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Obamacare Is In Big Trouble!

November 18, 2015

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

There are so many parts of Obamacare that are failing it would be impossible to describe each failure in a single blog..

President Obama and his administration keeps telling the American people that Obamacare is working great. It is here to stay.

I cannot believe Americans believe him. I cannot believe he thinks Obamacare is doing great.

It could be true that everything is going great for him if he wants Obamacare to fail and cause hardship for millions of Americans.

At that point Americans would beg President Obama or another progressive president loke Hillary Clinton to institute a single party payer system.

A single party payer system has been Hillary’s dream since Hillarycare 1993. Now she is saying she wants a private insurance based system. The purpose of this statement is to neutralize (freeze) her free market system critics.

Once more America is being exposed to Hillary Clinton’s use of a typical Saul Alinsky tactic. The tactic in his “Rules for Radicals” is to freeze your opponent by stating his position as yours even if it is a lie.

Hillary wrote her senior Wellesley College thesis on Saul Alinsky and “Rules for Radicals”. She also became a big fan and good friend of his.

Hillary Clinton and President Obama know Obamacare is failing. They are just waiting for the tipping point. The tipping point will be when the American people say please help us and give us a single party payer system.

At that point we will hear the typical gee shucks, I guess we will have to try a single party payer system.

A single party payer system will be a bigger financial and patient care disaster than what we have now.

The data on the first week of applications for Obamacare’s healthcare.gov was announced to the rave reviews by the Obama administration.

Since few pay attention to the actual numbers President Obama can get away with the lie.

The CBO predicts 19 to 21 million will sign up for Obamacare for 2016. The administration estimates they are going to have 9.1 to 11 million enrollees for 2016.

The Obama administrations estimate is 30% lower than the announce 13 million enrollees in 2015. In reality only 9.7 million enrollee paid for healthcare insurance through healthcare.gov 2015. Of those 9 million only 6.5 million kept their insurance premiums current for the entire year.

The www.acasignup.net quoted the Obama administrations claim that 595,590 filled out applications to get price insurance quotes. Only 8% of the reported applicants or 47,243 paid their first month’s premium for 2016.

These numbers are not a cause for celebration unless you want to misinform the public by claiming a successful first week enrollment.

Let’s do the math. The enrollment period for 2016 is from November 1^st until December 31^st 2015 or eight and one have weeks with four major holidays, Veterans Day, Thanksgiving, Christmas and New Years.

Let us the assume all 600,000 that filled out applications will pass the application requirements and pay their assigned premium for each month. Let us also assume the average weekly application rate is 600,000 per week for the 81/2 weeks. The grand total enrollees would be 5.1 million enrollees for 2016. This is 4.5 million less paid enrollees than in 2015.

There was an attrition rate 2% a month in 2015. President Obama extended the enrollment period several times to get more people to sign up.

2015 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE PROJECTION:

2014 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE (FINAL):

It is clear that President Obama’s victory laps celebrating the success of Obamacare is unwarranted.

However the media is the message. He controls and manipulates the media. It would have been much easier to provide Medicaid and CHIP coverage to the poor outright than destroying the healthcare system with changes that are not working.

The final enrollment for 2014 was 6,338,622 not over 13 million. The final enrollment for 2015 was 9,736,350 and not over 13 million. This is a net gain of 3.5 million new paying enrollees in 2015.

This year the Obama administration estimates that 9 million will purchase insurance through the health insurance exchanges. At the present rate only 5.1 million will purchase insurance for 2016 at the end of the enrollment period December 31, 2015.

The CBO’s estimate was 19-21 million paid enrollees.

It does not represent a very successful net gain when the government publishes that there are 34 million uninsured Americans. No one knows if the 90 million unemployed Americans are counted in the number uninsured.

All anyone hears is the Obama administration’s reasons our taxes, and insurance premiums are going up, while our insurance coverage is going down. The Obama administration is blaming the healthcare insurance industry and Republicans.

President Obama has used, with the help of the mainstream media, the Saul Alinsky tactic to freeze opponents by shocking them with unsustainable factoids.

The Avalere Health consultancy’s analysis of 2015 signup data showed surprisingly weak ObamaCare enrollment at modest income levels. At between 150% and 200% of the poverty level, just 41% of those eligible signed up for coverage. The number falls to 30% among those between 200% and 250% of the poverty level.

In 2016 President Obama is going to penalize people that do not have healthcare insurance.

It’s now clear that the actual impact of ObamaCare’s individual mandate tax penalty will be far worse than the benign intent that the Obama administration claimed.

“What we’re talking about is a penalty for the few people who will refuse to buy health insurance — even though they can afford it — and who expect the rest of us to pick up the tab for their care,” a September 2009 White House defense of the individual mandate states.”

Reality should be coming into focus by now for the average American taxpayer and the poor. Obamacare is ripping everyone off.

“The mandate’s primary impact will be to compel low-income households to buy bronze coverage with deductibles of up to $6,850 per adult that are well beyond their capacity to afford. “

Even after these poor people pay the $6,850 deductible they have a 40% deductible on the rest of the billing.

Who said poor people are too stupid to handle their own money and be responsible for their healthcare dollars?

They are smart enough to know the government is ripping them off.

George Shore101 • 3 months ago

“If the Obama administration and Democrats love the poor why did they force the poor to purchase something they can not afford and then penalize them for not being able to afford it?”

It is a horrible thought to think President Obama is working to make the poor poorer and make the healthcare system fail the American people.

It looks like he is. His plan to replace it with a single party payer system will result in a bigger failure.

Why are Republicans just standing around doing nothing? Why don’t they publicize my Ideal Medical Saving Accounts?

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

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Healthcare Spending Increases To 18.2% of GDP

October 27, 2015

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

Healthcare spending has increased each year. Healthcare spending is now 18.2% of the GDP up from 17.7% in 2014.

In 2000 it was 14% of the GDP.

The data presented in the following charts are partially correct. They are derived from clams data which are also partially correct. The charts can give an idea on how the healthcare money is

spent. and wasted.

Wasted Money

Drivers of increased Healthcare Spending

Distribution of Healthcare Spending

There are many reasons for this increase. The Obama administration prefers to blame the increasing spending on his most popular reasons.

His reasons might not be completely true.

The traditional media then publicizes the President Obama’s popular reasons. The reasons get translated into public understanding and public opinion.

President Obama’s reasons for the increased healthcare spending are hospitals’ and physicians’ prices are increasing. Hospital and physician retail prices are increases. However, their insurance reimbursement has decreased. Public opinion then demands that physicians decrease their prices.

The reality is physician reimbursement has been steadily declining in recent years as spending has been increasing.

I have continually pointed this out.

Medicare, Medicaid and private insurance have forced physicians to accept lower reimbursement. Patients are increasingly discovering that “my doctor doesn’t take my insurance or my Medicare or my Medicaid.”

Consumers without insurance coverage are charged retail price by hospitals and physicians rather than the discounted prices hospitals and physicians accept.

These consumers can try to negotiate the prices. They are usually more successful with physicians than hospitals.

Decreasing reimbursement is one of the main reasons physicians are driven to see more and more patients in less and less time.

Physicians must continue to pay overhead and salaries.

This phenomenon of increased patient volume disrupts the magic of the physician/patient relationship. It is also the driving force behind the massive increase in concierge medicine.

If it is not the rise in physician reimbursement, what is the reason for the increase in healthcare spending?

There are several possibilities.

GDP is increasing at a lower rate than healthcare spending.
Consumers are sicker. They need more medical and surgical care than previously.
Healthcare insurance premiums are increasing at a greater rate than the GDP.
Bureaucratic support of the healthcare system is growing at a greater rate than the GDP.
Pharmaceutical use is increasing because a sicker population needs more drugs.
RNA Technology has lead to the discovery of more potent therapies that are costly to the healthcare system.

Statistics published by the Altarum Institute in July suggest that President Obama and his fans in the traditional media reevaluate their premises about the rising healthcare spending.

“Out-of-control spending on prescriptions drugs and the soaring cost of health insurance administration continue to be the two major drivers behind rising healthcare costs.”

Healthcare spending grew to $3.3 trillion in this year.

Prescription drug spending increased by 9.2% from the previous year. Part of that increase was the introduction of new drugs.

The Obama administration ignores the fact that more people are becoming sick because of an increase in obesity, diabetes and hypertension. These people now have to take medicine, see doctors, and buy medical devices.

Administration services costs and net costs of health insurance (after paying medical bills) have increased 9.4% from a year ago.

These costs included government bureaucratic costs, insurance bureaucratic costs, out of pocket expenses and insurance premium costs.

How much waste is in all these administrative services costs.

3. Hospital spending rose 6.1% from a year ago. Hospital bureaucracy has been try how to decrease spending by decreasing waste and personal. However, bureaucracy and unnecessary administrators and outrageous hospital executive salaries continue to increase.

Physician and outpatient clinical expenditures rose 5.0%.

Physician investment in medical structures and equipment rose only 1.7%. Physicians are reluctant to make investments in a failing healthcare system.

Each category in the various graphs above reveals opportunities to decrease the cost of medical care.

It cannot be done by the government’s complete take over of healthcare.

The government is the problem as we have seen and still are seeing with the VA Healthcare system.

Socialism does not work. In leads to unintended consequences as consumers adjust to the rules and regulations of an attempt to manage society.

Consumers must demand rule changes and permit the market place to sort things out.

Repair of the healthcare system can only occur in a consumer driven healthcare system with consumers in control of their healthcare and their healthcare dollars.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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President Obama Keeps Doing It

September 17, 2015

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D., FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is apparently not true.

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

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

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

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

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

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

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

Two additional weak arguments are being used.

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

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

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

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

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

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

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

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What Are The 3R’s?

July 22, 2015

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

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Stanley Feld M.D.FACP,MACE

The 3R’s are the Risk Adjustment, Reinsurance, and Risk Corridors program built into The Accountable Care Act (Obamacare). The 3R’s were meant to encourage the healthcare insurance industry to participate in providing insurance to participants in the State Health Insurance Exchanges. President Obama has extended the 3R’s to included Federal Health Insurance Exchanges.

The 3R’s were activated because of the poor enrollment in the State and Federal Healthcare Exchanges. It was billed to offer protection to the healthcare insurance industry against any losses incurred by participation in Health Insurance Exchanges.

The healthcare insurance industry’s participation in Obamacare’s Health Insurance Exchanges was negative at first.

The Health Insurance Exchanges were viewed as a trap set by the Obama administration to control the healthcare insurance industry. In the process the healthcare insurance industry would ultimately lose money.

The healthcare insurance industry did not participate widely in the health insurance exchanges at first.

“These risk-sharing programs are often called the “3 Rs” because they are Risk Adjustment, Reinsurance, and Risk Corridor.” The three risk-sharing provisions were intended to protect insurers financially, especially in the first few years the Exchanges are in effect if activated.”

The ACA includes various mechanisms to accomplish this goal including requiring insurers to cover everyone who applies, prohibiting insurers from imposing preexisting conditions limitations, and severely limiting the factors insurers can consider in setting premiums. Obviously, these mechanisms put insurers at financial risk, since their underwriters won’t have sufficient data to predict claims costs, such as the number of people likely to enroll, their health status or claims history, or other demographic information on enrollees.

The Obama administration included this safety net for healthcare insurers. It also set the traps for the healthcare insurance industry.

Purpose of Permanent Risk Adjustment

To combat overall adverse selection since health insurance is now guaranteed to anyone who applies. Healthcare insurance carriers cannot impose pre-existing conditions limitations. They cannot vary premiums based on individual’s health status.

The trap is that the government will redistribute money between insurance carriers. The Permanent Risk Adjustment scheme is supposed to redistribute profit from insurers with lower claims enrollees to those with higher claims enrollees and losses.

All non-grandfathered insured plans in the individual and small group market, in or out of the health insurance exchanges, are supposed to pay for this redistribution of money. This redistribution is to be monitored by the federal government. (Another bureaucracy)

Does anyone think this can work? I don’t.The second R is the Transitional Reinsurance Program. It is to run from 2014-2016 and then stop running.

The Transitional Reinsurance Program’s purpose is to stabilize premiums in the individual market during the first 3 years the exchanges operate, because higher-cost (sicker) individuals are more likely to enroll early.

This program’s purpose is to redistribute money from group health plans that make a profit to certain insurers with Qualified Health Plans on the individual State and Federal Exchanges that have high cost (claims) enrollees to prevent loses for those insurance companies. This is supposed to encourage insurance companies to join the exchanges.

All group health plans are required to pay for losses in 2014. There has been no reporting as yet to let anyone know how this has worked out in 2014. This provision further exposes President Obama’s lie that “if you like your plan you can keep your plan.” He knew no one could keep their healthcare plan as the bill was written.

A specific waiver was provided for 2015 & 2016. There are a few self-insured plans that self-administer their claims. Most corporations use healthcare insurance companies as third party payers. Therefore, the wavier is essentially eliminated.

The traditional reinsurance program is going to be very difficult to administer.

The Temporary Risk Corridor for 2014-2016 makes the 3R program even more complicated and more difficult to administer.

The goal of the temporary risk corridor is to limit insurer gains and losses in first 3 years of Obamacare and place all healthcare insurance company risks on a level playing field. The healthcare insurers have a limited amount of data on the risk of claims for Health Exchange enrollees. The healthcare companies have histories of claims for Qualified Health Insurance Plans and the expected enrollment. The health Insurance companies have to guess at their actuarial risk if they participate in Obamacare in order to set premiums.

Limiting the healthcare insurance industry’s risk will be complicated for the government.

Insurers who have actual claims more than expected claims will be paid the excess if funds from these insurers are not sufficient. HHS is directed to pay the excess.

The problem is Obamacare (ACA) did not provide for creation of a specified source of funds or a revolving fund for HHS to pay this excess.

In 2014, the first year of the exchanges insurers received $450 million dollars. The source of the government funds is unclear.

An important concept about insurance reimbursement is always ignored. Insurance claims have nothing to do with the actual insurance reimbursement. Reimbursement is usually 50% less than the claims.

Therefore, the amount of supposed payment is doubled using claims to calculate payment and probably future premiums.

The government is hoping that the entire scheme is budget neutral. It will collect and redistribute the profit made by one insurance company to the insurance company that loses money from the high-risk patients.

The government thinks it will have no out of pocket reimbursement obligation.

The government plans to compare insurers within a state based on the average financial risk of their enrolled population.

“ To more evenly spread the financial risk among insurers, government payments are made to insurers who cover a higher-risk population (e.g., people who are older, sicker or have more chronic conditions) from the profit of lower risk insurers. “

Theoretically, the insurers who make a profit from the lower risk population pay the insurers who make less from their older, sicker population with many chronic diseases.

This is called redistribution of profit and wealth. I have a tough time believing that profit making companies will sign up for that.

Below are the formulas that will be used in 2014 and 2015 for the redistribution of profit of healthcare insurance companies.

“2014: Once an insurer has paid $45k in claims for an individual (the attachment point), the insurer is reimbursed for 80% of costs between $45k & $250k per person. (Originally $45k was $60k)”

“2015: $70k attachment point per insured, then insurer will be reimbursed for 50% of costs between $70k & $250k per person. HHS publishes a Notice of Benefit & Payment Parameters each March, with the numbers for following year.”

“If actual claims are within 3% of expected claims, insurers in Exchanges keep the profits or bear the risks. If claims are 3-8% more (or less) than expected, insurer pays the gov’t (or is reimbursed by the gov’t) 50% of the gains (losses) and keeps (or bears the loss of) the other 50%.”

“If claims are at least or > 8% more (or less) than expected, insurer pays the gov’t (or is reimbursed by the gov’t) 80% of the gains (losses) and keeps (or bears the risk of) the other 20%.”

It is all very complicated. It will be impossible to enforce. This is another Obamacare trick to fake out the very profitable healthcare insurance industry.

I think the healthcare insurance industry knows all this. They are taking steps at this very moment to dodge the Obama administrations trap.

The losers will be the American people who will experience an increase in healthcare insurance premiums and higher taxes.

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The Defects In Obamacare

June 14, 2015

inMedicine: Healthcare System, Patients Problems, Physician's Problems, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

We live in an era of sound bites driving opinions rather than details driving opinions. The devil is always in the details.

The defects in Obamacare are too numerous to count. President Obama provides the traditional mass media with sounds bites leading to false conclusions.

The sound bites are misleading. Many of the sound bites are lies. One such sound bite is Obamacare is working and therefore does not need changing.

He and the Democrats keep the discussion on the sound bites level and do not dig into the real issue. President Obama even keeps the details away from congress the very people he is dependent on to pass the bill.

President Obama kept the facts and details about Obamacare away from the congress and the people. He is now doing it with the Trans-Pacific Partnership (TPP).

The Trans-Pacific Partnership (TPP) is a proposed regional regulatory and investment pact. Just as with Obamacare, President Obama expects congress to vote in favor of a pact they have not debated and have not had an opportunity to read the details in the final bill.

It is another one of those bills where the administration is telling the congress and the American people you have to pass the bill in order to see what is in it.

Americans are tired of his lack of transparency and lies. They do not trust President Obama anymore.

Congress should never make the same mistake they made with Obamacare. If they do all Americans should rally to throw all the bums out.

The devil is always in the details.

United States Senator Ron Wyden (D-OR) said,

“Congress is being kept in the dark as to the substance of the TPP negotiations, while representatives of U.S. corporations—like Halliburton, Chevron, PHRMA, Comcast, and the Motion Picture Association of America—are being consulted and made privy to details of the agreement. […]

" More than two months after receiving the proper security credentials, my staff is still barred from viewing the details of the proposals that USTR is advancing. We hear that the process by which TPP is being negotiated has been a model of transparency. I disagree with that statement.^[98]”

President Obama and the speaker have told us it is good pact for the country’s economy. Senator Cruz is right. “Don’t vote for something whose details you do not know.”

There are many defects in Obamacare. One major defect is that it is not affordable to consumers, the federal government or state governments. When fully implemented the cost of healthcare to the federal government will be at least 50% of our GNP not the 23% of GNP predicted. Twenty three percent is bad enough.

Federal and State taxes will have to be increased to cover all medical care entitlement costs.

President Obama keeps telling us that Obamacare is working. He says it is here to stay.

The reality is Obamacare is an unworkable and costly failure in multiple areas including the health insurance exchanges, healthcare.gov, insurance premiums and deductible costs, the development of Accountable Care Organizations, maintenance of employer insurance and more.

Americans deserve a better system than Obamacare.

It is impossible to cover all of the harmful details of every category in one blog.

It is disingenuous for President Obama to claim, in his repeated sound bites, that there is no need to change anything in Obamacare because Obamacare is working fine.

The real cost of Obamacare to consumers (especially taxpayers), the federal and state governments and the economy have not been disclosed nor are they transparent.

The real costs start to leak out with stories about how the costs affect consumers and their lifestyle.

This usually leads to the sound bites that it will be better to have a government single party payer system.

The underlying defect is that this system leads to consumers being dependent on government and not responsible for themselves. Government changes rules on a whim. Consumers do not have options. This is a road to serfdom.

“After the Affordable Care Act kicked in, a 52-year-old sales and marketing entrepreneur reported his monthly health-insurance premium to cover himself and his family grew to $848 from $513. Like others, he wasn’t happy about it. “It’s taking a lot out of pocket,” he said.”

He is one of millions of Americans who earn too much to qualify for government subsidies on policies purchased through the federal insurance exchange. He was in favor of Obamacare before he realized Obamacare’s effect on reality.

Obamacare requires insurance companies to offer insurance policies with broad coverage and greater protection against catastrophic medical costs. It also requires coverage on illnesses and conditions such as pregnancy and birth control coverage for people who do not need this coverage.

Obamacare was supposed to save every family $2,500 a year. It costs families more than $2,500 dollars a year. It was not supposed to affect anyone making less than $250,000 per year.

It is true that many of the above a not taxes. However it is a cost burden on consumers making less than $250,000 a year.

Others, making less than $50,000 a year, receive complete or partial government subsidies. This is what is meant by redistribution of wealth. It is a significant cost burden on consumers making $50,000 to $250,000 dollars a year.

Everyone remembers President Obama promising that Obamacare will not cost families making less that $250,000 one dime.

Obamacare premiums have become unaffordable to people earning less than $50,000 per year as well.

Obamacare’s goal was to cover everyone with broad insurance coverage and greater protection against catastrophic medical costs.

Yet, only 10 million out of 330 million are covered by the exchanges. Each enrollee in the exchanges also has high deductibles. These deductibles can be as high as $6,000 a year.

Many of the insurance companies claim they will be losing money after the government’s health insurance industry subsidies disappear in 2016.

These companies will leave the Obamacare federal health exchanges reducing competition. This in turn will increase premiums further and make premiums more unaffordable.

Another detail overlooked is enrollees are poorer, sicker and older. The pool is not diluted by younger, healthier and richer. The result is more expensive insurance rates.

“ HHS was saying that it needed about 40 percent of the exchange policies to be purchased by people age 18-35 to keep the exchanges financially stable. It was 28 percent in both 2014 and 2015, according to HHS data. The CBO had projected about 85 percent of exchange enrollees to be subsidized, falling toward 80 percent as enrollment grew; instead, that number is 87 percent and actually rose slightly from 2014.”

According to a study last year by the National Bureau of Economic Research, people who bought silver and bronze plans on the federal and state health insurance exchanges saw total premiums and out-of-pocket payments rise an estimated 14% to 28% higher than pre- Obamacare premiums and out of pocket expenses.

Obamacare is not fulfilling any of President Obama’s sound-bite promises.

His claim that Obamacare is working well and does not have to change makes absolutely no sense.

If one tells a lie enough times it becomes eventually becomes the truth.

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

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Chaos Continues At HealthCare.gov

June 4, 2015

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems

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Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

One month later Optum suddenly quit.

An Optum spokesman said,

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

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

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

Kathleen Sebelius said in a blog post,

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

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

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

CGI was then relieved in December 2014.

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

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

Suddenly, in May 2015, QSSI quit.

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

Consumers and physicians do not approve of Obamacare.

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

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

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

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

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

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

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

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

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The Republican Alternative to Obamacare

April 7, 2015

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

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Stanley Feld M.D. FACP MACE

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

The Obama administration insists that the Republicans do not have a viable alternative. I doubt that anyone in the administration has read the alternatives.

President Obama’s tactic is to marginalize any opposition even if he has not reviewed it.

The Republicans have some good ideas. However, they do not address the basic problems in our healthcare system.

The implementation of their ideas will not repair our healthcare system.

“Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.”

Obamacare has so many parts. Most of Obamacare’s parts could have been predicted to fail. It is clear that congress did not understand this destiny before passage.

Obamacare was destined to fail from the start. It is on the way toward failure today. It will also destroy the entire healthcare system.

The Republican alternative is called, "The Patient Choice, Affordability, Responsibility, and Empowerment Act."

It's key provisions include:

A Full Repeal and Replacement of Obamacare

Eliminate Individual Mandate to Buy Health Insurance or an Employer Mandate to Offer Coverage

Consumer Protections – Republicans want to retain the popular consumer protections in Obamacare including no lifetime limits, coverage for children to age 26 on their parent's plan, and guaranteed renewability of coverage.

However, they propose to decrease the costs of healthcare insurance for younger consumers but want to increase the cost of healthcare insurance for older buyers.

The Republicans would create a new set of losers (older buyers) while increasing the incentive for younger people to buy insurance.

Republicans should be providing financial incentives for consumers to be responsible for their health and their own healthcare dollars. Consumers with chronic diseases should also be responsible for the control of their chronic disease.

A Return to Pre-Existing Condition Limits. This is a ridiculous provision. It guarantees the biggest villain in the healthcare system (the healthcare insurance industry) its control of premiums and profitability.

Default Enrollments – Republicans would allow states to create a default enrollment system for those eligible for tax credits as a means to reduce the number who would otherwise remain uninsured.

A complex agency would be needed to administer a complicated process.

High Risk Pools for the Uninsured – High-risk insurance pools did not work previously because of healthcare insurance companys’ control of the premiums for the sickest people and their high risk of disease.

Affordable Insurance Policies – This is also a pipe dream. America’s population is becoming more obese. Obesity generates more illness and higher risk. As long as the healthcare insurance industry is calculating and is in control of the actuary risk, healthcare insurance will not be affordable. The problem is how the insurance industry is allowed to do its accounting.

The Republicans are proposing the elimination of benefit mandates and downsizing guaranteed insurability with their "continuous coverage" provision.

This proposal is ridiculous. As long as consumers are not responsible for their health and their healthcare dollars and the healthcare insurance industry controls price, the healthcare system will be increasingly more expensive and dysfunctional.

Tax Credits to Buy Coverage – Tax credits are an unearned entitlement. Unearned entitlements do not work. Tax credits would be available for those in the individual health insurance market, those working for businesses with fewer than 100 employees, and those working for larger employers that do not offer coverage.

Tax Credits Only Up to 300% of Poverty – A system of tax credits leads to an agency that must be connected to another government agency, which leads to a larger government bureaucracy. In turn the bureaucracy leads to fraud and abuse

Flat Amount Tax Credits By Age – The goal of this proposal is to eliminate federal and state exchanges. Obamacare’s state and federal exchanges have not worked no matter how the administration spins the truth.

It would be easy to just give everyone a tax credit by age. A new bureaucracy would not be needed.

However, control of price and actuarial risk is still determined by the healthcare insurance industry. Consumers are not empowered. The healthcare insurance industry is empowered. Only at the time consumers are stimulated to control their health and healthcare dollars will the system work. Tax credits and price controls do not work.

No Limits on the Kind of Insurance Policies That Could Be Offered – This is not a bad idea.

Capping the Tax Exclusion on Employer-Provided Health Insurance – The entire tax benefit for the employer and the individual should be equalized. Benefits should not be exclusive. Healthcare insurance premiums should be paid for with pre-tax dollars by all. The individual market should not pay for premiums with after tax dollars and the group market pay for premiums with pre-tax dollars. The present system is a hidden tax on consumers buying insurance in the individual market.

Moving Toward Defined Contribution Health Insurance – This is a stab in the dark by Republicans. It would penalize consumers and it would benefit employers. Employer want to avoid providing the same level of healthcare coverage for all their employees

Medical Malpractice Reform – This is a sensible reform. It is estimated that is would lower healthcare cost between $300 and $750 billion dollars a year if all costs were included.

If malpractice reform took the right form to protect consumers and physicians, the abuse in the malpractice system by lawyers and the insurance industry would be eliminated.

Both the Democrats and the Republican have protected the lawyers and the insurance industry in the past. Past behavior is a predictor of future behavior.

Repealing the Medicaid Expansion – Medicaid should be eliminated and replaced by an all-inclusive healthcare system.

The poor should have the same insurance coverage as the rest of society. The immediate response is the nation couldn’t afford it. Yet President Obama is expanding Medicaid as access to care is being restricted. Therefore formulas that try to control costs fail because the development of severe illness is more expensive than consumers of healthcare learning how to control their disease. A consumer having healthcare insurance coverage does not make those consumers well.

Empower Poorer Consumers by Giving Them Mainstream Health Plans –

Republicans do not offer a plan of action within this category. It sounds good but feels as if it is an empty promise. Actually it is an important factor in repairing the healthcare system. I will explain in the next blog.

The solution to the healthcare system’s dysfunction must be a simple solution.

The Republican solutions are almost as complex as Obamacare. It does not decrease governmental bureaucracy nor does it avoid the potential for fraud and abuse.

The Republican solutions promote continued control over consumers and their freedoms.

The Republican solutions do not get to the main problem in the healthcare system.

The healthcare system must be set up so consumers are motivated to have incentive to be responsible for their own health and healthcare dollars.

The alternative to Obamacare should exclude the government from making consumers dependent on the government.

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

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Obamacare Tax Hikes That Are Forgotten

March 15, 2015

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

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Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year.

According to Grover Norquist there will be ½ trillion dollars ($500 billion) in new taxes collected from the group of people making less than $250,000 a year.

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

https://youtu.be/eHlRY3kHhBk

I am not talking about the increase in taxes on capital gains and dividends that seniors rely on to survive. I am talking about all the other taxes that affect purchasing power.

In 2012, Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

The traditional media have ignored these new taxes and Mr. Norquist’s summary. No one is talking about how these taxes are hurting seniors and the middle class economically.

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said people earning under $250,000 would not pay one single dime more in taxes.

I suggest everyone watch President Obama’s lying and defending of his lies. After the first You Tube let it keep playing to hear subsequent You Tubes.

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organized the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in their taxes.

Mr. Norquist’s article appeared in 2012.

“Obamacare contains 20 new or higher taxes on American families and small businesses.

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

	Capital Gains	Dividends	Other*
2012	15%	15%	35%
2013+	23.8%	43.4%	43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

	First $200,000 ($250,000 Married) Employer/Employee	All Remaining Wages Employer/Employee
Current Law	1.45%/1.45% 2.9% self-employed	1.45%/1.45% 2.9% self-employed
Obamacare Tax Hike	1.45%/1.45% 2.9% self-employed	1.45%/2.35% 3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that took effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

	1 Adult	2 Adults	3+ Adults
2014	1% AGI/$95	1% AGI/$190	1% AGI/$285
2015	2% AGI/$325	2% AGI/$650	2% AGI/$975
2016 +	2.5% AGI/$695	2.5% AGI/$1390	2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

Mr. Norquist left out the worst tax of all. The “tax” is under everyone’s radar. It has not been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
Monthly Fee of $96.40, rising to:

$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely
delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus. Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare could be repealed.

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.

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

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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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