Is Obamacare turning the corner?

The Washington Post

By Ezra Klein and Evan Soltas, November 26, 2013

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

A spin through HealthCare.Gov this morning went smoothly. The site loaded quickly. The process progressed easily. There were no error messages or endless hangs. I didn't complete the final step of purchasing insurance but, until then, the site worked -- or at least appeared to work -- exactly as intended.

My experience isn't rare. There are increasing reports that HealthCare.Gov is working better -- perhaps much better -- for consumers than it was a few short weeks ago. "Consumer advocates say it is becoming easier for people to sign up for coverage," report Sandhya Somashekhar and Amy Goldstein in the Washington Post. "The truth is, the system is getting stronger as it recovers from its disastrous launch," writes Sam Baker in the National Journal. Applying "was no problem at all, with no delays," says Paul Krugman.

Reports from inside the health care bureaucracy are also turning towards optimism. People who knew the Web site was going to be a mess on Oct. 1st are, for the first time, beginning to think HealthCare.Gov might work. Data backs them up: By mid-November, the pace of enrollment in the federal exchanges had doubled from what it was in October.

The Obama administration is certainly acting like they believe the site has turned the corner. Somashekhar and Goldstein report that they're "moving on to the outreach phase, which had taken a back seat as they grappled with the faulty Web site. Next week, the White House will host an insurance-oriented 'youth summit' aimed at people ages 18 to 35, an age group whose participation in the health-care law will be critical to its success."

The White House had held off on this kind of outreach because they believed it would simply drive people to a useless Web site. If they're restarting the outreach, it's because they believe, rightly or wrongly, that HealthCare.Gov will be able to convert the interest into enrollments.

The worry, at this point, is that the site is working in ways that are visible but broken in ways that are harder to see. The Obama administration won't answer direct questions on the percentage of "834s" -- the forms insurers need to sign people up for the correct policies at the correct prices -- that are coming through with errors. Robert Laszewski, a health-industry consultant with deep contacts among the insurers, told the National Journal the problem is getting better, but that his clients are still seeing a five percent error rate. That's still too high.

The systems that determine whether applicants are eligible for insurance are also improving. But inside the administration there's a recognition that it was error-ridden in the first six weeks of Obamacare -- and so the question is how to handle the many people who unknowingly received an eligibility determination that can't be trusted.

Still, it's clear that HealthCare.Gov is improving -- and, at this point, it's improving reasonably quickly. It won't work perfectly by the end of November but it might well work tolerably early in December. A political system that's become overwhelmingly oriented towards pessimism on Obamacare will have to adjust as the system's technological infrastructure improves.

The next challenge for the law, as the White House knows, will be the outreach challenge of signing up enough young-and-healthy people to balance out its risk pools. That's a challenge the White House spent quite a lot of time thinking about before this IT nightmare. The question is whether they still have enough time, and enough clout, to get it right.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/26/wonkbook-is-obamacare-turning-the-corner/?print=1

This chart is amazing news for our health cost problem

The Washington Post
By Sarah Kliff, Published: November 20 at 3:55 pm

This just might be my favorite chart about health care costs as of late. And it's one that contains billions of dollars' worth of good news!

The chart, from the Council of Economic Advisers, shows the Congressional Budget Office constantly revising downward how much it thinks the federal government will need to spend on health care costs over the next decade. That's because health care costs have been growing a lot more slowly over the past few years than they typically do. You can see that below, with a breakdown of health care cost growth by source of coverage.

In private insurance, the average spending growth rate per person has slowed a lot over the last few years. In Medicare, there was no spending growth between 2010 and 2013 and, in Medicaid, per person costs actually decreased some.

All told, health care costs have been growing more slowly over the last three years than any other time period since 1965. More recently, yearly health cost growth slowed from an average rate of 3.9 percent between 2000 and 2007 to 1.3 percent between 2011 and 2013.

The big health policy parlor game for the past few years has been to ask: How much of this change is cyclical, owing to the recession, or structural, partially due to the health law's payment reforms?

The White House has long argued that the changes are structural, and it made that case again Wednesday in a briefing with reporters.

"The slowdown is indisputable," Council of Economics Advisers chairman Jason Furman said. "A very important part of that is structure, and a very important part of the structural story is the Affordable Care Act."

Most health care economists now agree, at least to some extent, with this more structural view.  Even those who argue that the current slowdown is unlikely to last, such as Harvard's Amitabh Chandra and Dartmouth's Jonathan Skinner, still expect slower health care cost growth in the next decade compared with the previous one.

And in some cases, that translates into better health care, too. This chart from the council's report shows a significant drop in preventable readmissions to hospitals (when  treatment goes wrong the first time and the patient must return to the hospital). That happened right around the time Medicare began penalizing such return trips to the hospitals.

Cost savings aside, that's great news for patients, suggesting that the quality of care hospitals are delivering is improving at the same time that spending on that care is slowing down.

Original Article

Fewer Than 50 Staffers? Your Four Main Obamacare Options

Entrepreneur
August 7, 2013

BY Dinah Wisenberg Brin

Small businesses with fewer than 50 full-time employees -- or the equivalent -- as defined by the U.S. Affordable Care Act may wonder what they should do to prepare for employee open enrollment on the new healthcare exchanges this October.

If you're among those with questions, watch this recent webinar hosted by a state office of the U.S. Small Business Administration. In it, Frank Knapp Jr., president and CEO of the South Carolina Small Business Chamber of Commerce, shares the main options. We've listed the highlights below, but you can access it yourself here.

Option 1: Do nothing. Businesses with fewer than 50 "full-time-equivalent" employees aren't obligated to provide coverage under the ACA. These businesses can opt out of providing health insurance and take no action. In this scenario, employees will be responsible for obtaining their own health insurance and will be eligible for government premium subsidies if they qualify based on income and if they purchase coverage on the individual exchanges. Bear in mind that the law defines full-timers as employees who work, on average, at least 30 hours weekly, and counts the hours worked by part-timers toward an employer's number of full-time-equivalent workers.

To note: You may decide to "do nothing" as a business owner, but you're still required (as an individual) to obtain health insurance for yourself and family, either via the exchange, outside the exchange or through your spouse's employer.

Option 2: Do not offer health insurance, but offer help. These companies can find an insurance agent or broker to guide employees through the exchange, and help them choose the most appropriate coverage for themselves and their families. Qualifying employees will be eligible for subsidies under this scenario as well. Keep in mind that subsidies are not just for low-income Americans; many middle-class individuals and families will qualify as well. Brokers receive commissions from the exchanges and might negotiate fees with businesses, depending on the additional services they can offer you.

Option 3: Use the exchanges to offer one plan for all employees. Offer health insurance to employees through the small-business exchange in your state, choosing one plan for all employees. You can do this on your own or consult with an insurance broker or agent who also can handle enrollment. Employees enrolled in this plan will not be eligible for government premium subsidies. (The Obama administration expects that employers eventually will be able to offer employees a choice of plans on the small-business exchanges for coverage starting in 2015.)

Option 4: Obtain health insurance for employees outside of the exchange. Employers may do this on their own or through a broker or agent. By securing group health insurance outside the exchange, however, the employer will become ineligible for the tax credits that are available to many small businesses offering coverage through the official, state-based marketplaces. Employees won't be eligible for government premium assistance in this scenario.


Read more: http://www.entrepreneur.com/article/227674#ixzz2bOF4eRAE

Without Medicaid Expansion, Employers Face Higher Tax Penalties Under ACA

Study By Brian Haile
Senior Vice President for Health Policy
Jackson Hewitt Tax Service Inc.

March 13, 2013

Key Findings

 States that do not expand Medicaid leave employers exposed to higher “shared responsibility” payments under the Affordable Care Act (ACA).

 The associated costs to employers could total $876 million to $1.3 billion each year in the 22 states that have opposed, are leaning against, or remain undecided about expanding Medicaid. By way of example, the decision in Texas to forego the Medicaid expansion may increase federal tax penalties on Texas employers by $299 to $448 million each year.

 Any projections of the “net” costs of Medicaid expansions should reflect the very real costs of the shared responsibility penalties to employers in any particular state.

Click here to read the study

Big money behind misinformation on healthcare law

The Hill's Congress Blog

June 29, 2012

By Frank Knapp, Jr., president and CEO, South Carolina Small Business Chamber of Commerce

I received a call from a gentleman, Ralph, this morning asking about my statement to the press yesterday regarding the Supreme Court ruling on Obamacare. He wanted to know why I thought the law was good for small businesses because he had heard so much about how it was going to be harmful.

I’m sure that Ralph had also read the statement by the South Carolina state director of the National Federation of Independent Business (NFIB) following the Supreme Court ruling in which he insists that now that Obamacare has been ruled constitutional there will be an “onslaught of taxes and mandates” on small businesses that will result in “job losses and closed businesses.”

It turns out that Ralph is retired living along South Carolina’s coast but he has a brother in Pennsylvania who owns a small business with less than 10 employees. I learned that his brother does offer health insurance to his employees. So it was natural for Ralph to be concerned for his brother’s business.

I don’t blame Ralph for being concerned. For over two years the NFIB has been misleading the small business community and public on this issue. The organization spent about $4 million in fighting Obamacare in the Supreme Court arguing that the law was unconstitutional. Now with that line of attack gone, all the NFIB has left is continuing to lie about what the law does.

So I explained to Ralph that businesses with fewer than 50 employees, which account for 97 percent of all businesses, do not have to offer health insurance to workers and will not be penalized if they don’t. Therefore there can be no job losses or closing of the doors for these small businesses due to Obamacare.

I also explained that there are no other taxes imposed on these small businesses but there are health insurance tax credits available to millions of small businesses like his brother’s who offer healthcare to their employees. “Do you think your brother could use some tax credits,” I asked Ralph. “I’m sure he can,” was the response.

I asked Ralph to have his brother call me so I could help him on the tax credit issue. I also thanked him for calling and told him that I wish I could have a civil conversation with everyone who has concerns about Obamacare. It has been my experience since the law passed in 2010 that when I have the opportunity to have such conversations with individuals or small groups, the fears fall away.

But the real question is why do supporters of the reform have to continue to correct the misinformation being spread by organizations like the NFIB which are suppose to represent small businesses. Why did the NFIB work so hard and spend so much money trying to kill a law that has already benefitted hundreds of thousands of small businesses that have received the tax credits and will help in other ways to make health insurance more affordable when the law fully goes into effect in 2014.

The answer is money.

According to a Public Campaign analysis of IRS 990 filings from the NFIB and NFIB Small Business Legal Center for 2009-2011, the NFIB organizations have had dramatic increases in contributions since the Affordable Care Act was passed in 2010. But the new-found wealth is not from dues of the average NFIB member. The IRS filings show that the NFIB organizations received $10 million from just 10 contributors in 2010-2011. In the previous year the largest individual contribution was just $21,000. News reports have identified the conservative and superpac Crossroads GPS as one of the NFIB contributors in 2010 giving $3.7 million.

It is clear that the NFIB is acting on behalf of its partisan big contributors and not their members such as Mike Roach. Mr. Roach is one of the small business owners receiving the tax credits. He owns Paloma Clothing in Portland, Ore, and is a NFIB member for 36 years. In March Mr. Roach told the United Press International that “tearing down the law won’t help us; it would hurt….repealing the Affordable Care Act would send us back to the Dark Ages of health insurance.”

So while the Supreme Court Ruling is the end of this story as to the constitutionality of Obamacare, it is not the end of the political story and certainly not the end of the NFIB lies that are intended to scare people like Ralph and his brother. That is what the NFIB is being paid to do.


Knapp is the president & CEO of the South Carolina Small Business Chamber of Commerce. He is also the vice chair of the American Sustainable Business Council.

Source:
http://thehill.com/blogs/congress-blog/healthcare/235665-big-money-behind-misinformation-on-healthcare-law

Obamacare ruled to be constitutional

Today marks an extraordinary day for American small businesses. The positive measures under the Affordable Care Act that began in 2010 will continue to benefit our small businesses, the engine of America’s economy.

The new law has already helped hundreds of thousands of small businesses, many of which are based here in South Carolina, through healthcare tax credits. 2014 will bring an insurance marketplace that will create more competition among insurance companies to drive down premiums. Fewer people without insurance will curtail cost shifting that results in those with health insurance paying higher premiums. When the ACA is fully implemented, small businesses will finally be paying the same rates as big corporations.

Today is a great day for small businesses in the United States.

The only concern with the Supreme Court ruling is that each state now has the option of not expanding Medicaid to 133 percent of the federal poverty level. Small business will benefit from the expansion because to do so will reduce the number of employees needing to be covered by a company’s healthcare plan and thus reducing the cost to the business. But that fight is for tomorrow. 

Round three...reality sets in

Now the waiting begins…Oh, and the PR efforts continue in an effort to influence the final decision.

The Supreme Court had its hearings, all sides had their say, and the reality sets in.

But it’s not the reality for all Americans that the Affordable Care Act come July might be intact, altered or gone entirely. 

No, the reality setting in is the one on the Justices themselves.  The consequences of their decision are weighing very heavily on them.  Yesterday’s flippant comment by Paul Clement, attorney for the plaintiff states, surely raised the Justices anxiety over their decision.   “It won’t be a big deal”, said Clement, for Congress to simply re-pass the Affordable Care Act (ACA) minus the parts the Court might rule to be unconstitutional causing the whole law to be thrown out.

This polarized Congress is not going to easily fix anything. 

If the ACA goes, there is no hope for ever having affordable health care for individuals or small businesses.  Americans with pre-existing conditions will never be able to have individual coverage.  Policyholders who get very ill will continue to have healthcare coverage cancelled or their premiums skyrocket.  More small businesses will drop this employee benefit.  Seniors will again start paying more when they hit the donut hole.  Young adults will be thrown off their parents healthcare policies.  No healthcare CO-OPs will be created to compete with private health insurance companies.  They’ll be more and more uninsured Americans shifting healthcare costs to those who do have insurance until the system implodes completely.

Rep. Gerald Connolly of Virginia is absolutely correct.  If the Court strikes down the individual mandate, “you go back to the law of the jungle in America.”

That is the reality weighing heavily on the Justices.  They can let the work of Congress stand or return the country to the jungle ruled by the insurance industry.  There are no other options.

Happy B-Day ACA and Success in U.S. Senate

The Affordable Care Act turns 2 today (read my op.ed here) while we all wait for the Supreme Court hearing on the constitutionality of the individual mandate to start next week.  More on that on Monday.

Yesterday was a big and surprising victory in the U.S. Senate.  The CROWDFUND Act that we, the American Sustainable Business Council and other organizations were supporting was successfully amended onto the JOBS Act.  Thanks to all who contacted your Senators in this important effort to help small and mid-size businesses have more access to capital without throwing the doors open to fraud and abuse.

Webinar: Affordable Care Act Benefits for Small Business

The Affordable Care Act signed into law two years ago this Friday continues to inspire controversy and misinformation for small-business owners.  What exactly are the benefits and requirements for small businesses will be addressed in a free webinar sponsored by the South Carolina Small Business Chamber of Commerce (SCSBCC).  The webinar will be held from 5:00 to 6:00 PM, Wednesday March 21^st. 

Small-business owners are encouraged to participate in the webinar and hear from the SCSBCC President and CEO, Frank Knapp Jr., who will provide information on health insurance tax credits and an affordable high risk pool for people with pre-existing conditions.  Mr. Knapp will also discuss new features in the Affordable Care Act to be rolled out as well as proposed changes to the law. 

Joining Mr. Knapp will be Lee Long of Gibson & Associates, an independent insurance agency headquartered in Columbia.  Mr. Long will share information about a new small business health plan offered through the SCSBCC.   The health plan was created by Carolina Care Plan specifically for South Carolina small businesses.  The benefit-rich plan has proved to be very competitive offering up to double-digit reductions in premiums for many small businesses.

The webinar is free.  To register small businesses should contact Sheila Starkey at Sheila@scsbc.org to receive the link to the webinar.

Will She or Won't She?

Yesterday the U.S. Department of Health and Human Services (HHS) announced that states would now be eligible for a new round of grants to help them regulate health insurance to stop excessive premium hikes. Almost $200 million is set aside for the effort that has already had $46 million given to states to help them start planning for this requirement under the Affordable Care Act (ACA).

South Carolina took advantage of the first round of funding under the ACA receiving $1 million for the S.C. Department of Insurance to begin the process of improving its ability to review health insurance premiums. In addition, the Department has also received $441,000 to support a Consumer Assistance Program and another $1 million to plan for a health insurance exchange. All three of these ACA-required programs are much needed.

So will South Carolina submit another grant to HHS for some of this new $200 million for a premium rate review—an effort to make sure consumers and businesses are not being taken advantage of by the insurance industry?

Well, that’s really not the first question that needs an answer.

The immediate question is—will Governor Haley’s administration keep the first three Federal grants? With all the tough political talk about how South Carolina doesn’t want Federal money especially for the new health care law, the decision might be to just tell the Feds to “keep its stinkin’ money.

But even if the critics miraculously win a 2013 Supreme Court verdict that the ACA’s individual mandate is Unconstitutional, the rest of the law with all its provisions would go on.

And even if it didn’t, what’s wrong with the state moving forward with health insurance premium rate review to protect consumers. Or setting up an insurance exchange that allows individuals and small businesses to pool together to save money on health insurance. Or improving a program to really help consumers understand health insurance options in order to make well-informed decisions? All are still great ideas even if a state does them on its own.

The inside scoop is that the Haley administration will keep the Federal grant monies to pursue all three programs and still trash the ACA calling for its repeal. Who doesn’t like having your cake and eating it too?

Setting the Record Straight on the Affordable Care Act

If you get confused with conflicting messages about the new health care law, you’re not alone.

The South Carolina Small Business Chamber of Commerce (SCSBCC) and other organizations want the public, media and politicians to be well-informed with accurate information.

The Affordable Care Act Implementation Initiative (the Initiative) of South Carolina has released a Talking Points guide that includes essential information and content experts for a variety of topics related to the new law.

I chaired the Information, Dissemination & Communication Working Group of the Initiative, which produced the Talking Points guide. 

The Initiative is a public-private collaboration of over 60 stakeholders from the non-profit sector, state and local government agencies, health care organizations and others. The Initiative was convened by the South Carolina Public Health Institute in cooperation with South Carolina Healthcare Voices consisting of S.C. Appleseed Legal Justice Center, S.C. Fair Share, AARP-SC and SCSBCC.

The Talking Points guide provides essential information and South Carolina contacts for numerous aspects of the ACA. The information guide and the convening partners of the Initiative can be found on the SCSBCC  web site and is also available at: http://www.scphi.org/.