Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[chipwhich]

Answers which you haven't mentioned, to questions which you also haven't mentioned?

 

Out of curiosity, why would a link to a CBO post about Obamacare posted at the CBO sight yesterday posted in the Obamacare thread for informational purposes have you in upheaval.

 

It's an interesting read if you read it

Edited February 11, 2014 by chipwhich

[Larry]

Out of curiosity, why would a link to a CBO post about Obamacare posted at the CBO sight yesterday posted in the Obamacare thread for informational purposes have you in upheaval.

Just out of curiosity, why would asking a poster if he had a point, when he posts links to multi-page documents without making any point whatsoever, have you jumping in and making false claims about the person asking the question?

[twa]

 

 

It's an interesting read if you read it

 

He suspects a trap and ulterior motives.

 

 

I have no idea why..(angel/halo) 

 

I simply thought it relevant Larry,..... I was trying to good and refrain from selective quoting and interpretation.

 

it does answer the question of why they felt they needed a revised projection(which I asked earlier)

[twa]

anyone seen this?

 

http://www.washingtontimes.com/news/2014/feb/11/businesses-must-certify-under-penalty-perjury-job-/

 

Businesses with 50 to 99 employees now have another one-year reprieve from Obamacare mandates, but they also will be forced to certify to the federal government — under penalty of perjury — that jobs they cut between now and 2016 are not due to Obamacare.

“Treasury officials said Monday that businesses will be told to ‘certify’ that they are not shedding full-time workers simply to avoid the mandate,” Fox News reported. “Officials said employers will be told to sign a ‘self-attestation’ on their tax forms affirming this, under penalty of perjury.”

Read more: http://www.washingtontimes.com/news/2014/feb/11/businesses-must-certify-under-penalty-perjury-job-/#ixzz2t9rW4ccx 
Follow us: @washtimes on Twitter

 

I'm beginning to wonder if I live in Venezuela.....probably next up mandates to hire   

 

I'm about convinced employing is not in my future

[chipwhich]

It seems the Dems are pushing this thing out to the next election so the Republicans can kill it and the Dems can blame the Repubs for killing healthcare reform.

[Kilmer17]

anyone seen this?

 

http://www.washingtontimes.com/news/2014/feb/11/businesses-must-certify-under-penalty-perjury-job-/

 

Businesses with 50 to 99 employees now have another one-year reprieve from Obamacare mandates, but they also will be forced to certify to the federal government — under penalty of perjury — that jobs they cut between now and 2016 are not due to Obamacare.

“Treasury officials said Monday that businesses will be told to ‘certify’ that they are not shedding full-time workers simply to avoid the mandate,” Fox News reported. “Officials said employers will be told to sign a ‘self-attestation’ on their tax forms affirming this, under penalty of perjury.”

Read more: http://www.washingtontimes.com/news/2014/feb/11/businesses-must-certify-under-penalty-perjury-job-/#ixzz2t9rW4ccx 

Follow us: @washtimes on Twitter

 

I'm beginning to wonder if I live in Venezuela.....probably next up mandates to hire   

 

I'm about convinced employing is not in my future

Does that mean that a company isn't allowed to let people go to save money?

I hate the law, I think it will destroy our economy.

But I cant believe this is accurate.

[Larry]

It seems the Dems are pushing this thing out to the next election so the Republicans can kill it and the Dems can blame the Repubs for killing healthcare reform.

Doesn't sound that credible, to me.

But I confess, I can't think of a better explanation for what they're doing.

[twa]

Does that mean that a company isn't allowed to let people go to save money?

I hate the law, I think it will destroy our economy.

But I cant believe this is accurate.

 

apparently it is treating the delay in the mandate as a waiver subject to penalty if you take advantage of the delay.

 

I saw it yesterday from several sources and waited to see if more info came out.

 

it is rather unbelievable even if toothless.....perhaps a result of Treasury following law Obama has no real authority to delay.

 

Who the hell knows

[Poman]

In order to avoid Obamacare penalties/mandates until 2016 you have to certify that you are not avoiding Obamacare penalties/mandates?  Am I reading that correctly?

[twa]

In order to avoid Obamacare penalties/mandates until 2016 you have to certify that you are not avoiding Obamacare penalties/mandates?  Am I reading that correctly?

 

Something like that....a gift from the person that wishes to avoid the political results of his choice.

 

http://patterico.com/

 

Sign this thing we can’t legally ask you to sign, or we will not give you the break we have no right to give, but that we will give anyway to people who do sign.

 

 

 

https://www.federalregister.gov/articles/2014/02/12/2014-03082/shared-responsibility-for-employers-regarding-health-coverage

See XV-D-6-a

Employers who do not certify that they did not reduce workforce or hours in order to satisfy the size criterion (less than 100 FTE employees) cannot receive the “2015 transitional relief” (i.e. exemption from the tax) otherwise provided by that section.

Edited February 14, 2014 by twa

[TradeTheBeal!]

Does that mean that a company isn't allowed to let people go to save money?

I hate the law, I think it will destroy our economy.

But I cant believe this is accurate.

 

Oh My God.  This is the big one!

[twa]

Oh My God.  This is the big one!

 

naw, he delayed the big one

 

how could he deny all those poor unfortunates the blessings of Obamacare....for a bit....if they promise to behave and keep their mouth shut......

http://www.youtube.com/watch?v=5D-Lk8_rC1s

[Wrong Direction]

Doesn't sound that credible, to me.

But I confess, I can't think of a better explanation for what they're doing.

 

They're hoping the law works, but the problems aren't over by a long shot. I've heard some incredibly pessimistic takes lately.   

[autoidiodyssey]

From the HHS Facebook page. I'm not familiar with the meme but this surely must be the high point of the Obamacare marketing campaign. Young healthy people will be flocking to sign up now.

 

[Wrong Direction]

I suppose now's as good of a time to provide context to the current ACA news as any. Specifically, I'm referring to:

 

1. Enrollment projections. These are below the 7 million forecasted, though final numbers won't be known until April.

2. Mandates on mid and large size companies being weakened.

3. Waiving the grandfather clause.

4. **Speculation** delaying the mandate for 12 months.

 

With enrollment lower than anticipated, total government costs will also be lower, in theory. The question with the lower enrollment remains the enrollment mix. If older/sicker than originally projected, profitability of plans will remain in question in a big way.

 

The simple story behind #'s 2-4 are that all original rules will anger voters so delay is purely political. Mandates on companies will cost companies money. That will cause disruptions in hiring, companies to choose to drop insurance and pay the fine, or higher costs for employees. 

 

Waiving the grandfather clause for two years will mean that disruptions to coverage for tens of millions of people is now delayed. That is interesting for this year (purely political), but also very interesting to put that on 2016. If I'm right, the President just rescheduled cancellation of plans for millions of people until days before the next presidential election. That's crazy to me, so maybe I'm wrong.

 

R's in the house are proposing to delay the mandate for 12 months. I suspect the D's in the Senate will agree rather than stand for it during an election year. This is speculative at this point though.

 

The larger point here is that every financial assumption related to the marketplaces is being turned on its head. The CBO cost projections will go down in a big way if enrollment is significantly lower than projected (all of 2-4 have that effect on enrollment). Actuaries at health plans no longer have an immediate pathway toward greater enrollment and younger/healthier patient mix. That means they'll basically have to project based on year 1 costs, which are apparently not financially positive. 

 

Furthermore, while I didn't mention it above, there are doubts about how effective the risk corridors and risk adjustment payment to plans (basically subsidies for patient sickness levels and subsidies to losing plans) will be. In a nutshell, some in industry seem to believe that the regulations on these topics are poorly written, and effectively subsidize poor plans over good ones.

 

All of this background tells me that the total cost of this bill is going down, but for bad reasons that will ultimately cause plan costs to go up. If that's the case, depending on severity, it's the definition of a death spiral where premiums in future years increase pretty dramatically.

 

Add this all up, throw in a dose of website magic (still massive costs and problems) and a pinch of Congress being totally unwilling to help and I'd say this law is in serious jeopardy of imploding by the end of 2015 (can't believe D's will want this in 2016). The outlook is bleak, and this is the strongest position I've taken on the law to date.

 

Moreover, it appears Obama is choosing the self-destruct button. In my opinion, the law needs the additional enrollments to succeed. All of these delays only serve to undermine the law. The President appears to be trying to minimize the bleeding in 2014 rather than standing for the financial stability of this law. I think he just shot himself in the foot.

[Larry]

HuffPo: Uninsured Rate Drops, Thanks To Obamacare

 

WASHINGTON (AP) — The share of Americans without health insurance is dropping to the lowest levels since President Barack Obama took office, but sign-ups under his health care law lag among Hispanics — a big pool of potential beneficiaries. 

 

With just three weeks left to enroll on the new insurance exchanges, the Gallup-Healthways Well-Being Index, finds that 15.9 percent of U.S. adults are uninsured thus far in 2014, down from 17.1 percent for the last three months — or calendar quarter— of 2013. 

 

Released Monday, the survey based on more than 28,000 interviews is a major independent effort to track the health care rollout. The drop of 1.2 percentage points in the uninsured rate translates to about 3 million people gaining coverage. 

 

Gallup said the proportion of Americans who are uninsured is on track to drop to the lowest quarterly level it measured since 2008, before Obama took office.

 

 

Not much more at the link.  And no doubt there's a lot of phrases in there that can be considered half full or half empty, depending on what you want to see.  But thought it was at least worth mentioning.  (Although just barely.) 

[Dan T.]

Obama (sp?) appears on "Between Two Ferns" with Zack Galifinakis:

 

http://vo.fod4.com/v/18e820ec3f/v110.mp4

 

 

[gbear]

I almost hesitate to post on this attack thread because I am not sure how many will read anything with any attempt at understanding.  We are all so stuck in our mindsets we can't see any other views or reconcile differences. Still,...

 

I get frustrated when I see attack ads put out that turn out to be completely misleading like the Americans for Prosperity ad telling the story of a woman who can't afford her insurance despite the truth of the ACA actually saving her money,  The problem is she didn't know and niether do most consumers.  They go the "truth in advertising" premise, and this susceptablity by people on both sides to only see and hear only what they expect.  The same problem happens with thos of us on the left as many of us will probably shrug off the Feb. enrollment numbers not meeting their goals.  It is all an arguement for the failure of the free market in healthcare.  A free market's success is predicated on the consumers acting in their own best interest which requires the market place to have perfect information and the ability to understand it.

 

In an only slightly different vein, I was asked to interview for the position of patients' advocate on a prestigeous board a couple of weeks ago.  One of the questions posed to me was "If you had a magic wand to fix the ACA and the healthcare industry in the U.S. how would you use it?"  As I thought about it afterwards, I wrote the interviewing committee back with this adendum to my answer:  http://thelifewelllived.net/2014/02/18/could-versus-should-the-unasked-question/

 

I'm curious how much of that would run counter to what many on here who think about healthcare would say is a major source of our healthcare woes.  For what's worth I was offered the position.

[Wrong Direction]

I'm curious how much of that would run counter to what many on here who think about healthcare would say is a major source of our healthcare woes.  For what's worth I was offered the position.

 

It's a thoughtful answer. I enjoyed the read.

 

Rather than focus on someone else's determination of what care is or is not needed, I'd focus on two things:

 

1. Not paying for care that isn't covered. By this, I mean the massive amounts of payments made for care beyond clinical best practice.

2. Giving patients skin in the game, so the cost of "unnecessary" care (regardless of patient condition) is weighed by patients and their families. I readily admit that disparities between rich and poor make policies like this a challenge, but I believe there are ways to do it.

 

If you did those two things, I think people would be surprised at how many of the financial problems we face could be solved.

[gbear]

Wrong Direction,

Australia has a 2 teered healthcare system.  From what I read from an MS research blog, Englands healthcare may be moving to a similar model:  http://multiple-sclerosis-research.blogspot.com/2014/03/is-australian-healthcare-system-better.html

 

Here's the irony:  A system where the state says we can affor to treat x,y, and z but not A or B is the 90's Hillary care proposal.  From memory, her plan had a lot of Tsongas healthcare plans where what to treat and how to do so on hte state's dime was determined by looking for maximum returns on dollars spent.  All sub-optimal dollars would have to come from individuals.  It was a healthcare based on the idea of "greatest good for the greatest number."  It's a tough sell to those who could have more.

[Wrong Direction]

Wrong Direction,

Australia has a 2 teered healthcare system.  From what I read from an MS research blog, Englands healthcare may be moving to a similar model:  http://multiple-sclerosis-research.blogspot.com/2014/03/is-australian-healthcare-system-better.html

 

Here's the irony:  A system where the state says we can affor to treat x,y, and z but not A or B is the 90's Hillary care proposal.  From memory, her plan had a lot of Tsongas healthcare plans where what to treat and how to do so on hte state's dime was determined by looking for maximum returns on dollars spent.  All sub-optimal dollars would have to come from individuals.  It was a healthcare based on the idea of "greatest good for the greatest number."  It's a tough sell to those who could have more.

 

I don't mean this to sound as disparaging as it'll likely come across, but this sounds like utopian concept.

 

In a nutshell, I don't trust that economists could come up with accurate models. Sure, there are cost-benefit scenarios that are easy, but the vast majority simply are not. Additionally, quality care is often very expensive care and the effectiveness of treatment is often driven at the patient level. It seems like the cost-benefit would come at the end of life, but I don't think people want those decisions made by actuaries.

 

Then the idea that politicians will be part of that program adds more confounders. I mean, it's easy to say that the politicians would simply stand up a program based on rigorous scientific evidence. However, reality in America has proven that politicians with authority can't keep their hands off. So, if a government panel wants to come out with a payment cut to hospice, for example, politicians will jump all over that. Look at what happened with mammograms. A CDC task force said they weren't worth it. Politicians came in and said they are worth it, and they have to be available for free. Now, imagine our entire healthcare system was built that way. 

 

My alternative attempts to put all patients in a position to make their own healthcare decisions, if they want. I'd like the patient to have skin in the game. I'd like that to be true if you're poor or rich. I'd simply like to subsidize the poor with something like health dollars or health credits which could be used when needed, accrue over time (with a cap) and theoretically could pass on to family. In other words, the patient would have an asset to apply to their care, or to pass on to loved ones if the care just wasn't worth it. They'd have skin in the game and no government, economist or politician would be making formulaic determinations regarding what care an individual should get.

[Busch1724]

I'm heading negotiations for our union. The Cadillac Tax is something our school board is deeply concerned about, from what I've read rightly so. So is it true that come 2018 the Cadillac Tax is 40 percent for every dollar over the threshold? At our school, just for teachers, it'll be right around 600,000 dollars. This is based on projections and previous premium increases. I guess what I'm getting at is there any exemptions/loopholes to the tax?

[gbear]

The tax is on health insurance plans costing more than $10.2K per individual or 27.5k per family.  The tax is 40% on every dollar above this threshold.   There are adjustments for locations (some places have higher premiums) and risk pools of the people covered.  For example, if the majority of the workers are premedicare retirees or working in a high risk vocation, the amount before the tax is incurred rises.  The threshold is also set to rise at the level of inflation plus one percent for 2018 and 2019.  After that the rise is linked to the consumer price index (inflation) which typically goes up slower than medical costs.  I don't know the term of your negotiations, but if you are negotiating a long term deal near that threshold you should account for projected increases in costs relative to incurring the tax.

 

If you are negotiating a deal near the tax, could you prpose a deal such that workers always get a benefit = threshold - $100?  Keep in mind the threshold applies to healthcare savings accounts and insurance premiums. 

 

A good site for information on Cadillac tax: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99

[chipwhich]

I guess what I'm getting at is there any exemptions/loopholes to the tax?

 

Yeah, don't buy a cadillac health plan.  Part of the reason for the high deductible plans and putting the onus of paying something for health care visits is American doctor visits have become so cheap or free that we run to the doctor at any sign of a runny nose.  If it hits the wallet a little, you might choose to go to the doctor when you really need it.

[Wrong Direction]

Yeah, don't buy a cadillac health plan.  Part of the reason for the high deductible plans and putting the onus of paying something for health care visits is American doctor visits have become so cheap or free that we run to the doctor at any sign of a runny nose.  If it hits the wallet a little, you might choose to go to the doctor when you really need it.

 

Yeah, I was talking to a health plan in Michigan several months ago who noted the "performance" of a particular physician network fell off the table. What they meant was that costs for that plan's members who went to those doctors shot through the roof. Upon investigation, they realized it was all members of a particular employer who basically provided everything for free, so utilization shot up.

 

Bottom line: I have to wonder what more aggressive benefit designs would do to health costs if you're currently negotiation off of a cadillac model. In other words, a lesser model might reduce benefits (obvious and quantifiable), but it might ultimately have a multiplier effect which would mean much lower costs for the county (or whatever municipality/employer you're talking about). So, if I were negotiating, I'd probably accept the cadillac tax as a cap on my member plans. I'd try to get the other party to reimburse me for that cut (salary or bonus pools offsetting healthcare savings) and I'd try to negotiate to share any savings above and beyond the cuts in the insurance plans for my members.