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Obamacare Deceptions Keep Coming

November 24, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at HealthCare.gov.

Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall.

Some people did complete their applications, but it often took them 90 minutes. Some people were unable to finish what they started, so they left the clinic with plans to return at another time.

The insurance exchanges are supposed to be the centerpiece of Obamacare.

Ms.Sylvia Burwell, the Secretary of the Department of Health and Human Services said, “23,000 people had completed online applications in the first eight hours after HealthCare.gov, the federal website, opened on Saturday morning.”

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas. It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees.

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

The estimate of total enrollees (old and new) for the end of the 2015 enrollment period was lowered from 13 million to 9 million. If 8 million were enrolled in 2014 this is only an increase of 1 million new enrollees.

There were clearly not 8 million valid enrollees when President Obama did his victory lap at the end of the extended enrollment period on March 31,2014.

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It was later announced that 85% of enrollees were to receive subsidies (tax credit). The tax credits were to make the insurance premiums affordable to enrollees earning less than $50,000 a year.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of payment due from people who received the invalid subsidies.

How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.

Last week it was discovered that 400,000 people were counted in the total enrollment number that did not buy healthcare insurance. The 400,000 enrolled for low cost dental insurance.

This new revelation lowered the total number of claimed enrollees to 6.9 million from the 7.3 million claimed enrollees.

Kathleen Sibelius declared over a year ago that Obamacare would have to have over seven million enrollees to be viable and declared successful.

In a previous blog my estimate of valid enrollees for 2014 was 3 million. I have also pointed out that the healthcare insurance industry is not worried about the number of enrollees because if they lose money the government would bale them out and subsidized the difference.

The loser is the taxpayer. We have been paying a tax increase of more than 10% for Obamacare since 2010.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.

The website is, http://acasignups.net

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said,

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

“While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on the fact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupid to understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

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

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The Significance Of The Jonathan Gruber Controversy

November 16, 2014

inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System

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Stanley Feld M.D.,FACP,MACE

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.

http://youtu.be/G790p0LcgbI

The cover-up always makes it worse.

http://youtu.be/zhavicDc0Ts

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.

http://youtu.be/iUOyqw5HhRI

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.

An initial diversion came from Paul Krugman in his Victory Lap article about Obamacare.

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.

MSNBC used this emotional stimulation to get its followers to ignore Jonathan Gruber’s comments.

“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 .

Nancy Pelosi is incredible.

She said,

“Let’s put Jonathan Gruber aside.”

“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 15^th.
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

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Government Is The Problem Not The Solution

October 1, 2014

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The government has been attempting to take over the healthcare system since 1935 at the time of the Roosevelt administration.

The government took over the healthcare system 30 years later during the Lyndon Johnson administration. LBJ passed Medicare and Medicaid. It turned out that financial projections were faulty and the business model was defective.

Medicare and Medicaid provided medical care for the elderly and the poor at an affordable price at that time. Everyone loved it. At the time it was also affordable for the government.

I do not think anyone contemplated the healthcare inflation that occurred as a result of the government’s business model.

Inflationary pressure increased rapidly.

Finally, President Reagan said the government could not afford the increasing prices any more. He said enough is enough. He decreased provider (hospital, doctors, pharmaceutical company, and insurance company) reimbursement for Medicare and Medicaid services.

The reduction in reimbursement for services resulted in price shifting increases in reimbursement in the private sector.

Both the private sector and the public sector experienced increased inflationary pressure as a result of this maneuver.

It was clear by 1984 that Medicare and Medicaid were unsustainable long term.

America did not have a free market healthcare system before Obamacare. It was a hybrid system.

The country already had 90 million Americans in a single-payer system. Ninety million Americans get coverage from Medicare, Medicaid, and the Veterans Health Administration systems.

The problem is these government controlled single-payer systems did not work efficiently. They were financially unsustainable.

Obamacare expands the single party payer system to eventually cover all Americans. Obamacare simply adds on to an existing unsustainable healthcare. Raising taxes is not going to make it more sustainable.

The expanded bureaucracy will only make the system more inefficient and more prone to fraud and abuse.

President Obama is already modifying the law without congressional approval. He is trying to hide elements of this unsustainability from the American public.

The federal government’s Obamacare enrollment system www.Healthcare.gov alone has already cost taxpayers about $2.1 billion dollars according to a Bloomberg government analysis of contracts related to the project.”

The website is still not working perfectly at the backend after spending $2.1 billion dollars.

Americans will experience more of the www.healthcare.gov dysfunction after the mid term elections.

Navigator companies hired to help people enroll cost $48 a session. These companies are increasing their prices for the 2015 enrollees.

These same companies have had their fraud and abuse exposed. Nevertheless they have been rehired at the increased price by the Obama administration.

President Obama announced to Democrats last spring that Obamacare would not be an issue at the time of the midterms.

This week the administration also announced that the cost of healthcare insurance through the health insurance exchanges is decreasing next year.

It was also announced that there is an increase in the choice of insurance carriers in most states resulting in competitive premium pricing and lower premiums.

President Obama announced that Obamacare is working. He said Obamacare is a non issue in the 2014 mid term elections.

Nothing could be further from the truth.

If our elected officials cannot see President Obama’s trick play how can the public expect to understand the deception?

This is another of the manipulations of Obamacare designed to hide its impending failure from the public.

The Obama administration set up a reinsurance company funded by taxpayers that eliminates any insurance risk the healthcare insurance companies might incur in insuring enrollees.

Healthcare insurance companies are signing up and competing for market share to gain profit from this no risk insurance. They can easily afford to lower the premiums because the government will cover their supposed loses.

None of this has anything to do with patient care or the quality of patient care.

It has little to do with providing low cost insurance. The cost of insurance keeps increasing. The government pays the difference between the cost of insurance and what patients who receive subsidies pay for their premiums.

Obamacare misses the main problems in the healthcare system. Obamacare creates more dysfunction in the healthcare system.

Obamacare will result in greater unfunded future liabilities.

“White House spin pretends otherwise, but the unfunded liabilities may exceed $100 trillion.”

The Congressional Budget Office said,

“Looking indefinitely into the future, the unfunded liability, with optimistic assumptions, is $43 trillion—almost three times the size of today's economy.”

Based on more plausible assumptions, such as those reflected in the "alternative" scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.

It is the responsibility of our elected officials control America’s expenditures.

Unfortunately, for American’s, this is not how a government controlled system works.

Voters must decide how long they are going to tolerate this abuse of power.

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

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http://online.wsj.com/news/articles/SB10001424127887323393804578555461959256572

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Anyone Can Get An Exemption From The Obamacare Mandate

August 24, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

The third big deal that occurred in Obamacare in the last few months was the elimination of the mandate to buy healthcare insurance in the individual market.

The waiver qualifications have become broader as they have been clandestinely declared by President Obama’s executive orders.

It took the mainstream media four months to discover the new executive order waivers for the mandate.

The Supreme Court didn’t repeal the mandate to buy insurance. The Supreme Court called the mandate a tax.

President Obama insisted the mandate was not a tax. His campaign promise was any family making less than $250,000 a year would not experience a penny of increases in new taxes.

This campaign has clearly been a lie. President Obama felt victorious about the Supreme Court decision. The traditional media gave President Obama a pass on its social, political and economic implications.

In fours years of delays in implementing Obamacare’s deadlines imposes by the law have been changed by executive orders and collecting the laws new supportive taxes on time, no one has questioned what Americans have gotten for these new taxes.

President Obama has changed many aspects of the law without the consent of congress.

No one in congress has challenged him.

The new mandate waivers were predicted to be the death knell for Obamacare's most controversial component. We had been told that the individual mandate was crucial to the survival of Obamacare.

Very few know about the new waivers. The new waivers allow anyone to skirt the mandate in the individual market. Almost no one has to buy insurance or pay a penalty. The waivers made through executive order, essentially exempts everyone from the mandate to buy insurance or pay a penalty.

“There already had been 13 distinct exemptions, but this document added one more — apparently it was added in late December. “

The problem is no one was made aware of the waivers by either the government or the traditional media.

“The most recent exemption was included in an ObamaCare application document. The document said that individuals can now qualify for a "hardship exemption" — meaning they would not have to pay a penalty for not buying insurance — if they "experienced another hardship in obtaining health insurance."

The document does not define what "another hardship" means, and suggests the administration might not be a stickler when it comes to proof either. It says anyone seeking this exemption should "submit documentation if possible."

New waiver, number 14, was quietly extended through 2016 on March 14^th 2014. The mandate is to go into affect 2017.

The first 13 exemptions were created for people who are homeless, who filed for bankruptcy, who experienced a fire and who dealt with other financial emergencies. These exemptions covered millions of people.

Waiver 14 reads as follows:

An individual has been notified that his or her plan will not be renewed and

believes that the available plan options are more expensive than the plan that was not renewed."

Patients only have to claim they believe that the available plans are too expensive for them to buy.

The wavier is not well known. It is advertised on purpose by the Obama administration. It has not been picked up by the traditional mainstream media.

The then Health and Human Services Secretary Kathleen Sebelius defended the "hardship exemptions" and blamed them on Republican governors who did not expand Medicaid.

This attack is the typical progressive attack against the enemy and is meant to act as a diversion.

"It's been really aimed at people who could not afford coverage one way or the other," she said. She noted that the list includes people who live in states that did not expand eligibility for Medicaid.”

Kathleen Sibelius statement is meaningless. The list of states include those states that expanded Medicaid.

To date the federal government has not processed 3 million applications. Republicans have not called out the Obama administration on the unprocessed applications.

Holtz-Eakin, former director of the Congressional Budget Office under the George W. Bush administration, said,

“That for someone to qualify for waiver 14, they could simply say they couldn't get through on HealthCare.gov or plans were too expensive or a special condition they have didn't appear to be covered.”

Adverse selection of patients is certain to be the result in the independent insurance market. Only people with preexisting illnesses or people making less than $50,000 a year have bought the health insurance exchange insurance. The later group receives a large subsidies.

The problem will be compounded whenever small business waivers expire.

In any event all American will experience double-digit increases in healthcare insurance premiums as a result of Obamacare and its unlawful waivers.

All Americans are paying higher taxes for Obamacare since 2010. Taxes to fund Obamacare have been increasing yearly for the last 4 years.

Obamacare was supposed to be fully implement in 2014. It has been minimally implemented so far.

Obamacare taxes have been implemented. Therefore, increased taxes should produce a decrease in the budget deficit.

Nevertheless the budget deficit has continued to increase yearly by over $1 trillion dollars a year.

There is something wrong with the math unless Obamacare is generating bureaucratic waste.

A reader wrote

"Good judgment comes from experience and a lot of that comes from bad judgment"

Will Rogers

A reader sent me this list of increased taxes starting January 1,2014

In case you didn't notice
>
>
> Here is what happened on
> January 1, 2014:
>
>
>
> Top Medicare tax went
> from 1.45% to 2.35%
>
> Top Income tax bracket
> went from 35% to 39.6%
>
> Top Income payroll tax
> went from 37.4% to 52.2%
>
> Capital Gains tax went
> from 15% to 28%
>
> Dividends tax went from
> 15% to 39.6%
>
> Estate tax went from 0%
> to 55%
>
> Remember this fact:
> These taxes were all passed only with democrat votes,
> no republicans voted for these taxes.
>
>
> These taxes were all
> passed under the Affordable Care Act, aka Obamacare.
>
>

Is Obamacare worth the increase in taxes?

What are we getting for the increase in taxes?

What it is doing to the economy?

Why are Republicans afraid to say anything? Who should say something?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Obamacare Application Data Is Wrong For 2 Million Applicants Receiving Subsidies

August 20, 2014

inDisinformation and the healthcare system, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The second really big deal is the fact that over two million people lied on their application for Obamacare through the federal health insurance web site www.healthcare.gov.

We do not know how many of the 1.2 million who received insurance through state exchanges lied.

Unfortunately, the Obama administration throws so many numbers out of context at the American public that it is impossible to follow the true facts and subsequent disastrous consequences.

Let us look at the numbers slowly. President Obama was claimed that 8 million people signed up for Obamacare by March 31,2014.

President Obama and the healthcare insurance industry were terrified about adverse selection by the people signing up. Both worked hard to get young people with no preexisting illnesses to sign up so the insurance premiums would not increase next year.

Basketball, baseball and football stars were recruited to advertise Obamacare’s benefits on TV and encourage enrollment.

The population, in the uninsured individual insurance market, was only 14 million out of a population of 350 million people. Three hundred and thirty six million received waivers from Obamacare for one reason or another.

What will happen when 336 million must participate in Obamacare? The percentage of participants in the population will be tiny if the individual market is a guide.

Seven million of the fourteen million lost their healthcare insurance because of Obamacare’s requirements. Eight million signed up for healthcare insurance under Obamacare. This represents an increase of only one million and not and increase of eight million.

Of the 8 million, 85% or 6.8 million people applied and received government subsides. These subsidies were supposed to be tax credits.

The www.healthcare.gov did not have a functional back end to the website to check if these people were lying about their income, job status, and even citizenship.

If people intentionally misstated information, they were warned they could be charged with perjury. I assume President Obama will waive that charge.

Only citizens and legal immigrants are eligible under the law for subsidized coverage.

The government signed up about 5.4 million people, while state-run websites signed up another 2.6 million.

Only 1.2 million of those were not eligible for subsidies.

Are these 1.2 million the part of the 7 million who lost their insurance because of Obamacare? Are the 8 million the people who did not have insurance before Obamacare?

Both are important questions that we have not gotten answers to.

My guess is the people who signed up were people who could not get insurance because of preexisting conditions or people who could not afford insurance in the individual market.

In either case the will be adverse selection and increased healthcare utilization. Insurance premiums will increase for everyone in the health insurance exchanges.

“Some 80% of all those who have enrolled in plans nationwide, according to federal statistics released today, have chosen a silver plan, meaning deductibles of $2,000 for singles and $4,000 for families, or gold or platinum plans, which have no deductibles. “

“Only 18% have opted for bronze plans, which offer lower premiums, balanced by deductibles of $4,500 for singles/$9,000 for families.”

Many consumers can hardly afford the bronze plans with subsidies much less the high deductibles. Those consumers will be forced drop out of Obamacare.

“The Associated Press reports that of the 5.4 million people who signed up for health insurance through the federal marketplace 2 million submitted information that does not match up with federal data.”

The discrepancies could affect their subsidy adversely. Applications were accepted on boy scouts’ honor. The subsidies were determined on the basis of the information on the application. These people will owe the government the difference plus a penalty. They are also liable for perjury.

The back end of www.Healthcare.gov is still incomplete.

“Serco, a foreign contractor already under investigation, was awarded a $1.2 billion contract to process Obamacare’s paper applications, and the AP reports they will be tasked with resolving these application issues. “

Despite having had three years and more than $600 million to work with the federal governmentand its chosen contractor could not build a functional website. It cost an additional $200 million dollars and four months to get the front end to work.

The $600 million to build www.healthcare.gov was more than it cost Apple to develop the iPhone. Apple is an American company with American jobs.

It should be recalled that another foreign contractor (CGI of Canada) got the first contract. Michelle Obama’s Princeton classmate happened to be an executive,

“Serco is a foreign company riddled with a history of transgressions. The most recent transgression was that Obamacare contractors were literally being paid to do nothing.”

The White House has attempted to dispel concern about the website being dysfunctional.

However, the report of over 2 million falsified applications has reignited the questions of government incompetence and misleading information about the dysfunctional website as the enrollment period approached.

“As Americans for Prosperity reported in the Washington Times early last month, “the website was originally intended to function automatically, calculating premium subsidies, making government payments, and tracking enrollment information that would affect future costs.”

“ But the interim system currently in place (that resulted in the newly revealed data discrepancies) is “pretty much a spreadsheet and some informed estimates,” according to Politico.

Compounding www.healthcare.gov problems are a Roll Call report that almost 3 million Medicaid enrollees have not yet had their applications processed.

These issues are all separate issues from Obamacare’s cancelled healthcare plans, physicians opting out or retiring, and the scandal with the Veterans’ Affairs health care system.

In reality all the issues are one with the Obama administration making it clear that a government run bureaucratic healthcare system is a nightmare that will destroy the healthcare system in America.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Three Very Big Deals

August 17, 2014

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

Three very big deals occurred with to Obamacare the last few months that have received very little traditional media coverage. There has been sparse traditional media coverage of the significance of these three issues to the future of Obamacare.

It looks like the Obama administration is losing its ability to freeze, marginalize and scandalize its opposition to gain public approval of President Obama’s agenda.

Obamacare and all of its lawless modifications are negatively affecting all the stakeholders who thought they would be better off with Obamacare.

This includes the indigent, middle class workers, the upper class and all the businesses involved in healthcare.

The three issues are:

1. The D.C. appeals court overturns subsidies given by federal health insurance exchanges.

2. Obamacare application data is wrong for 2 million applicants receiving subsidies.

3. The Obama Administration adds major exemptions to the Obamacare individual mandate.

I will cover each issue in separate blogs. What is common to the three issues is that the Obama administration changes the law passed by congress at its whim without the consent of congress.

The D.C. Appeals Court Overturns Subsidies From Federal Health Insurance Exchange.

A three judge panel of the powerful U.S. Court of Appeals in Washington D.C. ruled that subsidies may not be offered in the federal health insurance exchanges. The Department of Justice immediately announced it will challenge an appeals court ruling that strikes Obamacare subsidies for millions of americans using HealthCare.gov, the federal health insurance exchange.

The subsidies are critical to the success of Obamacare. Otherwise, Obamacare premiums are unaffordable to people making less than $50,000 per year. There is some debate as to whether the premiums are affordable to people making more than $50,000 per year.

Obamacare was written to encourage states to set up health insurance exchanges. Many states refused to set up health insurance exchanges. The state governors and congress realized the economic and bureaucratic burden was going to be overwhelming even if the government covers 90% of the costs.

Additionally, states that opted out fear the federal government would have too much control over the states’ rights.

As soon as the Obama administration saw this coming in 2010 after the law was passed, it had the IRS issue a ruling that contradicted the law’s intent.

The IRS rule allows the federal health insurance exchanges to provide subsidies to people buying insurance through the federal health insurance exchanges.

The intent of the law passed bywas that only states could provide tax credits. I have not yet been able to figure out how tax credits can mean tax subsidies.

“ ACA Section 1401 provides that eligible taxpayers may receive income tax credits for the purchase of insurance “through an Exchange established by the State under Section 1311.”

"Section 1311 calls upon states to establish health insurance exchanges. It does not provide for the federal government to create health care exchanges."

"Rather, a separate provision of the act, Section 1321, provides that if a state does not “elect” to create an exchange that meets federal requirements, the federal government shall then “establish and operate” an exchange."

"Thus, under a plain reading of the text, the ACA only provides for tax credits for state-run exchanges, and if states fail to create exchanges, there are no tax credits for insurance bought on a federally run exchange.”

The IRS’s ruling provides that eligible taxpayers may receive tax credits for the purchase of qualifying health insurance plans established by states under Section 1311 or by the federal government under Section 1321. The only problem is that this is not consistent with the actual text of the statute passed by congress or the intent of the law.

"Section 1311 expressly requires that an authorized Exchange must be “established by a State.” Section 1304(d) also expressly defines “state” as “each of the 50 States and the District of Columbia.” Later amendments to the PPACA also provide that Exchanges created by territories are to be treated as the equivalent of state-run Exchanges, but there is no such language concerning federally run health insurance exchanges.

There are all sorts of legal arguments on both sides of the issue. It will be up to the Supreme Court to decide.

However, Jonathan Gruber, MIT economist and Obamacare architect has repeat over and over again that“states that set up their own health care exchanges would make their residents eligible for subsidies.’”

Jon Gruber spent a couple of years barnstorming the country warning states that they had to set up their own exchanges, and that failure to do so would cut their residents out of the subsidy pool. This was the intent of Obamacare as stated by the architect of the law.

In a speech Jon Gruber gave in 2012, he delivered both a promise and a threat.

"In the law, it says if the states don't provide them, the federal backstop will. The federal government has been sort of slow in putting out its backstop, I think partly because they want to sort of squeeze the states to do it.”

“ I think what's important to remember politically about this, is if you're a state and you don't set up an exchange, that means your citizens don't get their tax credits.”

“But your citizens still pay the taxes that support this bill. So you're essentially saying to your citizens, you're going to pay all the taxes to help all the other states in the country.”

“ I hope that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these Exchanges, and that they'll do it.”

http://youtu.be/LbMmWhfZyEI

Government supplied subsidies are vital to the survival of Obamacare and its accompanying bureaucratic waste.

It should be pretty clear what the intent of the law is. President Obama has been brazen in changing and enforcing laws to fit his agenda.

It is obvious he is trying to do the same in this case with the IRS ruling that many believe is illegally modifying the intention of the law without the consent of congress.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Holy Cow!

August 3, 2014

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System

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Stanley Feld M.D., FACP,MACE

I cannot believe it.

President Obama continues to deceive the America public about his "Accountable Care Act" (ACA or Obamacare). Our elected officials continue to do nothing to stop him. Unelected administrative officials are making spending decisions that neither congress nor the public is aware of until after the fact. A case in point is www.healthcare.gov.

William T. Woods, a senior official at the Government Accountability Office in testimony prepared for a House hearing on Thursday, warned of “significant risks in the next open enrollment period, which begins Nov. 15.”

He said, “the marketplace and its website,HealthCare.gov, were over budget and behind schedule because of “new and changing requirements” imposed by administration officials.”

This is in direct contrast to what Sylvia Mathews Burwell, the secretary of Health and Human Services told the congress and the American people a few weeks ago. She said the problems were mostly solved.

The American people have still not gotten an accurate accounting of how many people have signed up legally through the health exchanges. My best estimate it is less than 3 million and not 8 million.

About 80% are getting subsidies by signing up on the federal government health insurance exchanges. It is also against the law according to the definition for subsidy eligibility as written the law. President Obama said the administration did did not mean what the law says.

Let us concentrate on the costs of the website until this point. Initially it was supposed to cost $56 million dollars.

The cost rose from $56 million dollars to $209 million dollars from September 2011 to February 2014. The Obama administration launched the disastrous web site in October 2013 without having a quality assurance surveillance plan to monitor the work of the main contractor CGI. A principle in CGI was a college buddy of Michelle Obama. A linkage of their friendship and the contract with CGI has never been proven.

On October 1, 2013 the disaster of the web site became apparent. There was confusion within the Obama administration about who had the authority to approve contractor request to expend funds for additional work.

Mr. Woods said,“In 40 instances, the staff members of the federal exchange inappropriately authorized contractors to expend funds, totaling over $30 million.”

Mr. Wood also said, “As the Oct. 1 deadline approached, federal officials identified significant performance problems in computer systems developed by CGI Federal, but “took only limited steps to hold the contractor accountable.”

The administration withheld only $267,000, or 2 percent of CGI’s $12.5 million fee. There is no indication of the profit CGI made on the work done that cost the government $209 million dollars.

It gets more complicated and bizarre.

In January 2014 the Center for Medicare and Medicaid Services (CMS) awarded a contract valued at $91 million to Accenture Federal Services to continue work on the project.

“Accenture Federal Services costs have ballooned to more than $175 million and the marketplace is still unable to perform essential computer functions needed to pay insurers and update information on consumers.”

The question that must be asked is what in the world is going on?

James E. McAvoy, a spokesman for Accenture said that another “task order” had increased the total to $190 million.

Accenture said, “It is helping the government develop an insurance exchange for small businesses, is expanding the federal exchange to serve additional states and is adding new features to verify the income of people seeking federal subsidies.”

The Government Accountability Office, an investigative arm of Congress, said that through March of this year the administration had made formal commitments to spend $840 million on the federal health insurance exchange and marketplace.

The $840 million dollars is a long way from the original $56 million dollar in the original Obamacare budget.

The plot thickens.

Andrew M. Slavitt the No. 2 official at the Centers for Medicare and Medicaid Services told Congress that the agency was changing requirements for its contracts to expand the scope of work that must be done.

Mr. Slavitt said that the administration was making improvements in the federal health insurance exchange’s software , but that the second round of open enrollment, starting in November 2014, would not be perfect. “There will certainly be bumps,” he testified at a House hearing.

Mr. Slavitt avoided answering how much the website should cost.

Mr. Slavitt said, “That’s a really good question.” He did not specify the proper cost, but he said the nation was getting invaluable results, including new insurance coverage for millions of people.

Mr. Slavitt, who joined the government three weeks ago. A congressional panel has questioned his credibility.

Mr. Andrew Slavitt, a former executive at Optum, the technology company tasked with “saving” HealthCare.gov,ran into sharp questions from a House panel about a potential conflict of interest in his new role.

Rep. Morgan Griffith, R-Va., pressed Mr. Slavitt on his previous job at OptumInsight/QSSI. Optum, and its parent company, UnitedHealth Group. UnitedHealth Group, one of the nation’s largest insurers, offers health plans on the federal health insurance exchanges. Optum had a large role in the creation of HealthCare.gov and built the data hub, The data hub is still not working properly.

The Obama administration granted an ethics waiver to Mr. Slavitt so that he could participate in decisions affecting his former employer, Optum, and its parent company, the UnitedHealth Group.

Optum is the tech firm the Department of Health and Human Services picked in October 2013 to straighten out HealthCare.gov. It was awarded an $84.5 million contract with HHS’s Centers for Medicare and Medicaid Services in January 2012 to build the part of HealthCare.gov known as the federal data hub.

The purpose of the data hub is to connect multiple government agencies to streamline verification of crucial consumer information—including Social Security number and immigration status when Americans log into the federal and state exchanges and apply for Obamacare subsidies.

Doesn’t this sound fishy? Can we trust the Obama administration to decide what treatment American should get and what treatment Americans cannot get access to?

It looks like the VA all over again?

Let the buyers beware!

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Another President Obama Lie

June 11, 2014

inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

At the moment, ideology and political philosophy stands in the way of Repairing the Healthcare System.

President Obama believes in central control of the healthcare system. Central control of other healthcare systems has not worked to control healthcare costs while maintaining quality of care. The only possible exception is Switzerland’s healthcare system.

Each province in Canada spends at least 50% of its GDP on healthcare according to the Frazier Report. The access to care is less than ideal. Healthcare spending is unsustainable in Canada

England is slowly switching to a private healthcare system.

Obamacare has already demonstrated its inefficiencies and lack of cost control even though most of the population has received waivers from Obamacare for at least one year.

The trajectory of failure is not going to change until President Obama is out of office and the system changes to put the consumers in control of their health and healthcare dollars rather than having the government in control.

President Obama declared in 2010;

“Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the regulations, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.”

Unfortunately, for Americans, President Obama tells us what we want to hear in a very seductive way and then does the opposite.

President Obama is always calling for someone to provide a new idea in order to fix Obamacare. His promise to the public is a good idea. However it is not reflected in the Obamacare regulations.

What is the meaning of Medical Loss Ratio?

The definition of medical loss ratio is the incurred claims received divided by premiums collected.

The healthcare insurance industry negotiated all the rules it wanted from President Obama and Kathleen Sebelius in defining incurred claims in the new Obamacare regulations. The rules contradict Mr. Obama’s promise to the American public.

The healthcare insurance industry is supposed to spend 85% of the premiums collected on direct medical care costs.

The remaining 15% of the premiums is for the insurance industry’s expenses and profit.

The healthcare insurance industry claims it is lucky if it clears 3% profit under the Obamacare rules.

In order to encourage the healthcare industry to participate in Obamacare, President Obama pledged that the government would subsidize the healthcare insurance industry for any shortfall in profit.

A self-insured employer sponsored healthcare plan outsources the administrative services to the lowest bidding healthcare insurance company. The government outsources Medicare, Medicaid and Tricare (VA insurance) to the lowest bidding healthcare insurance company.

The Obama administration has included most of the healthcare insurance industry’s requests in the incurred claims (direct patient care) formula that is used to calculate the medical loss ratio.

Inflating the incurred claims decreases the amount of money spent on direct patient care in order to maintain an eighty-five percent (85%) medical loss ratio.

If the incurred claims costs go up the medical loss ratio goes down. The potential increase in the medical loss ratio is the justification used by the insurance industries to increase premiums.

Obamacare requires insuring with a pre-existing condition. Insuring everyone with a pre-existing condition increases the insurance risk. Hence Americans experience double-digit increases in healthcare of insurance premiums.

The expenses the industry wanted included:

1. The cost of verifying the credentials of doctors in its networks.

2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.

3. The cost of programs that keep people who have diabetes out of emergency rooms.

4. The sales commissions paid to insurance agents.

5. Taxes paid on investments.

6. Taxes paid on premium income.

7. Unpaid claim reserves associated with claims incurred.

8. Change in contract reserves.

9. Claims-related portion of reserves for contingent benefit.

10. Lawsuits experience-rated refunds (exclude rebates based on issuers MLR.

All these expenses are administrative expenses in my view. It is questionable that these should be included in direct patient care (incurred claims).

These expenses also increase a healthcare insurance company’s profit. Each incurred cost has a built in 15-20% profit.

As these expenses continue to be are permitted as incurred claims (direct medical care expenses), the resources available for direct medical care decrease from eighty-five cents to sixty cents on every premium-collected dollar.

At the same time people complain about the grotesque profits and salaries of those in the healthcare insurance industry.

Obamacare, contrary to President Obama’s promise, did nothing to solve this abuse.

It is almost as bad as the promise," If you like your doctor you can keep your doctor. If you like your insurance plan you can keep your insurance plan.

The closest I could get to transparency and the distribution of one healthcare dollar to direct medical care is the following.

Fifteen cents goes to the doctor and twenty-five cents to the hospital. The remaining sixty cents goes to the healthcare insurance companies.

The definition of direct medical care according to Obamacare is:

Definition of Medical Claims By Obamacare

Incurred claims = direct claims incurred in MLR reporting year + unpaid claim reserves associated with claims incurred + change in contract reserves + claims-related portion of reserves for contingent benefits and lawsuits +

experience-rated refunds (exclude rebates based on issuers MLR

Medical Claims and Quality Improvement Expenditures

As illustrated in Figure 1, increases in either medical claims or quality improvement expenditures (holding other factors constant) will increase

the MLR and reduce the likelihood of premium rebates to policyholders. Conversely, reductions in medical claims and/or quality improvement

expenditures (holding other factors constant) will decrease the MLR and increase the likelihood that insurers will have to provide rebates to policyholders.

Medigap plans (Medicare Part F) have separate medical loss ratio requirements. The healthcare insurance industry has to meet a 65% level for individuals and a 75% level for groups. It means that for every dollar in premium the individual has 65 cents minus incurred expenses coverage for direct medical care and for groups 75 cents minus incurred expenses.

Medigap plans, which are supplemental policies that Medicare beneficiaries can purchase to fill gaps in Medicare coverage, are not covered by the ACA MLR provisions.

Medigap plans are subject to their own separate MLR requirements, found in Title 18 of the Social Security Act; the MLR requirements are 65% in the individual marketplace and 75% in the group market.

Finally, the ACA’s MLR requirements do not apply to long-term care, dental, vision or retiree healthcare plans.

President Obama promised to fix these problems. He said,

He didn’t. He won’t.

He knows the problem. Fix it.

If he did he would save Obamacare and tax payers a great deal of money.

I am confident this suggestion will be ignored and at election time more false promises will be made.

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

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April Fools Day

April 6, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Universal Healthcare

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Stanley Feld M.D.,FACP, MACE

On Tuesday April 1,2014 President Obama did a victory lap for Obamacare. April 1^st is April Fools Day.

He stopped calling it the Affordable Care Act and once again called it “Obamacare”.

He announced that 7.1 million American have signed up for Obamacare on the Health Insurance Exchange web site healthcare.gov.

Since October the Obama administration has avoided providing the number of enrollees in Obamacare and its demographic makeup. The administration claimed they did not have the exact numbers.

The public viewed this as the administration’s avoidance of the number of enrollees who have purchased insurance because the numbers were so pitiful.

On April Fools Day one day after enrollment ended, President Obama announced the exact number that has signed up to the exact decimal point. It was 7.1 million.

Is that not strange?

I am publishing President Obama’s entire press conference. It is a must watch.

His words and body language is a site to behold. The audience's body language in also very telling.

http://youtu.be/hmONeJ_j8EU

President Obama is extremely charming. The speech is littered with half-truths, misinformation and lies.

He calls all his critics liars just as Harry Reid did. The president doesn’t point out where they have lied just as Harry Reid did not.

This is a Saul Alinsky tactic.

He is so charming in his delivery that the audience wants to believe him despite the dysinformation.

He even threated the media. He warned them not to headline news of these glitches and problems just because there are some glitches and bad events ahead with Obamacare.

The most transparent half-truth was when he said “we haven’t seen any death panels yet as our opponents predicted.”

He right correct. He postponed initiating his “death panels”, the Independent Physicians Advisory Board (IPAB) himself until after the November 2014 elections.

His message is the Republicans are liars. The Democrats in vulnerable states can run on Obamacare because Obamacare is great for the people. He gave three examples to prove his point. Beware of the man with three cases.

He did not discuss the Congressional Budget Office’s view of Obamacare’s effect on the economy.

In Appendix C of the rather dense document, the CBO concludes that various provisions of Obamacare will “reduce the total number of hours worked,” “will cause a reduction…in aggregate labor compensation,” and most dramatically will result in “a decline in the number of full-time equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024” as compared to employment growth in the absence of the Affordable Care Act.

The Obama administration called the CBO report a lie. It measured the wrong things.

The main cause of this trend is the work-discouraging combination of taxes and subsidies for lower-income Americans in Obamacare. In other words, the implied tax and subsidy penalties for success are so high that it won’t be worth a lower-income person’s effort to try to climb up the income ladder.

There goes the American dream. A dream that has driven America to the success it has achieved.

And while the CBO does suggest that demand for labor will not decline substantially due to the costs imposed by Obamacare, they do say that costs “will be borne primarily by workers in the form of reduced wages or other compensation.” So even the White House’s good news is bad news for working Americans.

Here is what he failed to discuss.

How many of those who signed up have actually paid the premium and purchased the healthcare insurance?

How many of those 7.1 million included the 6.6 million who lost insurance because of Obamacare?

How many were young adults signed up?

How many of the young and uninsured enrolled and paid their first premium?

How many of the older adults signing up had preexisting illness?

What is going to happen to the additional millions who are going to lose their healthcare insurance when their work hours are reduced below 30 hours per week?

How will they afford Obamacare insurance?

How will the McDonald waiver insurance workers afford insurance when the waivers expire?

What will happen to unions when the workers realize they are losing $5 dollar an hour in pay because of Obamacare?

If 7.1 billion people now have healthcare insurance what does it cover?

The are hundreds of examples of cancer patients losing their doctors, buying health insurance care insurance and discovering that their cancer therapy is not covered?

How many of the previously 48 million uninsured now have become insured?

The entire idea of Obamacare is to insure the uninsured.

The Rand Corporation has completed a secretive survey for the Obama administration. The goal was to estimate how many uninsured received healthcare insurance.

Numbers from a RAND Corporation study that has been kept under wraps suggest that barely 858,000 previously uninsured Americans – nowhere near 7.1 million – have paid for new policies and joined the ranks of the insured by Monday night March 31,2014.

Isn’t the price America has paid so far for overturning, uprooting, and revolutionizing 18% of the economy and the medical care ecosystem staggering for only insuring 875,000 of the previously uninsured.

Someone should add up the cost in newly levied taxes, the effect on middle class income and standard of living, the cost of the massive bureaucracy, and the cost regulations as well as the cost of economic growth that Obamacare has had on the American economy.

The bizarre thing is Obamacare does not solve the issue of the dysfunction in the healthcare system. The ever increasing price of healthcare is the result of the misalignment of all the stakeholders' incentives.

The misalignment has increased with Obamacare.

A new business plan that aligns all the stakeholders incentives which is focused on consumers must be developed.

Obamacare does not bend the cost curve no matter how President Obama has lies about it.

President Obama has had no interest in the cost of Obamacare to America. His goal is complete central control over the healthcare system.

His April Fools Day press conference is no joke!

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

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