American Elephants


Affordable? Not So Much. Some Big Hikes. by The Elephant's Child

Conservatives have always giggled at the title chosen for ObamaCare — “the Affordable Care Act” — because having observed all the tricks and mandates crammed in, knew it was going to be increasingly unaffordable. And so it is. State Insurance Commissioners are beginning to report in.

Obama said at a July town hall in Nashville, Tennessee that he expected premiums to come in significantly lower than what’s being requested. He added that Tennesseans had to work to ensure the state’s insurance commissioner “does their job in not just passively reviewing the rates, but really asking, “O.K, what is it that you are looking for here? Why would you need very high premiums?”

The Tennessee commissioner, Julie Mix McPeak responded on Friday by approving the full 36.3% increase sought by the biggest health plan in the state, BlueCrossBlueShield of Tennessee. She said the insurer demonstrated that the hefty increase was needed to cover higher than expected claims from sick people who signed up for individual policies in the first two years of the Affordable Care Act.

Oregon’s Laura Call allowed an average 25.6% increase for that state’s biggest plan. In Ohio, it was 14.5%, in Michigan, 11.4%.

Democrats typically add mandates designed to make particular groups like the plan, then are astonished to find that it costs a lot more. Do remember that the Affordable Care Act was passed without a single Republican vote because Republicans thought it would not work and would soon become unaffordable. They just had no idea that it would happen quite so soon.

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Some plans offered low rates for the first and second year eager to  capture new business. Others simply found that business was more expensive than expected. Some programs designed to cushion insurers  against high risk participants are ending. Some state commissioners have not yet reported their decisions, or completed their analysis.



But We Were Sure It Would Save Money! by The Elephant's Child

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One of Obama’s big promises about ObamaCare was that once people had the wonderful new “Affordable Care”insurance,  emergency room use would sharply decline and the country would save all sorts of money on medical care. Conservatives knew that was bunk, but the Affordable Care Act passed without a single Republican vote — for good reason, and really, not because we hate the president. We just hate his health care bill.

A peculiarity of Progressives is that they decide a policy would be another step on the path to a ‘better world,’ but they don’t spend much effort on analyzing how it would actually work. They have enrolled lots more people who were uninsured in Medicaid. They feel wonderful about that — all ‘Lady Bountiful’. That they have at the same time, in order to make it affordable, cut back so far on what they will pay doctors, that nobody in need of health care can find a doctor who will accept Medicaid’s low payment. Voila! Increased use of emergency rooms.

ABC reports that Bakersfield Memorial Hospital broke records and now serve 300 people daily in the ER. A Registered Nurse, Jenny Wilson, with Memorial Hospital explains that they have developed a fast track system that categorizes the patients based on illness and directs the less serious cases with sprains, cold or cough to get quick treatment and then releases them.

A Los Angeles Times article confirmed that according to state records, Los Angeles County’s 74 emergency rooms, 11 treated an additional 2,000 patients or more in the first six months of 2014 compared with the same time in 2013.

The VA scandal arose when veterans died before they could finally get an appointment to be seen. Higher-ups demanded that hospitals see more patients in less time in order to save money, but hospitals could not meet the demand, so in order to save their jobs, they parked people on hidden wait lists. Apparently nobody asked if it was possible to do what was requested. It wasn’t. But veterans inconveniently died when forced to wait too long.

ObamaCare was going to save all sorts of money by computerizing everybody’s records, so everybody could share them, and the federal government would have national records of the nation’s health that they could study and find even more ways to save money. Hospitals and clinics, at great expense and trouble have indeed computerized.

My local hospital and all the associated clinics are getting used to the system, though it means that in most cases the doctor spends his time interacting with the computer instead of the patient. That’s a problem. An even larger problem is that hospitals can’t talk to each other. Their systems were separately designed, and the programming cannot and will not connect unless re-done. Affordable Care isn’t affordable.

Rules create incentives, regulations have consequences— often unintended. That is true in all of life. Progressives eyes are so fixed on the warm feelings to be engendered by their action that they just don’t expect any untoward consequences. Need proof? These are the people who think they can run up the national debt to $18 trillion, without understanding that they have to pay it back.



Rep. Trey Gowdy Questions Professor Jonathan Gruber by The Elephant's Child

At the House Oversight Committee hearing, Representative Trey Gowdy (R-SC) questions Dr. Jonathan Gruber, professor of economics at MIT, who has become known as an ‘architect’ of the Affordable Care Act. Professor Gruber has become widely known for remarks about the stupidity of Americans, but since Republicans unanimously opposed the Affordable Care Act, his demeaning comments could only be directed at Democrats. He was a major promoter of ObamaCare.



So Who is This Jonathan Gruber Anyway? Everything You Wanted to Know: by The Elephant's Child

It’s quite clear that Dr. Gruber believes the American voter to be terminally stupid, unable to comprehend smart stuff like the Affordable Care Act. He is an economist at MIT, major contributor to the ObamaCare bill, yet unable to craft a law that is anything more than a political stunt, devised to sweep the public, over time, into a disastrous single-payer health-care system that will bankrupt the country and kill off  a lot of its customers earlier than necessary. Let’s face it, it’s lousy health insurance.

The federal government is unable to run a health care plan. Medicare in its current shape is going broke, hastened by the retirement of the Baby Boomers. It must be reformed, but Congress is scared to death to deal with it.  Meanwhile the government deals with it by paying doctors, hospitals and other providers less and less, and fewer and fewer doctors will accept Medicare payments.

Medicaid was meant to be insurance for those who could not afford insurance, and to get all the uninsured — insured. Studies show clearly that the uninsured have better health outcomes than those on Medicaid. Fewer and fewer doctors will see Medicaid patients at all. The Indian Health Service is said to be inferior to Medicaid.

And then there’s the Veterans Administration. The problems have been exposed in one of the Obama administrations worst scandals that has even had deaths among veterans waiting on an endless (probably non-existent) list for care. Wrapped up in fraud and self-serving  and public-sector unions, they can’t even manage to get rid of the people responsible.

You cannot take a medical system that everyone claims costs too much, add a vast bloated government bureaucracy on top, add on unnecessary freebies (like birth control that is extraordinarily cheap and will probably soon be offered over-the-counter) and claim that it will cost less than the free market. Inevitably, under such a system, doctors and hospitals would have to become government employees.

Dr. Gruber has a lot more to answer for than merely calling Americans stupid. It was not the American people who voted it into law, or who were fooled into thinking it was a good thing, but the Democrats in Congress. So the question becomes —just who were the stupid ones?



The Affordable Care Act May Not Be Affordable. Who Knew? by The Elephant's Child

The Health and Human Services inspector general has been busy. Two new audits reveal failures in ObamaCare on an astounding scale. There are unresolved discrepancies, rules violations and technology problems that expose taxpayers to unknown costs.  They bit off more than they could chew.

The HHS inspector general found 2.9 million “inconsistencies” in applications that were submitted to the federal Health Care.gov exchange during the first five months of open enrollment. “Inconsistencies” refers to things like Social Security numbers that don’t match government data, income data, family size, and citizenship that don’t check out. Around 1.3 million of the problems dealt with citizenship. An additional million involved declared income.

The inspector general was unable to resolve these “discrepancies” because the ObamaCare “eligibility was not fully operational.” In other words, who knows if the applicants were eligible to receive ObamaCare at all? Or if they are eligible are they getting the right subsidies? Are they even citizens?

Only 6 million had filled out applications by the end of February, and only 2.6 million had enrolled. Of the 300,000 problems that HHS was capable of resolving, it had only managed to clear up for just 10,000.

Eleven states ran exchanges, and had problems with 34% of the applications they had received — a total of 422,772 problems. They didn’t say if they had resolved any. The federal exchange and two state exchanges didn’t have adequate internal controls to make sure taxpayers were protected from fraud and abuse.

To top that all off, the government hasn’t been reconciling its enrollment numbers with insurance companies to account for dropouts and cancellations. Who knows how many are actually enrolled, or how many people believe they are enrolled and are not? And how many have tried to get coverage to which they are not entitled?

In the private sector, there would be criminal charges and a lot of self-important people would be heading to jail.

The president has changed the law, changed due dates, changed requirement and delayed one thing and another. How that plays out I don’t know. It’s probably one of those —”after the election” things he is so fond of.

If I understand correctly, he has promised the insurance companies that the government would (taxpayers would) bail them out if they came up short. What that means I don’t know.



ObamaCare: Fewer Enrollees, Higher Costs. by The Elephant's Child

The ObamaCare Exchanges are “disappointing” with fewer than 4 million newly insured. The Obama administration had hoped for 26 million. In April, President Obama told the nation that “marketplace” or “exchange” enrollments at 8 million customers as of March 31, had exceeded expectations and were lower than expected. The media blithely accepted the “selectively released statistics”, in spite of the administration’s habit of providing incomplete information.

The White House has not released any enrollment figures in the last 2½ months, nor do they plan to issue any updates soon. Hmmn. Government numbers included 20 percent of enrollees who did not pay their premiums. Estimates of how many were previously uninsured range from about one-third to more than half. Some who were forced out of their existing coverage find themselves having to re-enroll at much higher rates than before.

Some insurers have increased their rates by 35 percent to bring their rates into compliance with ObamaCare. So you have people with (perhaps) more benefits but for 35% more premium.

Coverage expansion in the ACA are estimated to increase federal spending by $1.383 trillion over the next two decades. Economist Greg Mankiw has estimated that the ACA or ObamaCare will reduce long run GDP in the U.S. by 5%. He insists that it is a rough estimate. University of Chicago economist Casey Mulligan says the Affordable Care Act added “about six percentage points to the marginal tax rate faced, on average, by workers in the economy. A useful rule of thumb is that taxation of $1 means that 20¢ of economic activity just never takes place.

Rates will increase significantly for next year. ObamaCare, as expected, is going to cost way more than it was planned to cost.



Health Care Costs Rose 10% In The First Quarter! by The Elephant's Child

Back in May of 2009, President Barack Obama had a big health care announcement, flanked by the heads of several major health lobbying groups: The American Hospital Association, the American Medical Association, The Pharmaceutical Research and Manufacturers of America, the Medical Device manufacturers, and the health care worker unions.

The President announced:

T]hese groups are coming together to make an unprecedented commitment. Over the next 10 years — from 2010 to 2019 — they are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year — an amount that’s equal to over $2 trillion.

The providers group said:

We will do our part to achieve your Administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate — saving $2 trillion or more. … To respond to this challenge, we are developing consensus proposals to reduce the rate of increase in future health and insurance costs through changes made in all sectors of the health care system.

They are developing proposals about the way they might come up with a plan to cut the rate of growth of health care spending, but they don’t yet have a plan, or any idea how they could cut costs. But the cost curve was already heading down and had been for 7 years, slowing only when Democrats devised the Affordable Care Act.

Didn’t work out so well, health care costs rose by nearly 10 percent in the first quarter according to the Bureau of Economic Analysis. In 2013, costs rose only 2.4 percent.

“The rise in costs and rate of growth calls into question claims from supporters of the federal health care law, including President Obama, who claimed Obamacare would “bend the cost curve” and slow down the rate of growth in health care spending. Obama and Obamacare supporters have been trumpeting, for instance, their exceeding a goal of signing up nearly 8 million enrollees on health insurance plans by way of the laws provisions.

Over the longer term, what does track with the declining growth rate is the growth of Health Savings Accounts (HSAs), the growth in Health Reimbursement Accounts (HRAs) and the general trend toward higher deductibles. When health insurance was first offered during World War II, because wage controls prevented raises, companies offered health insurance as a way to attract workers. When health care is paid for entirely by insurance the incentive is to use more of it — and so it was. HSAs have a high deductible, but lower premiums, and the incentive is to use less of it. You don’t go see the doctor for a cold. And your savings can be rolled over tax-free from  year to year, and are there for future health care expenses.

HSAs were created by legislation in 2003. Participation in HSAs has been growing by double digits every year since than. They grew by 22% in 2012. There has been parallel growth in HRA plans, a similar plan offered by some large employers.

Republicans were inclined to wonder how Obama was going to make it all cost less while adding a huge government bureaucracy on top to administer it.

Charles Blahouse of the Mercatus Center says:

It is quite possible that the ACA is shaping up as the greatest act of fiscal irresponsibility ever committed by federal legislators. Nothing immediately comes to mind as comparable to it. …The ACA is a commitment to permanently subsidize comprehensive health insurance for millions who could not otherwise afford it, which the federal government has no viable plan to finance.

Sowell




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