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 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.
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.
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. Please have a friend subscribe
The U.S. Preventive Services Task Force’s (USPSTF) grading system for measuring the quality of healthcare is an wrong. It results in a way to limit physicians’ judgment and treats medical care as a commodity. It enables a computer program to judge if physicians have followed an algorithm to treat patients.
Level II-1: Evidence obtained from well-designed controlled trials without randomization.
Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.”
“Evidence-based behavioral practice (EBBP) "entails making decisions about how to promote health or provide care by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected.”
“Empirically supported treatments (ESTs) in some clinical settings are defined as "clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population" [3]
Only when physicians’ clinical judgment and observations are included in the assessment of their quality of medical care should evaluation of that quality of care be measured.
The narrow criteria of the USPSTF will not define quality. It will only serve to restrict access to care and penalize physicians for using clinical judgment and consumers’ from receiving medical care.
Suddenly, it becomes easy to see how difficult it is to assess the quality medical care.
There is little question that an occasional physician practices terrible medicine. This is obvious to the medical community. The mechanism for improving a bad physicians quality of care is in place but not well executed.
Few, especially healthcare policy wonks, seem to understand the difficulty of assessment of medical care.
It should be easy for policy wonks to understand the limitations and criticisms of evidence based medicine.
Yet the Obama administration regards evidence-based medicine as measured presently as the gold standard of clinical practice,
EBM produces quantitative research, especially from randomized controlled trials (RCTs). Accordingly, results may not be relevant for all treatment situations.[67]
This is obvious to most physicians.
The theoretical ideal of EBM (that every narrow clinical question, of which hundreds of thousands can exist, would be answered by meta-analysis and systematic reviews of multiple RCTs) faces the limitation that research (especially the RCTs themselves) is expensive; thus, in reality, for the foreseeable future, there will always be much more demand for EBM than supply, and the best humanity can do is to triage the application of scarce resources.
The reasons for EMS shortcoming are listed below. The list is not complete.
There is a lag between when the RCT is conducted and when its results are published.[68]
There is a lag between when results are published and when these are properly applied.[69]
Certain population segments have been historically under-researched (racial minorities and people with co-morbid diseases), and thus the RCT restricts generalizing.[70]
Not all evidence from an RCT is made accessible. Treatment effectiveness reported from RCTs may be different than that achieved in routine clinical practice.[64]
Published studies may not be representative of all studies completed on a given topic (published and unpublished) or may be unreliable due to the different study conditions and variables.[71]
Research tends to focus on populations, but individual persons can vary substantially from population norms, meaning that extrapolation of lessons learned may founder.
Thus EBM applies to groups of people, but this should not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand" and suggests that evidence-based medicine should not discount the value of clinical experience.[56] Another author stated that "the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."[72]
Hypocognition (the absence of a simple, consolidated mental framework that new information can be placed into) can hinder the application of EBM.[73]
Valid enthusiasm for science should not cross the line into scientism, losing critical perspective.
Although clinical experience and expert opinion are insufficient by themselves, neither are they valueless, as EBM fervor that approaches scientism sometimes tends to paint them.
This last point is repetition of a very important shortcoming.
An informed clinician can weigh confounding variables in a clinical case and decide that following a population-based guideline to the letter feels inadequate for the situation. Thus clinical backlash against "cookbook medicine" is not always misguided, and "guidelines are not gospel."[74]
Conceptual models, by having fewer variables than always-multivariate reality, face limits of predictive accuracy, just as even the best supercomputer simulations cannot predict the weather with 100% accuracy, whether because of the butterfly effect or otherwise.
Thus, just as clinical judgment alone cannot give epistemological completeness, neither can RCTs and systematic reviews alone.”
The answer to the reader’s last comment and question, “I believe a carrot and stick approach may be necessary with more carrot and less stick. Your thoughts?” is
I believe that government must learn how to evaluate quality medical care accurately, if they want to base healthcare payments on the quality of medical care. Presently, the government is far from achieving that goal.
It could also be that measuring quality medical care is not President Obama’s goal.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
As a retired Clinical Endocrinologist I don’t have a vested interest in generating income for myself from the healthcare system.
What I am trying to do is help consumers and healthcare policy makers understand the present healthcare system. I fear they have no interest in understanding what would work to repair the healthcare system.
I am also trying to explain to consumers that few politicians are interested in helping them. Politicians are interested in power. They are interested in making the people dependent on them.
Politicians and the central government are interested in controlling the healthcare system, the financial system, the Internet and the environment. Once politicians control these systems the people have lost their independence and freedom. Politicians will have the power they seek.
Many of our constitutional freedoms have been disappearing. American have been on the Road To Serfdom for many years.
President Obama has hastened the journey on the road to serfdom with his blatant disregard for the constitution and the bill of rights. To my chagrin he is succeeding.
President Obama is pretending to want to provide universal care. His goal is to destroy the healthcare system so that the people will beg for the central government to control the healthcare system. There are more uninsured people now than when he became President.
Paul Krugman is one of President Obama’s henchmen. He stated in a recent article that Obamacare is costing the government less money than the administration thought it would. He therefore calls Obamacare a success.
This administration and its henchmen in the traditional media flood us with half-truths.
Obamacare might be costing the government less than they expected. The Obama administration never told Americans what they expected to spend.
The Obama administration is the most non-transparent administration in my lifetime. Meanwhile, the Obama administration tells Americans it is the most transparent administration in history.
CGI is a Canadian company with offices in the U.S. It had the contract to develop the Obamacare website healthcare.gov. The website was a disaster. The development cost overruns were unbelievable.
CGI received the contract through an Obama crony capital award and a non-competitive bid.
CGI receive another contract to complete the backend of healthcare.gov.
The Affordable Care Act (Obamacare) is supposed to be affordable for consumers. Consumers are experiencing higher premiums and out of pocket expenses for medical services.
1. Obamacare has been under subscribed. Only 10 million people are verified premium paying subscribers. The Obama administration projected 30 million subscribers by 2015 when Obamacare was passed in 2010.
2. The deductibles are unaffordable. Obamacare is even unaffordable to those people who receive subsidies.
The subsidized people have avoided seeing physicians in a timely manner. The result is government costs are less in the short run but will be more in the long run as people get very ill.
3. The Obama administration is keeping the expenses for infrastructure and bureaucratic structure non transparent.
4. Obamacare’s rules and regulations are resulting in restricting access to care.
There has been an explosive increase in premiums and higher deductibles though the health insurance exchanges as well as private insurance.
The Obama administration has been silent about this reality.
The Affordable Care Act is not affordable. It has not increased the “quality of care.”
Paul Krugman does not publish the real truth in his New York Times articles. Those who still read the New York Times take his words literally. They are deceiving themselves.
One of the ways the Obama administration is restricting access to care to lower its costs is through the U.S. Preventive Services Task Force’s (USPSTF) recommendations.
The task force is composed of a group of physicians that do not have clinical expertise in the medical or surgical topic they are evaluating.
The group simply reads the medical papers assigned to them to evaluate. The committee decides the efficacy of treatment on the quality of the literature they are given to evaluate. Clinical judgment is not included in their evaluation.
A positive decision is made if the literature contains a double blind controlled study yielding positive results.
The Annals of Internal Medicine (AIM), a journal of the American Medical Association published the USPSTF recommendation without expert clinical endocrinology comment or critique.
R. Mack Harrell, MD, FACP, FACE, ECNU current President of the American Association of Clinical Endocrinologists (AACE) is having the AACE Thyroid Scientific Committee submit a note to the Annals of Internal Medical addressing AACE’s concerns with the USPSTF’s paper.
AACE has studied and written many guidelines on the evaluation and treatment of thyroid disease. Its members have vast experience as practicing clinicians in the treatment of thyroid disease. Its input should be sought by the Obama administration not ignored in favor of a default decision that saves Obamacare money and puts the financial burden of care on consumers.
The following is Dr. Mack Harrell’s comment to AACE’s membership.
In my opinion Dr. Harrell’s’ comments are totally correct and should be heeded by the Obama administration.
“While agreeing with the USPSTF’s call for new, controlled thyroid screening studies, AACE issued a press release outlining its position on aggressive case finding suggesting: that this approach is an appropriate alternative to screening in patient groups where thyroid risk factors are present.
More specifically, AACE stressed that testing and treatment are indicated in those patients who are at highest risk for developing life-altering, overt thyroid disease, including:
Patients over 60, in whom symptoms of hypothyroidism are often minimal, absent or atypical
Newborns (continued mandatory screening for congenital hypothyroidism recommended)
Those with autoimmune diseases often associated with thyroid disease, such as type 1 diabetes and pernicious anemia
Patients with a prior history of thyroid disease or thyroid surgery, an abnormal thyroid exam, or taking drugs known to affect the thyroid
Patients with a family history of thyroid illness
AACE further emphasized that careful consideration should be given to thyroid testing in women who are planning pregnancy or are already pregnant given the clear-cut detrimental effects of thyroid hormone lack on fetal development in the early phases of pregnancy.
We also intend to submit to AIM a formal statement from the AACE Thyroid Scientific Committee to address concerns that the task force’s “lack of data” argument could be incorrectly interpreted as a “lack of clinical need” to find and treat thyroid disease.
For years, members of AACE and the American College of Endocrinology have worked diligently to provide up-to-date, useful clinical guidelines and recommendations regarding decision-making about thyroid function testing for physicians. We will continue to keep our members and the medical community apprised as we communicate our position regarding thyroid disease testing.
Best regards,
R. Mack Harrell, MD, FACP, FACE, ECNU
The Obama administration has made many mistakes in writing Obamacare. Most of them have not been in favor of the consumers it professed to help.
About 50% of women over the age of 60% might have subclinical hypothyroidism. Overt clinical hypothyroidism can take several years to declare itself. During the time of subclinical hypothyroidism evolves to overt hypothyroidism patients can suffer mild to moderate symptoms that would decrease their quality of life on many levels.
I believe President Obama should show compassion and responsibility toward the millions of who people would suffer from subclinical hypothyroidism. President Obama is setting up the healthcare system to restrict access to care for these people.
I do not think he should rely on a committee that does not have the expertise in the field of clinical thyroidology.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. 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 have been passed on to consumers in the form of higher prices.
I am not talking about the increase in taxes on capital gains and dividends that seniors rely on to survive. I am talking about all the other taxes that affect purchasing power.
The traditional media have ignored these new taxes and Mr. Norquist’s summary. No one is talking about how these taxes are hurting seniors and the middle class economically.
Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.
President Obama was not telling the truth when he said people earning under $250,000 would not pay one single dime more in taxes.
I suggest everyone watch President Obama’s lying and defending of his lies. After the first You Tube let it keep playing to hear subsequent You Tubes.
In my blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.
Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in their taxes.
“Obamacare contains 20 new or higher taxes on American families and small businesses.
Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:
Taxes that took effect in 2010:
1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.
2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.
3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.
4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.
5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.
6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.
Taxes that took effect in 2011:
7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.
8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.
Taxes that took effect in 2012:
9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.
Taxes that take effect in 2013:
10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.
Capital Gains
Dividends
Other*
2012
15%
15%
35%
2013+
23.8%
43.4%
43.4%
*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.
11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:
First $200,000 ($250,000 Married) Employer/Employee
12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986
13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995
14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389
15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994
16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000
Taxes that took effect in 2014:
17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following
1 Adult
2 Adults
3+ Adults
2014
1% AGI/$95
1% AGI/$190
1% AGI/$285
2015
2% AGI/$325
2% AGI/$650
2% AGI/$975
2016 +
2.5% AGI/$695
2.5% AGI/$1390
2.5% AGI/$2085
Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337
18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346
Combined score of individual and employer mandate tax penalty: $65 billion/10 years
19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993
Taxes that take effect in 2018:
20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956
Mr. Norquist left out the worst tax of all. The “tax” is under everyone’s radar. It has not been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.
"The per person Medicare Insurance Premium will increase from the present Monthly Fee of $96.40, rising to:
$104.20 in 2012
$120.20 in 2013
And
$247.00 in 2014."
All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.
This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.
These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.
Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus. Obamacare must be repealed.
Everyone must stay focused. President Obama is going to try to change the conversation.
Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare could be repealed.
Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
In the run up to the February 15th ending of the 2015 www.healthcare.gov enrollment period and the new Republican congress’ upcoming vote to repeal Obamacare, the Obama administration is trying to convince Americans that Obamacare is working and is good for all Americans.
The public knows better by now. The middle class is feeling the economic pain Obamacare has created. They sense President Obama telling another lie.
President Obama’s deception implies Obamacare is cost effective. All the CBO is saying is the numbers given to it, this time, by the Obama administration show the cost of Obamacare will be 20% lower than the CBO original estimate in 2011.
The additional new taxes for Obamacare were initiated in 2011 based on those CBO estimates.
One important reason for the 20% decrease in cost from the original estimate in 2010 is that fewer people have chosen to enroll in www.healthcare.gov in 2014.
Since fewer people enrolled there is a $51 billion of savings in federal subsidies for fewer enrollees in health insurance exchanges.
This represents a failure of Obamacare not a success as claimed by the Obama Administration.
The government estimates a total 10.7 million will enroll by February 15,2015. On February 2,2015 there were 7.53 million qualified enrollees. The original estimate in 2010 was 17.5 million. The first 2015 estimate enrollment in 2014 was reduced 3 months ago to 13 million. The enrollment figure was modified.
The taxes the middle class have been forced to pay for Obamacare were not modified.
The real numbers are totally confusing because the government documentation is very difficult to follow. CMS modifies the numbers constantly with corrections. The modifications serve to keep Americans stupid and confused.
The Obama administration is now spinning the significance of the CBO report to its political advantage.
· Government will spend $1.993 TRILLION over a decade and take in $643 BILLION in new taxes, penalties and fees related to Obamacare
· The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag perpersonat best
· The law will still leave 'between 29 million and 31 million' nonelderly Americans withoutmedical insurance
Numbers assume Obamacareinsuranceexchange enrollment will double between now and 2025 "
Buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook were numbers to calculate the cost of Obamacare legislation to add patients to the insurance role. “The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag perpersonat best.”
It is impossible to judge whether these estimated figures are correct because estimates are mostly wrong.
What we do know is Obamacare is not doing well from everyone’s except President Obama’s point of view. The spin is keeping all Americans who are seeking the truth confused. Americans want a solution to the deterioration of the healthcare system.
Another reason for the reduction in Obamacare healthcare spending could come from the reduction in reimbursement to physicians.
Insurance companies have not suffered the same reimbursement insult because the government has subsidized the healthcare insurance industry and provides a guaranteed profit that is not included in the CBO estimate.
A fourth reason for the 20% reduction could be that the insurance products on the health insurance exchanges have high deductibles. It takes a while before the patients reach their deductibles and the government starts spending money on reimbursement. Patients can also be staying away from receiving appropriate medical care because they cannot afford the deductible.
The CBO report projects that 75 percent of enrollees will receive subsidies in 2015. However, 87 percent received subsidies in 2014. This is wishful thinking on the part of those who provided the data for the CBO to evaluate to believe the subsidy percentage will decrease. The CBO projected a further decrease in subsidy to 71% in 2025.
The health insurance exchange experience so far suggests there is adverse patient selection. It can be assumed that there will be an increase in healthcare risk and an increase subsidy percentage in the future.
However, I do not think anyone can draw any conclusions from the CBO’s report.
I do believe that Obamacare is President Obama's push to a single party payer healthcare system because of the structure of its market driven elements are destined to fail.
Government will then take over telling us what medical care we can or cannot have.
”We are fast approaching the stage of ultimate inversion: the stage where the government is free to do anything it pleases, while the citizens may act only by permission.” - Ayn Rand
The CBO report of a 20% reduction is spending as a result of Obamacare is meaningless. It is being used by President Obama to confuse the public for political reasons.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
The New York Times continues to have Ezekiel Emanuel M.D., Provost of the University of Pennsylvania write a medical opinionator column.
It is no wonder the Times circulation has fallen to only 2 million readers. It is no longer the newspaper that prints “all the news that is fit to print.’
Malcolm Gladewell, in a critique of Steven Brill’s “Bitter Pill”, describes Ezekiel Emanuel as follows,
Emanuel was the “brashest” and most “academically credentialed of the trio of brilliant Emanuel brothers,” took “edgy” positions, and had an “MD and a PhD (in political philosophy) from Harvard, a master’s from Oxford, and a position teaching oncology at the Dana-Farber Cancer Institute in Boston.”
He had “brains, cunning and [a] biting persona,” and was “ready, willing and able to layer it with the self-righteousness of a guy who treated cancer patients.”
He also does not give a straight answer when challenged.
In my opinion he des not understand either the healthcare system or the medical care system. He does not understand patients’ problems or needs.
Yet President Obama has used him as his medical care advisor for Obamacare. Two recent articles that he has written emphasize the above.
It must be read to be believed. No amount of commentary can describe this unbelievable argument. It left me speechless. It is a set up for government to ration medical care.
It also made me wonder how the President of the United States can permit Dr. Emanuel to be the spokesman for medical care in America. President Obama can only permit it if he agrees that government should control our freedom of choice.
“Dr. Ezekiel Emanuel, last heard from claiming that he wants to die at 75 in order to avoid becoming a burden on society, writes in the New York Times that “screening healthy people who have no complaints is a pretty ineffective way to improve people’s health.”
He believes that government should control patients’ freedoms.
Dr. Emanuel is all about rationing care for individuals. He is all about the government telling individuals what care they are entitled to depending on their age and usefulness to society.
President Obama had built into Obamacare preventive services requirements. This resulted in at least 5 million people in the individual healthcare market losing their insurance and their doctors.
Obamacare mandates that Americans pay via new taxes and inflated health insurance premiums for services they do not need or they do not want. One ridiculous service would be birth control for the elderly.
Additionally the National Commission on Prevention Priorities found that by increasing just five preventive services, clinicians could save more than 100,000 lives per year. These services include breast cancer screening in women 40 and older, flu immunizations in adults 50 and over, colorectal cancer screening in adults 50 and over, smoking cessation counseling, and a daily aspirin in high risk cardiovascular patients.
Ezekiel Emanuel now contradicts this previously adopted notion. Now he wants it out. President Obama can probably take it out by executive order.
One can get a deeper an understanding of this man’s temperament when listening to these two interviews.
Obamacare’s architects are setting up Americans to be resolved to accept what the government will decide and provide. Americans will have no option to decide what medical care they can have and what physicians they can see. Non-elected bureaucrats will decide for us.
I implore Americans, congress, all of organized medicine and all physicians to say enough is enough. Obamacare should be repealed.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.
I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.
In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.
The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.
Every week indications of Obamacare’s failures appear but are kept under the public’s radar. The Obama administration spins the facts and the mainstream media’s regurgitates that spin.
The Obamacare signup figures as complied by http://acasignups.net as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.
Obamacare’s enrollment is still 1 million below estimate at this point
HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through HealthCare.gov in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.
The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from HealthCare.gov could lose their premium subsidies.
Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.
HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.
The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.
To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.
“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”
The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.
The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.
The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.
It is destined to fail at a tremendous waste of taxpayers’ dollars.
The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.
This year physicians can expect another 4% reduction for a total of 32% since 2002. We will see if congress fixes this defective formula this year.
Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.
Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.
Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.
The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.
The cascade of rules and regulations will affect every specialty of medicine. The only thing left is for physicians to quit participating in government programs.
Then government can force medical license renewal to be tied to participation in government healthcare programs.
Where is physicians’ choice and freedom? There is currently a physician shortage. If physicians quit medicine and surgery what will happen to patient care?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
The disinformation coming from the Obama administration is unrelenting.
CMS has released Obamacare’s open enrollment numbers through 12/15/14.
On December 15,2014 all of last years enrollees who did not change their health plan or did not discontinued their plan were automatically re-enrolled for 2015.
The Obama Administration bragged with the following statement.
The number of people enrolling or re-enrolling last week was considerably higher than in previous weeks. Week one saw 500,000 enrollees, week two had 300,000 and week three saw 600,000 sign up through HealthCare.gov.
Week four saw 850,000 people enrolling or re-enrolling.
The cumulative estimate of people needed to sign up was 4.7 million through 12/15/14. The sign up number included people who were automatically re- enrolled with the same insurance policy they bought last year. This year’s premiums and deductibles will be higher that last year’s premiums in most cases.
The Obama administration picked up 1 million enrollees for the week as a result of the automatic re-enrollment. These enrollees have been warned that they will be paying a higher premium than if they searched for a different plan by a different insurance carrier.
Only 3.4 million sign ups were confirmed to receive healthcare coverage by January 1,2015.
This is only seventy percent (70%) of the expected enrollment through 12/15/14. The enrollment had been extended previously to February 15, 2015.
CMS told us that last year 8 million were enrolled. The number was modified to 7.2 million and then changed to 6.7 million as 400,000 were not enrolled in healthcare but bought dental care insurance.
We were never told that 65% of the enrollees received federal subsidies in the traditional media. How many of those people who received subsidies subsequently lost their subsidy because the IRS could not confirm their reported income?
The next critical question is how many of the people who lost their subsidy dropped their insurance because they could not afford the premiums and deductibles.
How many people that enrolled have preexisting illnesses? How many of the people who enrolled can pay the high deductibles and copays?
How many people in the individual market can afford to pay the insurance premiums with pre-tax dollars?
Whatever the premium is in the individual market the enrollee has to have twice as much disposable income to pay the premium because the premium is not tax deductible.
Healthcare insurance premiums are tax deductible to employers in the employer group markets.
How many taxpayers know that the Obama administration is subsidizing the healthcare insurance industry so the industry cannot loss money if the healthcare insurance is bought through Obamacare?
The original goal for enrollment for 2015 was 13.5 million. It was lowered to 12 million and now 9 million by the time the enrollment started. If 6.7 million were originally enrolled the increase in new enrollment will only be 2.3 million.
What happened to all the millions of people who lost insurance through their employer because they were shifted to part-time work?
It seems that Obamacare is unattractive or unaffordable to those who need it most. If taxpayers knew the waste in Obamacare’s administration and guarantees to the healthcare industry, taxpayers would not be very happy.
It goes back to Jonathan Gruber’s statement that the people are stupid and the lack of transparency is very powerful political tool.
Meanwhile, the enrollment rate is low but the Obama administration is feeding the traditional media the spin that enrollment is surging. This game is not going to promote Obamacare’s credibility.
“More than a million people signed up for health insurance plans onHealthCare.gov in the past week, bringing the overall total of signups for the first four weeks of the current open-enrollment period to nearly 2.5 million, the CMS announced Tuesday.
Dec. 15 was the HealthCare.gov deadline to enroll for coverage to go into effect Jan. 1.”
Many of the State Health Exchanges are already extending the deadline for coverage to begin January 1,2015, California, Maryland and Minnesota, Idaho, Massachusetts, New York, Rhode Island and Washington already have extended their deadlines for signing up.
If enrollment was going as well as the Obama administration claims, there would not be so many 2 week extensions.
Why wouldn’t the healthcare insurance companies want more enrollees? They are selling insurance policies for the Obamacare at no financial risk.
“Federal plans are underway for a special outreach campaign to the roughly 250,000 individuals whose existing plans are no longer being offered on the federal exchange for 2015. HHS plans to point these people in the direction of a plan that is substantially similar to the ones they've lost but they won't be auto-enrolled.”
The Obamacare’s enrollment period is desperate for more enrollees
HHS is rolling out online partnerships with three online firms to further promote HealthCare.gov during the current open-enrollment period,which ends Feb. 15. The partnerships are with Monster.com, Peers.org, and Higi, a provider of interactive health stations tracking weight, BMI and other vital signs to supermarkets such as Kroger and Meijer. The company will post messages informing users of the open-enrollment period.
The partnerships are innovative but have a low probability of success.
President Obama and his administration continue its information spin. The real truth is the Obama administration is not transparent at all. It takes hard work to figure out what is the truth.
The public is beginning to figure out that they are not getting the truth. Consumers are directly affected by the manipulation of the truth personally. Consumers are not showing up to participate.
Presently, Obamacare is only covering consumers in the individual marketplace.
Just wait until Obamacare affects the small group and large group employers that are going to have to pay a penalty for providing unqualified Obamacare healthcare coverage.
One outstanding example is the worthless Mini-med plans of McDonald and Burger King that President Obama gave a waiver to until 2017.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Jonathan Gruber, a professor of Economics at MIT and one of the authors of Obamacare, made comments in 2013 about the trick plays the Obama administration used to pass the Affordable Care Act.
Jonathan Gruber’s comments serve to help Americans understand the mechanics of the passage of Obamacare. Hopefully it will serve as a wakeup call for the entire electorate.
Jonathon Gruber’s comments reflect the attitude of President Obama and his entire administration toward the electorate.
Mr. Gruber admits what many of us have understood throughout President Obama’s years in office. President Obama’s attitude is reflected in all the trick plays he has pulled on congress and the American people during the passage and implementation of Obamacare.
Please look at all the articles covering President Obama’s trick plays since 2008 by clicking here.
The mainstream media has done President Obama’s bidding. It has not covered the meaning of Jonathan Gruber’s comments and the disrespect he and others have for the intelligence of the American public.
A reader sent me this comment before Jonathan Gruber’s comments were discovered.
“Dr. Feld,
There is some science behind the Progressive methodology that non-progressives need to learn. The Progressive movement talks directly to the limbic portion of the brain while non-progressives tend to sort through facts in the neocortex.
Decisions are made in the emotional limbic portion of the brain, hence the reason and way marketers appeal to emotions versus your facts.
The bottom line is this, non-progressives need to turn their facts into stories that are emotional or conservatives will always be out sold by those who’s arguments are devoid of facts (or outright lies) but full of emotion.
Have an awesome day.”
The Gruber controversy has given Americans a story that stimulates an emotional response. Americans are offended by being called stupid.
Jonathan Gruber did not make these statements in a void. It had to reflect the thinking of Obama administration. Even John Kerry gave him some help.
Published on Nov 12, 2014
Gruber explains how Senator John Kerry helped him fool stupid voters into accepting a tax hike.
Mr. Gruber could not have made the decisions on his own to take the policy actions he described.
He never should have described the actions of those involved in public.
The Obama administration also provided the Congressional Budget Office (CBO) with wrong information. The information led to wrong CBO’s conclusions regarding Obamacare’s real costs. The CBO crunches numbers fed to it by the Obama administration.
The Obama administration used CBO’s false scoring to sell the CBO’s economic conclusions to the public through the mainstream media.
It is clear that President Obama and his administration believe they are smarter than the American people. President Obama believes that his administration knows what is best for Americans.
The only reason the American people have not connected the dots is because they believe the president is an honorable man. The president is not expected to lie to the public.
The progressive press is trying to divert attention from Jonathan Gruber’s comments. It is trying to get the public to ignore Mr. Gruber.
Paul Krugman said the health economist Jonathan Gruber, one of the principal architects of health reform recently summed it up:
“The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.”
Paul Krugman did not provide any facts just an appeal to emotion.
“Part of the problem with the Jonathan Gruber “stupid” story is that it’s a shiny object for the political world to stare at for a while. It offers more heat than light. It’s a bouncing ball for political insiders to chase after, despite its relative insignificance.”
“But since it’s likely to soon be the subject of congressional hearings, and since your crazy uncle who watches Fox News all day will be talking about nothing else at Thanksgiving, let’s grudgingly tackle this week’s Most Important Story Of All Time As Agreed Upon By Republicans And The Beltway Media.”
Please note the inference that Republicans and Fox News are stupid for making an issue out of Jon Gruber’s statements. The implication is MSNBC is smart.
Progressives need public support in order to maintain power.
The problem is the public is tired of progressives’ emotional appeals devoid of facts.
The progressive press including MSNBC and The New York Times need examine their premises. They are daily losing listeners and readers .
“House Minority Leader Nancy Pelosi responds to Jonathan Gruber’s comments on the Affordable Care Act, saying, “I don’t know who he is. He didn’t help write our bill. So with all due respect to your question, you had a person who wasn’t writing our bill commenting on what was going on when we were writing the bill who has withdrew some of the statements that he made. So let’s put him aside.”
It is almost as bad as "we will not know what is in the bill until we pass it."
President Obama and his administration are trying to prevent public understanding of his current tricks plays. He continues to try to divert American from the truth about Obamacare.
President Obama needs to explain the truth to regain his credibility with the American people.
He must address these unanswered issues if he wants to maintain his promise of transparency.
Why the healthcare.gov open enrollment period was delayed until November 15th.
What is the actual number of valid enrollees in Obamacare in 2014? Is it 8 million, 7 million, 5.6 million or 3 million? I thought Obamacare and its mandate would be in effect for small businesses and corporations in 2015.
Why has the estimate of total enrollment for 2015 been reduced from 13 million to 9 million? I thought 2015 Obamacare would be fully implemented and many more people would sign up as they lost employer sponsored insurance.
How many people who received government subsidies last year lied on their application?
Why weren’t the rules for subsidies enforce?
How many people lost their subsidy?
How are you going to collect the subsidy from people that lied?
How many people have claimed they are not going to re-enroll in Obamacare this year and why are they not going to enroll?
How does a person receive a tax credit when he has no taxable income to apply that tax credit to?
10. Explain the status of the open enrollment and the mandate for small businesses and large corporations.
11. What is the status of waivers that companies and unions received from Obamacare for 2015?
12. Why does the state of Massachusetts have a failed State Health Insurance Exchange that required $400 million dollars in federal supplements each year if Romneycare is so successful?
13. Why would the government subsidize healthcare insurance companies to participate in Obamacare?
14. Why is the public being told that healthcare exchanges premiums are going down when in reality they are going up?
15. What is happening with the Minimed Insurance policies that were supposed to expire in 2015?
16. What does Obamacare cost the federal government? Is it budget neutral?
17. What is the exact amount of increased taxes used to fund Obamacare?
18. What percentage of the increased taxes are collected from each income group?
These are just a few of the questions President Obama and his administration have not provided the answer to.
The answers to these questions would permit the public to understand Obamacare’s sustainability.
The Jonathan Gruber incident has made it clear how President Obama and his administration operates as well as its lack of respect for the intelligence of the American public.
Americans are not dumb. They want to believe their leaders. Their leaders have lied to them. Americans recognize that. President Obama and his administration have little credibility with the American public. President Obama promised a transparent government. There is not any transparency.
The midterm elections proved Americans are aware. It is a good first step. Now we have to see what the Republicans will do with this leadership opportunity.
An explanation of Obamacare.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone