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Let’s Do The Numbers : Another Obama Trick

March 19, 2015

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

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Stanley Feld M.D.,FACP,MACE

Have the increased Obamacare taxes added enough value to the healthcare system to be worth the costs?

The answer is no.

Are the increased taxes becoming painful yet?

The answer is yes.

The yearly cost of Obamacare has not been transparent. There have been multiple delays in the implementation of Obamacare.

Favored businesses and unions have received waivers and exemptions from the laws required coverage. All the while taxes have increased and less than 10 million people have received healthcare coverage from the healthcare insurance exchanges. Eighty-five percent of those people enrolled are receiving federal subsidies.

No one has explained how a tax credit becomes a federal subsidy.

The public has no idea what the costs of Obamacare are or will be in the future. The CBO has revised its estimates several times.

Are all the Obamacare pronouncements confusing?

Yes. I believe they are intentionally confusing.

All the stakeholders are dissatisfied. Neither President Obama nor his administration is listening to the primary stakeholder (patients).

Why are there so many waivers and exemptions being handed out by the Obama administration? I believe it is because President Obama is listening to his political base.

He is delaying the implementation of his agenda so his goal of socialized medicine is not obvious to all Americans.

President Obama and his administration have mislead us about the exact number of enrollees since the very beginning of the first enrollment period, October 1,2013.

The American public was mislead about ,

The disastrous website development, reason for website crashes and cost of website development.
The exact number of enrollees the first year. (9.5 million correct to 8 million and then down to 6.8 million)
The resulting further correction by a decrease in 800,000 more people losing insurance because of discovered ineligibility for subsidies.
Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
The change in the start of enrollment from October 1,2014 to November 15^th to avoid discussion of enrollment around the time of the November 2014 elections.
Extending the 2014 enrollment three months.
Extending enrollment for 2015 for one to three months.
Finally in 2015 announcing the back end of the website sending information to the IRS was still not complete.
Rehiring CGI the same Canadian company that built the disastrous healthcare.gov to fix the back end of the website.
Discovering that 1.2 million were counted that should not have been because they got dental insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
Eight hundred thousand (800,000) enrollees lost their subsidy because they lied on their application
Announcing that the group market Obamacare enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

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

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

However, only ten million people have Obamacare insurance. Eighty five percent of those on Obamacare are receiving subsidies and still cannot afford the deductibles.

The rest of the enrollees have a pre-existing illness. They cannot find private insurance to buy. What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?

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

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

14 million lost their healthcare insurance on the individual market. 10 million gained insurance on the healthcare insurance exchanges.

Several states healthcare insurance exchanges have failed.

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

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

The following is President Obama’s next trick play.

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

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

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

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

The present discussion is about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

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

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

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

http://acasignups.net

There are two possible reasons for the Obama administration’s pronouncement at this time.

The first is the Republicans are about to announce its alternative plan to Obamacare. The administration’s goal would be to blunt the impact of the alternative plan by announcing the false success of Obamacare.

The second reason is to play mind games with the Supreme Court.

Justice Kennedy’s questioning at the hearing of King vs. Burwell expressed his concern for 85% of 10 million people who would loss their federal subsidy. Justice Kennedy did not address the letter of the law in his questioning.

Only the state healthcare exchanges can provide subsidies not the federal exchanges according to the written law. This is executive overreach of power granted by the constitution. President Obama should have asked congress to rewrite the law’s provision.

In an attempt to pressure the Supreme Court to vote in President Obama’s favor the administration has given the impression of confidence the Supreme Court will act in its favor.

The Obama administration has announced, a few times, that it does not have an alternative plan if the Supreme Court rules against it.

This is not true. The Obama administration has at least three alternative plans in the works.

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

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

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Wrong Is Wrong

February 18, 2015

inHealthcare Insurance Industry, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

When the Democrats were in power in one or both houses of congress, President Obama had Republicans tied up in knots. Now that Republicans are in charge of both houses of congress, President Obama still has Republicans tied up in knots. The reason is the administrations spin the story to the traditional media blaming the Republicans for everything and the media sends the spin to the American citizens.

Republicans don’t fight back effectively. As a recent example, Republicans are being afraid of being blamed for an impending Homeland Security non-funding.

Aren’t the Democrats holding up progress by filibustering? Why haven’t they made any positive suggestions to move the process along? Come on Republicans. Democrats and the traditional media would attack you for that behavior. Get smart!

Scott Walker fought back when Howard Dean (a Democratic plant and hatchet man), told Morning Joe that Scott Walker did not graduate from college and he would be unknowledgeable. Unknowledgeable is a new word invented by Howard Dean on the spot.

Scott Walker immediately replied with names of people who have been very effective without a college degree like Steve Jobs, Bill Gates and Einstein, among many others.

Howard Dean’s attack is a typical Saul Alinsky tactic.

Obamacare is a bad law. It is having a negative effect on our economy and healthcare delivery in America.

I said Obamacare would fail. It has failed so far.

President Obama has pulled lots of tricks and caused lots of delays in the implementation of the law so as not to upset too many American at one time.

He has made a lot of promises and told lots of lies to all the stakeholders to get them to support Obamacare.

It is easy to remember President Obama’s promise, “If you like your doctor you can keep your doctor. If you like your insurance policy you can keep your insurance policy.”

Another lie was “Anyone making less that 250,000 a year will not pay a dime, not a dime more in taxes.”

He has promised the insurance industry it would have more customers buying healthcare insurance. The healthcare insurance industry has not seen an increase in subscribers yet. It is betting on future consumers buying insurance that is no risk to the healthcare industry because it has a government guaranteed no risk insurance subsidy attached to it.

So far the healthcare insurance industry has seen nothing but sick people who they would not sell insurance to before Obamacare.

It has not seen a balanced insurance population. President Obama had to subsidize the insurance industry by guaranteeing their profit in order to get the industry participation. I have warned the healthcare insurance industry that this is another President Obama trick play.

He promised that healthcare insurance premiums would decrease. Families would save $2500 dollars year. The premiums have gone up $2500 a year.

In addition, healthcare insurance has increased to unaffordable levels for both the unsubsidized and subsidized Americans buying insurance through the health insurance exchanges. The deductibles are out of reach of the middle class.

Why doesn’t the Republicans expose this issue?

Only 20% of the population uses the healthcare system at any one time. As it is there are too few physicians accepting both Medicare and Medicaid.

People who can afford it have to go out of the system and pay extra for concierge physicians to have a doctor they can communicate with. Few physicians are willing to accept Medicaid reimbursement. It is hard to get an appointment with a physician.

President Obama just undermined Primary Care Physicians by letting their promised increase in reimbursement expire.

The Obama administration has delayed implementation of the law even though the law specifies an implementation timetable.

Why doesn’t the Republican Party explain this to the public?

The implementation of penalties to consumers and businesses, which are supposed to start January 1, 2015, will probably be delayed by executive order. President Obama’s Democratic base is unhappy with the penalty and that frightens Democrats in congress.

Obamacare taxes have been collected for the past four years while full implementation of the law has been constantly delayed. Some of the executive orders have been constitutional and many of the delays in implementation have been unconstitutional.

The deceptions and unconstitutional maneuvers are TNTC (too numerous to count.)

Republicans should point this out clearly for taxpayers and those people who do not earn enough to pay tax. Yet the Republican Party gives all these maneuvers a pass.

The Supreme Court will decide the King v. Burwell case in June. The law clearly states that only States with Health Insurance Exchanges can provide subsidies to qualified consumers.

The law does not provide for Federal Health Insurance Exchanges to grant subsidies to consumers buying insurance through Federal Health Insurance Exchanges. It can be done by congressional changes in the law. The Obama administration cannot change laws according to the constitution.

President Obama and his administration have ignored the law. The subsidy restriction was written into the law to encourage States to set up State Health Insurance Exchanges.

Thirty-three states felt that health insurance exchange formation was a bad deal for their state, their state deficits and the people living in the state. Those states refused to set up a state health insurance exchange.

President Obama even told the state governments he would pay the costs for three years. It still worked out to be too expensive for the states.

Two appeals courts voted in favor of the plaintiffs against the government and one voted for the government. It was a Democratic full court in one state and a judicial panel in Washington D.C that voted in favor of the plaintiff.

Congressional Republicans are convinced that the Supreme Court will rule against the government. If that happens Obamacare will collapse because 85% of the enrollees receive subsidies.

This is part of the reason Republicans are not offering an alternative to Obamacare.

Even though I believe the Obama administration is wrong in providing subsidies that are not written into a law by congress and signed by the President I would not bet on the Supreme Court’s decision.

Secondary stakeholders in the healthcare system are resilient. They have figured out how to make more money with Obamacare. It happens to be at the expense of consumers.

These secondary stakeholders are now appealing to the Supreme Court to uphold President Obama’s unconstitutional executive order.

“These business supplicants have little and often nothing to contribute on the legal merits. But they do want the Justices who might be inclined to obey the law’s text—which limits subsidies to exchanges established by states, not the 36 run by the feds—to know the woe that withdrawing the subsidies would visit on patients and especially on their corporate welfare.”

Obamacare enrollment is going poorly. Potential enrollees now understand that Obamacare is a bad deal for them.

In 2015 only 10.5 million have enrolled at the end of the enrollment period. The original projection for 2015 enrollment was 17 million enrollees. This goal was modified by the Obama administration in 2014 to 13 million and then at the start of enrollment to 10.5 million.

The public does not know how many of the 10.5 million enrollees paid their January premium and how many qualify for subsidies in 2015.

“America’s Health Insurance Plans notes that 85% of Obamacare enrollees claim subsidies, which on average fund 76% of their premiums. Cancelling this “would make health insurance less affordable—the precise result the tax credits were intended to prevent.”

The healthcare insurance is unaffordable now even that the subsidies cover 76% of the premiums. The government pays the remaining premium fee.

The deductibles are also unaffordable. Last year many paid their premiums initially and dropped out during the year because of the high deductibles. The number of people dropping out might be more that 1 million of the 8 million who supposedly enrolled and paid their first month’s premium.

The higher the enrollment the more secondary stakeholders profit. The taxpayers and patients are the losers.

A system needs to be developed that levels the playing field for patients.

These irrelevant arguments belong to the larger lobbying campaign to intimidate the High Court into disregarding the law to rescue the political project of Obamacare. If the Justices must do so, we hope they find a better reason than the health industry’s self-interest.

The lobbying groups must not influence the Supreme Court’s decision. It would be wrong.

Obamacare is bad law that has been subjected to unconstitutional executive orders.

Two wrongs do not make a right!

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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Another Day, Another Unconstitutional Change

March 5, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

The Obamacare’s new mandate delays are a bid to save Senate Democrats from losing their election in 2014.The mandate delays are also a bid to save Obamacare’s health insurance exchange.

It is strange that no one has noticed that the taxes resulting from Obamacare have not been waived.

An additional insider leaked delay in the law is coming up in the next few days. The hope of this next delay is to keep Obamacare off the minds of the voters in November 2014.

The Russian invasion of Ukraine has steered the subject away from Obamacare in the news.

President Obama has continued to spin Obamacare positively.

“President Obama predicted at the House Democratic retreat on Friday that "10 years from now, five years from now" people will look back on the Affordable Care Act as "a monumental achievement."

Unfortunately Obamacare has so many defects that it continually reminds the American people it is a disaster.

The laws mandate requires businesses with the equivalent of 50 full-time employees based on a 30-hour work week to cover 100% of their workers or else pay a fine, starting Jan. 1, 2014.

The unconstitutional change is to push the deadline to 2016. President Obama also changed the definition of the category. The new category is a business with 100 or less people rather than 50 people working in the business.

Businesses with more than 100 people employed full time will have to cover only 70% of their workers as opposed to 100% of their workers.

I think this will continue to prevent businesses from expanding and dampen the creation of jobs. Business does not trust President Obama anymore.

The only way for President Obama to alleviate labor market uncertainty would be to ask Congress to repeal the mandate permanently.

I am waiting for someone to challenge these ad hoc changes to Obamacare on constitutional grounds. No one has the guts in this election year.

I think healthcare insurance cancellations will still occur before the November 2014 elections.

Insurance companies are permitted to charge for Obamacare’s costly gold-plated "essential benefits" that all plans will have to cover. Insurance premiums will be unaffordable. The elimination of these essential benefits would reduce the cost for small business coverage.

We get it. President Obama does everything for his political benefit. He has created a political alibi of claiming to exempt some businesses so he can shift the blame to the insurers when the cancellations begin.

The public will remember that he created the insurance burden and had also permitted the healthcare insurance industry to raise the price of premiums.

The mandate delays can also serve as another President Obama trick play. As small business employers drop coverage of their employees more employees will sign up for Obamacare health insurance exchange coverage.

He might be surprised as more and more healthy people opt out of the insurance market to be self-insured.

The Obama administration is doing its best to eliminate high deductible insurance plans. However hospital systems are exempt from the Obama administration restrictions on high deductible plans. They are adopting these plans in order to gain advantage over their local competitors.

Obamacare enrollment has been abysmal through February. The administration has been very quite about the actual numbers as both Dick Durbin and President Obama are announcing that10 million have signed up.

My guest is they will be lucky if 3 million have signed up and gotten insurance coverage. All of these probably have preexisting conditions and are at high risk for high cost.

This number is far below the 6.6 million people who have lost insurance in the individual market so far because of Obamacare.

The more lies we are told the more credibility and trust is lost and the less cooperation will be forthcoming.

America is waking up.

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

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As President I Can Do Anything I Want To Do

February 19, 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

The passage of time has a tendency to help us forget promises made with regard to principles and policies.

It is clear to me that one reason President Obama beat John McCain in 2008 was because he was going to go back to the principles of the constitution.

He taught constitutional law and professed to know how important the constitutional principles are to the laws of the land as well as our economic and political freedom.

John McCain represented the past. In the past America experienced a creep toward bigger and bigger government in order to protect our homeland security.

The result was an impingement on our religious, economic and political freedom.

President Obama does not think about the constitution in the way he did when he was trying to win the hearts and minds of the American people in 2008.

http://youtu.be/UBZIM0ZFiYU

If fact, after the 2012 election victory he has shown a total disregard for the United States constitution. He has a total disregard for the balance of power.

http://youtu.be/yiOmwayoSrw

He has ignored congressional authority. He has issued executive orders changing laws at will. If congress challenges him he accuses them of being obstructionist.

President Obama has made at least 10 significant changes to Obamacare by executive order up to now. Congressmen and Supreme Court scholars have deemed that these executive orders are unconstitutional.

The Obama administration is now dowplaying his executive orders significance.

We tend to forget abuse of power episodes. I think it is worthwhile to publish all available examples at once to get a complete feel for the abuse of power.

These large numbers of executive changes were adopted to avoid Obamacare’s failure. Obamacare’s failures have persisted in spite of the unconstitutional changes.

Obamacare is basically a defective bill. It should be repealed. Small patches will not repair it.

Many of the executive orders slipped by the traditional media without discussion.

The following are President Obama’s changes by administrative action.

1. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013).

This is a subsidy congress did not have the guts to fight about. It is self-serving. Why should the congress get a special privilege that ordinary people doesn’t have?

2. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid February. (October 23, 2013).

In addition to this order, if a consumer signed up before December 31 they would have insurance January 1^St. If they signed up by January 15^th they would have insurance by February 1^st. If they signed up by February 15^th they would have coverage by March 1^st.This occurred by executive order in order to encourage enrollment. The government is unable to process these applications. Patients had not paid premiums.

3. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

This executive order was issued in July just before Independence Day. This has been typical of the Obama administration. They have released executive order when the public is emotionally preparing for a weekend or a holiday. Friday afternoon at 4.30 is a favorite time.

4. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

It looks like the administration knew that they did not have the computer systems’ back end connected to check income tax returns with the IRS two and one half months before on October 1^st. Congress was not consulted for advice.

5. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and has instead delayed the implementation of the SHOP (Small-Employer Health Option Program) exchanges until 2015. (March 11, 2013)

I did not realize that this executive order appeared so early in 2013.

6. Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment. (February 15, 2013)

This is a mind blower. The Obama Administration decided to discontinue funding the high-risk pool in order to have the money to pay for advertising for Obamacare enrollment.

This order was issued on February 15,2013. It was seven and one-half months before Obamacare enrollment was to begin.

7. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay exodus of MA plans from the program. (April 19, 2011)

Medicare Advantage was a big mistake for reasons beyond the scope of this report. Political pressure forced President Obama to take money out of one pile and apply it to the Medicare Advantage pile without consulting congress.

8. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012)

The one-year delay adds to the uncertainty of what is going to happen the following year. It makes hiring decisions harder for employers in the long run even though it helps in the short run. The net effect is it will be bad for the economy.

9. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowingmaximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

This executive order was issued in February 2013 to the advantage of the healthcare insurance industry.

10. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

The administration knew what to expect from the rollout as early as February of 2013. The executive orders changed the law in an effort to cover-up the tremendous cost overruns that will occur.

The public does not have any idea what those cost overruns will be.

It is important to see how many of these unconstitutional executive orders were released and how far back in relationship to enrollment they were ordered.

http://youtu.be/9FgFUOGFpnk

President Obama’s mind-set is expressed in the above You Tube video.

As President he “can do anything he wants to do.”

Wake up America!

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

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The Method Of Operation

October 27, 2013

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

It’s clear. President Obama
has used the same techniques to neutralize the scandals and mishaps during his
administration.

In has been the same for Benghazi,
NSA, IRS, and Fast and Furious scandals.

President Obama makes his
characteristic statement, “This is unacceptable
and we will get to the bottom of this.”

After this statement there is
never any follow-up. What has been done? Has President Obama gotten to the
bottom of it?

The public never learns who
was responsible for the debacle. No one ever gets fired and the traditional
media carries on. The public soon forgets about a non-resolved scandal.

President Obama always leads the
public to believe he had nothing to do with the scandals or the decision-making
leading to the scandals.

He is the President. He should
know. If congress investigates the scandal it gets stonewalled by the administration. The investigationg committee then is accused
of muckraking.

Somehow the traditional media
buys this story and sells it to the public. It is the journalist’s obligation to
dig into a scandal and find out the real story. It is not done.

Nothing this administration
does has been transparent. The traditional media ignores the scandals and so
does the public.

The devil is always in the
details.

The real story is the attack on individual
freedoms and choices. They are being impinged upon by the bureaucratic regulations of
big government. The traditional media should make this clear.

America does have a freedom
of information act and constitutional rights that have to be protected and not
ignored.

All the participants in the
various scandals finger point to others being responsible for the actions that
would not be approved by the people.

No one ever questions whether President Obama is
responsible for the scandals.

The same method of operation
is being put in place to explain the colossal disaster of www.healthcare.gov’s rollout.

The Obamacare web site has
many problems. It is not a simple fix as the President and his administration
has declared it to be.

President Obama claims he did
not know anything about the problems before the launch. He has promised to get
to the bottom of this.

He is finger pointing to
everyone except himself and his administration.

If the Obama administration
did not know about the impending failure it is either stupid, or irresponsible
or both.

President Obama is not stupid. He is cunning.

These are President Obama’s remarks in the
Rose Garden of the White House last week.

“Shortly
before the president’s appearance, White House officials let it be known that the “president will directly address the technical
problems with HealthCare.gov – troubles he and his team find unacceptable.” But
in that Rose Garden appearance, the president did not explain what the
technical problems with HealthCare.gov were, though he did acknowledge their existence and stated “there is no excuse” for them.

He then promised he would recruit the best
information technology talent in the country to come to the rescue and fix the
problems.

President Obama happened to hire one of Michelle
Obama classmates at Princeton in a no-bid contract to build the web site. The
administration paid $634 million taxpayer dollars to Michelle Obama’s friend’s
company and got a disaster.

"Toni
Townes-Whitley, Princeton class of ’85, is senior vice president
at CGI Federal, which earned the no-bid contract to
build the $678 million Obamacare enrollment website at Healthcare.gov. CGI
Federal is the U.S. arm of a Canadian company.

"Townes-Whitley
and her Princeton classmate Michelle Obama are both members of the Association of Black Princeton Alumni."

The Obama administration also awarded CGI
another no-bid contract for 2 billion dollars to clean up from the Sandy
Hurricane.

Mr.
Nelson chair
of Housing Trust Fund Corporation presented that the State
received a $1.7 billion allocation in CDBG Disaster Recovery aid from HUD to
aid impacted businesses and residences.

The
corporation requires immediate access to consultant services to assist in policy and
procedure development, training, surge capacity, and call center assistance,
and stated that CGI Federal Inc. could provide such services.

The
resolution was passed and scheduled to “take effect immediately.”

Nearly a
year after the devastating storm, a majority of the 24,000 families that have
requested monetary assistance have yet to receive a penny from the federal aid
package.”

Does anyone think something funny going on at
taxpayers’ expense?

Shouldn’t President Obama have hired the best
minds in the country to build the web site to begin with?

Do you
remember this famous statement?

http://nyti.ms/18ThbbJ

Ezra Pound
is a big fan of President Obama and Obamacare. What happened? Did he change his
mind?

http://www.youtube.com/watch?v=AQxYY2dyChY&feature=player_detailpage

Uwe Reinhardt is an economics professor
Princeton. He gave
President Obama an F on his mid-term grade on Obamacare.

“With proper management and more energetic work earlier
on, and untainted by the political desiderata reported to have affected the architecture of
HealthCare.gov, that Web site’s management team should have been able to
achieve the same success. It did not, hence the midterm grade F.”

A key discussion being avoided in the
mainstream media is whether President knew about the impending disaster. I suspect
he did.

It was one of the reasons he gave the group
healthcare insurance holders a one-year waiver. Parenthetically, he is not
seeking the advice or consent of the congress. This is probably
unconstitutional.

The group healthcare insurance market represents
the largest percentage of people insured. The individual insurance market represents
a relatively small percentage of the total insured population. The number of
people affected cannot make a big enough stink to be noticed by the traditional
media.

If the group insurance market were included in
the rollout, the community uproar would be too great for the Obama administration
to ignore or pivot from.

The public is already hearing the pivot from
President Obama and Kathleen Sibelius. They claim the past is the past. We must
ignore the past and go forward to fix the problem.

It sounds like the same story Hillary Clinton
told congress about Benghazi when she scolded a congressman during her Benghazi
testimony about Ambassador Stevens death. “He
is dead. Let us go on and deal with the problem.”

This method of operation is going to back fire
on President Obama for two reasons.

1. Americans are finally recognizing the Obama
administration’s methods of operation. It is to deflect with half-truths,
deceive and pivot. The public is getting angry.

2. There are an increasing number of people
who have lost their job, their healthcare insurance and the doctors. In the last
week 650,000 people lost healthcare insurance coverage they liked.

This is because of the exclusive regulatory
control the Democrats gave Kathleen Sibelius in passing Obamacare.

Not one single Republican voted for the
Affordable Care Act (Obamacare).

The preparations for the implementation of
Obamacare for the group healthcare insurance market through health insurance
exchanges and www.healthcare.gov have unleashed gigantic outcries from both the
young and the middle-aged middle class.

The outrage is not over yet.

President Obama said he did not anticipate
that so many corporations would reduce insuring so many of their workers.

President Obama has discovered an obviously
scapegoat.

The “glitch” is not
Obamacare fault. It is the big bad corporations that are trying to make a
profit.

Wait a minute! Isn’t that the American way?
You build a business to try to make a profit within the rules.

The 40,000 new Kathleen Sibelius healthcare
regulations are preventing them from making a profit while providing healthcare
insurance. They want to provide affordable healthcare coverage.

The only way corporations can make a profit is
by dropping healthcare insurance of their employees.

Maybe driving people into the health insurance
exchange was President Obama’s goal in the first place. Remember Barney Frank
and John Kerry’s dismay about passing a bill without a public option. President
Obama response was don’t worry.

Well, we have an expensive public option that
doesn’t work. Who is going to pay for it?

The
middle class is going to pay for it with increased healthcare insurance
payments and increased taxes.

The
cost of insurance on the health insurance exchange is high unless one qualifies
for a government subsidy. I have previously explained the dynamics involved in the
cost of healthcare insurance when a person receives a government subsidy.

Young healthy people will not buy insurance.
With the present computer programs the government will not know who qualifies
for a subsidy or be able to identify people will should be penalized.

A key to a business’ survival is to adjust to
adverse circumstance as long as the business has the freedom to adjust.

Watch out for the freedom to adjust to
anything.

Watch out seniors. Medicare is next.

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

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Healthcare Policy in The Post Truth Era

January 4, 2020

inUncategorized

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Healthcare Policy in The Post Truth Era

Stanley Feld M.D.,FACP, MACE

The government has been deficient in trying to do anything to Repair the Healthcare System.

Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress. His reason was feeble and politically naïve.

John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.

Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.

I believe the Trump administration has the right idea.

President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.

We are living in a Post-Truth era.

“Post-truthpolitics(also called post-factual politics^[1]and post-reality politics)^[2]is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.

Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”

https://en.wikipedia.org/wiki/Post-truth_politics

The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media. He also threatens some of the Republicans.

He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.

He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.

President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.

The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.

It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.

President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.

Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15^th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.

85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.

Open enrollment as of December 7, 2019, was awful.

http://acasignups.net/blogs/charles-gaba

There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014.

Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.

President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years. The states, which signed up for the Medicaid expansion, did not have an increase in costs.

When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.

The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.

2014

The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.

In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016

2016

Medicaid enrollment increased in 2016 to 15.3 million. The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid. The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.

The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”

2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.

2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance.

Everyone is dissatisfied.

Only 6.1 million consumers have enrolled in Obamacare for 2020.

President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.

I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!

Obamacare was destined to become unaffordable to consumers, the states and the federal government.

Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.

Most of all the taxpayers in the nation will suffer the most.

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

Copywrite 2006-2020

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Associations Are Growing

February 20, 2019

inConsumer Driven Health Care, Medicine: Healthcare System

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Stanley Feld M.D. FACP, MACE

Any initiative President Trump and his administration presents to the public is criticized as junk as soon as it is presented. It is criticized without any evidence for the criticism because it does not fit into the Democrat’s narrative of “Medicare for All.”

When the Trump administration rolled out the plan to once again let associations sell healthcare insurance plans to its individual and small businesses Democrats charged that these plans would be worthless.

The mainstream media did not publicize the Trump administration’s initiative. The fact that Obamacare has resulted in higher premiums and deductibles for small businesses and individuals has been downplayed by the mainstream media. In fact, we occasionally see articles declaring that the people like Obamacare. Only twelve million people are insured by Obamacare.

It is not true that people like Obamacare. The fact is premiums and deductible are not affordable for many on Obamacare despite the fact that 85% of the enrollees receive federal government subsidies

The fact is that individuals without healthcare insurance and who do not qualify for Medicaid need insurance. They are stuck buying Obamacare insurance because they do not have any other option. Many have had to go uninsured because they could not afford premiums and deductibles. Many have gotten jobs in our excellent economy where the large employers pay for group healthcare insurance.

The associations’ plans were proposed to provide a less expensive alternative to Obamacare by allowing workers and small businesses to pool together to buy healthcare insurance through the association.

An association, like big corporations, has the ability to negotiate with healthcare insurance companies to lower premium prices and deductible. The tax treatment is also favorable.

The association initiative started in January 2019. Early evidence suggests that the initiative is working out — at least for now.

“The administration’s alternatives, known as “association health plans,” have been covering the same benefits that Obamacare plans do, even though they are not obligated to, according to a new analysis by the industry publication Modern Healthcare and another by AssociationHealthPlans.com.”

Just like Obamacare plans, the associations’ plans are paying for prevention, visits the doctor’s office and the hospital, emergency medicine, prescription drugs, maternity care, and mental healthcare.

The plans are also covering people with pre-existing conditions, such as cancer or diabetes.

“In fact, the plans are required to cover all of the above. This is an aspect of their coverage that was not well publicized by the mainstream media, according to Kev Coleman, president of AssociationHealthPlans.com. “That’s something that was lost in the mix.”

The requirement is part of Obamacare’s regulations. Since Obamacare has not yet been repealed by Congress the rules will remain.

“Officials in the Department of Labor announced new rules for the plans in June, with some of the plans allowed for purchase beginning in September. Since then, at least 28 plans have launched in 13 states, according to Coleman’s analysis.”

Self-employed consultants working out of their homes, plumbers, and massage therapist are joining associations to have the negotiating power of large numbers of people seeking healthcare insurance.

Chambers of commerce and small cities have been forming state trade associations and their employees are joining these rapidly forming associations and enrolling in their insurance plans.

The Nebraska Farm Bureau Federation has 59,000 farmers and ranchers in their association. The associations are similar to what Jeff Bezo,Jamie Diamond and Warren Buffett are planning to do for their 700,000 employees. They plan on selling the insurance across state lines which will reduce the price even further than the 33% reduction the associations are anticipating offering.

The Obama administration had limited the formation of associations selling healthcare insurance. Associations were selling their own plans. They were inexperienced administrating them. Some associations went bankrupt. Large healthcare insurance companies have strict criteria and oversite. Self-run associations are going to take longer than.

Associations are being formed. Outside health insurers have run a few association plans since September 2018. Associations were only allowed to begin running their own plans beginning in January 2019.

Critics complain that the healthcare insurance industry is providing teaser rates to associations now. The critics claim the healthcare insurance companies will eventually raise the premiums. It is a possibility. However, with the increase contributions allowed for Medical Savings Accounts and Health Savings Accounts, association members will have a financial incentive to become a prosumer. Consumers would have incentive to become responsible for their health and healthcare dollars.

“A more recent study by the Congressional Budget Office projected that 5 million would be enrolled in the plans each year, 1 million of whom would otherwise have been uninsured. The analysis did not assess how many people on Obamacare would become uninsured.”

The Trump administration plan is truly a disruptive plan to the healthcare industry and government healthcare establishment. The Democrats are terrified because it might work much better than Obamacare and result in a total rejection of “Medicare for All.”

https://www.washingtonexaminer.com/policy/healthcare/uninsured-rate-rises-during-trumps-first-two-years-in-office

“It’s not clear from the Gallup poll whether those who are now uninsured used to have an Obamacare plan or had one through an employer or government program. Other data, from the Department of Health and Human Services, show that the number of people in Obamacare plans has dropped only slightly since Obama left office.”

The problem is that enrollment in Obamacare has not risen while the uninsured has.

The number of people on Medicaid has risen dramatically due to some states accepting Medicaid expansion. The federal government is due to stop paying over 90% of the bill for Medicaid and transfer the burden of payment to those states. Most of those state have large budget deficits that are only going to become larger.

“The highest increases in the uninsured rate were among women, people living in households with annual incomes of less than $48,000 a year, and adults under the age of 35. The young adults had an uninsured rate of more than 21 percent, a 4.8 percentage point increase from two years earlier. Among women, the uninsured rate increased from 8.9 percent in 2016 to 12.8 percent by the end of 2018.”

People cannot afford Obamacare premiums or deductibles. Associations might provide more affordable options. People working for large organizations presently have healthcare coverage.

Consumers understand how inefficient government-run programs have been. It is appropriate to let the free market give it a try. The formation of associations with appropriate regulations is certainly a free market step as opposed to the Democrats’ Obamacare that has failed. It is clear that government control of medical care is financially unsustainable.

We will see how associations and consumers responsible for healthcare dollars works out.

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

Copywrite 2006-2019

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A Thoughtful Solution To Repairing The Healthcare System

January 17, 2019

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D., FACP,MACE

President Trump might be going in the right direction. Unfortunately, the media’s hatred of him and the Democratic Party’s ideology and obstructionism might prevent him from potentially pursuing a new and sustainable direction that gives consumers the power to choose their healthcare goals. There is no reason that the government could not incentivize and subsidize the needy and less fortunate with this simple system.

I think everyone is tired of the political noise in the healthcare system. There seems to be no room for an understandable signal. However, I believe that effective technology and social networking can serve to decrease that noise to signal ratio and provide a less complex system.

President Trump is offering association directed healthcare plans, a blueprint to reduce decrease drug costs and health reimbursement arrangements to reduce the cost of healthcare insurance.

All three initiatives, if kept simple, can put control of the healthcare system in the hands of consumers.

Associations can provide healthcare plans to its members. An association health plan (AHP) can provide multiple medical insurance plan options. Smaller employers, freelancers and self-employed association members can buy healthcare insurance through the association.

President Trump’s new regulations have made it easier for the members of associations to be equal to large corporations in negotiating the purchasing for health care insurance. They can also offer multiple healthcare plans and still have a high enough enrollment to obtain deeply discounted premiums and deductibles for small businesses, freelancers and self-employed that the members cannot get on their own.

These consumers will also be able to spend pre-tax dollars on their healthcare plans.

“Access to the savings and benefit flexibility enjoyed by large group health plans is the foundation of the new association health plans. These savings can range from 8 to 18 percent for the same health insurance policy.”

“ Savings can be increased further through tactics such as self-insuring. Avalere Health, a healthcare research and consulting firm, has projected in a recent report that “premiums in the new AHPs are projected to be between $1,900 to $4,100 lower than the yearly premiums in the small group market and $8,700 to $10,800 lower than the yearly premiums in the individual market by 2022, depending on the generosity of AHP coverage offered.”

I think Jeff Bezos, Jamie Diamond and Warren Buffet’s new alliance has the right idea. They will provide deeply discounted healthcare coverage for their combined employees.

The primary advantage of offering health insurance through an association is the ability for an association to aggregate multiple employers so that the resulting health plan:

“Operates under a large group health plan rules, which can be less costly than Affordable Care Act rules for small group plans.”
“Leverages its scale of participants in negotiations with health providers in order to obtain more favorable rates for medical services.”

The country has not been given enough information nor data to understand Obamacare’s inefficiency. The media has not been helpful in letting consumers understand Obamacare’s inefficiency and deficiencies.

President Trump is interested in having associations form and compare their success to the failed structure of Obamacare. Obamacare would seize to exist.

If associations are done right they can become a simple system that consumers can easily understand and use. This was Steve Jobs vision when Apple developed the iPod, iPhone, and iPads.

The insurance product that could achieve this vision for healthcare is my Ideal Medical Savings Accounts.

Americans need the new option to create a sustainable healthcare system.

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

Copywrite 2006-2019

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