It may be easier than expected for states to save their ObamaCare subsidies, if the Supreme Court rules against the law this month.
Two states — Pennsylvania and Delaware — said this week they would launch their own exchanges, if needed, to keep millions of healthcare dollars flowing after the decision. Both want to use existing pieces of the federal ObamaCare exchange, like its website and call center — a path that would be far less costly than the way most other states have created their exchanges.
If those plans win approval, many of the other 36 states that stand to lose their subsidies could then pursue a similarly simple strategy.
“I think that’s a pretty easy workaround,” Tom Scully, the former director of the Centers for Medicare and Medicaid Services under the Bush administration, said about the two states’ plans.
“The administration has a lot of flexibility, potentially, to define a state exchange,” he added.
But that would spell trouble for Republicans who view the King v. Burwell case as their best chance yet to dismantle Obama’s healthcare law. GOP members of Congress have repeatedly said they must create a backup plan for states so that they are forced to make ObamaCare “fixes.”
With the ruling inching closer, many of the 34 states that could lose big from the King v. Burwell ruling have been quietly plotting how to avert the potential chaos from a decision against the Obama administration.
The poor keep getting poorer under Democrat rule, Save Jerseyans.
Just the latest example: around 100,000 New Jerseyans are about to see their Obamacare plan premiums rise by 10%, or more, effective January 1, 2016. That’s according to a new look at government data and insurance company reported rate increases from NJ Advance Media‘s Kathleen O’Brien.
Why? Besides the general suckiness of the government’s latest attempt to override the immutable rules of economics and nature? A bunch of stuff that critics like yours truly predicted way back before the ACA was signed including a spike in the number of doctor’s office visits.
And it’s entirely likely to get MUCH worse. We’re expecting a decision from the U.S. Supreme Court in King v. Burwell any day now that will decide the fate of Obamacare’s federal subsidies. Bottom line: as I’ve explained before, the lawcannot survive without subsidies (which should tell you everything right there).
Health insurers across the country are eyeing slightly steeper cost increases in 2016, a year that will be an important test for how well ObamaCare is working.
The costs of the lowest-tiered individual plans appear to be ticking up, according to multiple experts who have reviewed the proposed rates. The increases vary wildly among plans and among states, but experts say people are still unlikely to face the kind of doomsday scenario critics predicted would occur under the healthcare law.
“The trend is a little bit higher this year than last year,” said Gary Claxton, director of the healthcare marketplace program for the Kaiser Family Foundation.
And as in past years, some of those rate increases have been “enormous,” said Cheryl Fish-Parcham, who directs the private insurance program at the nonprofit Families USA.
Under ObamaCare, all proposed rate hikes above 10 percent were required to be posted online by Monday. Now begins a six-month back-and-forth between insurance companies and regulators as the government tries to reduce rates before locking them in this November.
“These specific rates will be subject to vigorous rate review and revision,” said Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services (CMS).
The proposed 2016 rates will offer the most accurate portrait so far about the health of the marketplaces. Claxton, who reviewed several states’ data, said many of the increases are around 15 to 20 percent, though there are large disparities across regions.
Tennessee’s biggest insurer has proposed an increase of 36 percent for some plans, while one of New Mexico’s biggest carriers is looking at a 50 percent increase. The most popular carrier in Maryland has called for a 30 percent hike.
MAY 31, 2015 LAST UPDATED: SUNDAY, MAY 31, 2015, 9:38 AM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
They were moments of crisis for each family. A newborn who wasn’t breathing was rushed to intensive care. A 15-year-old skier who wiped out on a slope in the Catskills needed surgery to reconstruct his shoulder. A 65-year-old insurance agent who survived a heart attack needed urgent bypass surgery to clear his arteries.
The stress didn’t stop once these medical crises passed, however. Within a few weeks, each family received an unexpected medical bill.
They had been savvy enough to follow their insurers’ rules and choose in-network hospitals to maximize their coverage and minimize their out-of-pocket costs. But one or more of the physicians who took care of them — and over whom they had no choice — did not participate in their insurance network.
Major insurers in some states are proposing up to 51 percentpremium increases for health plans sold under the Affordable Healthcare and Patient Protection Act, commonly referred to as Obamacare. Despite single digit increases for 2015, insurance companies are seeing their costs jump and are demanding to be compensated with dramatically higher rates.
When Insurance plans proposed 2015 rates last summer, they had only a little information about the health of the new customers they expected to sign up during the fall Obamacare expansion. Big insurers tended to ask for increases of less than 10%, while some smaller insurers tried to under-cut pricing by the major’s to take market share, according to theWall Street Journal.
Under Obamacare, insurers must file proposed premium rates with their local state regulator and the federal government by June. But some states have already started publicly disclosing the premium requests. Due to the high utilization costs from people newly enrolled under Obamacare, the 2016 insurance premiums are about to skyrocket.
According to states that have released rate requests, New Mexico’s market leader Health Care Service Corp. is asking for an average premium spike of 51.6 percent; Tennessee’s top insurer BlueCross BlueShield of Tennessee wants an average spike of 36.3%; Maryland’s market leader CareFirst BlueCross BlueShield is requesting an average spike of 30.4%; and Oregon’s top insurer, Moda Health, is seeking a 25% spike.
AMONG liberals, it’s almost universally assumed that of the two major parties, it’s the Republicans who have become more extreme over the years. That’s a self-flattering but false narrative.
This is not to say the Republican Party hasn’t become a more conservative party. It has. But in the last two decades the Democratic Party has moved substantially further to the left than the Republican Party has shifted to the right. On most major issues the Republican Party hasn’t moved very much from where it was during the Gingrich era in the mid-1990s.
To see just how far the Democratic Party has moved to the left, compare Barack Obama with Bill Clinton. In 1992, Mr. Clinton ran as a centrist New Democrat. In several respects he governed as one as well. He endorsed a sentencing policy of “three strikes and you’re out,” and he proposed adding 100,000 police officers to the streets.
In contrast, President Obama’s former attorney general, Eric H. Holder Jr., criticized what he called “widespread incarceration” and championed the first decrease in the federal prison population in more than three decades. Mr. Obama, meanwhile, has chosen to focus on police abuses.
One of the crowning legislative achievements under Mr. Clinton was welfare reform. Mr. Obama, on the other hand, loosened welfare-to-work requirements. Mr. Obama is more liberal than Mr. Clinton was on gay rights, religious liberties, abortion rights, drug legalization and climate change. He has focused far more attention on income inequality than did Mr. Clinton, who stressed opportunity and mobility. While Mr. Clinton ended one entitlement program (Aid to Families With Dependent Children), Mr. Obama is responsible for creating the Affordable Care Act, the largest new entitlement since the Great Society. He is the first president to essentially nationalize health care.
Mr. Clinton lowered the capital-gains tax rate; Mr. Obama has proposed raising it. Mr. Clinton cut spending and produced a surplus. Under Mr. Obama, spending and the deficit reached record levels. In foreign policy, Mr. Obama has shown himself to be far more critical of traditional allies and more supine toward our adversaries than Mr. Clinton was. Mr. Obama has often acted as if American strength is a problem to which the solution is retrenchment, or even retreat.
Another bellwether: Hillary Rodham Clinton, in positioning herself for the 2016 election, is decidedly more liberal than she and her husband once were on illegal immigration, gay marriage and incarceration. She has called to “end the era of mass incarceration” and spoken about the importance of “toppling” the wealthiest 1 percent. She has remained noncommittal on the Trans-Pacific Partnership, the free-trade agreement that has drawn ire from the left.
The Democratic Party, then, has moved steadily to the left since the Clinton presidency. In fact, since his re-election, Mr. Obama’s inner progressive has been liberated. (An exception is the administration’s conditional approval of oil drilling off the Alaskan coast, starting this summer.) Other examples are his executive action granting temporary legal status to millions of illegal immigrants, his claim that gay marriage is a constitutional right, and his veto of legislation authorizing construction of the Keystone XL pipeline.
A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability.
Many of the 13 state-run ObamaCare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year.
Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange.
The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.
But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.
Proposals set the stage for debate over federal health law’s impact
By
LOUISE RADNOFSKY
May 21, 2015 5:34 p.m. ET
Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.
In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%.
All of them cite high medical costs incurred by people newly enrolled under the Affordable Care Act.
Under that law, insurers file proposed rates to their local regulator and, in most cases, to the federal government. Some states have begun making the filings public, as they prepare to review the requests in coming weeks. The federal government is due to release its rate filings in early June.
Insurance regulators in many states can force carriers to scale back requests they can’t justify. The Obama administration can ask insurers seeking increases of 10% or more to explain themselves, but cannot force them to cut rates. Rates will become final by the fall.
“After state and consumer rate review, final rates often decrease significantly,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, the federal agency overseeing the health law.
One-quarter of people with healthcare coverage are paying so much for deductibles and out-of-pocket expenses that they are considered underinsured, according to a new study.
An estimated 31 million insured people are not adequately protected against high medical costs, a figure that has doubled since 2003, according to the 2014 national health insurance survey by the Commonwealth Fund.
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Rising deductibles — even under ObamaCare — are the biggest problem for most people who are considered underinsured, according to the 22-page report.
“The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead,” the report warns.
The data is an early warning sign for the Obama administration, which has promised that the millions of people who gained insurance under the president’s law would have affordable access to healthcare.
The survey found that millions of people are paying into the insurance system but are largely unable to reap the benefits.
People who purchase the lowest-quality health insurance are also less likely to see a doctor when they are ill or injured because they fear their high out-of-pocket costs.
“People who have high deductibles do tend to skimp on healthcare,” the study’s lead author, Sara Collins, told reporters.
When people do see a doctor, the costs accumulate quickly.
Half of underinsured adults and 41 percent of privately insured adults with deductibles of $1,000 or higher were paying off accumulated medical bills of $4,000 or more, the report found.
Americans’ satisfaction with the direction of the country continues to slip, falling 6 percentage points from early this year, according to a new Gallup poll.
Twenty-six percent of Americans are satisfied with the direction of the country, according to Gallup, returning to levels around the end of 2014, before a sharp 9-percentage-point uptick in satisfaction heading into the new year.
In the poll, which parallels a similar drop in economic confidence, Gallup notes, respondents list government, the economy and unemployment as top problems.
During President Obama’s term, satisfaction topped 36 percent in August 2009, but has ranged between 11 percent and 33 percent since then, according to Gallup.
MAY 14, 2015, 11:38 PM LAST UPDATED: THURSDAY, MAY 14, 2015, 11:45 PM
BY LINDY WASHBURN AND DUSTIN RACIOPPI
STAFF WRITERS |
THE RECORD
Pushback came from many sides Thursday as Democratic lawmakers in Trenton unveiled a plan to corral high out-of-network charges and protect consumers from surprise medical bills when they go to the hospital.
A chain of Hudson County hospitals called the bill “a massive gift to large insurance companies.” The state medical society said it would have “a dangerous and deleterious effect on health care quality in New Jersey.” It labeled a provision that would have an arbitrator settle billing disputes “an insult.”
Hundreds of millions of dollars is at stake as the measure seeks to limit the amount hospitals and doctors can charge for their services. The measure calls for full written disclosure of expected charges for hospital patients and creation of a database to set the limits on what out-of-network providers can charge insurance companies. It would prevent patients from being charged more than the in-network rate for any service when they chose an in-network hospital and doctor for their care.
The savings — to patients, insurers, and those who pay for insurance coverage, including state and local governments and school systems — could be enormous. Opponents, however, say it could drive hospitals and doctors out of business.
MAY 13, 2015, 8:18 PM LAST UPDATED: WEDNESDAY, MAY 13, 2015, 8:24 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
Consumers would be protected from surprise medical bills when they go to the hospital under a measure to be unveiled Thursday in Trenton by a group of powerful Democratic lawmakers.
Out-of-network charges to insurers would be capped. And in an unprecedented push for transparency, the state would publish a list of the average prices for almost every service, based on data the insurers would be required to submit. When hospitals or doctors and insurers disagree on the appropriate amount for an out-of-network bill, the measure calls for “baseball arbitration” — a state-appointed arbitrator to choose one side’s final offer.
The financial stakes are enormous, and a high-powered offensive from those whose revenues or income would be diminished by the measure is expected, including specialist physicians and hospitals.
“I think it’s going to be a fight,” for passage, said Assemblyman Gary S. Schaer, a Passaic Democrat who chairs the Assembly Budget committee and helped draft the “The Out-of Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” to be introduced today at a noon news conference.
But he pointed to the high-ranking Democrats who drafted the legislation, including state Sen. Joseph Vitale, chairman of the Senate Health Committee, and Assemblyman Craig Coughlin, chairman of the Assembly committee in charge of health insurance, both Wood-bridge Democrats — as well as Assemblyman Troy Singleton of Mount Laurel. Schaer is chairman of the Assembly Budget Committee.
Most lawmakers are expected to agree, he said, that “significant remedial action needs to be undertaken to tackle this issue, which contributes a lot to the rise in health-care costs,” as well as bankruptcies among state residents.
An important way insurance companies control costs is by negotiating contracts with hospitals, doctors, and other health-care providers who agree to accept their reimbursement and become part of their network. Some health plans include coverage for care received from providers who are not part of the insurer’s network.
The out-of-network charges billed by some New Jersey hospitals are among the highest in the country, and insurers say that they drive up premiums for everyone. In addition, patients who receive care from hospital-based physicians – over whom they have no choice – often are surprised to learn that they were out-of-network providers and charge much more than expected.
MAY 10, 2015, 2:55 PM LAST UPDATED: MONDAY, MAY 11, 2015, 12:28 AM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
A Franklin Lakes couple did everything possible last fall to stick to their insurance company’s rules when their baby was born.
To keep out-of-pocket costs to a minimum, they chose an obstetrician and a hospital that were part of their health insurance plan. When Brenda Cristiano required a C-section after a long labor, they thought they were covered.
But a few weeks later, they received a bill from the anesthesiologist — for $1,852.
It turns out that no anesthesiologist practicing at The Valley Hospital in Ridgewood, where GianLuca was born on Oct. 15, accepts Cigna, their insurance plan. So even though the Cristianos used an in-network hospital and in-network obstetrician, they could not avoid out-of-network charges.
It happens over and over again: Hospital-based physicians — whom patients are powerless to choose — do not participate in some or all of the insurance plans a hospital accepts and end up demanding additional payment from patients for their fees. Surprise medical bills from anesthesiologists, emergency-room doctors, pathologists and radiologists, among others, have led to complaints and appeals and forced consumers to pay thousands more than they expected.
Many consumers wind up deeply in debt when they are billed out-of-network rates, said Chuck Bell, director of programs at Consumers Union, the publisher of Consumer Reports. “Patients are trying hard to play by the rules, to use provider directories and stay within the network,” he said. “It seems that the system is not fair. It does not make it easy for patients to do that.”
These concerns are driving an effort by some New Jersey lawmakers, who plan to submit legislation this week to overhaul the way out-of-network providers and their bills are regulated in New Jersey. Nationwide, nearly one in three Americans with private insurance received a surprise medical bill, in which their health plan paid less than they expected, in the last two years, a Consumer Reports survey found. Of those, nearly one in four received a bill from a doctor whom they didn’t expect to bill them.
The Cristianos went to the hospital to have a baby, and inadvertently stumbled into a crossfire of competing interests, including those of doctors, the facility and their insurance company. For the businesses involved, the stakes are high. Mutual mistrust abounds. Patients are left unprotected, accepting care from physicians whose network status and fees they do not know. The one thing all agree upon is that there has to be a better way.
Anthony Cristiano, a financial services executive, has been sued over his failure to pay the bill from Bergen Anesthesia Group — and he’s hired his own lawyer to fight back.
“The fact that this organized monopoly of … doctors has the local hospital and the residents of Bergen County hostage needs to stop,” Cristiano said. “Valley should be required by law to have a medical specialist on staff, or available” who accepts every insurance plan the hospital does, he said. Otherwise, he said, it “cannot be called an in-network hospital.”
Megan Fraser, Valley’s spokeswoman, said the hospital does not require physicians who practice at its facilities to participate in the same insurance networks the hospital does. However, she said the hospital does “encourage our doctors to negotiate with the plans in which Valley participates and suggest that they be transparent with their patients regarding what plans they do and do not participate in.”
Bergen Anesthesia Group did not respond to repeated requests for an interview, but the head of the state doctors’ association said the issue was “much more complicated than it seems on the surface.”
Doctors don’t have the bargaining clout with insurance companies that a hospital like Valley does, said Lawrence Downs, chief executive of the Medical Society of New Jersey, because insurance companies know the hospital is essential to their network. In contrast, “the terms and conditions the anesthesiologists are offered may be very poor,” he said. “They may not meet the financial needs of the group, or the terms may be objectionable. They have no ability to negotiate that — they are not part of the hospital.”
The health law was supposed to reduce pressure on emergency care facilities. It hasn’t.
Peter Suderman|May. 4, 2015 2:40 pm
In September, 2009, President Obama gave a prime time speech to the joint Congress making the case for the health care law that would come to be known as Obamacare. Much of the speech was devoted to explaining and justifying the law’s major components. Subsidies, he argued, were necessary to ensure that health coverage would be affordable enough that people would actually buy it. The individual mandate requiring most people to maintain coverage was necessary to ensure that free-riders didn’t take advantage of the law’s regulations and subsidies to wait until sick before purchasing coverage.
“Such irresponsible behavior costs all the rest of us money,” Obama said. “If there are affordable options and people still don’t sign up for health insurance, it means we pay for these people’s expensive emergency room visits.”
Nearly six years later, the mandate is in force, and the subsidies are offsetting a hefty chunk of the premiums for most of the people who’ve gained private coverage through the law’s exchanges. Millions of people have been covered by the law; last month, Gallup reported that the national uninsurance rate had dipped to its lowest point since 2008.
And yet in the time since Obamacare’s major coverage expansion has kicked in, the number of emergency room visits has not gone down. Nor has it held flat. Instead, it appears to be growing, perhaps quite a bit, according to a survey of nearly 3,000 ER doctors notedin The Wall Street Journal.
APRIL 19, 2015, 10:36 AM LAST UPDATED: SUNDAY, APRIL 19, 2015, 10:36 AM
BY RICARDO ALONSO-ZALDIVAR
ASSOCIATED PRESS
WASHINGTON — Republican or Democrat, the next president will have the chance to remake the nation’s health care overhaul without fighting Congress.
The law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own health care systems.
States could not repeal some things, such as the requirement that insurance companies cover people with health problems. But they could replace the law’s unpopular mandate that virtually everyone in the country has health insurance, provided the alternative worked reasonably well.
A Democrat in the White House probably would use the waiver to build bridges to Republican governors and state legislators opposed to the law. The “state innovation” provision, Section 1332 of the nearly 1,000-page law, has gotten little public attention.
But “you would be hard pressed to find a state that doesn’t know what Section 1332 is,” said Trish Riley, executive director the National Academy for State Health Policy, a nonpartisan forum for state policymakers. “It provides some opportunity for taking the rough edges” off the Affordable Care Act, as the law is known.
For a Republican president, state waivers could be the fallback option to avoid the political cost of dismantling Obama’s law and disrupting or jeopardizing coverage for millions of newly insured people, not to mention the upheaval for insurers, hospitals and doctors.
“If you were a Republican on record as opposing or wanting to repeal the ACA, but really felt deep down that you couldn’t accomplish that even as president, then you could say your second preference would be to use this provision to go down a completely different road,” said Stuart Butler, a health policy expert at the nonpartisan Brookings Institution.
Butler, who was with the conservative Heritage Foundation for 35 years, has long been a voice for Republican thinking on health care policy. “The short answer is, this presents a tremendous opportunity for either party,” he said.
The state waiver was the idea of Oregon Democratic Sen. Ron Wyden, who has a record of crossing party lines in search of ways to tackle health care costs and coverage.
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