Ridgewood NJ, Obamacare has been an epic fail for many who had insurance. The Affordable Care Act has been anything but affordable for those of us paying in part or in full for our own Healthcare. For many, basic health care previously covered by insurance is now approaching prohibitive cost levels. Although insurance was previously expensive, after payment for insurance was rendered the cost of medical care itself was substantially covered by the insurance company.
Shortly after Obamacare was introduced, many did see a significant reduction in their premiums. However, there was an equal and sometimes greater increase in their out-of-pocket costs after the care was rendered. Over a short period of time, premiums increased to pre-Obamacare levels and the out-of-pocket costs continue to climb. These facts alone indicate that the program was overreaching and a failure.
Additionally, here in New Jersey, those such as small business owners or independent contractors responsible for their own insurance coverage are limited to a minimal number of insurance companies and an even smaller number of those companies are actually accepted by a majority of medical care providers. The net result is that many who were previously insured are now unable to afford insurance and those who were previously uninsured currently remain either uninsured or covered by government programs paid for by the very people who can no longer afford insurance of their own.
Fort Worth Tx, On Friday night a federal judge in Texas ruled the Affordable Care Act unconstitutional , likely setting up a final decision on the law’s fate at the Supreme Court.
The law, known as Obamacare, was effectively nullified by the ruling. Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas, in Fort Worth, heard arguments in the case in early September, but did not issue his ruling until Friday evening.
He did not, however, grant the plaintiffs’ request for an injunction, meaning the law’s provisions remain in effect until an appeal reaches the Supreme Court, or the ruling is reversed by an Appeals Court. That means that the current open enrollment period regulated by Obamacare continuing through its Saturday deadline.
At issue in the case was the individual mandate, the provision in Obamacare that requires everyone to have health insurance or face a penalty in the form of a tax. The Supreme Court upheld that part of the law in 2012, ruling it fell in line with Congress’ power to levy taxes. Congress, eliminated the tax penalty last December as part of President Trump’s major tax overhaul which, means the mandate is no longer a tax and therefore is unconstitutional.
Washington DC, President Donald J. Trump is taking action to improve access, increase choices, and lower costs for healthcare. The President thru executive action on Thursday , the president said , “The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide far better care.”
EXPANDING ACCESS TO MORE AFFORDABLE OPTIONS: President Donald J. Trump is taking action to increase the healthcare choices for millions of Americans, potentially allowing some employers to join together across State lines to offer coverage.
• President Trump signed an Executive Order to reform the United States healthcare system to take the first steps to expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers.
• The order directs the Secretary of Labor to consider expanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines.
o A broader interpretation of the Employee Retirement Income Security Act (ERISA) could potentially allow employers in the same line of business anywhere in the country to join together to offer healthcare coverage to their employees.
It could potentially allow employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance.
o By potentially making it easier for employers to band together, workers could have access to a broader range of insurance options at lower rates in the large group market.
o Employers participating in an AHP cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions.
• The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost short-term limited duration insurance (STLDI).
o STLDI is not subject to costly Obamacare mandates and rules. One study found that on average STLDI costs one-third the price of the cheapest Obamacare plans.
o Despite its low cost, STLDI typically features broad provider networks and high coverage limits.
o The main groups who benefit from STLDI are people between jobs, people in counties with only a single insurer offering exchange plans, people with limited coverage networks, and people who missed the open enrollment period but still want insurance.
• The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider changes to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees.
o HRAs are employer-funded accounts that reimburse employees for healthcare expenses, including deductibles and copayments.
o The IRS does not count funds contributed to an HRA as taxable income.
o Expanded HRAs could potentially give American workers greater flexibility and control over how to finance their healthcare needs.
OBAMACARE IS FAILING: The status quo is not delivering quality healthcare options for the American people, who are facing higher premiums and fewer options.
• The percentage of workers at small firms receiving coverage through their employer has declined from nearly half in 2010 to about one-third in 2017.
• In 2018, more than 1,500 counties (nearly 50 percent of all counties) are projected to have only one option on their individual insurance exchanges, according to the Centers for Medicare and Medicaid Services.
o This means 2.6 million Americans, or nearly 30 percent of exchange participants, will be left without a choice of insurers.
• From 2013 to 2017, average premiums for individual health insurance plans have doubled, increasing by $2,928 according to the Department of Health and Human Services.
o During this period, every State using www.healthcare.gov saw individual insurance premiums increase.
• Americans are departing the Obamacare exchanges and millions are choosing to pay the law’s penalty instead.
o 500,000 fewer Americans enrolled in an Obamacare plan in 2017 compared to the prior year.
o Current exchange enrollment is 60% below what the Congressional Budget Office expected when the law took effect.
o 6.7 million Americans chose to pay the Obamacare penalty in 2015 rather than purchase insurance on the exchanges. 37% of penalized households made less than $25,000, and 79% of penalized households made less than $50,000.
Ridgewood NJ, It seems the Vermont Attorney General’s Office has concluded its investigation into the invoices and billing practices of Dr. Jonathan Gruber, an economic consultant, who contracted with the State of Vermont in July 2014 to provide policy expertise, research and economic modeling relating to the implementation of Vermont’s single-payer healthcare system, Green Mountain Care. The Office’s investigation was opened following a referral by State Auditor Doug Hoffer. The Attorney General’s Office and Dr. Gruber have reached an agreement to settle the State’s potential legal claim that Gruber submitted false claims to the State under Vermont’s Civil False Claims Act.
Gruber, who helped design the federal Affordable Care Act, also known as Obamacare, came under fire in 2014 after he made disparaging comments about voters, calling Democratic voters stupid and saying these voters would believe anything they were told.
According to the Settlement Agreement, Dr. Gruber’s personal services contract with the State was a standard “time and materials” contract which specified that Gruber would be paid only for services actually performed and required Gruber to submit monthly invoices describing the work performed and the amounts billed for such work. The Office’s investigation revealed that Gruber submitted at least two invoices that were false with respect to the amount of work performed by Gruber’s research assistant. Further, the supporting documentation provided by Gruber did not reflect the actual hours worked by the research assistant, nor did the assistant keep records accurately reflecting the hours he devoted to the state project. The Attorney General’s Office concluded that Dr. Gruber’s conduct violated the Vermont Civil False Claims Act. While Dr. Gruber denied that there was a violation, in order to resolve the matter, he agreed to forgo any further payment that might be due from the State under the contract, including $90,000 outstanding for retainage amounts and unpaid research assistant tim
Remember Robert Menendez? The Democratic Senator from New Jersey has kept a relatively low profile since being indicted in early 2015on corruption charges, perhaps hoping to play out the clock. His effort to stave off a trial by using the Speech or Debate Clause ran aground at the Supreme Court in April, and the scene will shift to the courtroom in just under three weeks.
So far, Menendez has steadfastly proclaimed his innocence and refused to resign. A conviction for corruption will leave no choice but to vacate his seat, and as Shane Goldmacher reports at the New York Times, that will have consequences far beyond the electoral complications. With Chris Christie able to appoint an interim replacement, Democrats worry that Mitch McConnell might finally get the 50 votes he needs to repeal ObamaCare once and for all:
Weeks after the collapse of the attempt to repeal and replace the Affordable Care Act, uncertainty around federal action is affecting premium rates and continues to unsettle the health insurance industry.
“The continued uncertainty is making it very difficult for carriers,” said New Jersey Association of Health Plans president Ward Sanders.
In two recent reports, from the Kaiser Family Foundation and the Stop the Health Insurance Tax Coalition lobbying firm, premiums are estimated to increase by hundreds of dollars for New Jerseyans.
According to Stop the HIT, with the reintroduction of the premium fee:
Individuals will see an increase of at least $178.
Small group plans will increase by $209 for individuals and $556 for families.
Large groups will see an increase of $207 for individuals and $615 for family.
Seniors and disabled individuals in Medicare Advantage will see their premiums increase $516 per couple (or $248 for every individual).
State Medicaid programs will incur an additional cost of $268 for each of their insured Medicaid enrollees in 2018.
“From what we’ve seen from other state filings (as highlighted in the KFF report), the cost sharing reduction payments, if they are not going to be there, it is going to have a significant impact on insurance premiums,” Sanders said.
Whether or not the individual mandate and federal subsidies are kept intact, plus the reintroduction of the premium fee on insurers — which alone will increase premiums by close to 3 percent — are forcing significant increases for 2018 plans.
If subsidies are cut off for marketplace enrollees and the individual mandate is removed, insurers are likely to see fewer (mostly healthy) enrollees and therefore need to increase premiums.
Psst: You might pay less for health care if you put away your insurance card.
Like most of us, you probably think your insurance policy gives you access to better prices. But that’s not always true.
How do you find out? It takes a little bit of work. But when you’re done, you’ll know more about health care and insurance – whether you’re an individual looking for a simple blood test or a sore-throat visit, or whether you’re an employer trying to beat back health costs.
And with the confusion in Washington over the future of health care in this country, we will all need to take ownership of issues we previously left to the insurer and the doctor.
Here’s an example: A person in California was asked to pay $1,850 for an MRI. Because he has a high deductible, he asked the office manager and she said if he agreed not to report the transaction to his insurance company, he could have the MRI for $580.
Life expectancy gains have stalled. The grim silver lining? Lower pension costs
August 8, 2017, 4:00 AM EDT
Steady improvements in American life expectancy have stalled, and more Americans are dying at younger ages. But for companies straining under the burden of their pension obligations, the distressing trend could have a grim upside: If people don’t end up living as long as they were projected to just a few years ago, their employers ultimately won’t have to pay them as much in pension and other lifelong retirement benefits.
In 2015, the American death rate—the age-adjusted share of Americans dying—rose slightly for the first time since 1999. And over the last two years, at least 12 large companies, from Verizon to General Motors, have said recent slips in mortality improvement have led them to reduce their estimates for how much they could owe retirees by upward of a combined $9.7 billion, according to a Bloomberg analysis of company filings. “Revised assumptions indicating a shortened longevity,” for instance, led Lockheed Martin to adjust its estimated retirement obligations downward by a total of about $1.6 billion for 2015 and 2016, it said in its most recent annual report.
Mortality trends are only a small piece of the calculation companies make when estimating what they’ll owe retirees, and indeed, other factors actually led Lockheed’s pension obligations to rise last year. Variables such as asset returns, salary levels, and health care costs can cause big swings in what companies expect to pay retirees. The fact that people are dying slightly younger won’t cure corporate America’s pension woes—but the fact that companies are taking it into account shows just how serious the shift in America’s mortality trends is.
By Bill Bartel and Scott Daugherty
Aug 4, 2017 Updated 15 min ago
A retired attorney in Virginia Beach is so incensed that Republicans couldn’t repeal the Affordable Care Act he’s suing to get political donations back, accusing the GOP of fraud and racketeering.
Bob Heghmann, 70, filed a lawsuit Thursday in U.S. District Court saying the national and Virginia Republican parties and some GOP leaders raised millions of dollars in campaign funds while knowing they weren’t going to be able to overturn the ACA, also known as Obamacare.
The GOP “has been engaged in a pattern of Racketeering which involves massive fraud perpetrated on Republican voters and contributors as well as some Independents and Democrats,” the suit said. Racketeering, perhaps better known for use in prosecuting organized crime, involves a pattern of illegal behavior by a specific group.
Washington DC, Judicial Watch today released two productions of documents 1123 pages of Department of Health and Human Services (HHS) records showing security officials’ concerns about the Obamacare website prior to its launch.
Judicial Watch obtained the HHS documents in response to a court order in a Freedom of Information Act (FOIA) lawsuit (Judicial Watch v. U.S. Department of Health and Human Services (No. 1:14-cv-00430)). The lawsuit was filed in March 2014 after HHS failed to respond to a December 20, 2013, FOIA request seeking:
All records related to the security of the healthcare.gov web portal including, but not limited to, studies, memoranda, correspondence, electronic communications (e-mails), and slide presentations from January 1, 2012 to the present.
The documents show a flippant disregard for Senior IT Security Official Tom Schankweiler’s security concerns in a September 23, 2013, email exchange, one week before the launch of Obamacare, Fryer and CMS official Jacqueline Toomey. Toomey tells Fryer: “Breathe … don’t allow him to suck you in.” Toomey responds later in the exchange: “I’m afraid of who he’s ‘blind copying’ on his emails.” Fryer says: “When [Consumer Information and Insurance Systems Group] gets theirs, can you make a gagging sound for me?” Toomey responds: “Giggling.”
In a September 28, 2013, review, Chief Information Security Officer (CISO) Jane Kim notes that “the risk associated with the Illinois Integrated Eligibility System ATC [Authorization to Connect] as “high,” noting that “87 security controls [were] not documented or incomplete.” Risk associated with Minnesota’s application to connect was also deemed “high,” with 110 incomplete or undocumented security controls. Pennsylvania’s risk was also deemed “high,” with 10 high level security findings. Hawaii was also considered a “high” risk, with 23 “high-impact” security findings.
A security spreadsheet in a September 19, 2013, email exchange shows a “high” level defect in the Obamacare website was discovered. That finding prompted top IT security officials to schedule an emergency conference call in which Senior IT Security Official Tom Schankweiler tries to persuade then-CMS Chief Information Officer Teresa Fryer to issue a “short term ATO [Authorization of Operate]”
In the CMS “Pre-Flight Checklist” published on September 20, 2013, is a chart that indicates that the “Hub,” designed to help with verifying applicant information used to determine eligibility for enrollment, was unable to perform its tasks. Regarding verification of citizenship is the comment: “Hub has been too irregular to work thorough this, and still don’t have the right data to test to the 5 year bar.” Regarding verification of SSN is the comment: “Hub has reliability issues …” The Pre-flight Checklist also notes nine “high” security risks, 123 “moderate” security risks, 68 “low” and 17 “common” risks in various components of the Obamacare system.
On October 1, 2013, Americans started shopping for health insurance on healthcare.gov, and the site crashed.
“The Trump administration should do an immediate security audit of the Obamacare official website,” said Judicial Watch President Tom Fitton. “In the meantime, Americans should be warned that their private health data is at risk on the Obamacare website.”
In September 2014, Judicial Watch released 94 pages of documents obtained from the U.S. Department of Health and Human Services (HHS) including Security Controls Assessment Test Plans sent by CMS to Mitre Corporation. CMS advised Mitre that the highest “Risk Rating” should be given to flaws that could cause “political” damage to CMS. Moderate and low “Risk Ratings” were to include those resulting in potential “public embarrassment” to the agency.
In March 2015, Judicial Watch released documents from the U.S. Department of Health and Human Services (HHS) revealing that Department of Homeland Security (DHS) worked with HHS on security for healthcare.gov.
In January 2016, Judicial Watch released documents showing federal health care officials’ concerns with the Obamacare website in two productions of records: a 143-page production and an 886-page production. The emails showed that CMS Security Officer Teresa Fryer’s refused to approve the “ATO” (Authorization to Operate).
Recently, Judicial Watch released 944 pages of Department of Health and Human Services records showing that the Obamacare website was launched despite serious concerns by its security testing contractor, Mitre Corporation, as well as internal executive-level apprehension about security.
Washington DC , a simple idea to lower healthcare costs continues to be ignored by New Jersey state legislator ,according to Alieta Eck, MD ,”this was a hearing in 2011. Our bill, NJ S239, is still waiting to be heard by the NJ Senate Health Committee. We believe we have enough votes to pass it through, but Senator Vitale refuses to post it. What we are asking, and I fear I did not make this clear enough in the hearing, is that we are asking the state to cover the liability of the PRIVATE practices of physicians who donate 4 hours/week in or through a non-government free clinic. The federal government already protects us for the work we do in the free clinic via the Federal Tort Claims Act. ”
She goes on , “This would improve access to care for the ambulatory Medicaid population, for people who have no insurance or funds to pay for primary care, for people who are undocumented and need medical care– and it would take a huge burden off the taxpayers. If the federal government would block grant those Medicaid dollars back to the states, the states could use the funds to continue to care for the poor and disabled and for indigent nursing home patients– and the state contribution to the Medicaid system would be far less. State budgets would be much easier to balance and taxes would be lower.”
“The hospitals complain that they cannot publish their prices because they would have to ask the insurer in order to state the price up front. What other industry thinks like that? “How much is this dress?” Answer, “What credit card are you using?” Forget the insurer. What is the best CASH, check or credit card price? ” Alieta Eck, MD For Real Health Care Reform
By Rachel Bluth July 25, 2017
COLUMBUS, Ohio — Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation.
One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.
But the law didn’t go into force on Jan. 1 as scheduled. And its troubled odyssey illustrates the political and business forces opposing a common-sense but controversial solution to rein in high health care costs for patients: Let patients see prices.
Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as adjust their household budgets for upcoming health-related outlays at a time of high-deductible plans.
Before resigning themselves to socialized medicine, flummoxed legislators should consider the experience of our neighbors to the North. In the Netflix series House of Cards, President Frank Underwood campaigned for the White House by telling Americans, “You are entitled to nothing.” The fictional president — a Democrat, no less — was forthright with American voters about the unaffordable and unsustainable structure of America’s entitlement programs, and he was rewarded at the polls. In real-life America, unfortunately, there is no such courageous honesty from the political class. Even many in the Republican party, once the stalwart force fighting against the growth of big government, are now resigned to contemplating a government takeover of the health-care industry in the wake of their failure to repeal and replace Obamacare. Charles Krauthammer, for example, woefully predicts that President Trump will opt for single-payer health care. F. H. Buckley, meanwhile, optimistically calls for Trump to look to the Canadian model of universal coverage. There’s just one problem: The Canadian model of universal coverage is failing.
Posted by Tony Smith on Friday, February 26th, 2016, 4:00 PM
Of the 11 remaining health insurance co-ops created under Obamacare, eight of them could collapse in less than a year. Moreover, the 11 remaining are less than half of the original twenty-three that were established in 2012 to compete with for-profit, private insurance companies. This from Mandy Cohen, one of the top federal health officials in charge of overseeing the implementation of Obamacare. As COO of the Centers for Medicare and Medicaid Services, Cohen’s responsibilities not only cover the physical presence of Obamacare throughout the country but its disastrous virtual presence in the form of healthcare.gov.
In addition to the possible collapse of the healthcare co-ops, Cohen hinted that there was much more at stake than just the loss of insurance for consumers. From the Daily Caller:
“About $1.4 billion of the $2.5 billion in Obamacare loan funding was lost when the 12 failed co-ops went under.
Cohen ominously hinted that many local hospitals, medical clinics and doctors may not be paid for services they delivered to co-op patients because federal law requires that the government be first in line among creditors.
“For federal loans, there is an order of repayment,” she said. “I believe we are at the very top of all of the creditors,” but who gets paid “is on a case-by-case basis” determined by the Justice Department.”
Facing a House oversight panel, Cohen refused to reveal further information on which co-ops were in danger of collapse, citing possible damage to the co-ops if consumers were informed their insurance providers may not be able to do their jobs and provide them with insurance in the near-future. For an administration so apparently concerned with protecting consumers from the dangerous and irresponsible corporations, it would seem that same standard of consumer protection does not apply when the government’s reputation is at risk.
Obamacare was supposed to ensure that every US citizen would have affordable healthcare without the threat of it being taken away from them. But as the old saying goes, “what the government gives it can take away”, and in this case, the American people face the loss of their insurance by the very administration who promised it to them.
The Obamacare program has been riddled with failure. From a website launch that would make only North Korea envious, to billions in possible fraudulent payments, and billions more wasted on failed exchanges that never got off the ground, Obamacare has been an abject failure that has cost taxpayers billions and created industry-crushing regulations that have hurt, rather than have helped, the health and welfare of the American people. And it would seem that with Mandy Cohen’s most recent testimony, the beginning of the end for another part of the Affordable Care Act’s infrastructure
Ridgewood Nj, you have heard it over and over again ,”20 million people gained healthcare due to Obamacare. This confirms that Obamacare was successfully addressing the underlying problems within the healthcare market.”
The reality is far different ,the majority of these people were simply placed on an expanded version of Medicaid, meaning, rather than addressing the issues plaguing the dysfunctional healthcare market, Obamacare did little to improve markets and simply pushed people into government-run healthcare, paid by taxpayers.
People keep touting, as though it were some sort of success story, that “more people have health insurance today due to Obamacare.” This particular talking point seems astonishingly absurd, however, since Obamacare contained within it a MANDATE that FORCED people to get health insurance. Of course, if you put a gun to someone’s head and tell them to buy something, they’re more likely to buy it. This is akin to passing a law requiring everybody to buy one additional pair of shoes, then proclaiming yourself a business genius because you then saw shoe sales increase. If sales didn’t increase because the product became more affordable or more desirable, however, it should be obvious that you didn’t actually “fix” anything.
Let’s take a look at the numbers:
• A 2015 estimate showed that, of the 20 million newly insured people, 14.5 million were put on Medicaid and CHIP (Children’s Health Insurance Program). [a]
• Of this 14.5 million placed on tax-payer financed health insurance, about 3.4 million were previously eligible before Obamacare [b], but hadn’t enrolled because they didn’t need it. That means tax payers are paying the health insurance costs of 3.4 million people who knew they didn’t actually need it but were forced to accept the hand-out anyways since Obamacare mandates they have insurance.
• Additionally, of the 20 million, 2.3 million were simply young adults (aged 19 to 25) who gained coverage between 2010 and 2013 as a result of Obamacare’s provision which said they got to stay on their parent’s insurance until they were 26. [c] People 19-25 rarely require extensive healthcare, however, which is why they rarely choose to buy it themselves. So while letting them stay on their parent’s insurance may have been helpful in a handful of circumstances, it was mostly “fixing” a problem which did not exist. Matter of fact, the reason the ACA wanted younger people insured was precisely BECAUSE they don’t get sick enough to cost money, and thus represent income for health insurance providers rather than costs.
• Lastly, in 2016, the numbers didn’t look much better. Preliminary data indicated that net total enrollment increased by “2,535,020 individuals in the first three-quarters of 2016.” [d] But of that 2.5 million increase, the net increase in PRIVATE (market) insurance was actually only “490,211 individuals.” Again, Medicaid accounted for “81 percent of the incremental growth in enrollment in 2016.” [d]
Thus, roughly 81% of the newly insured people in 2016 were simply given free insurance which everyone else funded. How is that a success? A successful reform would have seen people affording their own private health insurance – when and only IF they wanted it – because the product would have gotten better, cheaper, or both. Instead, since that wasn’t accomplished, Obamacare simply pushed people into government-run insurance to pretend it had “solved” the problem. It was called “The AFFORDABLE Care Act,” but a more appropriate name would have been “The Forced Welfare Expansion Act.”