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A Small Glitch In Healthcare.Gov?

Stanley Feld M.D.,FACP,MACE

President Obama and his mainstream media shills such as Paul Krugman keep on insisting that Obamacare is working fine.

A recent “secret shopper” audit by the GAO (Government Accountability Office) has discovered  that the Obamacare website healthcare.gov has exposure to fraud and abuses. Obamacare does not have a plan to prevent this kind of fraud and abuse.

The title of this blog should be, “How To Fake A Healthcare.gov  Application And Get A Healthcare Insurance Subsidy.”

 “Last year the Senate Finance Committee asked investigators at the Government Accountability Office, or GAO, to test the Affordable Care Act’s internal eligibility and enrollment controls. So they created a dozen fictitious identities and applied for insurance subsidies—and 11 fake claimants got them.”

Healthcare.gov did not have a verification protocols operational.  This was supposed to be part of the non existent back end for 2014.

The GAO online and over the phone supplied invalid Social Security numbers, doctored citizenship status or misstated income on tax documents.

Eleven of the twelve phony applicants received up to $2500 per month in tax credits or $30,000 per year.

What is worse is that these 11 phony applicants re-enrolled in 2014 for 2015. Some of them received a larger tax credit without providing additional documentation for 2015. Some were renewed automatically.

How much did the taxpayer pay for this pathetic website?

The exact amount is not known because it is not transparent.

Which part of the federal budget was charged for the website?

Was the website an Obamacare expense?

How many people received large and fallacious subsidies by lying?

How much has the government spent and wasted on Obamacare so far?

How can President Obama tell us with a straight face that Obamacare is working well?

How can we tell President Obama we are sick and tired of his lies?

How can we prevent President Obama from getting away with these lies?

The health insurance exchanges are supposed to verify income and identities before approving subsidies. This was promised but could not happen in 2014. The back end of healthcare.gov was not completed. The back end was supposed to be completed for 2015.

The GAO study was able to circumvent the initial identity proofing.

The exchanges are “required to seek post-approval documentation in the case of certain application ‘inconsistencies.’

The post-approval documentation was only requested if there were inconsistencies in the application. Some applications were automatically renewed.

The GAO also reports that the follow-up was often unclear or inaccurate and didn’t turn off the subsidies.”

The GAO concluded that the customer service representatives were clueless and incompetent.

No one in the Obama administration has been held accountable or fired.  The cover-up by the Obamacare administration is obvious.

Officials running ObamaCare told the GAO they possess “limited ability to respond to attempts at fraud” and that measures to ensure program integrity would undermine “consumers’ ability to ‘effectively and efficiently’ select Marketplace [ObamaCare] coverage.”

The explanation is an affront to logic and the taxpayer’s intelligence. This incompetence was not reported in the New York Times or the traditional media.

As President Obama was telling the American public that Obamacare is working fine and as Paul Krugman was backing him up with his Noble Prize T-Shirt on, the Obama administration was wasting probably wasting  billions of taxpayer dollars on a program that was not working.

When are the American people going to wake up and say this has to stop?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Chaos Continues At HealthCare.gov

 

Stanley Feld M.D.,FACP,MACE

http://wtvr.com/2015/02/20/obama-administration-extending-health-care-enrollment-deadline/

Chaos continues at healthcare.gov with the sudden departure of QSSI. QSSI was a minor hub manger of healthcare.gov in early 2014 when the site was failing. It became the major integrator and senior advisor.

CGI was the major integrator at first.  Michelle Obama’s college friend was a principle in CGI. The friend obtained the non-bid CGI contract. CGI was dismissed as the web site disaster unveiled itself. The contract was for more than $600 million dollars.

QSSI was hired as the senior advisor and the web site’s prime integrator.

QSSI is a subsidiary of Optum the IT healthcare arm of healthcare insurance company United Healthcare. 

 Andy Slavitt, a senior executive at Optum, joined CMS in June 2014. He had subsequently been heralded by CMS as the savior of healthcare.gov

He received a rare waiver from federal ethics rules at the time which allowed him to be involved in contracting issues involving Optum and the United Healthcare Group.

When Slavitt joined CMS, a little known loophole in government hiring practices permitted him to pocket $4.8 million in tax-free money when he joined the government agency.”

Andy Slavitt was initially hired as deputy administrator of CMS. He was promoted to acting administrator when Marilyn Tavenenner left.

There has always been a question of conflict of interest between Slavitt , Optum and United Healthcare. It is not clear if Andy Slavitt is still at CMS.

Republican Sens. Chuck Grassley of Iowa, and Orrin Hatch of Utah, asked CMS and United Health Group in June 2014 about Slavitt’s potential conflicts of interest.

The answer to Senator Grassly and Hatch’s questions were never made public.

A scandal occurred recently when 800,000 Obamacare enrollees received incorrect subsidy information on the 1095-A tax forms sent by the federal exchange healthcare.gov.

Some enrollees were mistakenly told they received too large a subsidy, while others were told their subsidy was too small.

Publicity of this error was buried in the news that the Obamacare enrollment period for 2015 healthcare insurance was being extended until April 30th, after initially being extended to February 15th.

 The real reason for the extension appears to be poor enrollment in healthcare.gov despite the administration bragging that the enrollment was great.

 One month later Optum suddenly quit.

An Optum spokesman said,

 “Having achieved the goal of making HealthCare.gov a stable, reliable platform for people seeking health coverage, Optum will not seek to continue our role as senior adviser to HealthCare.gov,”

This isn’t the first time this has happened. Jeff Zients took over when healthcare.gov was launch in October 2013.

In December 2013 Zients, who Obama had turned to in the past to fix sticky issues, had “made it clear that he was not going to stay on the job past December.”

Kathleen Sebelius said in a blog post,

Today, the site is night and day from what it was when it launched on October 1. I am very grateful for his service and leadership," Secretary of Health and Human Services.”

The Obama administration then announced that former Microsoft executive Kurt DelBene took over the operation of HealthCare.gov in December 2013 in consultation with Marilyn Traverner and QSSI.
 

Somewhere in 2014 CGI was rehired and DelBene left. QSSI remained.

CGI was then relieved in December 2014.

Accenture was hired. In December 2014 Accenture was rehired with a $563 million dollar contract to run healthcare.gov.

“The Centers for Medicare and Medicaid Services (CMS) in January dropped a key contractor on the project, CGI Federal, and selected Accenture Federal Services to rehabilitate and build out the portal.”

Suddenly, in May 2015, QSSI quit.

This all seems fishy to me. The price tag of more than $1.1 billion dollar for healthcare.gov seems very high. The web site is still incomplete. The healthcare insurance premiums are unaffordable and rising.

Consumers and physicians do not approve of Obamacare.

State exchanges are losing money they cannot afford. There is little evidence that the electronic medical records program is increasing the quality of medical care.

The individual health insurance market through healthcare.gov is a mess.

The public does not know how many people are uninsured, have become uninsured and do not have access to medical care.

Obamacare has been delayed in the group market. Private insurance has increased in price. Large corporations are increasing part-time employment to avoid paying for employees’ healthcare insurance and to avoid federal government penalties.

Yet, the Obama spin machine is trying to influence the public and the Supreme Court through the media saying the subsidy should be extended to the Federal Health Exchanges.

It all seems crazy to me. There is a better, more efficient way to help Americans purchase insurance and be protected in case of serious illness.

It is not a government run single party payer system. The government cannot even build an efficient website.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Is Anyone Confused Or Convinced?

Stanley Feld M.D.,FACP, MACE

Obamacare has failed. You wouldn’t know it by the massive misrepresentation by the mainstream media.

The mainstream impression is that registration during the open enrollment period for 2018 ending December 15,2017 is doing well.

I have not written a blog in about a month because there has been nothing to write about.

I have laid out my ideas about what is necessary to repair the healthcare system. It is all about personal responsibility and physician/patient relationships for both acute and chronic diseases.

It is the only way to control costs and decrease waste in the healthcare system.

Frankly, I am saddened that our representatives in congress don’t give a damn about the costs to the American people.

They simply want Americans to be dependent on government. The government wants to control Americans rather than Americans controlling the government.

Both the Republican and Democratic establishment have been brain dead on how to effectively repair our healthcare system.

Republicans had seven years to figure out an efficient system. The have controlled the house for two terms. They have controlled the senate for one term.

Then they failed. Almost 100 bills passed the house. any passed both houses and were vetoed by President Obama.

Why couldn’t they send one of those bills to President Trump?

Tom Price M.D. had some ideas on how to repair the healthcare system. However he was disposed of by claims of misuse of government funds.

There has been little published since the Republican establishment failed it its effort to repeal and replace Obamacare in November 2017.

It is unclear to me whether the Republican effort failed because it was a step in the wrong direction or the Republican establishment hates Donald Trump.

In any case the Democratic establishment is trying to blame Donald Trump for the Obamacare failure.

They claim it is Donald Trump’s fault the healthcare insurance industry is not being paid the unauthorized supplement President Obama promised but could not pay. He could not find the money.

It is the House of Representative that authorizes expenditures. The cost of those promised subsidies that were unauthorized was 88% short of the healthcare insurance industry’s claims.

The Obamacare cost overruns were gigantic. It must be remembered that the Health Insurance Exchanges only provided insurance for less than 10 million people in the individual healthcare market.

Many factors added to the cost overruns including subsidizes of over $15,000 dollars a year for these premiums in the individual market. The 2018 subsides will be over $20,000.

The healthcare system has become such a partisan issue that the truth about Obamacare’s failure is not the point anymore.

It seems that the Republican establishment is not any smarter than the Democrat establishment in trying to repair the system.

The end of the open enrollment period for 2018 is supposed to be December 15, 2017.

I posted two graphs in this post. One represents enrollment until 11/25/2017 and the second represents enrollment until 12/2/2017.

They bring out several points about Obamacare’s failure.

Seven states of the 39 states have already extended their open enrollment period. California has extended open enrollment until 1/31/2018.

On 11/25/2017 confirmed but not paid enrollment was only 2,660,938 with only 2,277,079 through Healthcare.gov and 383,859 for Medicaid.

Open enrollment projected for 11/25/2017 was 4.2 million with 2.6 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 4.6 million with 2.8 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 500,000 person enrollment short fall for healthcare.gov. It also must be remember that 85% of the people enrolling through healthcare.gov have preexisting illnesses and are subsidized by the government.

  Chart 1 3 8

The open enrollment numbers look worse on December 2, 2017 although there is not a word of it in the mainstream media.

On 12/2/2017 confirmed but not paid enrollment was 3,491,164 with only 2,751,260 through Healthcare.gov and 709,904 for Medicaid.

Open enrollment projected for 12/2/2017 was 5.1 million with 3.5 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 5.8 million with 4 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 1,248,840 (4,000,000-2,751,260= 1,248,840) person short fall for healthcare.gov with 13 days to go for the open enrollment period.

Chart 2

It is difficult seeing these numbers by casually studying these charts.

Obamacare is an unmitigated failure. Democrats want to throw more money at it.

Republicans do not know what to do.

I suggest they look at my blog entitled The Ideal Medical Saving Accounts are democratic.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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The Republican Health Care Con By THE NYTimes EDITORIAL BOARD JAN. 21, 2017

Stanley Feld M.D., FACP, MACE

The New York Times editorial “The Republican Healthcare Con” should really be entitled “The New York Times Con of The Republican Health Care Con”

In my opinion The New York Times has become a biased newspaper. Instead of publishing “all the news fit to print”, it is printing articles and editorials that are biased opinions with incomplete facts.

The Republicans have not introduced their replacement of Obamacare yet this editorial is critiquing the replacements effect on the healthcare system..

Everyone is entitled to his or her own opinion. No one is entitled to his or her made up facts.

Republicans say the Affordable Care Act provides health insurance that manages to be both lousy and expensive.”

This is true. Most of the population seems to agree with this statement.

The only people buying insurance from the health insurance exchanges are people with pre-existing illnesses. These people have no other insurance available.

“Whatever the flaws of these policies (Obamacare), the new Trump administration is trying to pull off a con by offering Americans coverage that is likely to be so much worse that it would barely deserve the name insurance.

It would also leave many millions without the medical care they need.”

How does the New York Times editorial board know this when the Trump administration’s healthcare plan has not been introduced?

The liberal media keeps saying the Republicans have no plan. If Republicans do not have a plan how can the NYT criticize it?

How can a non-existent healthcare plan leave many millions without the medical care they need”?

There is no evidence for the statement above.

This reality became increasingly clear when President Trump’s choice to run the Department of Health and Human Services, Tom Price, testified before a Senate committee last week.

He looked pained as he described the terrible predicament of people who earned around $30,000 to $50,000 a year and had to deny “themselves the kind of care that they need” because they had Obamacare policies with deductibles of $6,000 to $12,000.

Tom Price M.D. is correct in saying the Obamacare deductibles are $6,000-$12,000. The NYT left out that the Obamacare networks available are restrictive and the access to proper healthcare is difficult.

The NYT editorial board also left out the fact that 85% of people buying healthcare insurance from the health insurance exchanges are subsidized by the government and have a pre-existing illness.

“ Yet, earlier in the same hearing, Mr. Price extolled the virtues of policies that would be woefully inadequate — policies that cover medical treatment only in catastrophic cases.”

This is a misrepresentation of Dr. Price’s testimony.

Perhaps the NYT editorial Board does not understand Health Savings Accounts?

If you want to understand a potential Trump administration proposal read my blog “Medical Savings Accounts Are Democratic.”

Dr. Price was talking about the virtues of health saving accounts without being specific.

The goal of health savings accounts are to put consumers in control of their medical care and healthcare dollars while providing them with financial incentives to save retirement dollars and not waste medical care dollars.

Consumers could have control of what they spend for their own healthcare.

The employer or government would pay for the deductible and the reinsurance above the deductible.

The money would be put in a healthcare trust. The money in the trust would pay for medical care.

If consumers did not spend the money on medical care that year, it would go into a personal saving trust for those consumers retirement.

“ Such policies often have deductibles of around $14,000 for family coverage.”

FALSE! One can get excellent coverage with a $6,000 deductible and first dollar coverage after spending $6,000 at a reasonable price.

Health Savings Accounts are the fastest growing healthcare insurance vehicle.

The government has put so many restrictions on health savings account that employees are hesitant to offer it. The government must remove these restrictions. www.unitedheath.com

“ This is simple hypocrisy. Condemn the policy you don’t like, propose something far worse as a replacement and claim that it is much better”

This paragraph is written to condemn Dr. Price and rile up the anti-Trump forces with false information.

The editorial completely disregards the fact that a proposal has not yet been announced by the Trump administration.

There were 2000 plus pages published about President Obama’s Obamacare proposal. There were glaring defects in he proposal.

The NYT did not comment on these defects at the time. Others did. I turned out that the defects were the source of Obamacare’s failure.

In reality the NYT has no idea of what the Trump administration’s proposal will be.

The NYT editorial also ignores the fact that Obamacare is unsustainable, unaffordable and is restricting access to care while rationing care for the very citizens that need the care.

“Mr. Price and Mr. Trump have recently said that their goal is to offer health care to many more people than are covered by the current health care law, which has driven the uninsured rate to historic lows.”

I believe historic lows are a counting error just as the unemployment rate and the inflation rate are counting errors in order to provide the Obama administration acceptable numbers.

Average people know exactly what is happening.

Mr. Price’s testimony and the legislation he introduced in the House (a few years ago), where until recently he was the Budget Committee chairman, show that the new administration will make decent health care less affordable and less accessible for most people.

The underlined portion is a NYT editorial opinion. It is an opinion without facts or evidence. It could also be a lack of understanding of the bill Dr. Price’s introduced.

The Trump administration’s upcoming proposal might be completely different.

How would the NYT know the Trump administration’s healthcare plan would make decent health care less affordable and less accessible for most people?

This is an unsubstantiated bias that would qualify as fake news.

“Those Health Savings Accounts would not help families earning the median household income of $56,000 a year because these families would never be able to sock away enough money.”

The NYT editorial either missed the concept of Health Savings Account totally or is reporting the concept to fit its bias.

The best description of what Mr. Price stands for can be found in a bill he introduced in 2015, the Empowering Patients First Act. It would “empower” Americans by eliminating the health care law’s expansion of Medicaid that has helped more than 10.7 million newly eligible people enroll in that government-run insurance program.

Many of these Medicaid patients cannot find a physician or hospital that accepts Medicaid.

Therefore they have very limited access to care.

A potential proposal could expand Medicaid patients’ access to care using health savings accounts.

It would also drastically cut subsidies that have helped 11.5 million people purchase private insurance on federal and state health exchanges.

There is no evidence for this wild statement.

Under his bill, people buying insurance for themselves would get between $1,200 and $3,000 a year in subsidies, down from an average of $4,600 that people get now on HealthCare.gov.

The amount of tax benefits or tax credits for Health Savings Accounts have been restricted by Obamacare in order to discourage its use.

The Obama administration wanted to control medical care and eliminate consumer choice and power.

President Obama wanted healthcare decisions to be in the hands of the central government.

The Trump administration plans to modify these restrictions. President Trump has stated he wants to put healthcare decision making back into consumers’ hands and not the government’s hands.

The bill would even get rid of the requirement that allows young people to stay on their parents’ insurance policy until age 26, a provision that is widely popular.

This is totally false and once again fake news.

And it would hurt people who get insurance through their employers by setting a cap on how much of that expense businesses can claim as a deduction on their taxes. Experts say that over time this would encourage companies to stop offering health benefits to workers.

The independent insurance market has not had tax deduction. It should be on a level playing field with group insurance. There is no evidence that the group market will lose its tax deduction.

“When it comes to health care, Mr. Price and other Republicans say their goal is to give people more choices. It is hard to argue against choice. But in the ideological world inhabited by Mr. Price, House Speaker Paul Ryan and many other Republicans, choice is often a euphemism for scrapping sensible regulations that protect people.”

This claim also has no basis in fact. It is pure opinion by the NYT editorial board.

“Some Americans might well be tempted by this far-right approach. They would have to pay less up front for these skeletal policies than they do now for comprehensive coverage.”

Has Obamacare provided comprehensive care? It is unaffordable and inaccessible to all.

But over time, when people need health care to recover from accidents, treat diabetes, have a baby or battle addiction, they will be hit by overwhelming bills.

Where did this come from? It came from a negative bias toward Donald Trump and his administration without facts or evidence.

The Trump administration seems perfectly willing to sell those people down the river with false promises.

People are not stupid. They do not need government to rule their life and make healthcare decisions for them.

People need incentive to control their health and healthcare dollars.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Pre-Election Obama Administration Lies

Stanley Feld M.D.,FACP,MACE

The Obama administration is out in force telling pre-election lies so that the Democrat’s base that loves entitlements stays calm.

New data from Joint Commission on Taxation led the TPC to cut the number of people paying federal income taxes by 3.9 million. In total, 77.5 million individuals and married couples — or tax units. as they are defined by the TPC — won’t pay income tax this year out of a total of 171.3 million. The previous estimate was for 66.2 million out of 163.8 million tax units not paying income tax in 2015.

In 2015, this represented 45.2% of the taxpayer units.  In 2013, 40.4% of taxpayer units paid no taxes. With the influx of illegal immigrants paying no taxes the percentage of non taxpaying units will increase.

The illegal immigrants will receive Medicaid and other entitlements.

Hillary Clinton has pledged to increase illegal immigration with open borders and increase Medicaid enrollment.

Taxes will have to be increased. The middle class will be crushed. Hillary Clinton will hide some of these taxes as President Obama has done for Obamacare..

President Obama is trying desperately to save Obamacare from self-destruction.

I have recently reviewed the phony enrollment figures for 2014, 2015 and 2016 published by the Obama administration. There has not been a significant increase in enrollment in the last three years.

The claim that there are 20 million enrollees as a result of Obamacare is not even a half-truth. There are only 10 million enrollees from the Health Insurance Exchanges.

The failed Medicaid entitlement program has an added 10 million enrollees and insufficient physician coverage.

The first pre-election day lie was HHS Secretary Sylvia Burwell telling a group that the 2017 Open Enrollment period was going to sign up an additional 1 million enrollees. She said the Federal Health Insurance Exchange marketplace was strong.

The Marketplace is strong – and will continue to be strong – because it is offering a product people want and need.

This year, we know the Marketplace is strong, but we think it will grow even more.”

“As we look to this next open enrollment period, we project that the Marketplace will grow by another million people. By the end of open enrollment for 2017, we expect 13.8 million people to have selected a plan.”

Obamacare enrollment through the Health Insurance Exchanges was supposed to grow to 21 million last year according to the CBO estimate. At best, 11 million people are enrolled not 12.8 as claimed. Eighty-five percent of the enrollees receive subsidies.

President Obama’s goal is to have a single party payer in control, namely the government.

Secretary Burwell goes on to conclude;

“In closing, as the President said during the debate over the law, “we did not come to fear the future. We came here to shape it.”

It looks like President Obama is shaping the future in a way Americans did not anticipate or want.

The next big pre-election lie was President Obama’s lie admitting that Health Insurance Exchange premiums will go up 22% in 2017. He also said that the government would cover the premium increases for those receiving subsidies.

He did not discuss the government’s position on the increases in deductibles. Is President Obama also covering the deductible increases?

Where is President Obama getting the money? I think the money for the increased subsidies was built into the budget by telling the CBO that there were supposed to be 21 million enrollees in the Federal Health Insurance Exchanges. Only 10 million enrollees showed up.

The reason for these continuing lies is to calm the public. President Obama and Hillary Clinton want us to believe that Obamacare is good and is working well.

The obvious message of these lies is that the public should vote for Hillary Clinton to continue this good work.

 

https://youtu.be/ziVfvWO8oUE

This You Tube is an excellent summary of all the lies President Obama and the Obama administration have told the America public since the Affordable Care Act (Obamacare) was passed.

It is worth ten minutes of your time to review this deception.

This week he tried to dodge the responsibility for the Health Insurance Exchanges demise and also claimed he should not be blamed for the rise in premiums in the private group insurance market.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker),

Three hundred dollars a month or $3,600 dollars a year is a lot of money for a person making between $40,000 and $50,000 per year.

 The premium increases in Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493).

 “ Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).”

 In many states there isn’t any competition in healthcare insurance for consumers business.

“Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.”

Hillary Clinton bragged that healthcare reform was called Hillarycare long before it was called Obamacare.

I would not be very proud of that statement, if I were her.

I do not believe the American public is not going to be fooled again by progressive rhetoric and lies.

Obamacare is a disaster. I have described the disaster and its potential consequences for since its passage in 2010.

It has caused both the public and private healthcare markets to escalate insurance premiums to unaffordable levels for all Americans. The cost to the federal government is unsustainable.

The present awareness of the Obamacare disaster is the straw that is going to break the back of Hillary Clinton’s campaign.

All Americans deserve a better healthcare system than Obamacare.

My ideal medical saving account is the solution to the healthcare problem.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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If You Tell A Lie

Stanley Feld M.D., FACP, MACE

If you tell a lie enough times it becomes the truth. President Obama and Hillary and Bill Clinton keep telling the American public that there are 20 million new Obamacare enrollees.

Obamacare advocates believe that Obamacare provided healthcare insurance for 20 million people who did not have healthcare insurance before Obamacare.

These Obamacare advocates have little understanding of the details of this lie. They usually react negatively when I tell them the 20 million new enrollee figure is a lie.

Republicans do not pick this up and call Democrats out about this lie. Perhaps they have no understanding of what is going on.

The lie then becomes the truth.

I follow Charles Gabbe at http://acasignups.net. Charles Gabbe is pro Obamacare. He publishes daily and weekly statistics as well as news in general about Obamacare’s progress and enrollment.

His numbers come from government sources. His numbers are very different than the numbers President Obama, Hillary and Bill Clinton are announcing.

The Obama administration continually manipulates the enrollment figures in order to give the impression that Obamacare has been successful.

President Obama continuously lies about the enrollment figures.

Obamacare has been a total failure because of its structure.

On December 9, 2015 ACAsignups.net published these enrollment numbers for 2016.

ACAsignups.net publishes government release enrollment numbers weekly. These are the December 9th numbers.

Confirmed 2016 Exchange QHPs: 3,260,356 as of 12/09/15

Estimated 2016 Exchange QHPs: 4.73M as of 12/09/15 (3.60M via HCgov)

Projected Exchange QHPs: 5.76M by 12/12/15 (4.34M via HC.Gov)

Projected #OE3 QHP Selections: 14.70M nationally (11.23M via HC.gov)

Projected #OE3 QHP Selections by State

http://acasignups.net

Maybe 9 million signed up for Obamacare last year. (2015)

What were the 12/09/14 enrollee numbers with 3 weeks to go until January 1, 2015?

Christmas to New Years consumes one week of enrollment. Holiday shopping will consume the other two weeks.

Why did the government reduce the expected enrollment to 5 million when enrollment was 9 million last year (2016)?

Does the Obama administration expect 4 million people to drop out of Obamacare because it is too expensive?

How did the Obama administration’s data given to the CBO cause the CBO to predict an enrollment of 21 million enrollees for 2016?

The 2016 Obamacare enrollment figures barely touch 10 million, not 20 million.

What is enrollment going to be when most of the major insurance companies have dropped out of the health insurance exchanges?

What is enrollment going to be when 18 of the 22 Obama administration created State Co-Ops have gone bankrupt?

President Obama and his administration have mislead Americans about the exact number of enrollees since the very beginning of the first enrollment period starting October 1, 2013. The first enrollment was delayed until November 1, 2013 and extended 6 months.

The American public has been mislead about:

  • The disastrous website development, reason for website crashes and cost of website development.
  • The exact number of enrollees the first year. (9.5 million corrected to 8 million and then re-corrected to 6.8 million)
  • An additional correction that resulted in another decrease of an additional 800,000 enrollees losing Obamacare insurance. The government belatedly discovered these 800,000 were ineligible for subsidies.
  • Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
  • The change in the start of enrollment from October 1, 2014 to November 15th to avoid discussion of enrollment around the time of the November 2014 elections.
  • Extending the 2014 enrollment 6 months.
  • Extending enrollment for 2015 for one to three months.
  • Finally, in 2015 announcing the back end of the website’s ability to send information to the IRS was still not complete.
  • Rehiring CGI, the same Canadian company that built the disastrous healthcare.gov, to fix the back end of the website. A company’s employee is a friend of Michelle Obama.
  • Discovering that 1.2 million enrollees were counted that should not have been because they got dental insurance instead of healthcare insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
  • Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
  • Announcing that the group market Obamacare insurance enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted. HHS and CMS kept modifying and lowering them.

The Obama administration keeps telling American how great the enrollment is and that Obamacare is a success.

However, we are told only ten million enrollees had Obamacare insurance in 2016.

Eighty five percent of those on Obamacare are receiving subsidies so the premiums are affordable. These subsidized recipients still cannot afford the deductibles.

The remaining 15% enrollees have a pre-existing illness. They cannot find private insurance to buy.

What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?

After five years with all the new Obamacare taxes, I would not call Obamacare a successful healthcare reform program.

All of these enrollees are in the individual insurance market. These numbers do not include the group insurance market.

14 million people in the individual market lost their healthcare insurance pre Obamacare.

10 million gained insurance on the healthcare insurance exchanges in 2016. There is a net decrease of 4 million individuals that is not discussed by the Obama administration or the traditional mass media.

Many of the state healthcare insurance exchanges have failed.

Eighteen of the 22 state insurance co-ops have failed so far.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy.

Other enrollees did not sign up again because they could not afford the high deductible.

At the end of 2015 enrollment the Obama administration announced that 11.5 million people were enrolled.

On March 16, 2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The discussion should be about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

The 2014 enrollment figures as of March 18, 2015 were also inflated. It is noteworthy than the Medicaid/CHIP estimate was 14.1 M. It is down to 10 million in 2016.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15

Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

Estimated ACA Policy Enrollment: 33.1M
(10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

 http://acasignups.net

Written into the law is that only state healthcare exchanges can provide subsidies not the federal health exchanges.

President Obama has not asked congress to rewrite the law’s provision.

This was another example of executive overreach of power by President Obama.

It looks as if President Obama cannot help himself from trying to manipulate the American public.

Republicans have not pointed out all this manipulation to the voting public.

I believe the public has figured out the manipulation.

Hillary Clinton has promised she will expand Obamacare. Why expand a failed program?

Her unspoken goal is to institute a single party payer system. A single party payer system will also be unsustainable.

There is a better way!

It is a consumer driven healthcare system with my ideal medical saving account.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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More ACOs Rules Will Mean More Problems For Obamacare

Stanley Feld M.D.,FACP,MACE

 I have written many articles on why I believe Accountable Care Organizations (ACOs) will fail.

ACOs are critical to the success of Obamacare as are many the other programs introduced by the Affordable Care Act.

If one listens to the Obama administration’s propaganda about how wonderful Obamacare has been for the American public, one would be living in a dream world, not the real world.

Obamacare has failed on many levels. The administration believes the public will not remember the previous failures.

Here are the failed promises.

  1. You can keep your doctor if you like your doctor.
  2. You can keep your health insurance policy if you like your health insurance policy.
  3. Each family will save $2500 dollars on healthcare each year.
  4. Anyone making less than $250,000 a year will not pay one red      cent in new tax.

The failures of Obamacare

  1. Obamacare will bend the healthcare cost curve. It bent the cost   curve for the first three years because Obamacare collected new taxes without providing healthcare services until 2014.
  2. Thirty-two (32) states refused to expand Medicaid.
  3. Twenty-two (22) of 50 states signed up to have state health insurance exchanges.
  4. All of the states that developed state co-ops with federal loans are under water. Fourteen of the 22 are bankrupt now. All will be bankrupt by 2017 or 2018.
  5. Private insurance enrollment though the federal health insurance exchanges has not increased for the last 3 years. Many of the buyers of health insurance exchange insurance have pre-existing illness. The health insurance exchanges are the only available insurance.
  6. The hospital system and private practice meaningful use electronic medical records have not increased percentage wise as expected.
  7. Worthless electronic medical records have increase at high costs to medical practices and hospital systems. These electronic medical records are providing some false big data information to the government and healthcare insurance industry to generate defective policy regulations. Hospital systems and physicians benefit little from the data generated.
  8. Healthcare.gov is still not right after spending billions of dollars over budget.
  9. Healthcare insurance premiums have skyrocketed for companies providing healthcare insurance to its employees.
  10. Healthcare insurance premiums have skyrocketed for people buying healthcare insurance from the federal and the few remaining state health insurance exchanges.

The only success I have seen is in Medicaid enrollment for the poor and illegal immigrants. The access of care has not improved for tax paying people.

These are just a few of the Obamacare failures. The public would never remember there have been so many failures reading the propaganda and press releases that appear from the government in the traditional mass media.

The Obama administration’s information has blurred those failures. I sense the public does not want to know about the impending disaster in the healthcare system.

Many intelligent people ignore these facts. They keep reciting the administration’s talking points about Obamacare’s success.

ACOs were supposed to lower healthcare costs. They were supposed to provide incentives for hospital groups and private practice groups to save money by providing more efficient medical care.

If these groups did lower the cost of care they would share in the savings along with the government.

There are many ways to achieve these savings and many measurements to determine these saving.

In short, ACOs were designed to shift the financial risk of care from the government to the physicians. If the physicians didn’t hit the benchmark they would lose money. The goal was also to shift to a flat rate payment for each illness from the individual fee for service based payment system.

Physicians will get paid a flat rate for a particular illness. It means that the risk for taking care of the illness at a particular cost shifts the financial burden to physicians and not the insurance company or the government.

The gigantic defect in the system is there is no burden on the consumer nor is there an incentive for consumers to be responsible for their health or healthcare dollars.

No risk is placed on the patient for compliance with treatment advice.

I have pointed out most of the defects in the ACO model in past blogs. ACOs are essentially an HMO on steroids. Hillary Clinton did not do too well in 1993 with the HMO model

ACOs do not address the problem of the high salaries of hospital administrators and healthcare insurance executives (who provide administrative services for the government). These salaries increase the cost of the healthcare system.

Last week CMS released another final rule intended to improve the way Medicare pays accountable care organizations (ACOs) in its Medicare Shared Savings Program (MSSP).

It is clear that if another final rule is made the last final rule is not working.

The hype of this new final rule is that the Obama administration has solved what many viewed as a critical flaw in the bonus structure for Medicare’s accountable care organizations.

I think the new final rule might make ACOs fail completely.

CMS spokesman said, ”Physician buy-in is critical for the long-term sustainability of the ACO program, which could play an important role within Medicare’s broader reforms to physician payments under the Medicare Access and CHIP Reauthorization Act, or MACRA.

MACRA is another poorly designed program that makes payment for physician service more difficult to understand.

MACRA could inspire physicians to quit the whole ACO enterprise.

A group of executives on the MACRA (Medicare Access and CHIP Reauthorization Act) task force said,

“The goal is to force physicians and payers determine how to most effectively tie payment to performance and value.”

“A panel of healthcare experts and organizational leaders who began adapting to value-based payment years before the Medicare Access and CHIP Reauthorization Act started fleshing out regulations talked about their programs at the event sponsored by the Commonwealth Fund.”It is obvious to me that you cannot force anyone to do anything they do not want to do. You can only provide motivation and incentive for people to do what is best for themselves from their point of view.

MACRA will not get physician buy in because it will be too restrictive, arbitrary and controlling.

So far there are only 433 Medicare Shared Savings Program ACOs. There are 3000 hospital systems that should be participating in the Obamacare’s ACO program.

Only 14% of the hospital systems are participating after 3 years.

There are many large physician practices that should be participating in the ACO program. The number of these groups are unknown.

The lack of participation is a result of the complexity of the ACOs, the inability to form a unified culture of physicians in a hospital system and the difficulty hospital systems have with pricing risk.

Pricing risk is the job of the healthcare insurance industry and not physicians or hospital systems.

The government wants to put that task on the shoulders of the physicians and hospitals.

There are two risk tracts for ACO. Tract one is called one-sided risk.

The ACO only shares in the savings and does not participate in the losses if they spend more than the benchmark costs.

Tract 2 is call two-sided risk. The ACO shares in the savings with a more generous bonus from Medicare than the bonus of the tract 1 participants but pays a penalty to Medicare if doesn’t save money or demonstrate high quality care.

Only 22 of the shared-savings 433 ACOs or 5% of the participating ACOs have chosen two-sided risk. The Obama administration’s goal is to have all 3000 hospital systems participate the two-sided risk model.

The participation rate is .7% participation rate for the 3,000 hospital system that should be participating. It is far short of the Obama administration’s goal.

I would not rate the ACO participation rate as a success after 3 years.

This absolute failure has not been acknowledged by the Obama administration or the Obamacare praise singing traditional mass media.

The new final regulations and MACRA will not fix this failure. It will only make the failure worse. I will discus both the new final rule and MACRA next time.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Biased Newspaper Reporting

Stanley Feld M.D.FACP, MACE

I used to read every word of the New York Times. After all it was “all the news fit to print.”

It took me a long time to figure out it was the same sensational journalism as the New York Daily News and the New York Post. Its sensationalism is subtler.

Both the News and the Post had better Sports sections than the Times. All three newspapers are biased. They all leave out important facts.

The New York Times leaves out important facts and does not connect related facts. The result is intelligent people reading and believing the New York Times can have one world view, while another group of intelligent people reading and connecting the facts can have an opposite world view.

The following headline appeared on the front page of the Sunday Times on Easter Sunday.

On Campaign Trail, Republicans Tone Down Criticism of Obamacare.

On its surface the headline infers that Obamacare is working and citizens like it.

The Times claim is, “Among the most embattled Senate Republican incumbents, the campaign websites of Kelly Ayotte of New Hampshire, Mark Kirk of Illinois and Ron Johnson of Wisconsin barely mention the health care law.

The article goes on to quotes Health and Human Services Secretary Sylvia Mathews Burwell.

“The explanation for (the lack of criticism of Obamacare) may be that for all its controversy and imperfections, the sweeping law has taken hold.”

 “This (Obamacare) is in the fabric of the nation,” said Burwell.

 “To be sure, the presidential election outcome will be a determinant of whether the health care law is reshaped, bolstered or downsized.”

Is reporting this Obama administration bias?  To me it certainly is. This conclusion is total nonsense. It is an attempt by the New York Times to help the Obama administration spin the truth and save President Obama’s legacy

The Times also points out that; President Obama took part in a celebration in Milwaukee this month after the city was given an award for increasing health insurance enrollment.”

Paul Krugman’s New York Times articles have been telling reders how successful Obamacare has been. The problem with his commentary is it does not fit the facts.

Meanwhile President Obama and the administration have been modifying the law almost monthly without the consent of congress.

It has also been spending money without congressional approval because the law has not worked out well for President Obama and his administration.

Obamacare has been a failure for all the stakeholders. It has had a negative impact on the economy and the delivery of medical care.

It cannot be fixed with a few modifications.

I hope the New York Times is just printing the Obama administration’s press releases. However, the Times editorials reflect the lies.

Anyone running for congress who believes the New York Times propaganda about the success of Obamacare should not be elected.

Many patients credit the President with giving them access to coverage even if they have a pre-existing condition and are not in a group plan. Meanwhile, the cost of the insurance has changed with higher premiums and deductibles, and the cost of coverage is increasing annually for both Obamacare and private insurance.

Remember President Obama’s promise, “If you like your insurance you can keep your insurance

 The cost of HealthCare.gov has been a debacle. It had been riddled with scandals, inefficiency, cronyism, and disrespect for consumers’ intelligence. I thought the original $800 million dollar cost estimate was ridiculously high. Its present estimate is $2.1 billion dollars. the web site healthcare.gov is still not right.

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How much did CMS really spent on Obamacare? No one really knows. It has not been cheap. Most of the expenditures have not been approved by congress.

For the last three years the Obama administration has lied about the enrollment numbers. At the same time they have bragged about the enrollment success. In 2014 the grand total enrollment in private insurance through the Obamacare exchange was 260,000 while 14 million privately insured lost coverage.

However the total number of consumers enrolled through Medicaid was 8.99 million. This occurred with only 23 states participating in the expansion of Medicaid

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The enrollment figures had not improved at the end of 2015 even though the Obama administration extended the enrollment period constantly throughout the year.

“Earlier this month (2016), the Centers for Medicare and Medicaid Services announced that nearly 8.8 million Americans had “effectuated” coverage at the end of 2015, meaning they were paying their health insurance premiums.”

The agency praised this number as a sign of Obamacare’s success in expanding access to coverage.”

This is a perfect example of spinning the news. At the of the 2015 enrollment period before the enrollment extensions 11.69 million members signed up and paid. At the end of 2015 only 8.78 million people continued to pay their premiums.

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This represents less than the Obama administration claimed enrollment of 2014.

 The New York Times is publishing fiction because of it’s bias toward President Obama and Obamacare. The truth about Obamacare’s lack of success is public record. Unfortunately the New York Times ignores the truth.

Obamacare enrollment decreased even further this year (2016). The insurance premiums and deductibles are too high for people making over 50,000 dollars a year. Only the fully subsidized people can afford to stay in Obamacare.

 Obamacare’s State Co-Ops were formed to have states run their own state insurance exchanges. Inefficiencies and faulty business model cause 13 of the 23 to fail so far.

The Obama administration provided 2.5 billion dollars in loans to these State Co-Ops. So far the federal government has lost 1.2 billion dollars of it 2.5 billion loaned to the state Co-Ops.

The Affordable Care Act allowed for the creation of consumer-operated and oriented plans, or co-ops, that were intended to inject competition into areas where consumers had few choices.

At present 8 more Co-Ops are on the verge and will probably close for enrollment for 2017.

The Centers for Medicare and Medicaid Services have little hope or collecting the money lent to the State Co-Ops. Information surrounding the liability of the failed state Co-Ops for the loans has not been transparent.

A total of $2.4 billion in loans was awarded to 23 Co Ops start-up and solvency loans to the 23 co-ops.

Now, 12 of the 23 co-ops that opened their doors in 2013 have closed and have left 900,000 consumers without insurance. No one can tell if these people were assimilated into the federal health exchanges. Republicans in Congress are questioning whether the taxpayers will ever get repaid $1.2 billion loaned to those failed Co-Op insurers.

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Obamacare has made insurance available to millions of Americans with pre-existing conditions were denied coverage. This is true. However both the premiums and the $6000 deductibles are unaffordable.

A diabetic wrote to me, “Obamacare is great! Now I can buy insurance. My premium cost $12,000 a year. My deductible is $6,000 for a total of $18,000 a year. My medical bills were $100,000 last year.

I asked what was her HbA1c. She said it was 9.2% (normal 4.5% -5.5%).

The high HbA1c means she is a poorly controlled diabetic.

Shouldn’t this patient be responsible to lower the HA1c to 6% in order to reduce her diabetes complication rate?

Not everyone can afford $18,000 per year. Most of the diabetic patients who cannot afford the high insurance rates in the federal health exchanges have even higher HbA1c levels. They will ultimately cost the payer of last resort, the government, even more after the patient is bankrupt.

A better system needs to be developed to incentivized these people to be responsible for their own diabetes control.

 

Another feature of Obamacare that is publicized as one of the great successes is that children can stay on their parents’ plans until age 26.

The unintended consequence of this feature has given the healthcare insurance industry and excuse to raise insurance premiums by double digits increase each year.

President Obama has bragged, and the New York Times has applauded him for it, that health care inflation has been lowered since Obamacare was passed into law. He say that Obamacare has bent the healthcare cost curve.

This is false. Obamacare was collecting Obamacare imposed tax increases on every income bracket for three years prior to implementation of the healthcare coverage.

The cost curve was bent because there were no expenditures in the delivery of healthcare. In 2015 the healthcare cost curve is rising.

There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year. .

These new taxes contradict President Obama’s promise that “anyone making under $250,000 a year will not pay a dime in new taxes.” Many of these taxes on businesses are being passed on to consumers in the form of higher prices.

https://youtu.be/eHlRY3kHhBk

Insurance companies are leaving the federal health exchanges in droves because they are not making as much money as promised by the Obama administration. Obamacare will disappear without insurance company participation.

When compared to 2015, 22 states and the District of Columbia have fewer insurers offering coverage on the exchanges in 2016.

 Just 10 states have more insurers offering coverage on Obamacare’s exchange.
The New York Times presents deceiving information about Obamacare. I cannot understand why readers believe these lies.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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The Obamacare Spin Goes On