A new report by Forbes contributor John G. Goodman (online, Oct. 20) says the federal government has announced it is changing how its nursing home ratings system will work. Goodman says, nonetheless, “Pay-for-performance has no chance of succeeding unless the payer can measure quality. Without quality control, provider can always lower costs by simply providing less care.”
Currently, the feds use a five star system to rate nursing homes. According to Goodman’s Forbes story only one of three standards to determine ratings – the “annual health inspection” – actually employs an independent evaluation process. The other two measurements of quality – staff levels and quality stats – are the result of self-evaluations.
According to the Investor’s Business Daily (Investors.com, Oct 17) Obamacare premium increases in the double digits remain the exception versus a rule - so far. The IBD article by Jed Graham goes on to say, however, that beginning November 1 of this year, with the next (or second) round of open enrolment for Obamacare, some Obamacare customers may be in for an unpleasant rate surprise. According to the IBD report, 2015’s rates in 15 U.S. states, as well as Washington, D.C., show premium pricing for the cheapest “bronze” healthcare coverage, spiking by 13.9% for some. This could hurt Obamacare enrollment figures for 2015. The surge in the cost of the cheapest subsidized bronze policy could negatively impact enrollment in 2015.
The IBD account tellingly adds, with respect to 2015, “While some potential enrollees may opt out because of the higher cost of bronze, some young adults may instead pick catastrophic plans available to those under 30. The latter scenario is also not great news for Obamacare exchanges, since catastrophic plan members are grouped separately, leaving the main risk pool relatively older and more costly.”
The Daily Caller contends in a recent report on its web page(s) that “Obamacare is hiding in plain sight as a cause of the slow recovery.” This account by John R. Graham, additionally claims, employers continue to reduce employment opportunities, in response to adverse impacts of the Affordable Care Act. Also according to The Daily Caller, a recent survey of employers by the New York Federal Reserve inquired specifically about Obamacare business impacts. Commercial respondents, 20 percent, anticipate increasing – - proportionally – - the number of part-time workers. However, only 5 percent expect to hire relatively fewer part-timers; 22 intend to implement wage cuts, as well as benefits reductions. Also according to the New York Fed, as outlined by the Daily Caller, 68 percent of businesses polled are planning reductions in healthcare services covered.
Dan Mangan asks in his recent report on the CNBC Web site (Oct. 20) “What happens if they flip the switch to begin Obamacare’s second open enrollment period next month and hardly anybody shows up?” This question could also potentially be put to others, chiefly the Obama administration. Have they done all they can to educate the public about its signature Affordable Care Act? Including, its purported benefits and the procedures for getting on board?
Also, according to the CNBC report, a very recent Kaiser Family Foundation poll says 9 out of 10 those persons classified as uninsured did not know that open enrollment starts again – - in November, 2014. This is indicative of a widespread lack of knowledge when it comes to overall knowledge of the Affordable Care Act.
When Kaiser conducted similar research in 2013, it discovered Obamacare knowledge gaps at that time, as well. What is different in 2014 – is that the second enrollment period will only run from November, 2014 to February, 2015. Not for 6 months like it did back in 2013.
Mollie Brodie, who is in charge of the Kasier poll, is quoted by CNBC as saying, “I think a lot of work needs to be done. We’re at the very early stages of the second enrollment period, and right now one of the main target audiences is not primed or focused on it.”
According to a recent online post in the Daily Caller (Oct. 21) taxpayer funded ACA subsidies in the federally-overseen exchanges (or marketplaces) still face potentially daunting legal obstacles. Such subsidies – according to the Daily Caller – are responsible for 5 million out of 7.3 million Obamacare sign-ups.
The Daily Caller also cites a study recently out by RAND Health, which concludes that if taxpayer subsidies are done away with, the Obamacare Exchanges would succumb, going into a “death spiral.”
Also, according to the Daily Caller report, the RAND study additionally found that without the ACA subsidies, the cost of premiums will rise by 43 percent; Obamacare enrollment could decline by as much as 68 percent. Translation: 11.3 million Americans, additionally, would be uninsured.
Back in 1998, the Wall Street Journal featured an article about the then widely publicized practice of telecommunications slamming. Simply put, long-distance consumers were routinely “slammed” to new long-distance providers – - without prior consent. Now, Dr. Jeffrey A. Singer, also in the Wall Street Journal (online Oct. 20, 2014) reports several of his patients who had have been funding their own individual health insurance plans, have been ejected from those plans, then finding themselves Medicaid placed. This occurred, according to Dr. Singer, when those persons signed up for health insurance on HelalthCare.gov. Dr. Singer adds, those patients are, “Knocked out of private insurance, they are forced to settle for longer waits and worse care.” Dr. Singer elaborates, “Even if my patients save money by no longer paying premiums, they suffer in the long run by being trapped in a subpar health-care system. A Medicaid card does not translate into quality medical care. In some cases, it does not translate into medical care at all.” The recent Wall Street report cites a new polling study conducted by the healthcare company Merritt Hawkins, which says, “Only 45 percent of doctors currently accept new Medicaid patients, and that number has declined from 55 percent in the past five years.”
Medicaid patients are more likely to die, following major surgery, while still hospital-bound. This is according to 2010 study by the University of Virginia, so says the Wall Street Journal.
More details on potential budget deficit implications – - due to Obamacare. Those on the Senate Budget Committee Staff, who are actually analysts, may be contributing meaningfully to the continuing debate over Obamacare. A recent report in the Heritage Foundation’s Daily Signal (online, Oct. 14) recounts that the Congressional Budget Office’s (CBO) initial “baseline projections”, said “Medicare and Medicaid spending was even lower than originally anticipated; the CBO baseline changed, and thus the expected healthcare savings are now projected to be lower – by as much as $132 billion.”
The Daily Signal Report also says – - at one point – - the Republican Senate Committee staff looked at the impact of the ACA’s taxation provisions on labor. In 2014, CBO reported that the law would reduce the total number of hours worked in and thus reduce the actually monies, or wages, received by labor by 1 percent – - by the year 2024. Based on such labor force statistics RSC staff “estimated that the total federal revenue loss over the period of 2017 to 2024 would amount to a net $262 billion,” so says the Daily Signal report. Another conclusion: the deficit grows by $131 billion.
A new National Memo Web page post (Oct. 10) by Jonathan Bernstein, citing Bloomberg View, alludes to any negative views of Obamacare, not being due to President Barack Obama, but rather to inherent structural flaws of the Affordable Care Act itself. Very recently the Gallup organization released survey results showing 16 percent of those polled feel Obamacare has been a help, while 27 percent view the Affordable Care Act as a hindrance. These responses of course point up – pocketbook issues.
The National Memo Report adds, “For one thing, even though the ACA may have moderated the rise in the cost of healthcare, even smaller price increases will be perceived as a harmful result of the law. There is always a variation in costs, and Republicans are going to publicize any spikes and Democrats aren’t going to trumpet increases, even when they are at or below trend. Indeed, Republicans will blame reform for every bad healthcare story, regardless of whether it is ACA-related.”
Persistent bad, or at least unresolved feelings about Obamacare, overall, may persist (according to the National Memo report) due to:
●How many young people who are able to remain on their parents’ insurance, know it is due to a provision in the Affordable Care Act?
●How many individuals with “Expanded Medicaid” know they are actually getting Obamacare benefits?
●How many people know Obamacare is the reason they don’t surpass yearly or lifetime income reimbursement limitations?
A new report on Politico.com (online, Oct. 13) outlines the likely, central sticking point, as to why there is not simply just one alternative GOP Obamacare option. Maybe conservatives overall can’t agree whether “it should be one big alternative or a bunch of smaller ones,” suggests Politico.
Alternatives previously put forth by the likes of Sens. Orrin Hatch, Tom Coburn, and Avik Roy of the Manhattan Institute, have each garnered serious looks by the GOP. Each focuses in on what conservatives philosophically contend are the least-desirable components of the Affordable Care Act: higher coverage expenses and narrow choices, etc. Yet, these same parties can’t agree — as to “how much of the law they’d wipe away”, adds Politico.
Reformers may want to tread carefully. Tom Miller, a healthcare expert at the American Enterprise Institute, in describing Medicare changes over the decades, comments, “You never get back to a blank slate.”
Courtesy of Lanhee Chen in a recent Bloomberg View post (Oct. 14) is a report that Obamacare will likely send budget deficits higher – not lower. Chen cites findings by Senate Budget Committee Republicans. Chen says in his Bloomberg piece, “Fewer people working means less aggregate income is being earned, which translates less tax revenue for the federal government. That in turn leads to increased deficits.” Chen’s report also claims that Obamacare may affect the working labor force in two ways. First, by decreasing the actual supply of labor (meaning, the actual number of persons in the labor market). Second, by reducing the marketplace for such labor.
In his report, Chen adds, “[T]he law creates strong incentives for millions of people to just stop working – even though the Obama administration tried to spin this outcome as a good thing since it would allow people to pursue their dreams.”