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Obamacare Is Unaffordable For All

Stanley Feld M.D.,FACP,MACE

The 2016 Obamacare enrollment period through healthcare.gov is going to have lots of problems. The Obama administration knows it.

The enrollment projection by the Obama administration is far below the nonpartisan Congressional Budget Office’s projection of about 21 million people.

The CBO gets the numbers to calculate its projections from the Obama administration.

“ The administration has set the goal of 10 million to have coverage. That is about the same amount of enrollees who have paid for Obamacare now.”

“We believe 10 million is a strong and realistic goal,” said Health and Human Services Secretary Sylvia Burwell. “

The next sentence is the Obama administration’s spin to confuse the public about the truth.

“We’ve seen high levels of satisfaction with the marketplace and expect the vast majority of our current customers will re-enroll. And our target assumes that more than one out of every four of the eligible uninsured will select plans.”

The original Obama administration enrollment prediction for 2015 was 17 million.

The Obama administration claimed Obamacare was a success in 2014. Eleven million people enrolled despite the healthcare.gov problems.    Enrollment in 2014 was extended for most of the year.

The final enrollment number was reduced to 6.6 million after not payment of premiums, false applications, miscounting and dropouts.

Enrollment numbers for 2015 were published as more than 13 million. It was again revised to 11 million and finally 9 million. Enrollment again was extended in 2015.

Two weeks ago it was announced that 330,000 enrollees did not make their second month’s premium payment. Enrollees have a 90 grace period in which they can use their insurance to pay for medical care.

The result is enrollees can have four months of healthcare insurance for the price of one.

People stopped paying the premium because they realized they could not afford the 2015 premium cost. This year the cost will be between 10-40 percent higher than 2015.

In 2012 fifteen (15) million people lost their individual healthcare insurance because of Obamacare’s changes in insurance policy requirements.

The CBO predicts there will be 21million enrollees in 2016.

The Obama administration, using taxpayers’ money, has loaned health insurance co-ops more than $2.4 billion spread over just 23 states.

Most of the Co-Ops are hemorrhaging cash. Four have gone bankrupt and Colorado and Oregon are on the way. Consumers who bought healthcare insurance from these “Co-Op’s” are going to have to find another insurance company through the health insurance exchange.

People are not going to be able to find an affordable insurer. Premiums and deductibles are going to be out of reach to everyone including people on subsidies.

In 2015 the 300,000 that did not pay after the first premium payment has proved this already.

Obamacare has other huge problems. Medicare is one of them

Medicare will expose millions of senior americans to a staggering 50 percent increase in their premiums for Medicare Part B.

It is a result of provisions in the laws governing Medicare and Social Security.

Here is the impending disaster.

The Part Medicare B premiums have been rising each year. The premiums are deducted from Social Security payments made to beneficiaries’ each month.

There is a “hold harmless” provision in the Medicare rules that guarantees that a dollar amount increase in Medicare’s premium one year cannot be so big that the senior is left with a Social Security check payment that is less than the year before.

The goal of the provision is to ensure that senior beneficiaries don’t have less money to live on the next year than the year before.

Inflation is not calculated into the equation.

Watch this.

Seventy percent of the Medicare beneficiaries are held harmless and do not have to pay the increased premium because of the rising premiums. These seniors will pay the same premium they paid the previous year.

The increased costs to the government will have to be paid by higher Medicare premiums and deductibles by the remaining 30 percent of beneficiaries not held harmless.

The Medicare rule is that beneficiaries have to cover at least 25% of the government’s Medicare Part B costs.

As premiums to the government are increased 10-40% by the healthcare insurance companies that do the administrative services for the government, the premium costs to the 30% who are not held harmless are going up over 50% of the previous year’s premiums.

“Medicare Part B deductible, which must be paid by everyone on Medicare (no one is “held harmless”). Medicare Part B premiums will rise from $147 in 2015 to $223 in 2016.”

“This will pose a particular burden to beneficiaries just above the poverty line who aren’t eligible for assistance from Medicaid in paying deductibles.”

The Medicare deductible of $1300 for each hospital admission is a tremendous burden on a senior.

President Obama and the Democrats are frantically seeking ways to avoid a senior uproar as seniors discover yet another hidden Obamacare tax increase.

The Democratic leadership is trying to figure out how to blame Republicans for this mess.

The leadership of both parties is quietly trying to figure out a way around the increase to the affected seniors.

“Premium increases could affect about 30 percent of the 51 million people enrolled in Part B of Medicare, which covers doctors’ services, outpatient hospital services, some home health care and other items.”

Nancy Pelosi has started grandstanding to blame the Republicans for the increase in premiums.

She said, “Congress has a responsibility to act,”

“If we do nothing, millions of American seniors will suffer. Democrats continue to press the Republican leadership to bring a fix to the floor so we can prevent the serious harm this increase will have.”

To avoid a big uproar from seniors Democrats want the federal government to absorb the estimated $7.5 billion dollar premium increases in 2016.

The blame game starts. John Boehner’s aids told Mrs. Pelosi’s staff that the cost would have to be offset by savings elsewhere in the federal budget.

“ President Obama’s staff is considering administrative action to moderate the increase in premiums, perhaps by using a Medicare contingency fund.”

The White House is grandstanding without regard for the law or fiscal responsibility.

“We share the goal of keeping Medicare’s premiums affordable, are exploring all options, and appreciate the interest and ideas of members of Congress,” said Katie Hill, a White House spokeswoman.

Republicans are worried that Democrats will depict them as waging a “War on Seniors” if they do not go along to soften the affect of any premium increase on some irresponsible funding solution.

Isn’t this terrible? Congress and the President refuse to look at and solve the real cause of these problems. They are the unintended consequences of Obamacare that got us into this situation.

The Democrats are using the banal excuse is that the country is to far down the road with Obamacare to abandon it.

Nonsense!

Maybe this is exactly what President Obama intended?

Obamacare has only enrolled 9 million people and yet.

  1. It is destroying employer insurance.
  2. The cost of adjusting to Obamacare’s rules is too high.
  3. It has left more uninsured than insured.
  4. It has caused insured persons healthcare insurance to be unsustainable.
  5. It has added millions to the Medicaid roles.
  6. Medicaid reimbursement is very low.
  7. People on Medicaid cannot find a physician because of low reimbursement.
  8. It has pushed up premiums and deductible for seniors who can barely afford the costs.
  9. Seniors on Medicare cannot find a physician.
  10. Obamacare has made the cost of our healthcare system more unsustainable that previously.

Why don’t Republicans teach the people to understand why Obamacare is such a terrible law?

Why can’t they stand up for what they believe?

Why can’t they use my ideal medical saving account to simplify and solve the complications of Obamacare?

The answer always is 50% of people are getting entitlements and they do not want to give them up.

Entitlements can be formatted so that they are earned and responsible entitlements that will not bankrupt the country.

Entitlements can be formatted to help people become independent and prosperous as opposed to more dependent on government and poorer.

Socialism has not worked well anywhere not even in Sweden.

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

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Wanting Something To Fail?

Stanley Feld M.D.,FACP,MACE

If someone wants something to fail, make it complicated enough so no one understands what is going on.

I am convinced that President Obama wants Obamacare, Medicaid and Medicare to fail.

President Obama wants a single payer health care system. He said it as far back as 2003. This You Tube was uploaded on Aug 12, 2009.

 

https://youtu.be/LhEX3rHssJI

President Obama won’t tell the American people the truth about his plans for health care. Watch President Obama declaring his intention in his own words.

The result is everyone will receive the same healthcare under the government direction and control.

The ultimate goal is to make people dependent on the government.

The people will have no power to choose their physician or their treatment. It is true that every country in the western world has this system.

No country has proven that a single party payer system works for countries with the single party payer systems economy or their citizens. Surveys have shown that their citizens are satisfied.

The main reason people like it is because it relieves anxiety of being able to receive medical care even though they have relinquished their freedom to choose their physician or insurance company.

The biggest loss is independence from the government bureaucracy. People will be dependent on the decisions of unelected government bureaucrats.

The big questions that are never answered about medical costs are; who is spending most of the healthcare dollars and what are the healthcare dollars being spent on?

Do you want the government to decide if you are young enough to get an artificial hip or knee when you need it?

Do you want the government to decide about your treatment or do you want your doctor to help you decide on what your best treatment is?

President Obama is changing medical care in a methodical way. He is utilizing executive orders and rules and regulations written by non-elected bureaucrats, who are forced to follow his orders. Our elected officials should be in charge of government spending.

Many in congress know better and would not let President Obama do what he is doing. Most in congress are happy that he has exempted congress from Obamacare.

President Obama and his administration have been trying to do bad things very quietly to avoid political uproar. The mainstream media has been a great Obamacare ally.

The mainstream media has helped Obamacare keep these destructive regulations and their subsequent failures out of public view.

The media has also publicized President Obama’s lies about the success of Obamacare.

President Obama is adept at diverting blame for errors and failures in pursuit of his single party agenda.

At the same time he is trying to take power away from the states he is trying to persuade states to not permit big insurance premium rate increases requested by many health insurance companies for 2016.

President Obama’s Obamacare is the cause of the increases. He is positioned to blame the state regulators for the insurance companies not showing up to sell insurance for 2016.

If the states act to cut back rate increases the insurance companies will not participate in the federal and state exchanges for the 2016 enrollment period. The result will be the erosion of the possibility of competitive pricing.

The Obama spin machine started working at the beginning of the summer to shift the blame and/or force insurance companies out of the market.

Kevin J. Counihan, the chief executive of the federal insurance marketplace said in letter to state insurance commissioners, “Recent claims data show healthier consumers.

He also said, “The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

This claim of costs data by Obamacare does not square with the healthcare insurance companies’ costs data. They are finding that new customers were sicker than expected. The insurance industry is also losing money because the Obama administration has paid them $2.5 billion dollars less than they were promised.

Health insurance plans sold through Obamacare’s Federal and State Health Insurance Exchanges are seeking 10 to 40 percent increases in premiums.

They are also seeking the same increase in the private sector as well as in Medicare and Medicaid.

The Obama administration is making up its own story to force state regulators to not allow the increased premiums.

The Obama agenda is choreographed to prove that insurance choices do not work. He is hoping that the public will conclude the only solution is a single party payer system.

The problem is the government cannot afford a single party payer system and the people will not tolerate it.

What is more bizarre is the Obama administration made loans to help start up state co-ops. These state co-ops were supposed to compete with the big insurance companies. They were supposed to sell insurance on the health insurance exchanges. The Obama administration invested $38 billion in startup costs and solvency loans to these co-ops.

Nevada Health Co-op received $66 million in federal loans. It is closing down on January 1,2016 because it ran out of money.

Louisiana Health Cooperative announced in July that it was voluntarily shutting down operations.

CoOportunity Health, which sold policies in Iowa and Nebraska, was liquidated and forced to close earlier this year.

Many state Co-op’s are on the way to bankruptcy. In Nevada alone one third of the health insurance exchange population will lose insurance coverage.

Nevada Health CO-OP’s departure will leave a big hole in Nevada’s exchange market. Open enrollment begins Nov. 1, and consumers will have to shop for plans with other carriers. The co-op had 21,300 members as of the first quarter this year. Nevada’s exchange population was about 63,000 at that time.

A.M. Best’s report shows a majority of the nation’s 22 co-ops have combined medical and administrative expense ratios above 100%.

All these failures and impending failures mean that either the Obama administration is stupid or things are going precisely as  President Obama had planned.

The healthcare system is on its way to destruction. The federal government as the payer of last resort will replace it.

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

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Obamacare Owes Insurance Companies $2.5 Billion Dollars For 2014 Health Exchange Losses

Stanley Feld M.D.,FACP,MACE

These days there is very little news in the traditional mainstream media about Obamacare.

The average person thinks everything is fine. President Obama has told us over and over again that Obamacare is a great success.

Unfortunately, this is far from the truth as the Obama administration prepares for the 2016 enrollment period.

Open enrollment is supposed to start November I, 2015 and end January 15, 2016 for 2016.

In 2013 and 2014 open enrollment was extended many months because of poor enrollment. I suspect the same will happen during the 2016 enrollment period.

The disastrous web site is still not fixed.

The healthcare insurance industry has increased Obamacare insurance premiums by double digits. The Obamacare deductibles remain in the thousands.

Even with large Obamacare subsidies people making under $50,000 cannot afford the subsidized premiums or deductibles.

Some people are registered through both the health insurance exchanges and Medicaid. This has been recently discovered by the Obama administration.

These people have received the Obamacare cash subsidy and Medicaid coverage. Now the Obama administration expects to be paid by these recipients for the government’s overpayment.

The Obama administration has refused to publish the number of people affected.

None of these issues have appeared in the traditional mainstream media.

The Obama administration continues to publish conflicting figures about how many people are actually enrolled through its federal health insurance exchanges.

The administration needs the healthcare insurance industry to do the administrative services for the health insurance exchanges.

At the onset of enrollment in 2013 healthcare insurance companies did not want sign up to do the administrative services. The companies figured that high-risk people without insurance would sign up for insurance and they would lose money. Obamacare required that the premium would be equal for everyone regardless of the health risk.

Obamacare originally wrote into the law three risk corridor programs that would be activated if necessary to subsidize the healthcare insurance industry against undo risk.

As a result of the healthcare industry’s lack of participation in the federal and state insurance exchanges, the risk corridors were activated.

“The healthcare reform law established three “market stabilization” programs to help insurers weather the first few years of covering a new population with unpredictable healthcare needs. At issue is the risk corridors program.”

I was astonished when I learned of these risk corridors. The corridors encouraged the healthcare insurance industry to participate in providing administrative services for each state and federal exchange at no risk of loss.

It was amazing that the leading Republicans for repeal of Obamacare did not make this clear to the public.

The insurance industry was actually guaranteed a profit because they provided its own profit and lost data. The Obama administration simply accepted its data. The healthcare insurance industry was supposed to receive the subsidy for its loss.

The government’s hope was to provide enough insurance choices to enrollees in the health insurance exchanges so there would be competitive pricing.

Unfortunately for Obamacare it did not work out as planned.

The government had planned on releasing risk corridors data in August but waited until October 1, 2015 due to discrepancies in the data.”

I suspect the delay was for political reasons and to provide enough time for the government to present the data in a less negative fashion.

The data provided by the Health insurers that sold health insurance plans showed that those insurers lost a great deal of money on the Affordable Care Act‘s exchanges in 2014.

The data shows the Obama administration has short changed the healthcare insurers that participated in Obamacare $2.5 billion dollars promised to them in the safety value risk corridor subsidies.

The Obama administration now is promising those insurance companies that the $2.5 billion dollars to cover the deficiency will be covered with budgeted monies from 2015 and 2016 if possible.

President Obama is now sowing the seeds to blame the nonpayment on Republicans since Republicans control congress.

Republicans thought the health insurance risk corridors were a stupid idea to begin with and predicted failure. Now the Obama administration is trapping the Republicans for not wanting to pay bills that are owed.

Some smaller insurance companies who were seduced into participating in this no risk insurance policy folly are now worried about experiencing “solvency and liquidity problems”.

CMS would not give the number of companies affected. It said the cases are isolated.

The insurers requested $2.87 billion in payments to cover their losses. The CMS will only reimburse 12.6% of the payment requests, meaning insurers will still be owed more than $2.5 billion.”

“ Names of companies that are owed money were not released.”

Does anyone think the insurance companies are going to sign up for the 2016 enrollment cycle?

Insurance companies do not know how much Obamacare will short- change them for the 2015 subsidies yet.

One can also begin to understand why insurance rates for both government and private insurance are increasing when physician and hospital reimbursement are falling.

The insurance industry feels it has to make up its loss.

Why are the Republicans not saying anything about this to the public?

Why aren’t Republican candidates for President not pointing out this folly?

Why are they letting themselves be set up to be blamed for not wanting to pay the government’s bill?

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

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Can Government Run Systems Function Efficiently And Cost Effectively?

Stanley Feld M.D.,FACP,MACE

It has been proven over and over again that government does not run its systems efficiently and cost effectively.

Think of the post office, the railroad, the military services, the EPA and the IRS, to name a few. One could go on and on and come up with the same answer to the question. No.

The same holds true for government’s goal to control the healthcare system. It will not work. It has already proven to not be cost efficient or effective.

The Federal Government’s goal is to take over more and more systems operating in the life of the average American. The excuse is to help all Americans live a better life, to help the poor and under privileged. Instead it has kept the poor dependent on government, poor and under privileged.

“Each according to his abilities and each according to his needs” has not worked wherever it has been tried.

Government’s real goal is to have power over citizens. It is to make citizens dependent on the central government.

It is hard to find an example on the planet where this strategy has worked for the people it claims to help.

The results are also just the opposite of what the U.S. Constitution guarantees.

The evolution of the VA Hospital System is a stunning example of how government controlling a system does not work. No matter how much money the central government throws at the system it does not help. Noble goals always go astray. It is because the structure and the incentives in the system are wrong.

No one seems to focus on the main defects. The most important questions are:

Who is the main customer?

What motivates the main customer?

How do you devise a system that fashions incentives to motivate that customer to help make the system work?

It is not a larger bureaucratic structure with larger budgets. Larger bureaucracies move the system further away from the goals of the main customer.

It is not a series of regulations that impose punitive measures on providers and customers who are in the system.

It is not guarantees of tenure for managers of the system.

It is a guarantee to have managers of the bureaucracy listen and understand lower managers in the system who point out the deficiencies in a system.

The larger the bureaucracy the more difficult it is to personalize the system and have participants in the system help and help make the system work. Bureaucracies isolate themselves from the main customers in a system. It is the reason they do not work.

Large corporations in the private sector fail also. These corporations form large silo like divisions that construct systems that do not relate to the main customers or each other.

Large corporations sometimes understand the dynamic and try to reformat the corporation to service their customers. If they do not, their product fails

The people do not have the power to force the government to service them, the customers. Citizens can vote their representatives out of power. The government tries very hard to keep the main issues that disrupt systems out of public view.

There are many government agencies and systems that are failing. Our representatives never fix the systems. Our representatives do not listen to the people who are involved in the systems or who run the systems.

The VA hospital system has had problems since at least the end of WWII. It came to a head since the war in Iraq and Afghanistan.

Veterans Affairs Secretary Robert McDonald had been a successful CEO in the private sector. He made some significant changes in the operations of the VA at the onset of his tenure.

He also needed a $16 billion dollar infusion through the passage of the Veterans Access, Choice and Accountability Act to keep the VA Hospital System open after the scandals in VA care came to the publics awareness.

As government bureaucracies usually act, congress and the president ordered independent multi-consulting firms to audit the VA and tell government how to fix the VA Healthcare system.

Analysts from Mitre Corp., Rand Corp. and McKinsey & Co conducted more than a dozen assessments. No one has told the public what should to be done and what these assessments cost the taxpayer.

“A sweeping independent review of the Department of Veterans Affairs health-care system made public Friday shows the multibillion-dollar agency has significant flaws, including a bloated bureaucracy, problems with leadership and a potentially unsustainable capital budget.”

All that was needed was a little common sense by an authorized executive to realize what the problems were and fix them. All the defects were reported previously.

The government did not need multiple high priced consultants to tell them their problems.

The Commission on Care was mandated by the Veterans Access, Choice and Accountability Act to create a comprehensive reform plan to congress and the VA in 2016.

How much is this going to cost taxpayers?

How long is it going to take?

“The report bears out collectively what I have seen individually, what I have seen in my role as chairman over the past nine months,” said Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs. “There is a huge focus on some glaring deficiencies that need to be addressed.”

The VA needs a lot of common sense and less bureaucracy, not more bureaucracy.

“Mr. Isakson said the VA suffers especially from a system saddled with a number of different departments that can’t effectively talk with each other, as well as a number of vacancies in leadership positions that need to be filled.”

America never learns. Big government does not work. Americans are starting to believe it.

President Obama and Obamacare are leading us in the same direction. It is the path to failure.

We must wake up now and stop this.

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

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Hospital Readmission Penalties

Stanley Feld M.D.,FACP,MACE

 Obamacare has set up a system whereby if a patient is readmitted to a hospital 30 days after discharge the hospital will not be paid for the readmission and will incur a fine.

Hospitals are paid for admissions by diagnoses. The more diagnoses the more they get paid. The length of stay the government will pay for is also determined by the diagnosis.

The number of games played with the diagnosis of a patient is legendary. Hospitals are in the business of making money. The more money hospitals make the higher the administrator’s salary.

If patients have to be readmitted to the hospital within 30 days the patients are told to get readmitted to a different hospital to avoid government non-payment.

Bureaucrats who know nothing about patient care and the natural history of disease created this dumb readmission criteria.

The bureaucrats’ goal was to provide incentives by the threat of penalty for hospitals to improve quality of patient care.

I told my readers that the incentives were wrong. It would be to the disadvantage of patients. Hospitals would figure out how to get around the penalties.

Medicare does not pay for outpatient (observation) admissions. Hospitals can admit patients on observation (outpatients) for 48 hours.

I explained how hospitals could extend outpatient admissions (observations) 72 hours. Patients are responsible out of pocket for the admission bill.

Many of the readmissions are recurrent congestive heart failure. These patients can be treated and released from the hospital in less than 24 hours and at most 48 hours. Patients with congestive heart failure must become “Professors of the Treatment of Congestive Heart Failure.” Patients must be responsible for their care. They must be provided with financial incentives to become “Professors” of their disease.

Most of the time readmission is not the result of poor quality hospital care. It is the result of patients not understanding the cause of the recurrence of their congestive heart failure.

Most of the time patients do not pay attention to what they are taught to abort an episode of congestive heart failure and subsequent readmission to the hospital.

Most of the time hospital call in help desks does not improve patient compliance with treatment.

Hospital readmissions that Medicare penalizes under the Affordable Care Act are largely driven by patient characteristics such as income and education rather than the quality of care they receive, according to a new study.”

“This finding suggests that Medicare is penalizing hospitals to a large extent based on the patients they serve,” the authors conclude.

Hospitals in poor areas and urban hospitals have been disproportionately penalized under the readmission program.

In fiscal 2016, about 1,600 hospitals will see their base operating DRG payments knocked down as much as 3%.

Medicare payments were decreased 1% in fiscal 2013 for readmission before 30 days. That number increased to 2% in fiscal 2014 and 3% in 2015.

Penalties and fines applied only for heart attack, heart failure or pneumonia until 2015. In 2015 readmission rates for chronic obstructive pulmonary disease and total hip and total knee replacements have been added to the penalty list.

The addition of these diagnoses will result in additional fines to hospitals. Additional penalties will affect hospitals’ bottom line severely and not lead to increased quality care.

Only 769 of more than 3,370 hospitals have avoided fines. Some hospital might have to close because of the penalities.

I have said many times that policy wonks do not know how to measure quality.

Hospitals that are flourishing are paying the CEO and other administrators millions of dollars a year in salaries.

Hospitals avoiding penalties and fines are not necessarily providing better quality care. These hospitals might treat less sick patients or more intelligent patients,

The Obamacare incentives are upside down. Punishment hardly ever works to improve quality healthcare.

Has anyone ever thought about providing incentives to patients to learn how to improve their own compliance to medical care?

In an entitlement society patients are taught to expect (entitled) to be cured without applying much effort on their own.

They are taught to be dependent on physicians and hospitals to cure them of their chronic disease.

Physicians should be the coaches. Patients are the players in the treatment of their diseases.

Obamacare’s readmission policy is all wrong. Its goal is to keep patients in a passive dependent role.

Only when government healthcare policy wonks understand that consumers of healthcare must be provided with incentives to be responsible for their healthcare and medical care decisions will America be on the way to Repairing the Healthcare System.

No one in Washington is thinking this way.

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

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President Obama Keeps Doing It

Stanley Feld M.D., FACP,MACE

President Obama is trying to avoid the press attention about  Obamacare’s continuing mess.

The insurance industry announced that insurance premiums in both the federal and state health insurance exchanges are going up to 50% in 2016. The group private markets will increase by the same percentages.

Insurance rates for 2015 were unaffordable for small businesses, and large corporations.

One church that buys insurance in the private healthcare insurance market had its rates increased 37%.

Instead of dropping insurance for their employees and paying the penalty, the church agreed to the pay the increased premiums. The church compensated for this increase in expenses by increasing church membership dues. Some members had to quit the church.

Eighty-five percent of members in Obamacare are receiving a government subsidy. A high percentage of that 85% are receiving higher subsidies than they are entitled to receive because of government lack of verification.

Eventually, when healthcare.gov website connects with the IRS, the government will find out that people received higher subsidies than they are entitled to. The recipients will get a bill they cannot afford.

Obamacare’s reinsurance subsidies for the health insurance industries are expiring in 2016.

The insurance industry is raising insurance premiums to cover the revenue lost by not receiving the Obamacare insurance company subsidies in 2016.

President Obama opened the Obamacare reinsurance program when too few insurance companies signed up to sell insurance through the health insurance exchanges.

The reinsurance program was a subsidy to cover the healthcare insurance industry’s supposed loses.

Obamacare hoped that multiple insurance companies would sign up in order create price competition among the companies and result in lower consumer premiums.

The healthcare insurance industry did not want to sign up. The insurance companies knew there would be adverse selection for insurance consumers.

Sicker people would enroll in the federal or state Health Insurance Exchanges. These sicker people could not afford or were not eligible to buy private healthcare insurance. The participating insurance companies would be at risk to pick up these sicker and more expensive patients.

“After finding that new customers were sicker than expected, some health plans have sought increases of 10 percent to 40 percent or more.”

Obamacare healthcare insurance coverage requirements would also cause them to seek an increase in premiums.

None of these issues appear in news stories that are covering this aspect of the story.

The political spin by the Obama administration is that the Obama administration is trying to persuade states to cut back big rate increases requested by many health insurance companies for 2016.”

I predict if the insurance companies do not get their rate increases they will drop out of the healthcare insurance market.

This is exactly what the Obama administration wants. It is a de-facto victory for a single party payout system and all of its ramifications.

It will not work because the Obama administration still needs the healthcare insurance industry to process and pay the claim. The result will be a higher premium for the consumer and an increased payout to the healthcare insurance industry by the government.

The government will be required to raise taxes or increase the deficit.

Kevin J. Counihan, the chief executive of the federal insurance marketplace is trying to convenience the healthcare insurance industry to reconsider its decision.

The facts spin war is starting. Mr. Counihan said in a letter to state insurance commissioners “Recent claims data show healthier consumers.”

This is apparently not true.

Scott Keefer, a vice president of Blue Cross and Blue Shield of Minnesota, which requested rate increases averaging about 50 percent for 2016, said his company had not seen an improvement in the health status of new customers.

“Our claims experience has not slowed at all,” Mr. Keefer said. “The trend has gotten a little worse than we expected.”

I have recently shown that the Obama administration’s claim that it is bending the cost curve is fiction. The cost to the government and the direct out of pocket cost to the consumers has increased.

The government costs have not risen as quickly as predicted by some but they are rising even more now.

Another weak argument the Obama administration is using is the federal tax penalty is increasing in 2016.

The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

Why should these people buy insurance when they cannot afford the premiums or the deductibles?

Two additional weak arguments are being used.

“Federal officials said, much of the pent-up demand for health care has been met because consumers who enrolled last year have received treatments they could not obtain when they were uninsured.”

There has not been a very large increase in those insured by the state and federal exchanges between 2013 and 2014 to eliminate the “pent up” demand.

“Federal officials have also told state regulators that medical inflation will be less than what many insurers assumed in calculating their rates for 2016.”

The Obama administration has told these lies over and over again.

Does the president really believe if you tell a lie over and over again it becomes the truth?

There is a much better way to deliver universal health care and spend less money.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2012/10/business-model-for-medical-care-2020-the-ideal-future-state.html

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Lies About Government Spending

Stanley Feld M.D.,FACP,MACE

President Obama and the mainstream media have been bragging about how well Obamacare is working. They cite that Obamacare is bringing down government health-spending growth.

However they have not been telling the truth. They have taken numbers out of context and have spun a lie.

The evidence presented by federal actuaries is that health growth has been under 4% in the five years prior to 2014.

The Obama administration has made a big deal out of this finding. President Obama has bragged that he is bending the cost curve with Obamacare.

His statements are deceptive. It means government health spending growth has been just under 4%. It is still increasing by 4% year to year and not the usual 6%-10% increase.  

Obamacare spending for direct medical care did not go into effect until 2014. All that went into effect was increases in taxes from 2010 until 2014 and spending on the growth of the bureaucracy resulting in a 4% growth. The math had nothing to do with increased direct medical care.

According to federal actuaries, spending on all health care grew 5.5% in 2014. Actual enrollment was lower than expected enrollment in 2014.

2014 was the first year of spending on direct medical care. Healthcare spending will continue to increase in 2015 to 5.3%. The reason is spending for Obamacare took affect in 2014 and continued in 2015. The reason for the slight predicted percentage decrease for 2015 is at least two fold. Less people signed up for Obamacare in 2015 than predicted and reimbursement for physicians and hospitals decreased.

Other reasons for a government decrease in spending are consumers are paying a greater share of their medical bills and reining in their use of medical care services.

One in three Americans said they or a family member delayed medical care because of costs in 2014, according to a report late last year by survey company Gallup.”

President Obama and his administration are deceiving the American public about the success of Obamacare.

The cost to taxpayers and people who are insured has actually increased. President Obama continually tells us costs are decreasing.

The mainstream media, especially The New York Times and Paul Krugman, continually repeat the lie. If you repeat a lie enough times people begin to believe it is the truth.

A reader asked me where did the New York Times readers leave their thinking apparatus. Someone else pointed out that the New York Times readership is decreasing because the newspaper has lost its credibility.

The New York Times opinions seem to be presented without supporting evidence.

The truth is premiums are increasing, coverage is decreasing and insurance deductibles are increasing for everyone including the middle class. Access to medical treatment is decreasing. Out of pocket expenses are skyrocketing.

The deception continues unchallenged by Republicans. No one is talking about the fact that the Obama administration is lying about what is happening on the ground.

“According to a report from actuaries at the Centers for Medicare and Medicaid Services published in the journal Health Affairs. In the years through 2024, spending growth is expected to average 5.8%, peaking at 6.3% in 2020.”

The cost of healthcare to the government is going to increase further and faster than predicted by federal actuaries as a result of expanded government insurance coverage under the 2010 health law, and the ever expanding Medicare’s baby-boom beneficiaries entering Medicare age.

As technology increases and as the baby boomers enter Medicare and more expensive life-saving drugs are developed costs to the government are going to increase.

The cost of pharmaceuticals is reported to have increased by 12% last year. The deals the government makes with the pharmaceutical companies are pathetic. The prices continue to mount for the government as consumer out of pocket costs for drugs increase.

By 2024 healthcare costs to the government and consumers are projected to be over 20% of our GDP and rising at the present Obamacare rate.

Americans will be older and sicker.

There is little government focus on helping our population become motivated to become  healthier and more responsible for their health and their own healthcare as they age.

Obamacare is forcing Americans to become more dependent on the government for their healthcare needs.

Hopefully, people are noticing that government does not work and more government will be a disaster to our medical and financial health.

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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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Obamacare 101!

Stanley Feld M.D.,FACP, MACE

I hope it is common knowledge that President Obama and his administration lie about the success of Obamacare.

The traditional media and especially the New York

Times simply regurgitates these absurd lies as published in the Obama administration’s press releases.

I have many smart, sophisticated friends who are physicians, lawyers, engineers and business professionals whose only source of the news is the New York Times.

They honestly believe that FOX news and the Wall Street Journal are entertainment vehicles of right wing conservatives. They think these organizations do not publish real news.

It is what the Obama administration and the New York Times told them.

FOX news and the Wall Street Journal get closer to the truth than the New York Times. They cover important stories of the day while many of the stories are not even mentioned in the traditional media.

The New York Times used to be my only source of news.  One day I realized the bias in almost every story in both the news and on the editorial pages.

I have been a critic of Obamacare from the beginning. It has been my opinion that Obamacare could not work. I have even suspected that President Obama wants to destroy medical care in America with Obamacare.

The construction of a massive bureaucracy to redistribute wealth for the benefit of the poor has not worked in the past because corruption, inefficiency and errors are usually built into the development of massive government bureaucracies.

Our federal government has never produced a well-oiled business devoid of inefficiency and corruption. Two recent examples are the TSA and the VA.

As medical care becomes more complex and as President Obama tries to control medical care the ability to develop a well-oiled machine becomes more elusive.

He does not understand that you cannot legislate morality especially by executive order. The bureaucracy and regulations make no sense to people he is trying to force to comply.

Government should be for the people and by the people. You have to provide incentive for people to enthusiastically operate within the systems created and encourage them to improve and take responsibility to improve the systems.

I have also presented my views on the value of the constitution and the freedoms we as Americans have under the constitution.

No one should be immune the law or the values of our constitution. President Obama and his administration are trying to force his ideology on the American people and trying to control our thinking by restricting our freedoms.

Many Americans do not pay attention to what is happening until it starts happening to them. Sometimes it is too late to change horrible laws and regulations.

Last week I received a note from a reader. The subject of the email said MANDATORY!

It is a simple explanation of the mechanics of the system imposed on us by Obamacare for everyone to understand.

Maybe some of my sophisticated friends and colleagues will start understanding the danger of Obamacare and why it cannot work.

President Obama’s Personal Experience: Obamacare 101!

Only weeks after leaving office on January 20, 2017, former President Barack Obama discovers a leak under his sink, so he calls Troy the Plumber to come out and fix it.

Troy drives to President Obama’s new house, which is located in a very exclusive, gated community near Chicago where all the residents have a net income of way more than $250,000 per year.

Troy arrives and takes his tools into the house.  He is led to the guest bathroom that contains the leaky pipe under the sink.  Troy assesses the problem and tells President Obama that it’s an easy repair that will take less than 10 minutes.  President Obama asks Troy how much it will cost.  Troy checks his rate chart and says, “$9,500.”

“What?  $9,500?” Obama asks, stunned, “But you said it’s an easy repair.  Michelle will whip me if I pay a plumber that much!”

Troy says, “Yes, but what I do is charge those who make more than $250,000 per year a much higher amount so I can fix the plumbing of poorer people for free.  This has always been my philosophy.  As a matter of fact, I lobbied the Democrat Congress, who passed this philosophy into law. Now all plumbers must do business this way.  It’s known as the ‘Affordable Plumbing Act of 2014’.  I’m surprised you haven’t heard of it.”

In spite of that, Obama tells Troy there’s no way he’s paying that much for a small plumbing repair, so Troy leaves.  Obama spends the next hour flipping through the phone book calling for another plumber, but he finds that all other plumbing businesses in the area have gone out of business. Not wanting to pay Troy ‘s price, Obama does nothing and the leak goes un-repaired for several more days.  A week later the leak is so bad President Obama has had to put a bucket under the sink. Michelle is not happy as she has Oprah and guests arriving the next morning.  The bucket fills up quickly and has to be emptied every hour, and there’s a risk the room will flood, so Obama calls Troy and pleads with him to return.

Troy goes back to President Obama’s house, looks at the leaky pipe, checks his new rate chart and says, “Let’s see, this will now cost you $21,000.”

President Obama quickly fires back, “What? A few days ago you told me it would cost $9,500!”

Troy explains, “Well, because of the ‘Affordable Plumbing Act,’ a lot of wealthier people are learning how to maintain and take care of their own plumbing, so there are fewer payers in the plumbing exchanges.  As a result, the price I have to charge wealthy people like you keeps rising. Not only that, but for some reason the demand for plumbing work by those who get it for free has skyrocketed!  There’s a long waiting list of those who need repairs, but the amount we get doesn’t cover our costs, especially paperwork and record keeping. This unfortunately has put a lot of my fellow plumbers out of business, they’re not being replaced, and nobody is going into the plumbing business because they know they can’t make any money at it. 

 I’m hurting too, all thanks to greedy rich people like you who won’t pay their ‘fair share’.  On the other hand, why didn’t you buy plumbing insurance last December?  If you had bought plumbing insurance available under the ‘Affordable Plumbing Act,’ all this would have been covered by your policy.”

“You mean I wouldn’t have to pay anything to have you fix my plumbing problem?” asks Obama.

“Well, not exactly,” replies Troy. “You would have had to buy the insurance before the deadline, which has passed now. And, because you’re rich, you would have had to pay $34,000 in premiums, which would have given you a ‘silver’ plan, and then, since this would have been your first repair, you would have to pay up to the $21,000 deductible, and anything over that would have a $7,500 co-pay, and then there’s the mandatory maintenance program, which is covered up to 17.5%, so there are some costs involved.  Nothing is for free.”

“WHAT?” exclaims Obama.  “Why so much for a puny sink leak?”

With a bland look, Troy replies, “Well, paperwork, mostly, like I said.  And the internal cost of the program itself.  You don’t think a program of this complexity and scope can run itself, do you?  Besides, there are millions of folks with lower incomes than you, even many in the ‘middle class’, who qualify for subsidies that people like you must support.  That’s why they call it the ‘Affordable Plumbing Act’!  Only people who don’t make much money can afford it.  If you want affordable plumbing, you’ll have to give away most of what you have accumulated and cut your and Michelle’s income by about 90%.  Then you can qualify to GET your ‘Fair Share’ instead of GIVING it.”

“But who would pass a crazy act like the ‘Affordable Plumbing Act’?” exclaims the exasperated Obama.

After a sigh, Troy replies, “Congress… because they didn’t read it.”

       I hope this simple example helps all those sophisticated New York Times readers understand the dangers of Obamacare more clearly.

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

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