HHS-Granted Waivers
Health Exchanges
Those "health exchanges" we are hearing so much about? They are nothing more than "websites." Bloomberg says it's about time states get "on board." But yet, HHS hasn't even provided specific guidelines regarding the websites:
Federal exchanges: due to time constraints (they need to be in place by October, 2013, less than a year from now), the industry will sort this out for the government. Federal exchanges will be folded into the DOD health care program, Tricare. Humana will be one of several huge winners. Posted November 28, 2012.
Only 15 states opt for state-run exchanges, December 13, 2012. Link to CNBC. Two less than reported November, 2012. This is going to be one huge mess. -- December 13, 2012. By the way, the "exchanges" are simply websites telling folks which insurance programs meet ObamaCare criteria. The federal government has not posted its own exchange as of this date. Four states will partner with the federal government, two more than in November, 2012.
Exchanges (as of November 12, 2012, with changes highlighted in bold)
Health Exchanges
Those "health exchanges" we are hearing so much about? They are nothing more than "websites." Bloomberg says it's about time states get "on board." But yet, HHS hasn't even provided specific guidelines regarding the websites:
The exchanges will basically take the form of websites, designed to lead people through the process of selecting an insurance plan, based on price and coverage. In the process, users will be able to determine whether they qualify for subsidies or for Medicaid. (The existing Massachusetts Health Connector is a model for what most exchanges are expected to look like.) To design and plan such a website doesn’t require knowing, as McDonnell demands, for example, how the federal government will manage pools of high-risk patients. [Really?]
It’s true that HHS delayed until this week issuing guidance on the benefits that insurance plans will be required to provide. It’s also true that the department was a little slow to come out with its rules on enrollment periods, rate increases, catastrophic-care plans and the ways in which premiums can vary. It’s eminently possible that these delays were attributable to politics (that is, a presidential election). Yet this information has arrived in plenty of time; the plain fact is that states didn’t need it in order to decide whether to go ahead with an exchange. [Really?]
At this point, a state that has done absolutely nothing to prepare probably has too little time to create its own exchange before October 2013, when HHS says it must be ready. Still, there is time enough to join in partnership with HHS; the deadline for deciding to do that is not until mid-February. In such partnerships, the federal government could provide the information technology, while the states would work with insurance companies on plans and provide guidance for residents.If everything is so easy, and everything is so straightforward, a) why has HHS not published the guidelines; and, b) why are Illinois and Ohio partnering with the Federal government. An "exchange" is simply a webpage, according to Bloomberg.
Federal exchanges: due to time constraints (they need to be in place by October, 2013, less than a year from now), the industry will sort this out for the government. Federal exchanges will be folded into the DOD health care program, Tricare. Humana will be one of several huge winners. Posted November 28, 2012.
Only 15 states opt for state-run exchanges, December 13, 2012. Link to CNBC. Two less than reported November, 2012. This is going to be one huge mess. -- December 13, 2012. By the way, the "exchanges" are simply websites telling folks which insurance programs meet ObamaCare criteria. The federal government has not posted its own exchange as of this date. Four states will partner with the federal government, two more than in November, 2012.
Exchanges (as of November 12, 2012, with changes highlighted in bold)
State exchanges: California, Colorado, Connecticut, Hawaii, Idaho (see below, rejects Federal exchange), Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont and Washington. (as of November, 2012)Medicare gutted by ObamaCare:
No-state exchanges (defer to the federal exchange): Alabama, Alaska, Georgia, Indiana, Kansas, Louisiana, Maine, Missouri, Nebraska, New Jersey (see December 6, 2012, note below), North Dakota, Ohio (see below), Pennsylvania (see December 13, 2012 entry below); South Carolina, South Dakota, Texas, Virginia, Wisconsin and Wyoming. (as of November, 2012)
Partnership exchanges with the federal government: Illinois (as of November, 2012); Ohio (see November 16, 2012 entry below).
Undecided about exchanges, state vs federal government: Arizona, Arkansas, Florida, Idaho (see below, rejects Federal exchange), Michigan, New Hampshire, Oklahoma, Pennsylvania (says "no'; see December 14, 2012 entry below), Tennessee, Utah and West Virginia (as of November, 2012)
Updates
April 3, 2013: a lot of ObamaCare stories today. When the Time Magazine story broke (see below), I e-mailed a friend, suggesting that ObamaCare would be delayed a year. Now, just moments ago (about 4:30 pm CST) a story broke on Fox News that a key provision of ObamaCare will indeed be delayed a year. It's very, very bad news for small business but it will result in ObamaCare, in general, being delayed a year. All those states that signed up to expand Medicaid are now in limbo, I assume, wondering what's in effect, what's not, what is the state liable for. What happens if the state expanded Medicaid, but the federal government now delays ObamaCare? From Fox News:
Parts of ObamaCare are starting to fray, even before full implementation.
The Obama administration now says a special system of exchanges designed to make it easier for small businesses to provide insurance will be delayed an entire year -- to 2015.
"Lots of small businesses struggle with providing insurance for their workers so this was supposed to facilitate it and make it easier for small business to do this," said Jim Capretta of the Ethics and Public Policy Center. "It was a huge portion of the sale job.
When they passed the law in 2010 there were many senators and members of Congress who were saying 'I am doing this because it's going to help small businesses.'"April 3, 2013: Cancer clinics turning away Medicare patients; clinics can't survive financially on Medicare reimbursement under ObamaCare. This is not particarly new; it's only going to get worse under ObamaCare.
April 3, 2013: To sign up for ObamaCare, start filling out the forms now, and hire a good accountant. -- Forbes. This is the 60-page form.
April 3, 2013: ObamaCare incompetence. -- Time Magazine. If they are only starting to plan for ObamaCare, they are way too late.
One thing is clear: Obamacare will fail if he doesn’t start paying more attention to the details of implementation, if he doesn’t start demanding action. And, in a larger sense, the notion of activist government will be in peril—despite the demographics flowing the Democrats’ way—if institutions like the VA and Obamacare don’t deliver the goods. Sooner or later, the Republican party may come to understand that its best argument isn’t about tearing down the government we have, but making it run more efficiently.
Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.April 3, 2013: Most individual health insurance policies not "good enough" for ObamaCare.
March 25, 2013: Would you like fries with that?
March 22, 2013: ObamaCare and Frequent Flyer Miles.
March 17, 2013: it's personal now. An older couple, husband-wife, both blue collar, older (50's), and relatives (that's why it's personal); both in long-term jobs; he was cut back to 30 hours; she was laid off. Being cut back to 30 hours is interesting isn't it? That's the ObamaCare cutoff. I told my wife this is just the beginning. My hunch is that Congress will start seeing the debacle develop this summer, but by the time they try to postpone implementation of ObamaCare, it will be too late. Once companies lay off workers, or cut back on their hours, the companies learn to do more (or as much) with less (and they will be helped through technology and automation). Once these companies learn to do more (or as much) with less, they won't be hiring folks they laid off.
March 15, 2013: The government cannot force Domino's Pizza to offer contraceptives to its employees under ObamaCare - federal judge. It is unlikely the administration would take these cases to the Supreme Court and risk further whittling of the program.
March 13, 2013: ObamaCare, gaming the system.
It appears that's exactly what's happening in Massachusetts, which passed its own Obamacare-like reform with an individual mandate in 2006.
Last year Charles Baker, former CEO of Harvard Pilgrim Health Care, one of Massachusetts's largest health plans, noticed some health insurance brokers posting comments on his widely read blog. They expressed suspicions that people were applying for health coverage after a medical condition developed, got the care they needed, and then dropped the coverage.
Coverage for an individual, noted Mr. Baker, now a Republican candidate for governor, might be $2,000 to $3,000 a year, whereas the penalty was only about $900. He asked his finance people to see whether they could find any discernible patterns.
Boy, did they.
March 11, 2013: it can't be much plainer -- Five Guys --
Between April 2008 and March 2009, 40 percent of the individuals who applied to Harvard Pilgrim stayed covered for less than five months. Yet claims were averaging about $2,400 a month, about six times what one would expect.
a) will not add any more restaurants until they get clarity on the impact of ObamaCareFebruary 22, 2013: Gallup poll on US health care.
b) they will pass on the costs of ObamaCare to their customers
c) they are looking at ways to lay off employees; hire fewer employees in the future
February 18, 2013: a Financial Times article on ObamaCare as it starts to hit businesses. They started complaining too later. Cue up Connie Francis. The interesting thing: the writer of this story does not "get it." The employer does not determine the number of "full-time" employees; the IRS determines the number of "full-time" employees by dividing total number of employee-hours worked, divided by 120 (as in 120 hours/month). So, if one has 100 "part-time" employees, each working 20 hours/week (well below the 30-hour threshold), the employer may think he/she has 100 "part-time" employees for which health insurance coverage is not required. In fact, 100 x 20 = 2000 hours x 4 weeks = 8,000. Divide by 120 = 67 "full-time" employees for which the company is required to provide health coverage, at $2,000/full-time, or in this case, $2,000 x 67. Very, very clever, how the law was written.
February 17, 2013: government running out of money to fund "uninsurables/pre-existing conditions." Discontinued the program. Decision released at end weekly news cycle, Friday afternoon. President goes on vacation.
December 13, 2012: Pennsylvania says "no" to state exchange. Idaho rejects federal exchange.
December 6, 2012: New Jersey governor Christie vetoes bill that would have mandated state-run exchanges.
November 28, 2012: majority of Americans do not think government should be guarantor of health care, Gallup. Cue up Connie Francis.
November 28, 2012: The feds blame the states for refusing to become ObamaCare subsidiaries, WSJ.
November 25, 2012: this is how ObamaCare will play out -- each individual mandate will end up in court. Congress mandating specific coverage without co-pays oversteps Congressional authority, some say.
November 21, 2012: Morning Joe sees the world differently; it will be interesting to see how this plays out; I do not understand why Joe surrounds himself with liberals; he has some of the lowest ratings of all tevevision talk shows.
November 20, 2012: states get a say in ObamaCare.
November 16, 2012: governors of Ohio and Wisconsin say they will not set up state-run exchanges; they will defer to the federal government;
July 10, 2012: California cannot afford ObamaCare -- LA Times.
July 10, 2012: Wisconsin rejects ObamaCare.
Texas, Florida, South Carolina, Wisconsin, Mississippi and Louisiana have rejected the two key provisions of the law, according to americanhealthline.com.July 10, 2012: 83% of physicians have considered quitting medicine over ObamaCare. This was the physicians vs the lawyers, and the lawyers won.
January 6, 2012: North Dakota denied waiver; unions granted waivers.
December 28, 2011: why ObamaCare is killing jobs.
"Our company, CKE Restaurants Inc., employs about 21,000 people (our franchisees employ 49,000 more) in Carl’s Jr. and Hardee’s restaurants. For months, we have been working with Mercer Health & Benefits LLC, our health-care consultant, to identify Obamacare’s potential financial impact on CKE. Mercer estimated that when the law is fully implemented our health-care costs will increase about $18 million a year. That would put our total health-care costs at $29.8 million, a 150 percent increase from the roughly $12 million we spent last year.September 20, 2011: Howard Dean, physician, ex-governor, ex-Presidential contender, says most employers will drop employee-health insurance once ObamaCare comes on line. "Small business will get out of the health care business."
September 6, 2011: Percent of health care uninsured adults has increased from 14.9 percent to 16.8 percent under President Obama. The trend continues to rise; this is up from 16.4 percent earlier this year. One can argue that it is due to folks losing their jobs and their healthcare but that was one of the whole purposes of ObamaCare: to protect those who lose their jobs.
July 21, 2011: An inconvenient truth -- the real jobs killer -- ObamaCare. I don't think folks understand that majority of jobs in this country are provided by small business. As long as they stay under 50 employees and do not engage in interstate commerce, they are not affected by Federal law (at least in general). Businesses close to 50 employees will do all they can to stay under that "magic" number.
May 15, 2011: The Obama administration approves 204 more waivers. At some point, there will be no one left to give waivers to.
April 13, 2011: Support for ObamaCare has now dropped below 35 percent; first time support among seniors dropped below 30 percent. Comment: ObamaCare will unravel in 2011/2012. Romney, whose Massachusetts RomneyCare was a model for ObamaCare, will have to finesse his "RomneyCare fits Massachusetts but doesn't fit the nation" theme.
March 23, 2011: One of the administration's strongest advocates of ObamaCare is now considering a waiver to release New York City from ObamaCare. I cannot make this stuff up. I assume it's a no-brainer to guess NYC will get the waiver if the city applies.
March 8, 2011: The State of Maine was given a waiver.
The federal government Tuesday granted Maine a waiver of a key provision in President Barack Obama's health care overhaul, citing the likelihood that enforcement could destabilize the state's market for individual health insurance. [This is becoming a joke. Any state that wants to opt out will simply "boiler-plate" Maine's waiver application.]March 6, 2011: Waivers for ObamaCare now exceeds 1,000. On Friday, March 4, 2011, 261 new waivers were granted. This is truly obscene. The HHS web page has not been updated.
January 31, 2011: Florida judge may rule in favor of 26 states who argue ObamaCare is unconstitutional.
November 18, 2010: Twenty percent of Americans with mental illness last year -- and that's why ObamaCare is doomed to fail. I was one of the twenty percent: hypermanic about the Bakken. My insurance covers that malady but I refused electroshock therapy.
November 14, 2010: "We" are now up to 111 companies and unions that get waivers from ObamaCare. This is incredible.
November 5, 2010: AARP is increasing the premiums on their health insurance due to ObamaCare. AARP was a big supporter of ObamaCare.
Original Blog
This has nothing to do with oil industry in North Dakota.
This posting will disappear within a day or two and will be filed elsewhere, so don't despair.
The Wall Street Journal posted a nice op-ed piece yesterday (May 18,2010) by Scott Gottlieb, a practicing internist, a partner in a health-care investment company, and a former official at the Centers for Medicare and Medicaid Services. I doubt he has anything to worry about with regard to his health care. But the rest of us have plenty to worry about.
With regard to ObamaCare, the short term concern: increasing difficulty to access medical care, especially if you are retired, or depend on Medicare.
Trailer, Movie to be released autumn, 2010
The long term concern: ObamaCare "bankrupts" the US economy.
1. The new program now mandates everyone have health insurance, which the "man on the street" interprets as meaning "we all have access to medical care." Of course, everyone had access to medical care before the new health care plan but that's a story for another day.
2. There will be a learning curve for those new to the bureaucracy of medicine. It is human nature not to schedule an appointment until a condition becomes urgent or emergent. Even for those who want to schedule an appointment, it is a steep learning curve to learn how.
3. Physicians are opting out of Medicare program at an increasing rate: a) overwhelming bureaucratic paperwork; b) mandates for unfunded information technology upgrades; c) mandates for unfunded training for office staff using that technology; d) risk of violating Federal crime for misunderstanding rules (if one thinks malpractice is a physician's biggest concern, going to prison for Federal crime probably ranks a bit higher); and, e) all the while, decreasing Medicare reimbursements.
4. The act mandated that "we all have access to medical care," but did not mandate that there be enough providers. It is painfully obvious that medical schools cannot ramp up to meet this new need. And even if they could, the new physicians will become specialists, not generalists, and will not necessarily practice where the need is greatest.
5. Short term, the emergency rooms will be overwhelmed. They already are, but the situation will get acutely worse. And if one is already on Medicare, I doubt it will be easy to find a specialist. If one is newly eligible for Medicare, good luck in finding a physician willing to take new Medicare patients.
More to follow. I have to go explore Boston.
Update: We had a great day in Boston. With regard to the above, those are my thoughts only. As JRR Tolkien says, "we all have our myths" and once we have our myths, it is very difficult for us to change our beliefs. The above is my myth and JRR Tolkien's comments about myths could not be truer. Others will disagree with me and that's fine with me. We won't know how this will all work out for several years, and even then, folks will interpret the data through their own lenses. As for me, I am thrilled that there was an attempt to address the health care challenges facing this country. I just feel very strongly that the growing pains will be great, as they always are with major change. The financial risks to the country are not inconsequential.
