Bruce Japsen, who has written about healthcare for more than two decades, returns to the pages of Forbes (online, 5/24). In an article he cites several studies which cover the impact of healthcare costs on U.S. families.
Japsen’s Forbes story cites a brief by the Urban Institute which concludes that while the Affordable Care Act, as Japsen says, “has taken a load off of family budgets with 9.4 million fewer families ‘having problems paying medical bills,’ concurrently only 1 out of 4 adults aged between 18 to 64 still have medical debt they are attempting to retire once and for all. Also, employers are passing healthcare costs onto their employees , and this has been occurring for as long as the past 10 years.
Japsen adds, “Some argue that cost-shifting has led to more medical debt and to some Americans being “under-insured” when they choose skimpier plans that have less expensive premiums. These plans generally have higher deductibles and related cost-sharing.”
A portion of the nation’s GDP is made up of “national health spending,” according to Breitbart (online, 5/25 – by Chriss W. Street). In 2014 that number was at 17.8 percent; which is up from 16 percent at the time Barack Obama became president.
Street is able to personally testify as to his contribution to that portion of the GDP, and the resultant increase in national health spending. In writing about his own experiences with the purchasing of healthcare coverage, Street says, “My own insurer, Aetna, left the ‘individual market’ rather than participate in the Covered California exchange. I was forced to purchase a 2014 Blue Shield Policy on the state exchange. The premium for my wife and I, who have not major health issues, almost doubled from $740 per month with Aetna to $1,340 under covered California.”
Street also adds in his Breitbart article, “President Obama claimed he compromised the design of Obamacare in 2010 to achieve fiscal neutrality over a 10 year projection to avoid increasing the deficit spending. But to achieve that mirage, the implementation was delayed for three years and the premium cost increases were ramped up over the next three years.”
Back in 2012 the U.S. Supreme Court ruled in the case of National Federation of Independent Businesses v. Sebelius. At the time, the high court addressed the constitutionality of the ACA’s “individual mandate.” According to a new report in World Net Daily, by Bob Unruh (online, 5/26) “Although it did not address standing, by reaching a decision, it implicitly affirmed the court of appeals’ analysis. In that case, the court of appeals held that private parties challenging the constitutionality of the ACA’s ‘individual mandate’ had standing to pursue their claims based on their need to incur anticipatory compliance costs.”
Approximately three years ago, the high court also found that penalties inherent in the Affordable Care Act were taxes, and are thus not unconstitutional.
A new case has been filed on behalf of Larry Kawa, and his company, Kawa Orthodontics. It is an appeal of an 11th Federal Circuit decision. As Unruh’s World Bet Daily account explains, “Judicial Watch, in announcing the appeal, said, the question, therefore is whether “an entity that loses the value of the substantial time and resources it prematurely expanded at the time value of the money it spent on anticipatory compliance costs is sufficiently injured to confer Article III standing.”
Kawa’s suit is not over the “text” of the healthcare law, nor is it questioning enforcement of its “employer mandate provisions,” but rather over the Obama administration’s choice to delay enforcement of the employer mandate for at least 24 months.
Back in 2009, according to The Washington Examiner (online, 5/26 – article by Byron York) real estate and construction analogies were being used by at least one member of Congress to describe the state of the Affordable Care Act back then; and with respect to its future. Sen. Tom Harkin, D-Iowa, told MSNBC’s Rachel Maddow, “The key to this is that this modest home, we can put additions onto it in the future.”
In his article, York argues, that “Harkin’s view prevailed, and many Democrats came to view Obamacare as a starter home. Now even though the Affordable Care Act still faces an uncertain future in the courts, they want to start building the additions.”
If the foundations of Obamacare are any current indications of its current viability, the ACA may indeed be on shaky ground indeed. This may be due to the phenomenon of “underinsurance.” York’s Washington Examiner report cites the Associated Press, who recently reported, ”It’s not the un-insured, but rather the problem of high out-of-pocket costs for people already covered. Democrats call it ‘underinsurance.’”
York adds, “The problem is that the deductibles on many Americans’ health insurance policies have shot up so high that as a practical matter they can’t afford care.”
Back during the economic crisis of 2008, like other organizations, hospitals became increasingly restrictive with budgets. Even nurses found it tough to find work. Now, with an economy arguably on the rebound, Cherisse Dillard, a “traveling nurse” says . . . “it’s back to full swing and there are abundant jobs for travel nurses.”
Thus, a new story in Kaiser Health News online (by Phil Galewitz, 5/27) profiles traveling nurses like Dillard and others, and it also says another economic stimulus may well be bolstering the increased prospects for such nurses, and that stimulus is Obamacare. “With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses” . . . “is at a 20 year high, say industry analysts,” according to Kaiser.
Yet, if hospitals have a love/hate relationship with any concept it is that of the roving nurses. For the KHN article cites the experiences of one Atlanta, Ga. Hospital: “From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fill gaps in staffing so they can serve more patients.”
A new report in The Hill, by healthcare reporter Sarah Ferris, says when it comes to Obamacare and its healthcare exchanges (or marketplaces) “Many of the 13 state-run Obamacare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year.” Ferris’ report also says, “For all states, technology is the biggest cost item and the biggest barrier for states to set up their own exchanges.”
And so, If a government-run program such as Obamacare cannot survive with public sector strategies, maybe it can with private sector ones. In an ironic turn, it is the merger which is now being mulled-over by one, if not more, ACA exchanges. Is it really feasible, or a logistical nightmare come true?
The attractiveness of the healthcare exchange merger may be two-fold. Now keenly viewed by some as a last resort to keep state-level healthcare exchanges afloat, it also means some state-level exchanges may be able to combine financial and other resources to stay solvent. As Ferris explains, “The idea is becoming more attractive as more and more states are facing dwindling budgets.”
By way of background The Hill story adds “ . . . [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.”
Jim Wadleigh who heads up the Connecticut exchange is quoted in the Hill story as saying, “What is happening is states are figuring out the money is running out. At the end of 2016, everyone has to be self-sustaining.”
Talk of healthcare exchange mergers leaves these questions:
In “Finance & Company News” on the ADVFN web page is a recent report (5/14) regarding a healthcare tech concern – – Optum. At one point, according to writer Louise Radnofsky, around the time of the ill-fated roll-out of HealthCar.gov (for Obamacare) “federal officals widely praised the company for its work fixing HealthCare.gov. Andy Slavitt, a group executive at Optum, left the company and took on the formal role within the federal government in the summer of 2014. He is now the acting administrator at the Centers for Medicare and Medicaid Services.”
Tellingly, Radnofsky’s report adds, “Some Republican members of Congress have raised questions about the transition, noting that CMS regulates Optum’s insurance parent company as well as its technology unit.” Meanwhile, according to the ADVFN story, “Enrollment workers who have been using HealthCare.gov frequently to sign up the uninsured say the system-wide problems have been fixed, though glitches arise from time to time.”
Elizabeth Colvin, who heads up Insure Central Texas is cited in the ADVFN account. Her contention, as recapped by ADVFN, is “the remaining problems typically stem from complicated situations such as very low-income, legal immigrants who have different eligibility or financial assistance than their U.S.-born counterparts. But more broadly, she said the biggest challenges remaining for the system rest on the intricacies of the law’s various rules for eligibility to users.”
ADVFN is a financial market web site.
A recent report on the Politico.com site (5/18) says the feds are picking up the full tab for Medicaid expansion expenditures through the year 2016. After that the feds plan a cutback, dropping that level down from 100 to 90 percent. This prospective scenario has raised the ire of conservatives who say that such financial responsibility winding up on the states’ backs (according to Rachana Pradhan writing in Politico) “are just too big a burden, and they see vindication in the sign up numbers, proof that costs will be more than projected as they have warned all along.”
Conservatives like Florida Gov. Rick Scott are quoted by Politico as saying, “The expansion of Obamacare will cost our state taxpayers $ 5 billion.” “Name the healthcare program – – I think the only one is Medicare Part D – that cost less than what they initially anticipated. . . . Historically, if you look at the numbers, with the growth in Medicare costs. Medicaid costs, it’s always multiples.”
Meanwhile, the legislature in Florida is bitterly divided over Medicaid policy. At one point Gov. Scott had advocated Medicaid expansion, but later had second thoughts.
Other governors are worried as well. In Utah, for example, Gov. Gary Herbert is scratching his head, trying to figure out a way for his state to expand Medicaid. According to Pradhan’s Politico account, “Herbert met with HHS Secretary Sylvia Mathews Burwell in late April and later voiced worries that any form of expansion could mean Medicaid consumes an even bigger chunk of the state budget starting in 2017.”
Meanwhile ACA advocates say “(Medicaid) expansion is providing significant health and economic benefits to states that more than offset costs.”
Yet another Capitol Hill lawmaker has a plan, an alternative to the Affordable Care Act – – at least as we may now know it. Freshman Sen. Bill Cassidy, R. La., according to The Wall Street Journal (online, 5/13 – Louise Radnofsky) has an ACA alternative whereby, “states could take the money they would have received under the law and give it to their residents to pay for health insurance in other ways. Also, in participating states, people wouldn’t have to pay a penalty for going without health insurance, and employers wouldn’t be fined for not offering benefits.” Additionally, Radnofsky outlines Cassidy’s proposals for HSAs (health savings accounts). These would have accompanying “age-linked contributions.” At the same time, those with them would not be “means-tested.” This means, according to the Wall Street Journal, “lower-income people would pay the same for premiums as wealthier consumers.”
Cassidy’s Obamacare alternative also contains this provision, that “Insurers would have to sell coverage to everyone initially but could later limit coverage for people based on their medical history if they hadn’t bought enough insurance during the sign-up window.”
Noted tax expert and attorney Robert W. Wood returns to Forbes. The subject this time is the dreaded-by-business Obamacare “Cadillac Tax.” According to Wood’s recent post in Forbes (online, 5/15) it seems increasingly this levy will affect both individuals and healthcare plans.
Wood also writes (and compellingly asks) “The tax is increasingly under fire from Congress, and this marketplace reaction is fueling the bonfire. If no one pays it, how else will we pay for Obamacare? The Supreme Court upheld Obamacare as a tax law, and it contains many taxes. One tax that hasn’t yet kicked in is the Cadillac tax. In enacting the law in 2010, the Cadillac tax was buried, not applying until 2018.”
Wood’s Forbes column gives some history of at least the intent of the 2010 Affordable Care Act, that “The theory of the law is that health insurance should be the great leveler. The Affordable Care Act included the Cadillac tax as a tool to cut healthcare costs. It puts direct and forceful pressure on employers to offer less-generous health insurance plans. Starting in 2018, Obamacare imposes a 40 percent tax on the cost of individual healthcare plans above $10,200 for individuals and $27,500 for family coverage.”
Wood describes the tax as “decidedly punitive.” The purpose of the tax is to ensure “that more health insurance dollars are spent across a greater number of people,” according to Wood in Forbes.