Monthly Archives: June 2013

Kathleen Sebelius: The Insurance Industry’s “Big Sister”

As the Administration gears up to sell Obamacare to the American people, it’s also gearing up its regulatory apparatus to strong-arm private companies.

The Hill reports that even though the Department of Health and Human Services (HHS) previously claimed that it would not try to negotiate rates with insurance companies, in reality HHS Secretary Kathleen Sebelius is doing just that:

“The department is working with state regulators to approach insurers whose rates come in significantly higher or lower than average to make sure their filings are correct,” a senior HHS official said.

So if insurance companies don’t offer the “correct” price, officials from HHS will tell them to come back and try again. Perhaps this is what Vice President Joe Biden meant when, just before Obamacare passed, he said that “we’re going to control the insurance companies.”

Obamacare relies on a series of strong-arm tactics to “control” prices—from price controls on insurance companies to a board of 15 unelected bureaucrats empowered to keep Medicare spending below an arbitrary target. But the real problem with Obamacare is that it forces individuals to buy more insurance than they might want or need, raising premiums in the process. No amount of top-down government controls—or “encouraging” insurance companies to offer the “correct” prices—can change that fact.

So while Secretary Sebelius and HHS continue their intrusive, government-centered tactics to try to offset the premium increases many Americans will see next year, there’s another concept the Administration should try. It’s called free markets and competition.

This post was originally published at the Daily Signal.

Donald Berwick’s Rationed Transparency

Dr. Donald Berwick is back in the public eye. The former administrator of the Centers for Medicare and Medicaid Services (CMS) has announced he will run for governor in Massachusetts.

Berwick first entered the public spotlight in April 2010, when President Obama nominated him for the CMS post. But Berwick never went through the regular confirmation process. Instead, the president granted him a surprise recess appointment that July.

The president renominated him in January 2011, but it became apparent that he could not garner enough votes for Senate confirmation. That December, Berwick resigned. Now, he is pursuing office as an elected, rather than an appointed, official.

Berwick’s short tenure at CMS was defined by a series of controversial statements he made before his appointment. He defended both Britain’s National Health Service and government rationing of health care. Most famously, in a June 2009 interview, he stated that “the decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

After leaving CMS, Berwick said his comments were merely an attempt to argue for greater transparency in decision-making. “Someone, like your health-insurance company, is going to limit what you can get. That’s the way it’s set up,” he told the New York Times. “The government, unlike many private health-insurance plans, is working in the daylight,” he insisted. “That’s a strength.”

Unfortunately, Berwick himself, while head of CMS, went to great lengths to avoid transparency. He ducked reporters, in one instance even “exit[ing] behind a stage” to avoid press queries. Another time he went so far as to request a “security escort” to avoid questions.

Today, Berwick concedes his lack of transparency. According to a Politico report, he now “regrets listening to White House orders to avoid reaching out to congressional Republicans.”

The lack of transparency is endemic in the Obama administration. Case in point: the enactment of Obamacare. During his 2008 campaign, Barack Obama promised health-care negotiations televised on C-SPAN. Instead, we got a series of notorious backroom deals: the Cornhusker Kickback, the Louisiana Purchase, the Gator Aid.

“It’s an ugly process, and it looks like there are a bunch of backroom deals,” Obama feebly admitted in January 2010 — only to retreat again to the smoke-filled rooms two months later, where he cut the final deals to ram the legislation through Congress.

As usual, special interests had their day — both before and after Obamacare’s passage. While Berwick wouldn’t talk to reporters, he gladly met with insurance-industry executives, even if it meant ignoring journalists in the process. Likewise, the administrator who wouldn’t speak to Republican lawmakers happily addressed a closed-door meeting of “industry stakeholders” in December 2010. The Hill noted: “The meeting comes as a number of lobbyists say they’ve noticed more White House outreach toward K Street.”

So government transparency is possible — provided you’re a high-priced K Street lobbyist.

Obamacare is premised on the belief that government knows best. And those who share that belief all too often regard transparency and public accountability as inconveniences.

Consider the administration’s approach to regulating the proposed health-insurance “exchanges.” Obamacare requires state-based exchanges to “hold public meetings and input sessions,” but it fails to apply these same transparency standards to the federally run exchanges Washington will create in 33 states. The result: Many key questions remain unanswered.

Thus a law written in secret is being implemented in secret, with a maximum of opacity and a minimum of accountability from the administration.

Berwick claimed that open government would eliminate public worries about government rationing of health care. But Obamacare was born in darkness, and those implementing it are assuredly not “working in the daylight.” Americans have every reason to be concerned.

This post was originally published at National Review.

Obamacare’s Shortcomings in Two Charts

Obamacare continues to fall short of the lofty predictions about it — and here are two new charts to prove it.

The charts, included as part of a Congressional Budget Office (CBO) presentation over the weekend, summarize the CBO’s cost estimates of the law in the three years since its passage. The charts show that in every instance, the CBO’s estimate of the number of uninsured has risen, as has the number of workers who will lose coverage under their existing employer plans:

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As the presentation notes, many factors affect the CBO’s cost and coverage estimates. Economic growth and the state of labor markets will determine whether individuals have access to employer-provided health care or qualify for subsidized insurance. In 2011, Congress twice changed provisions dealing with Obamacare exchange subsidies, impacting enrollment projections. And the Supreme Court’s June 2012 decision making Medicaid expansion optional for states reshuffled the number of people who might qualify for Medicaid or exchange coverage.

All that said, the CBO noted one other key change affecting its coverage estimates: “increased employer responsiveness to alternative options.” In other words, if workers can receive access to taxpayer-subsidized insurance through the exchanges, firms are more likely to pay a $2,000 penalty to the federal government rather than pay $10,000 or more to subsidize a family’s health insurance policy. If the trends the CBO identified accelerate when Obamacare takes full effect next year, the cost for federal exchange subsidies could rise by trillions more at a time when the federal government can ill afford more new spending and debt.

More workers losing their coverage and more Americans not gaining coverage—that’s not the health care “reform” President Obama promised.

This post was originally published at the Daily Signal.

Obamacare: Important Context on Next Year’s Premium Increases

The Associated Press yesterday published an article that at first appears to contain exciting and important news:

There’s good news for most companies that provide health benefits for their employees: America’s slowdown in medical costs may be turning into a trend, rather than a mere pause.

A report Tuesday from accounting and consulting giant PwC projects lower overall growth in medical costs for next year, even as the economy gains strength and millions of uninsured people receive coverage under President Barack Obama’s health care law.

As with many things in health care, however, if it looks too good to be true, it probably is. Only in the tenth paragraph does the full picture become clear:

PwC’s report forecasts that direct medical care costs will increase by 6.5 percent next year, one percentage point lower than its previous projection.

In other words, overall employer health costs in 2014 will rise by more than twice the rate of economic growth and nearly four times faster than overall inflation, based on recent Federal Reserve projections. Moreover, the PwC report notes that insurance premiums may rise even faster on insurance exchanges due to the massive uncertainty associated with Obamacare: “Insurers face the uncertainty of who will enroll—the sick, the healthy, or a combination of the two.”

The study also points out that consolidation in the health care sector has served to drive up prices: “Studies have shown that hospital mergers in concentrated markets can increase prices by more than 20%.”

The bottom line is clear: Then-Senator Obama promised that Obamacare would lower premiums by $2,500 for struggling American families. Today’s report from PwC puts President Obama even further away from living up to that promise.

This post was originally published at the Daily Signal.

Q: “Will Obamacare Encourage Fraud?” A: “I’ll Have to Think about That…”

As we learn more each day about what Obamacare will bring, a video that recently became available reveals another frightening turn. The federal government already struggles with fraud in many major programs such as Medicare and Social Security. What about the forthcoming Obamacare insurance exchanges?

Obamacare includes a “navigator” program of individuals paid by the government to encourage people to sign up for the exchanges.

A House Oversight Committee hearing from May 21 produced the following exchange with Gary Cohen, the director of the federal center charged with implementing health insurance exchanges under Obamacare:

Representative Paul Gosar: What will a navigator or assister do if an individual reports they are paid under the table?

[Long pause]

Gary Cohen: That’s a good question. I’ll have to think about that, and talk to folks.

That’s not the only good question about the navigator program; the House Oversight Committee sent a letter asking more questions. The Department of Health and Human Services has allocated $54 million to this Obamacare “outreach” effort, and yet the Administration has not answered basic questions, like whether navigators would have to pass a criminal background check. The video demonstrates that Obamacare navigators could end up encouraging tax fraud by failing to report individuals who are paid under the table.

In March 2010, Speaker Nancy Pelosi famously said we had to pass the bill to find out what’s in it. Apparently, three years later, even the people in charge of implementing Obamacare still don’t know what’s in the law, and how it will—or won’t—work.

This post was originally published at the Daily Signal.

What Obama’s Campaign Group Won’t Tell You about Obamacare

Organizing for Action, President Obama’s campaign group, is out this morning with its first advertisement promoting Obamacare. The ad claims to tell the “facts” surrounding the law, but here’s what it doesn’t tell you:

Claim: “Free Preventive Care for 34 Million”

Fact: Obamacare forces insurers to cover preventive services without a co-payment, but just because some services now don’t have a co-payment doesn’t mean they’re “free.” Mandates like the one surrounding preventive care are raising health insurance premiums. Earlier this month, CBS News reported that “Obamacare may cost more than experts previously thought, according to a survey of 900 employers.” What’s more, the preventive services mandate also forces religious organizations to violate their deeply held beliefs and provide employees with contraceptive products they find morally objectionable.

Claim: “$150 Average Rebate in 2012”

Fact: This talking point refers to Obamacare’s medical-loss ratio provision, which imposes price controls on insurance companies, forcing them to pay rebates to consumers if they do not meet Obamacare’s arbitrary standards. The Kaiser Family Foundation reported last year that rebates would be issued to plans covering 3.4 million people, or only about 1 percent of the population. The Kaiser report admitted that the rebates “are not particularly large in many instances.” While candidate Obama promised that premiums would go down by $2,500 by the end of his first term, the average employer premium has actually gone up by $3,065—from $12,680 in 2008 to $15,745 in 2012, according to Kaiser data.

Claim: “Up to 50% of Small Business Insurance Covered”

Fact: The ad claims that Obamacare’s small business tax credit—which funds a portion of health insurance premiums—is having a major impact. But a May 2012 Government Accountability Office (GAO) report found that only about 170,000 small businesses claimed the Obamacare tax credit—far less than expectations of up to 4 million trumpeted by supporters. The report also makes clear that the credit’s complexity and bureaucracy discouraged small businesses from applying for the credit. Here’s what tax preparers quoted in the GAO report said about the tax credit:

Any credit that needs a form that takes 25 lines and seven work sheets to build those 25 lines is too complicated.…

[Small business owners] are trying to run their businesses and operate and make a profit, and when you tell them they need to take two, three, four hours to gather this information, they just shake their head and say, “No, I’m not going to do it.”

In other words, bureaucracy, complexity, and regulations have stifled the small business tax credit—an apt metaphor for the law as a whole.

This post was originally published at the Daily Signal.

Obamacare’s Insurance “Solution:” Medicaid for All

Even as the Left celebrates Obamacare’s expansion of health coverage, a Reuters story highlighted what kind of “insurance” people will receive under the law.

First, the article noted that many large, national insurers have decided not to participate in Obamacare’s exchanges:

The nation’s biggest insurers have decided against joining the exchanges on a large scale, professing uncertainty about the roll-out and how much the uninsured would participate. Most are sticking to states where they already sell insurance directly to individuals, leaving at least half a dozen states with only one or two health plans to choose from.

The article then quoted a chief executive from one of the insurers participating in exchanges on the type of coverage they will offer:

Since we don’t offer commercial products, we aren’t paying the providers at commercial rates…. The products look a lot like the Medicaid plans that we are currently administering.”

In other words, people in the exchanges may not have a large choice of plans, and the available plans may end up closely resembling Medicaid coverage.

The problems with Medicaid coverage are well-documented. Low physician payments mean that many doctors do not accept Medicaid. As a result, health outcomes for patients on Medicaid remain poor, in some cases even worse than uninsured individuals. Perhaps one Michigan resident and Medicaid beneficiary said it best:

You feel so helpless thinking, something’s wrong with this child and I can’t even get her into a doctor…. When we had real insurance, we would call and come in at the drop of a hat.

Sadly, as the Reuters story notes, millions of Americans—not just those covered under Obamacare’s Medicaid expansion, but also those placed in the exchanges—could soon discover what it means not to have real insurance under the new health care law.

This post was originally published at the Daily Signal.

For Low-Income Families, Obamacare is the UNAFFORDABLE Care Act

Yesterday the Associated Press published an article summarizing how Obamacare’s supposed benefits may well turn out to be a mirage for many low-income workers:

It’s called the Affordable Care Act, but President Barack Obama’s health care law may turn out to be unaffordable for many low-wage workers, including employees at big chain restaurants, retail stores and hotels….Because of a wrinkle in the law, companies can meet their legal obligations by offering policies that would be too expensive for many low-wage workers. For the employee, it’s like a mirage — attractive but out of reach.

The company can get off the hook, say corporate consultants and policy experts, but the employee could still face a federal requirement to get health insurance.

Here’s how it could work: Obamacare includes numerous mandates that will raise premiums. CBS News reported this week that one survey of employers showed “Obamacare may cost more than previously thought” for many firms. Due to these new mandates, some employers may feel forced to scale back the employer’s percentage of premium costs. But as long as the employer’s insurance policies cost less than 9.5 percent of an employee’s income, the employer will not face taxes under the employer mandate—and the employee will not qualify for subsidies on the exchange.

The end result could be a no-man’s land for many low-income workers. The AP notes that a worker making $21,000 could face premium costs of as much as $1,995—and that coverage would still be viewed as “affordable” under Obamacare’s standards. In reality, the worker may not be able to pay that much in premiums—but under the law would have no other coverage option.

That’s not the only way Obamacare harms low-income families. The non-partisan Congressional Budget Office (CBO) concluded that under Obamacare, many workers could work fewer hours or give up working altogether. Thanks to the law’s perverse incentives, which according to CBO “will effectively increase marginal tax rates,” work will be discouraged.

What has been the Administration’s reaction to the plight of low-income families? In a word, complacency. From the AP:

White House senior communications advisor Tara McGuinness downplayed concerns. “There has been a lot of conjecture about what people might do or could do, but this hasn’t actually happened yet,” she said. “The gap between sky-is-falling predictions about the health law and what is happening is very wide.”

American families of all incomes deserve better than to be placed in a poverty trap that deprives them of health coverage while simultaneously discouraging work. They deserve better than Obamacare.

This post was originally published at the Daily Signal.

Ezra Klein Can’t Save Obamacare’s Broken Premium Promise

Ezra Klein’s column in Bloomberg this week attempted to defend then-Senator Barack Obama’s repeated promises to lower premiums by $2,500. Unfortunately for Klein, virtually all of his defenses fall short.

First, Klein claims that “there was no time frame attached to the promise.” On this count, he’s flat-out wrong. Campaign advisor Jason Furman—the President’s recent nominee to head the Council of Economic Advisors—told the New York Times in July 2008 that “We think we could get to $2,500 in [premium] savings [per family] by the end of the first term, or be very close to it.” If Klein wants to argue that Americans’ premiums have gone down by $2,500 since 2009, he’s welcome to do so—but I doubt many Americans would believe him.

Second, Klein claims that “the [health care] savings are actually materializing.” He cites a recent study from David Cutler to make his claim, but that study doesn’t actually say health costs and premiums are falling—it just says they’re rising by less than they otherwise would have. Similarly, the Administration has often cited a 2009 study from the Business Roundtable to defend its “lower premiums” claim. I don’t think many Americans would look at the chart from that study and define its projected trend—a line showing premiums going up by “only” $12,400 from 2009 to 2019—as “lowering” premiums.

Business Roundtable

Source: Report to Business Roundtable by Hewitt Associates, November 2009.

Third, Klein doesn’t point out that many studies view Obamanomics, not Obamacare, as the root cause of the current slowdown in health spending. One study recently released by the Kaiser Family Foundation—not exactly a group of firebrand conservatives—concluded:

Our analysis suggests that the vast majority (77%) of the recent decline in the health spending trend can be attributed to broader changes in the economy.

Of course, if Klein and the Obama Administration want to take credit for the lousy economy that’s slowing down the growth of costs, they’re welcome to do so.

Finally, Klein spends the second half of his column arguing that people on the exchanges will pay more for insurance, but will get better coverage. Trouble is, that’s not what then-Senator Obama promised. His plan promised that “For those who have insurance now, nothing will change under the Obama plan—except that you will pay less.” Klein effectively admits that neither of those provisions is true—at least some individuals will be forced to buy more expensive coverage.

The fact that Klein’s arguments are so far removed from the purported intent of Obamacare—defining premium savings down, and admitting millions of Americans will lose their current coverage and be forced into more expensive insurance—shows the massive gap between the law’s rhetoric and its reality. If he wants to mount an intellectually honest defense of the law, Klein should start by acknowledging the false promises upon which it was sold to the American people.

This post was originally published at the Daily Signal.

For Congress, Obamacare Finally Hits Home

The quotes are certainly ominous:

  • Employees are so worried “thanks to Obamacare that they are thinking about retiring early or just quitting.”
  • Workers fear being pushed “on to the government health exchanges, which could make their benefits exorbitantly expensive.”
  • “The chatter about retiring now, to remain on the current health care plan, is constant.”
  • Employees “young and old [are] worried about skyrocketing health care premiums cutting deeply into their already small paychecks.”
  • “The focus right now is…trying to figure out how to offset potential increases in premiums.”

Those quotes could refer to any number of employers and firms dealing with the effects of Obamacare. But, as this morning’s Politico reports, the quotes taken above come from Capitol Hill, where aides are terrified of a provision in Obamacare that dumps them onto the exchanges come January 1.

Federal employees, including those on Capitol Hill, currently receive generous “corporate level” health insurance benefits and a broad range of personal plan choice—from high-cost, comprehensive plans to low-cost, high-deductible plans—that is denied the vast majority of Americans.

Like all enrollees in employer-based coverage, Capitol Hill employees (and all federal workers) get employer subsidies for the cost of their coverage. It’s a flat, fixed-dollar amount and, like all employer-based contributions, is also tax-free.

When Members and staff are forced out of their existing coverage into Obamacare’s exchanges, they will lose both the generous subsidy and the tax break. Many on Capitol Hill will not qualify for subsidies in the exchanges—just like many private-sector employees who will lose their existing coverage.

Members and staff have another big problem. Obamacare was drafted so clumsily that it’s unclear precisely how placing Members of Congress and their staff in exchanges will work. Politico notes that “there has been no guidance” from the Office of Personnel Management on the issue, and fear levels have been rising as a result.

This is what happens when we have to pass the bill to find out what’s in it.

The Politico story really just shows the broader themes that have been playing out around the country: Regulators causing uncertainty for businesses and their workers? Check. Skyrocketing premiums in the exchanges? Check. Firms dumping their workers onto exchanges? Check. In other words, all of Obamacare’s chickens have finally come home to roost on Capitol Hill.

This post was originally published at the Daily Signal.