February 28, 2015
Telemedicine embraces technologies as diverse as surgeons operating robots remotely, radiologists reading scanned images remotely, or psychiatrists conducting therapy sessions via videoconference. A new research article in the Telemedicine and E-Health Journal shows how difficult state regulatory barriers are making it for doctors to practice effective telemedicine.
One barrier to effective adoption of telemedicine is that states license physicians, and those licenses are not portable. When physicians seek licenses in other states, they face pointless administrative hassles.
via Licensing Out-of-State Doctors: Half of Medical Boards Perform Poorly | Health Policy Blog | NCPA.org.
February 28, 2015
Blue Cross and Blue Shield, the state’s largest health insurer, said Friday that it posted its first financial loss in 15 years as a result of insuring high numbers of older and sicker people under the Patient Protection and Affordable Care Act.
The Chapel Hill organization signed up 257,704 people under the federal health care law, which requires insurers to provide coverage regardless of a customer’s health condition.
New enrollees last year swelled Blue Cross’s covered membership to 3.91 million people, and boosted revenue by 25 percent to an all-time high of $8 billion.
But steep medical claims – for hip and knee replacements, heart procedures, specialty drugs and other costs – drove up medical claims from $5 billion in 2013 to $6.4 billion in 2014. Blue Cross also paid $156 million in ACA-related fees, a new cost for the company.
via Blue Cross and Blue Shield of NC posts first loss in 15 years | The Charlotte Observer The Charlotte Observer.
February 26, 2015
Few Americans who read a newspaper didn’t hear about last year’s Veterans Health Administration scandal, in which VA officials manipulated patient waiting lists in order to deny care to ailing veterans. I observed at the time that the VA’s brand of government-run medicine was far worse than Obamacare. And I questioned why lawmakers hadn’t done more to reform veterans’ health care. Today, Concerned Veterans for America is publishing the most comprehensive effort in decades to reform the VA, and to ensure that veterans gain access to the same high-quality health care available to most Americans.
via The Veterans Independence Act: Giving Vets A Way Out Of Socialized Medicine.
February 26, 2015
Or, as the prosecuting attorney might say in the closing argument for a criminal trial, the Congress that enacted what became the ACA — before it lost a temporary “supermajority” in the Senate favoring its passage — had “the means, and the opportunity” to authorize tax credits in federal exchanges in December 2009, if it wanted to. By March 2010, it had a different “motive” to continue not to do so, when it needed to pass a law by any means necessary that became the final text of the ACA.
via Retracing the legislative history behind King v. Burwell » AEI | Health Care Blog » AEIdeas.
February 25, 2015
Gallup does a great service in tracking the decline in the uninsured rate state-by-state since ACA implementation. But they draw a misleading conclusion from their latest data set:
Collectively, the uninsured rate in states that have chosen to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace declined significantly more last year than the rate in states that did not take these steps. The uninsured rate declined 4.8 points in the 21 states that implemented both of these measures, compared with a 2.7-point drop across the 29 states that have implemented only one or neither of these actions.
In fact, the superior overall performance of these states in reducing un-insurance is due entirely to the Medicaid expansion. Collectively, their exchanges did not perform particularly well with regard to enrolling subsidy-eligible residents in private health plans.
via Gallup misreads its state ACA data: state-run marketplaces no better at reaching uninsured | xpostfactoid.
February 25, 2015
One of the biggest myths pushed in statehouses across the country is that Obamacare’s Medicaid expansion will be an engine of economic growth. The Obama administration promises that more than 350,000 jobs would be created nationwide in 2015 if all states opted into Obamacare expansion.
But the truth is that expanding Medicaid to able-bodied adults will discourage work, create massive new welfare cliffs and ultimately shrink the economy, not grow it. A new report by the Foundation for Government Accountability outlines how Obamacare expansion could affect the labor force.
via Obamacare's Medicaid Expansion Could Cause 2.6 Million Able-Bodied Adults To Drop Out Of Labor Force.
February 24, 2015
An important disclaimer: All those press releases about how the health care law is working – ignore them. We now have two open enrollment periods on the books (mostly) and the backend of HealthCare.gov is still not complete. Now, the HealthCare.gov CEO is disclosing the backend will not be complete before President Obama leaves the White House. Politico Pro reports this morning, “HealthCare.gov CEO Kevin Counihan told insurance brokers today that CMS is spending a lot of time focusing on how to improve the federal exchanges’ back-end functions and that the agency meets at least weekly with a group of insurance officials from large companies to discuss its two-year development plan.” Counihan added, “It’s not going to be as fast as everybody wants, but we’re going to get there. We’re going to make good progress this year and even more progress next year.”
The committee first uncovered that the backend of the health care exchange was not built in November 2013. The following month, then-Health and Human Services Secretary told the committee, “The financial management system, which is getting the insurance companies their money for accelerated tax credits and cost-sharing, is due to go into effect in mid-January.” That was “mid-January” of last year. Now, two open enrollment periods and more than 16 months after the exchanges first went live, the HealthCare.gov CEO reveals the backend will still not be complete for two more years.
via HealthCare.gov CEO: President Obama Will No Longer Be In Office When HC.gov’s Back End Is Expected to be Fully Complete | Energy & Commerce Committee.
February 24, 2015
The Cadillac high-cost health plan excise tax, which goes into effect in 2018, is one of the last-to-be-implemented provisions of the Affordable Care Act (ACA). It was one of the most controversial provisions of the ACA, which contributed to its delayed effective date. But 2018 is now getting closer, and the Internal Revenue Services (IRS) is beginning a discussion about implementation of the Cadillac plan tax.
The Cadillac plan provision of the ACA will impose a 40 percent excise tax on the cost of employer-sponsored health plans when that cost exceeds certain thresholds. It is projected to be one of the biggest sources of revenue under the ACA; the Congressional Budget Office (CBO) in its 2015 Budget and Economic Outlook Report estimated that it would account for $149 billion in revenue between 2018 and 2225. Of this, however, only one quarter will come from the tax itself, while three quarters will come from increases in taxes on income as employers shift compensation from health benefits to taxable wages.
via Implementing Health Reform: Beginning The Cadillac Tax Regulatory Conversation And Other ACA News – Health Affairs Blog.
February 24, 2015
An amendment to the 2015 federal budget continuing appropriation raises a question: Will insurers receive their full 2014 risk corridor payments?
What’s the issue?
The risk corridor program created by the Affordable Care Act (ACA) has proven to be one of the most controversial aspects of the health care law. Questions have been raised about the source of payments, whether the Department of Health and Human Services (HHS) has the authority to make payments under the program, and whether the program is required to be budget neutral.
In response to questions from the Government Accountability Office (GAO) on its budget authority for risk corridor payments, HHS cited section 1342 of the ACA, which establishes the risk corridor program and requires HHS to collect payments from and make payments to certain qualified health plans. HHS says that the fees collected and the payments made under the risk corridor program are consistent with the definition of user fees.
The fiscal year 2014 appropriation gives the Centers for Medicare and Medicaid Services (CMS) the authority to collect user fees and keep the fees available for use through the 2019 fiscal year. HHS states that this appropriation along with section 1342 gives CMS the authority to collect and distribute risk corridor payments. In an opinion issued September 2014, the GAO agreed that payments collected under the risk corridor program are “properly characterized as user fees.”
via Health Policy Briefs.
February 24, 2015
A new poll by McLaughlin & Associates finds that Americans strongly support having Congress advance a conservative alternative in the context of King v. Burwell.
The poll asked (question #7),
“If the Supreme Court rules that the Obama administration has been illegally paying out Obamacare subsidies in 36 states, what do you think Congress should do in response?”
Likely voters replied as follows:
“Do nothing and let people in those 36 states lose their subsidies and perhaps their insurance”: 4 percent
“Negotiate fixes to Obamacare with the Obama White House in exchange for turning the subsidies back on”: 20 percent
“Turn the subsidies back on temporarily but don’t try to fix Obamacare”: 5 percent
“Propose to effectively repeal and replace Obamacare in those 36 states with a conservative alternative that aims to help people get coverage and reduce costs”: 26 percent
“Give the states a choice between Obamacare and switching to a conservative alternative that aims to help people get coverage and reduce costs”: 25 percent
“Something else”: 8 percent
“No opinion”: 13 percent
Support for having Congress propose a conservative alternative (either for the 36 states in question or for all states that choose to switch to such an alternative) was 64 percent among Republicans and 55 percent among independents, while the most popular answer among Democrats (34 percent, compared with only 10 percent among Republicans and 12 percent among independents) was that Congress should negotiate fixes to Obamacare.
via Poll on Response to King v. Burwell Decision – THE 2017 PROJECT THE 2017 PROJECT.