Impeding changes to our Health Care system

[Urbane Guerrilla]

A Half Trillion Dollar Delusion

[TheMercenary]

Hmmmmm....

Medicare's chief actuary vs. President Obama on the ObamaCare facts.
There probably isn't a worse job in Washington than Medicare trustee, unpaid Capitol Hill interns included. Every year the trustees issue the gravest warnings about entitlement spending and at best prompt a moment of brow-furrowing before the political class returns to its default state of indifference.

This year's report, issued last week, has more than the usual political meaning because Democrats are hailing it as validation of their claims that ObamaCare will save taxpayers money. The trustee report shows "how the Affordable Care Act is helping to reduce costs and make Medicare stronger," the White House said in a statement.

One problem: That spin ignores the extraordinary companion analysis by chief Medicare actuary Richard Foster that repudiates this conclusion and is the most damning fiscal indictment to date of the Affordable Care Act.

The trustees do estimate the Medicare hospital trust fund will run out of money in 2029, some 12 years later than they estimated last year. (Keep in mind that the trust fund is a meaningless accounting artifact because Medicare was long ago financed in part by general tax revenues.) It's also true that, thanks to ObamaCare's changes under current budget rules, Medicare's unfunded 75-year liability has fallen to about $30.8 trillion from nearly $37 trillion in the previous audit.

Even in Washington, $6.2 trillion is real money. Yet this is a strange excuse for celebration. Democrats wrung about a half-trillion dollars from Medicare over the next decade, but then they turned around and plowed these "savings" into their new middle-class health-care entitlement. It's akin to paying off one credit card with another—while still being deeply in hock on the first.

But then comes the report's final appendix, where Mr. Foster disowns the previous 280-odd pages. Mr. Foster has been Medicare's chief actuary for 15 years, and as such he is required to evaluate the law as written. But as he notes in his appendix, the law as written bears little if any relation to the real world—and thus, he says, the trustee estimates "do not represent a reasonable expectation for actual program operations in either the short range . . . or the long range." In an unprecedented move, he directs readers to a separate "alternative scenario" that his office drew up using more realistic assumptions.

Mr. Foster shows that the Medicare "cuts" that Democrats wrote into ObamaCare exist only on paper and were written so they could pretend to reduce the deficit and perform the miracles the trustees dutifully outlined. With the exception of cuts in Medicare Advantage, those reductions will never happen in practice.

One of the fictions Mr. Foster highlights is the 30% cut in physician payments over the next three years that Democrats have already promised to disallow. Republicans would do the same, we hasten to add.

Another chunk of ObamaCare "savings" are due to cranking down Medicare's price controls for hospitals and other providers that Mr. Foster says are also "extremely unlikely to occur." In the absence of "substantial and transformational changes in health-care practices"—in other words, a productivity revolution in medicine that has never happened—costs will simply rise for private patients, or hospitals will refuse to treat seniors insured by Medicare. Congress will never allow that to happen either.

In other words, under ObamaCare the "cost curve" will not be bent as the White House has advertised.

Under his more plausible outlook, Mr. Foster notes that Medicare's share of the economy will rise 60% between now and 2040, while under the trustees report that Democrats are crowing about it would "only" rise by 35%. Didn't President Obama tell us that health-care reform is entitlement reform?

Politicians have deliberately written the ObamaCare rules, as they have for all entitlements, so the real costs are disguised and hard for taxpayers to figure out. During the ObamaCare debate, Mr. Foster was honest enough from his Medicare perch to expose the plan's true costs, and his new Medicare demarche continues this public service. He ought to receive the Presidential Medal of Freedom, or at least some media attention. But in Barack Obama's Washington, his honesty will be rewarded with obscurity.

http://online.wsj.com/article/SB1000...pinion_LEADTop

[classicman]

the law as written bears little if any relation to the real world—and thus, he says, the trustee estimates "do not represent a reasonable expectation for actual program operations in either the short range . . . or the long range." In an unprecedented move, he directs readers to a separate "alternative scenario" that his office drew up using more realistic assumptions.

Politicians have deliberately written the ObamaCare rules, as they have for all entitlements, so the real costs are disguised and hard for taxpayers to figure out. During the ObamaCare debate, Mr. Foster was honest enough from his Medicare perch to expose the plan's true costs,

Certainly a partisan piece, but still.... Damning statements from the one man who probably knows best.

[xoxoxoBruce]

Since there is no such thing as "ObamaCare", your arguments are invalid.

[TheMercenary]

Everyone calls it ObamaCare, therefore it is...

[classicman]

From Wiki ...

The term was usually used pejoratively, but some supporters of the act suggested after being passed that it be embraced and used positively.

[classicman]

Obamacare in Pictures Busts Health Care Myths

Heritage’s Center for Health Policy Studies has compiled the best and most recent research on the impact Obamacare will have on various aspects of the health care system. These charts (available for individual download or as a package) illustrate the unintended consequences of the new law and expose the unproven claims the President and other proponents of a government overhaul of health care made during the debate, such as:

* If you like your health insurance, you can keep it.
* It will bend the cost curve of health care spending.
* Obamacare won’t add a dime to our soaring federal deficit.
* Not a dollar of the Medicare trust fund will be used to pay for Obamacare.
* It will not lead to a government take over of health insurance.

The graphics available in Obamacare in Pictures show how, rather than achieving universal coverage, some 41 percent of Americans will be uninsured in 2019 under Obamacare. Additionally, more than 17 million Americans are expected to no longer have employer-sponsored coverage because of the new law. Then there’s the $529 billion in cuts to Medicare that will be used to pay for middle-income Americans to purchase subsidized health insurance. The list goes on.

The list of unintended consequences of Obamacare is long. Despite the exorbitant cost to Americans on several levels, the health care overhaul will fail to deliver on the promises for which it was sold. The best way forward is repeal of the Patient Protection and Affordable Care Act so that Congress can start over and get health care reform right. Obamacare in Pictures makes this clearer than ever.

heritage.org
Definitely a biased piece, but it brings some good points to the table.
I guess the "Its a start, we'll modify it as we go" plan might be a good idea.

[TheMercenary]

Obama and the Dems knowingly lied to the electorate. Payback is in Nov.

[classicman]

Now merc - go to the damn link first and actually read it - look at the pretty pictures and then make a snarky comment!

[Undertoad]

Isn't it funny how Heritage pretends to want to have a serious conversation about health care and yet they still call it "Obamacare".

Wake me when the solution is more important than the snark.

[TheMercenary]

Originally Posted by Undertoad

Isn't it funny how Heritage pretends to want to have a serious conversation about health care and yet they still call it "Obamacare".

Wake me when the solution is more important than the snark.

It will always be known as Obamacare. Get over it and get use to it. They own it lock, stock, and barrel. Good or bad.

[classicman]

I noticed that too. I had to post it though.

[Spexxvet]

Originally Posted by classicman

I noticed that too. I had to post it though.

Of course you did. And it was very helpful.

[TheMercenary]

While House and Senate leaders negotiate over the final version of a health care bill, they seem to have forgotten one thing: many of them, including the President, pledged to deny support to any bill which would add to the federal deficit. Until now, budgetary gimmicks have hidden the true cost of the health care bills, but neither chamber of Congress has succeeded at creating a bill which is deficit neutral and falls under $900 billion—the limit set by President Obama himself .

http://blog.heritage.org/2010/01/19/...idents-pledge/

FACT CHECK: Obama's tone shifts on health care
By ERICA WERNER and CALVIN WOODWARD (AP) – 3 days ago
WASHINGTON — President Barack Obama told voters repeatedly during the health care debate that the overhaul legislation would bring down fast-rising health care costs and save them money. Now, he's hemming and hawing on that.
So far, the law he signed earlier this year hasn't had the desired effect. An analysis from Medicare's Office of the Actuary this week said that the nation's health care tab will go up — not down — through 2019 as a result of Obama's sweeping law, though the increase is modest.
Obama offered some caveats when asked in his news conference Friday about the apparent discrepancy between what he promised and what's actually happening so far. On several other topics, too, his rhetoric fell short of a full accounting.
___
EDITOR'S NOTE — An occasional look at assertions by public officials and how well they adhere to the facts
___
A look at some of the claims at his news conference and how they compare with the facts:
OBAMA: Said he never expected to extend insurance coverage to an additional 31 million people "for free." He added that "we've made huge progress" if medical inflation could be brought down to the level of overall inflation, or somewhere slightly above that.
THE FACTS: Those claims may be supported in the fine print of the plan he pitched to Congress and a skeptical public months ago. But they were rarely heard back then. "My proposal would bring down the cost of health care for millions — families, businesses and the federal government," he declared in March.
Last August he predicted: "The American people are going to be glad that we acted to change an unsustainable system so that more people have coverage, we're bending the cost curve, and we're getting insurance reforms."
On Friday, he conceded: "Bending the cost curve on health care is hard to do." The goal: "Slowly bring down those costs."
The White House contends that although health care costs will rise when most of the changes take hold in 2014 and coverage is extended to the uninsured, costs will go down over the longer term as controls kick in.
___
OBAMA: "We took every idea out there about how to reduce or at least slow the costs of health care over time."
THE FACTS: One idea that most experts believe would do the most to control health costs — directly taxing health benefits — was missing in Obama's plan. Opposition from unions and others was too great, and Obama himself had campaigned against the idea.
Some of the major cost controllers that did make it into the law — including a tax on high-value insurance plans — don't start until 2018. That tax was watered down and delayed, and other cost-control approaches also softened after opposition from hospitals and other interest groups.
Health spending already accounts for about 17 percent of the economy and is projected to grow to nearly 20 percent in 2019.

http://www.google.com/hostednews/ap/...eo4qQD9I5913O1

[TheMercenary]

For every person that supported Obamacare I hope your premiums triple....


As insurers face health care law requirements, customers face cancellations

September 8, 2010

In the letter sent to the Alcantaras and other customers, Grand Prairie-based National Health Insurance Co. said it could no longer offer individual accident and health insurance policies. It blamed its decision on the company's inability to meet requirements of the health care overhaul signed into law this year.

The cancellation highlights one way the new law is reshaping the health care landscape in North Texas and elsewhere. Some health economists say more small insurers may soon buckle under the weight of the law's mandates.

The law's biggest challenge for insurers is a requirement starting Jan. 1 that specifies "medical loss ratios" – the percentage of an insurer's premiums spent on medical services for its customers. For individual plans, the new law requires that at least 80 percent of premiums go toward paying medical expenses; for large group coverage, the minimum rises to 85 percent.

Insurers that fail to meet the requirement will have to pay rebates to customers.

"The fact is that there are a number of plans who won't be able to meet this requirement and will simply exit the market," said Jared Wolfe, executive director for the Texas Association of Health Plans, an Austin-based group representing concerns of insurers.

But Ben Gonzalez, spokesman for the Texas Department of Insurance, said, "There is always some movement in and out of the market by smaller players. We do not see a specific trend at this point."

The U.S. Department of Health and Human Services, which has the responsibility of writing the rules for what will qualify as a medical expense, said insurers like National Health may be acting prematurely.

"We have recently heard reports that some insurers are making decisions about participation in particular markets based on the effect of these requirements," Kathleen Sebelius, U.S. secretary of health and human services, said in a statement. "It is premature for insurers to make business decisions about participation in particular markets based on rules that have yet to be published, or to apply for exemptions to rules that have not yet been drafted."

Approval to cancel
On July 26, the Texas Department of Insurance gave National Health approval to stop offering individual accident and health insurance policies. National Health sent letters to the Alcantaras and other customers four days later.

"After careful consideration of the recent health care legislation, National Health Insurance Co. has determined that it will not be able to meet the requirements set forth by the [health care law] recently enacted by the United States federal government," the company said in its letter. "With this knowledge, NHIC has decided to cease distributing and renewing its medical expense plans."

National Health, which declined repeated requests for interviews, did not say in its letter which of the requirements in the 906-page law it has trouble meeting.

But Wolfe said the new medical-loss ratio requirements will be more of a hardship for smaller insurance companies like National Health than for larger companies.

"The individual market has much higher administrative costs than the large group market due to a number of factors, [such as] costs are spread across fewer lives, the cost of underwriting and the role of brokers," Wolfe said.

A company the size of Blue Cross Blue Shield of Texas – the state's largest insurer, with 3.8 million members, 400 hospitals and 40,000 physicians – can rely on name recognition to generate business. But smaller insurers have to heavily rely on insurance brokers, and the new medical loss requirements will hurt their commissions, Wolfe said.

And, as smaller insurance companies bow out under weight of the medical loss ratio requirements, larger insurers stand to increase their market share. Blue Cross Blue Shield of Texas says it sees an opportunity.

"Although we are actively evaluating all aspects of pending health reform definitions and regulations, including the implications of minimum medical loss ratio requirements, we believe that individual insurance is a valuable service and are committed to that market," said spokeswoman Margaret Jarvis.

Financial pressures
The new law is adding to the pressures felt by companies like National Health, which has had financial troubles for at least three years, according to the insurer's financial records kept with the Texas Department of Insurance.

Since December 2007, its assets have fallen 31 percent, from $36.7 million to $25.2 million in December 2009. Premiums from its accident and health division fell 27 percent during the same period, from $8.1 million to $5.9 million.

And since October 2009, the insurer has racked up penalties in several states for not filing health care cost reports or financial statements on time, according to records kept by the Department of Insurance.

The insurer plans to continue writing Medicare supplement policies and specified disease policies. But as a condition of stopping its individual health insurance business, National Health will not be allowed to re-enter that market until 2015.

For the Alcantaras, the loss of their insurance policy is major blow, but not a complete surprise.

They've been pleased with their high-deductible policy, which is tailored to cover Al's Type 2 diabetes and gives them access to all the doctors they want. Their policy will be terminated Feb. 1.

"I honestly believed this would happen," said Jill Alcantara, a critic of the new health law.

High-risk pool
The Alcantaras now plan to join the Texas High Risk Insurance Pool. The plans available range from a $2,500 deductible with $1,025 monthly premium to a $7,000 deductible with a $662 monthly premium. Jill Alcantara acknowledges that's expensive.

"But that's just what we're going to have to do," she said.

http://www.dallasnews.com/sharedcont...1.26bb3e6.html