Data provided to the committee by every insurance provider in the health care law’s Federally Facilitated Marketplace (FFM) shows that, as of April 15, 2014, only 67 percent of individuals and families that had selected a health plan in the federally facilitated marketplace had paid their first month’s premium and therefore completed the enrollment process. Nationwide, only 25 percent of paid enrollees are ages 18 to 34. The Subcommittee on Oversight and Investigations today invited the leaders of some of the nation’s largest insurance providers and their trade groups to testify at a hearing, “PPACA Enrollment and the Insurance Industry,” on Wednesday, May 7, 2014, at 10:15 a.m. in room 2123 Rayburn House Office Building.
Committee Learns Who’s Paid for Obamacare: As of April 15, Only 67 Percent of Enrollees in Federal Marketplace Had Paid First Month’s Premium | Energy & Commerce CommitteeApril 30, 2014
Obamacare Canceled My Health Plan, And Increased My Premiums By 50 Percent, But At Least I’ll Have Maternity CareApril 30, 2014
Even if we don’t spend a dollar on deductibles, these plans still increase how much we’d pay in premiums. The plan from the exchange will cost us $7,200 annually; the other plan would cost us $14,400. Both are significantly more than the $4,800 we’re paying now.
But it’s not just about the money. It’s also about personal choice. We personally customized our plan to fit our health needs and our lifestyles. It included dental and vision, something that neither of the replacement plans fully do. The Obamacare plans just don’t give us the coverage we want at a price we can afford—and Obamacare basically makes it illegal for us to tailor a health plan that does.
But as I noted above, there is good reason to believe that a “repeal and replace” approach won’t beat Hillary, because it will be too disruptive of people’s pre-existing health insurance arrangements.
This prospect shouldn’t depress conservatives, however. Indeed, Obamacare’s exchanges—if heavily reformed—could serve as the foundation for sweeping entitlement reform, reform that could expand coverage, lower health costs for most Americans, and make Medicare and Medicaid permanently solvent.
The gap can be seen in the accompanying chart. The bottom line illustrates how Congress has permitted Medicare physician payments to grow. The middle line shows an index of medical spending — spending at a typical physician’s practice over time — that is a proxy for the change in price for a typical, or average, medical treatment.
Medicare patients don’t really know that CMS uses private bounty hunters paid on contingency to audit and deny hospital claims. Hospitals provide care, then either lose an audit or have to fight through a lengthy appeals process for reimbursement. The perceived risk changes hospital behavior, which can mean that a patient gets blindsided with big out of pocket expenses. Both the RAC system overall and the RAC appeal process are effectively broken. Bart Caponi MD, FACP, FHM
The bills can be substantial because they often include follow up nursing home care and prescription drugs that were administered during the hospital stay ‒ but not covered by Medicare for patients under “observation” status. There is an appeals process, but like most things involving Medicare, it’s long ‒ and primarily designed for the recovery of funds already paid by patients.
The Obamacare website may work for people buying insurance, but beneath the surface, HealthCare.gov is still missing massive, critical pieces — and the deadline for finishing them keeps slipping.
As a result, the system’s “back end” is a tangle of technical workarounds moving billions of taxpayer dollars and consumer-paid premiums between the government and insurers. The parts under construction are essential for key functions such as accurately paying insurers. The longer they lag, experts say, the likelier they’ll trigger accounting problems that could leave the public on the hook for higher premium subsidies or health care costs.
But is the idea implied by these locutions—that obesity is a disease like any other—correct? Based upon a growing number of considerations, it has some initial plausibility. Genetics undoubtedly influence the propensity to obesity and its opposite: even allowing for similarities of diet, fatness and leanness run in families. My father’s family was notably more inclined to fatness than my mother’s; and the difference was not all attributable to what, or how much, they ate. A genetic condition exists—Prader-Willi syndrome—characterized by, among other things, excessive appetite and gross obesity. Certain endocrine disorders, such as Cushing’s disease, also lead to fatness. If obesity is sometimes of pathological origin, why should it not always be of pathological origin? As one of The Lancet articles puts it: “The assumption that severe obesity is a behavioural or social choice, which can be reversed with a determined patient’s effort, is simply incongruous with medical fact.”
Thus, there is even less insurer competition at the county level. In one of every six counties in America (17 percent), the state exchange offers only one insurer–a monopoly. For another 35 percent of counties, only two insurers offer coverage. In another 25 percent, only three insurers are selling coverage. To recap, consumers in more than half of the nation’s counties can “pick” from only one or two insurers on an Obamacare exchange. In more than three of every four counties, competition is limited to three or fewer insurers.
The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of the world is not using ICD-10-Clinical Modification set, which has 68,000 codes. Only we, in the US, are considering that. The Canadian version of ICD-10 has about 16,000 codes, but the physicians do not use those codes for billing and reimbursement. They use a more limited code set of about 600 three-digit codes. Let me repeat this: The WHO version of ICD-10 that the rest of the world uses about 16,000 codes. Our version, developed jointly by the CDC and the American Hospital Association has 68,000 codes.
Cases involving religious details, however, do have a way of stopping big social legislation, and not only because they violate the principles of the religious denominations involved. Regardless of the Court’s decision, even pro-choice Jews, Unitarians, and Muslims may eventually change their views on the ACA precisely because of Hobby Lobby and cases like it.