relinquish the coverage they had prior to the March 2010 passage of the ACA and thus would have to cancel or change policies.

About 60 million people are covered in fully insured plans, which make up about 40 percent of employer-provided health plans. Fully insured plans are usually offered by large employers. These plans have the insurance company rather than the employer assume the financial risk of annual health care expenses exceeding expectations. The rest of employers self-insure.

To escape having to provide the new law’s minimum required benefits, plans would have to largely maintain the co-pays, premiums and out-of-pocket limits that existed prior to March 2010.

Already this year, only 36 percent of employer plans were pre-2010 plans, compared with 56 percent in 2011, according to the Kaiser Family Foundation, a leading health care research organization. That means that millions of people’s plans already had changed or were canceled in the three and a half years since the law was enacted in March 2010.

That doesn’t automatically mean the plans were changed or canceled because of the new law.

“I think there needs to be great emphasis that plans are not being canceled because of ACA requirements,” said Jon Gabel, a senior fellow at the University of Chicago’s Health Care Research Department. “They’re being canceled because insurers do not want to ‘grandfather’ some plans.”

This week, after millions of Americans mostly in the market for individually purchased plans began receiving cancellation notices or price hikes from their insurance companies, Obama added the caveat that people could lose their plans if insurance companies changed the plans.

“Now, if you have or had one of these plans before the Affordable Care Act came into law and you really like that plan, what we said was you could keep it if it hasn’t changed since the law was passed,” he said, adding the qualifier Monday during a Washington event with supporters.

Tuesday, November 5, 2013

2 Million Frauds and Climbing... Thank's Barrack!

from the Weekly Standard
In a continuing crackdown on the federal government's Lifeline program, sometimes known as "Obama phones," the Federal Communications Commission (FCC) has revealed that fraud and abuse in the program exceeded two million subscribers. New rules were established after it became clear that subscribers and providers were taking advantage of the system:
The FCC’s Enforcement Bureau has worked aggressively to enforce these new rules since their adoption, taking actions worth over $15 million, in addition to today’s $32.6 million in proposed forfeitures. Numerous additional investigations are ongoing. Moreover, over 2 million duplicate subscriptions have been eliminated, and the FCC’s reforms are on track to save the Fund more $2 billion over three years.
The two million is up from a figure of 1.1 million in an FCC press release just a month ago.

The Lifeline program was started in 1985 to allow low income household to have basic and emergency phone service, but has grown dramatically since its inception. The Wall Street Journal reported in February that payments ballooned from $819 million in 2008 to more than $2.2 billion in 2012. The Journal investigation also found that the kind of fraud uncovered by the FCC in its current action was rampant:
A review of five top recipients of Lifeline support conducted by the FCC for the Journal showed that 41% [almost 2.5 million] of their more than six million subscribers either couldn't demonstrate their eligibility or didn't respond to requests for certification.
The purpose of the November 1 press release was to announce that the FCC has proposed fines of $32.6 million against

three providers for rules violations. The FCC is accusing Conexions Wireless, i-wireless, and True Wireless of knowingly allowing multiple Lifeline subscriptions from the same household when the limit is one per household. Service providers may request reimbursement from the government under the program on the condition that they have verified eligibility of their subscribers under Lifeline rules. One of the companies, Conexions Wireless, also faces a $300,000 fine for "apparent willful and repeated failure to provide timely and complete responses to the FCC’s requests for information."

The total proposed forfeitures against providers to date amount to a relatively small $47.6 million versus the apparent billions in fraud. An email to the FCC requesting clarification regarding further actions possibly pending against providers has not yet been returned.

Growing Health Care Fraud - 357,000 Illinois Medicaid Benificieries Not Eligible?

Of the 712,000 Illinois Medicaid recipients audited so far, 357,000 have been found ineligible, and only 176,000 removed from the Medicaid rolls... Now would somebody PLEASE sign them ALL up for Obamacare subsidies?

Saturday, November 2, 2013

Got Employer Provided Health Insurance? Just Wait Until Next Year...

from the AP
MIAMI (AP) -- Dean Griffin liked the health insurance he purchased for himself and his wife three years ago and thought he'd be able to keep the plan even after the federal Affordable Care Act took effect.

But the 64-year-old recently received a letter notifying him the plan was being canceled because it didn't cover certain benefits required under the law.

The Griffins, who live near Philadelphia, pay $770 monthly for their soon-to-be-terminated health care plan with a $2,500 deductible. The cheapest plan they found on their state insurance exchange was a so-called bronze plan charging a $1,275 monthly premium with deductibles totaling $12,700. It covers only providers in Pennsylvania, so the couple, who live near Delaware, won't be able to see doctors they've used for more than a decade.

"We're buying insurance that we will never use and can't possibly ever benefit from. We're basically passing on a benefit to other people who are not otherwise able to buy basic insurance," said Griffin, who is retired from running an information technology company.

The Griffins are among millions of people nationwide who buy individual insurance policies and are receiving notices that those policies are being discontinued because they don't meet the higher benefit requirements of the new law.

They can buy different policies directly from insurers for 2014 or sign up for plans on state insurance exchanges. While lower-income people could see lower costs because of government subsidies, many in the middle class may get rude awakenings when they access the websites and realize they'll have to pay significantly more.

Those not eligible for subsidies generally receive more comprehensive coverage than they had under their soon-to-be-canceled policies, but they'll have to pay a lot more.

Because of the higher cost, the Griffins are considering paying the federal penalty - about $100 or 1 percent of income next year - rather than buying health insurance. They say they are healthy and don't typically run up large health care costs. Dean Griffin said that will be cheaper because it's unlikely they will get past the nearly $13,000 deductible for the coverage to kick in.

Individual health insurance policies are being canceled because the Affordable Care Act requires plans to cover certain benefits, such as maternity care, hospital visits and mental illness. The law also caps annual out-of-pocket costs consumers will pay each year.

In the past, consumers could get relatively inexpensive, bare-bones coverage, but those plans will no longer be available. Many consumers are frustrated by what they call forced upgrades as they're pushed into plans with coverage options they don't necessarily want.

Ken Davis, who manages a fast food restaurant in Austin, Texas, is recovering from sticker shock after the small-business policy offered by his employer was canceled for the same reasons individual policies are being discontinued.

His company pays about $100 monthly for his basic health plan. He said he'll now have to pay $600 monthly for a mid-tier silver plan on the state exchange. The family policy also covers his 8-year-old son. Even though the federal government is contributing a $500 subsidy, he said the $600 he's left to pay is too high. He's considering the penalty.

"I feel like they're forcing me to do something that I don't want to do or need to do," Davis, 40, said.

Owners of canceled policies have a few options. They can stay in the same plan for the same price for one more year if they have one of the few plans that were grandfathered in. They can buy a similar plan with upgraded benefits that meets the new standards - likely at a significant cost increase. Or, if they make less than $45,960 for a single adult or $94,200 for a family of four, they may qualify for subsidies.

Just because a policy doesn't comply with the law doesn't mean consumers will get cancellation letters. They may get notices saying existing policies are being amended with new benefits and will come with higher premiums. Some states, including Virginia and Kentucky, required insurers to cancel old policies and start from scratch instead of beefing up existing ones.

It's unclear how many individual plans are being canceled - no one agency keeps track. But it's likely in the millions. Insurance industry experts estimate that about 14 million people, or 5 percent of the total market for health care coverage, buy individual policies. Most people get coverage through jobs and aren't affected.

Many states require insurers to give consumers 90 days' notice before canceling plans. That means another round of cancellation letters will go out in March and again in May.

Experts haven't been able to predict how many will pay more or less under the new, upgraded plans. An older policyholder with a pre-existing condition may find that premiums go down, and some will qualify for subsidies.

In California, about 900,000 people are expected to lose existing plans, but about a third will be eligible for subsidies through the state exchange, said Anne Gonzalez, a spokeswoman for the exchange, called Covered California. Most canceled plans provided bare-bones coverage, she said.

"They basically had plans that had gaping holes in the coverage. They would be surprised when they get to the emergency room or the doctor's office, some of them didn't have drug coverage or preventive care," Gonzalez said.

About 330,000 Floridians received cancellation notices from the state's largest insurer, Florida Blue. About 30,000 have plans that were grandfathered in. Florida insurance officials said they're not tracking the number of canceled policies related to the new law.

National numbers are similar: 130,000 cancellations in Kentucky, 140,000 in Minnesota and as many as 400,000 in Georgia, according to officials in those states.

Cigna has sent thousands of cancellation letters to U.S. policyholders but stressed that 99 percent have the option of renewing their 2013 policy for one more year, company spokesman Joe Mondy said.

Cancellation letters are being sent only to individuals and families who purchase their own insurance. However, most policyholders in the individual market will receive some notice that their coverage will change, said Dan Mendelson, president of the market analysis firm Avalere Health.

The cancellations run counter to one of President Barack Obama's promises about his health care overhaul: "If you like your health care plan, you'll be able to keep your health care plan."

Philip Johnson, 47, of Boise, Idaho, was shocked when his cancellation notice arrived last month. The gift-shop owner said he'd spent years arranging doctors covered by his insurer for him, his wife and their two college-age students.

After browsing the state exchange, he said he thinks he'll end up paying lower premiums but higher deductibles. He said the website didn't answer many of his questions, such as which doctors take which plans.

"I was furious because I spent a lot of time and picked a plan that all my doctors accepted," Johnson said. "Now I don't know what doctors are going to take what. No one mentioned that for the last three years when they talked about how this was going to work."