Tag Archives: Bloomberg

A Status Update on the Senate Health Care Bill

The past week’s debate on health care has seen more twists and turns than a dime-store movie novel. “Repeal-and-replace” is dead—then alive again. President Trump calls for outright repeal, then letting the law fail, then “repeal-and-replace” again.

As Vince Lombardi might ask, “What the h— is going on out here???”

Never fear. Three simple facts will put the debate in context.

Leadership Is Buying Moderates for ‘Repeal-and-Replace’

Whether in the form of “candy,” “making it rain,” or old-fashioned carve-outs that help states with reluctant senators, Senate leaders are trying to figure out the amount and type of money and incentives that will win enough moderate votes to pass a “repeal-and-replace” bill. Details remain sketchy, but the broader outline is clear: senators don’t want to vote for provisions they approved 18 months ago—when they knew President Obama would veto a repeal measure. And Senate leadership hopes to “solve” this problem essentially by throwing money at it—through new funding for Medicaid expansion states, opioid funding, bailout funds for insurers, programmatic carve-outs for some states, or all of the above (likely all of the above).

Leadership Isn’t Serious about Repeal-Only

Some observers (not to mention some senators) are confused about whether the Senate will vote on a repeal-only measure, or a “repeal-and-replace” bill. But Senate Majority Whip John Cornyn (R-TX) explained leadership’s strategy to Bloomberg Wednesday: “There’s more optimism that we could vote on a repeal-and-replace bill, rather than just a repeal bill….But if there’s no agreement then we’ll still vote on the motion to proceed” to a repeal-only measure” (emphasis mine).

Translation: Senate leadership will only move to a vote on the 2015 repeal bill—which some conservative groups have argued for—if it knows it will fail. In fact, some observers have gone so far as to suggest Majority Leader Mitch McConnell’s Monday announcement that the Senate would vote on a repeal-only bill amounted to an attempt to bait-and-switch conservatives—convincing them to support starting debate on the bill by dangling repeal-only in front of them, only to pivot back to “repeal-and-replace” once the debate began.

Regardless of McConnell’s intentions earlier in the week, Cornyn’s comments make clear the extent to which Senate leaders take a repeal-only bill seriously: They don’t.

McCain May Make It Moot

It may sound impolitic or callous to translate a war hero’s struggle against cancer into crass political terms, but if the recent cancer diagnosis of Sen. John McCain (R-AZ) means the senator will be unable to travel to Washington, Republican leaders’ desperate attempts to cobble together a legislative compromise may ultimately prove moot. At least two conservative senators oppose the current bill from the Right; adding more money to appease moderates won’t reduce those numbers, and may increase them. And at least two moderate senators oppose the current bill from the Left, hence the effort to increase funding.

If McCain is unable to vote on the legislation, Republican leaders will be able to withstand only one defection before putting the bill’s passage in jeopardy—yet at least two senators on either side of the Republican Conference oppose the current bill. That math just doesn’t add up, which means that barring some unforeseen development, the hue and cry of the past several days may ultimately amount to very little.

This post was originally published in The Federalist.

A Reading Guide to the Senate Bill’s Backroom Deals

Buried within the pages of the revised Senate health-care bill are numerous formula tweaks meant to advantage certain states. Call them backroom deals, call them earmarks, call them whatever you like: several provisions were inserted into the bill over the past two weeks with the intent of appealing to certain constituents.

It appears that at least three of these provisions apply to Alaska—home of wavering Sen. Lisa Murkowski (R-AK)—and another applies to Louisiana, home of undecided Sen. Bill Cassidy (R-LA). Below please find a summary (not necessarily exhaustive) of these targeted provisions.

The Buy Off Lisa Murkowski Again Fund

Section 106 of the bill includes new language—page 13, lines 4 through 13, and page 18, line 12 through page 19, line 4—dedicating one percent of the new Stability Fund dollars to “each state where the cost of insurance premiums are at least 75 percent higher than the national average.” As a Bloomberg story noted, this provision currently applies only to Alaska, and could result in $1.32 billion in Stability Fund dollars automatically being directed to Alaska.

The Alaskan Pipeline

The revised Section 126 of the bill includes modified language—page 44, lines 9 through 17—changing certain Medicaid payments to hospitals based on a state’s overall uninsured population, not its Medicaid enrollment. As Bloomberg noted, this provision would also benefit Alaska, because Alaska recently expanded its Medicaid program, and therefore would qualify for fewer dollars under the formula in the original base bill.

The Moral Hazard Expansion

The underlying bill determined Medicaid per capita caps based on eight consecutive fiscal quarters—i.e., two years—of Medicaid spending. However, the revised bill includes language beginning on line 6 of page 59 that would allow “late expanding Medicaid states”—defined as those who expanded between and July 1, 2015 and September 30, 2016—to base their spending on only four consecutive quarters. Relevant states who qualify under this definition include Alaska (expanded effective September 1, 2015), Montana (expanded effective January 1, 2016), and Louisiana (expanded effective July 1, 2016).

The most recent actuarial report on Medicaid noted that, while the actuary originally predicted that adults in the expansion population would cost less than existing populations, in reality each newly eligible enrollee cost 13.6 percent more than existing populations in 2016. Some states have used the 100 percent federal match for their expansion populations—i.e., “free money from Washington”—to raise provider reimbursement levels. Therefore, allowing these three states to use only the quarters under which they had expanded Medicaid as their “base period” will likely allow them to draw down higher payments from Washington in perpetuity.

The South Dakota Purchase

The revised bill includes a new Section 138, which makes services provided by a state to Indian Health Service enrollees subject to a 100 percent federal Medicaid match. Under current law, only services “received through an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization” are subject to a 100 percent match. South Dakota Gov. Dennis Daugaard has pushed this provision for over a year, saying he would expand Medicaid under Obamacare—but only if the federal government would agree to provide a 100 percent reimbursement for all Medicaid services provided to Indian Health Service enrollees.

The Buffalo Bribe

This provision, originally included in the House-passed bill, remains in the Senate version, beginning at line 12 of page 69. Originally dubbed the “Buffalo Bribe,” and inserted at the behest of congressmen from upstate New York, the provision would essentially penalize that state if it continues to require counties to contribute to the Medicaid program’s costs.

More to Come?

While the current bill contains at least half a dozen targeted provisions, many more could be on the way. By removing repeal of the net investment tax and Medicare “high-income” tax, the bill retains over $230 billion in revenue. Yet the revised bill spends far less than that—$70 billion more for the Stability Fund, $43 billion more in opioid funding, and a new $8 billion demonstration project for home and community-based services in Medicaid.

Even after the added revenue loss from additional health savings account incentives, Senate leadership could have roughly $100 billion more to spend in their revised bill draft—which of course they will. Recall too that the original Senate bill allowed for nearly $200 billion in “candy” to distribute to persuade wayward lawmakers. In both number and dollar amount, the number of “deals” to date may dwarf what’s to come.

This post was originally published in The Federalist.

Donald Trump’s 47.5 Million Reasons to Support Obamacare Bailouts

Last Friday afternoon, Donald Trump caused a minor uproar in Washington when he signaled a major softening in his stance towards President Obama’s unpopular health-care law. “Either Obamacare will be amended, or it will be repealed and replaced,” Trump told the Wall Street Journal—a major caveat heretofore unexpressed on the campaign trail.

Why might Trump—who not one month ago, in a nationally televised debate, called Obamacare a “total disaster” that next year will “implode by itself”—embark on such a volte face about the law? Politico notes one possible answer lies in the story of Oscar, a startup insurer created to sell plans under Obamacare:

Oscar is about to have an unusually close tie to the White House: Company co-founder Josh Kushner’s brother Jared is posted to plan an influential role in shaping his father-in-law Donald Trump’s presidency. The two brothers in 2013 were also deemed ‘the ultimate controlling persons in Oscar’s holding company system,’ according to a state report.

In other words, the individual who multiple sources report personally influenced the selection of the next White House chief of staff also holds a controlling interest in a health insurance company whose primary business is selling Obamacare policies. Might that be why Trump has suddenly changed his tune on Obamacare repeal?

Government of the People—Or of the Cronies?

In 2000, while contemplating a run for the White House, Trump told Fortune magazine: “It’s very possible that I could be the first presidential candidate to run and make money on it.” That previously expressed sentiment—of using political office for personal pecuniary gain—would not rule out Trump assuming policy positions designed to enrich himself and his associates.

That need might be particularly acute in the case of Oscar, of which Jared Kushner was a controlling person, and in which Josh Kushner’s venture capital firm Thrive Capital has invested. On Tuesday, the insurer reported $45 million in losses in just three states, bringing Oscar’s losses in those three states to a total of $128 million this calendar year. Bloomberg said the company “sells health insurance to individuals in new markets set up by [Obamacare,]” and described its future after last week’s election thusly:

Trump’s election could be a negative for the insurer. The Republican has promised to repeal and replace [Obamacare,] though he’s softened that stance since his victory. The uncertainty could discourage some people from signing up for health plans, or Republicans could eliminate or reduce the tax subsidies in the law that are used to help pay for coverage.

Replace “the insurer” with “Trump’s in-laws” in the above paragraph, and the president-elect’s evolving stance certainly begins to make more sense.

Pimp My Obamacare Bailout?

In last month’s second presidential debate, Trump described Democrats’ position on health care: “Their method of fixing [Obamacare] is to go back and ask Congress for more money, more and more money. We have right now almost $20 trillion in debt.”

It’s an ironic statement, given that government documents reveal how Oscar—and thus Trump’s in-laws—have made claims on Obamacare bailout programs to the tune of $47.5 million. Those claims, including $38.2 million from reinsurance and $9.3 billion from risk corridors, total more than Oscar’s losses in the past quarter. The $47.5 million amount also represents a mere fraction of what Oscar could ultimately request, and receive, from Obamacare’s bailout funds, as it does not include any claims for the current benefit year.

Given that most of the things Trump should do on Day One to dismantle Obamacare involve undoing the law’s illegal bailouts, it’s troubling to learn the extent to which a company run by his in-laws has benefited from them. Following are some examples.

Reinsurance: Administration documents reveal that during Obamacare’s first two years, Oscar received $38.2 million in payments from the law’s reinsurance program, designed to subsidize insurers for the expense associated with high-cost patients. Unfortunately, these bailout payments have come at the expense of taxpayers, who have been shortchanged money promised to the federal Treasury by law so the Obama administration can instead pay more funds to insurers.

In 2014, when Oscar only offered plans in New York, the company received $17.5 million in Obamacare reinsurance payments. In 2015, as Oscar expanded to offer coverage in New Jersey, the insurer received a total of more than $20.7 million in reinsurance funds: $19.8 million for its New York customers, and $945,000 for its New Jersey enrollees.

While reinsurance claims for the 2016 plan year are still being compiled and therefore have not yet been released, it appears likely that Oscar will receive a significant payment in the tens of millions of dollars, for two reasons. First, the carrier expanded its offerings into Texas and California; more enrollees means more claims on the federal fisc. Second, Bloomberg quoted anonymous company sources as saying that part of Oscar’s losses “stem from high medical costs”—which the insurer will likely attempt to offset through the reinsurance program.

While the Obama administration has doled out billions of dollars in reinsurance funds to insurers like Oscar, they have done so illegally. In September, the Government Accountability Office ruled that the administration violated the text of Obamacare itself. Although the law states that $5 billion in payments back to the Treasury must be made from reinsurance funds before insurers receive payment, the Obama administration has turned the law on its head—paying insurers first, and stiffing taxpayers out of billions.

wrote last week that Trump can and should immediately overturn these illegal actions by the Obama Administration, and sue insurers if needed to collect for the federal government. But if those actions jeopardize tens of millions of dollars in federal payments for the Kushners, or mean the Trump administration will have to take Trump’s in-laws to court, will he?

Risk Corridors: Oscar also has made claims for millions of dollars regarding Obamacare’s risk corridor program, which as designed would see insurers with excess profits subsidize insurers with excess losses. In 2014, Oscar was one of many insurers with excess losses, making a claim for $9.3 million in risk corridor payments.

However, because Congress prohibited taxpayer funds from being used to bail out insurance companies, and because few insurers had excess profits to pay into the risk corridor program, insurers requesting payouts from risk corridors received only 12.6 cents on the dollar for their claims. While Oscar requested more than $9.3 million, it received less than $1.2 million—meaning it is owed more than $8.1 million from the risk corridor program for 2014.

CMS has yet to release data on insurers’ claims for 2015, other than to say that payments to the risk corridor program for 2015 were insufficient to pay out insurers’ outstanding claims for 2014. In other words, Oscar will not be paid its full $9.3 million for 2014, even as it likely makes additional claims for 2015 and 2016.

However, Oscar yet has hope in receiving a bailout from the Obama administration. In September, the administration said it was interested in settling lawsuits brought by insurance companies seeking reimbursement for unpaid risk corridor claims. The administration hopes to use the obscure Judgment Fund to pay through the backdoor the bailout that Congress prohibited through the front door.

As with reinsurance payments, a President Trump should immediately act to block such settlements, which violate Congress’ expressed will against bailing out insurers. However, given his clear conflict-of-interest in protecting his close relatives’ investments, it’s an open question whether he will do so.

Cost-Sharing Reductions: Like other health insurers, Oscar has benefited by receiving cost-sharing subsidies—even though Congress never appropriated funds for them. In May, Judge Rosemary Collyer agreed with the House of Representatives that the Obama administration’s payments to insurers for cost-sharing subsidies without an appropriation violate the Constitution. Although the text of the law requires insurers to reduce deductibles and co-payments for some low-income beneficiaries, it never included an explicit appropriation for subsidy payments to insurers reimbursing them for these discounts. Despite this lack of an appropriation, the Obama administration has paid insurers like Oscar roughly $14 billion in cost-sharing subsidies anyway.

Here again, Trump should immediately concede the illegality of the Obama administration’s actions, settle the lawsuit brought by the House of Representatives, and end the unconstitutional cost-sharing subsidies on Day One. But given his close ties to individuals whose insurance model is largely based on selling Obamacare policies, will he do so? To put it bluntly, will he put the interests of Oscar—and his in-laws—ahead of the U.S. Constitution?

Ask Congress for More and More Money?’

In general, health insurance companies have made record profits during the Obama years—a total of a whopping $15 billion in 2015. But while insurers have made money selling employer plans, or contracting for Obamacare’s massive expansion of Medicaid, few insurers have made money on insurance exchanges. That dynamic explains why Oscar, which has focused on exchange plans, has suffered its massive losses to date.

However, as Trump rightly pointed out just one short month ago, the answer is not to “ask Congress for more money, more and more money.” He should end the bailouts immediately upon taking office. Duty to country—and the constitutional oath—should override any personal familial conflicts.

This post was originally published at The Federalist.

Aetna’s New Obamacare Strategy: Bailouts or Bust

Tuesday’s announcement by health insurer Aetna that it had halted plans to expand its offerings on Obamacare exchanges and may instead reduce or eliminate its participation entirely, caused a shockwave among health-policy experts. The insurer that heretofore had acted as one of Obamacare’s biggest cheerleaders has now admitted that the law will not work without a massive new infusion of taxpayer cash.

In an interview with Bloomberg, Aetna’s CEO, Mark Bertolini, explained the company’s major concern with Obamacare implementation:

Bertolini said big changes are needed to make the exchanges viable. Risk adjustment, a mechanism that transfers funds from insurers with healthier clients to those with sick ones, “doesn’t work,” he said. Rather than transferring money among insurers, the law should be changed to subsidize insurers with government funds, Bertolini said.

“It needs to be a non-zero sum pool in order to fix it,” Bertolini said. Right now, insurers “that are less worse off pay for those that are worse worse off.”

A brief explanation: Obamacare’s risk adjustment is designed to even out differences in health status among enrollees. Put simply, plans with healthier-than-average patients subsidize plans with sicker-than-average patients. But the statute stipulates that the risk-adjustment payments should be based on “average actuarial risk” in each state marketplace — by definition, plans will transfer funds among themselves, but the payments will net out to zero.

Risk adjustment, a permanent feature of Obamacare, should not be confused with the law’s temporary-risk-corridor program, scheduled to end in December. Whereas risk corridor subsidizes loss-making plans, risk adjustment subsidizes sicker patients. And while plans can lose money for reasons unrelated to patient care — excessive overhead or bad investments, for instance — insurers incurring perpetual losses on patient care have little chance of ever breaking even.

That’s the situation Aetna says it finds itself in now. In calling for the government to subsidize risk adjustment, Bertolini believes that for the foreseeable future insurers will continue to face a risk pool sicker than in the average employer plan. In other words, the exchanges won’t work as currently constituted, because healthy people are staying away from Obamacare plans in droves. Aetna’s proposed “solution,” as expected, is for the taxpayer to pick up the tab.

It’s not that insurers haven’t received enough in bailout funds already. As I have noted in prior work, insurance companies stand to receive over $170 billion in bailout funds over the coming decade. For instance, the Obama administration has flouted the plain text of the law to prioritize payments to insurers over repayments to the United States Treasury. But still insurance companies want more.

Some viewed Aetna’s threat to vacate the exchanges as an implicit threat resulting from the Justice Department’s challenging its planned merger with Humana. But the reality is far worse: Aetna was conditioning its participation not on its merger’s being approved but on receiving more bailout funds from Washington.

Like a patient in intensive care, the Left wants to administer billions of dollars to insurers as a form of fiscal morphine, hoping upon hope that the cash infusions can tide them over until the exchanges reach a condition approaching health. Just last month, the liberal Commonwealth Fund proposed extending Obamacare’s reinsurance program, scheduled to end this December, “until the reformed market has matured.” But as Bertolini admitted in his interview, the exchanges do not work, and will not work — meaning Commonwealth’s suggestion would create yet another perpetual-bailout machine.

Only markets, and not more taxpayer money, will turn this ailing patient around. Congress should act to end the morphine drip and stop the bailouts once and for all. At that point, policymakers of both parties should come together to outline the prescription for freedom they would put in its place.

This post was originally published at National Review.

Insurers Now “Scared to Death” of Obamacare

Bloomberg has a must-read story this morning highlighting yet more faults with Obamacare’s exchanges. Specifically, the faults in the exchanges’ computer software aren’t just hitting consumers trying to shop for plans—they’re hitting insurers as well:

Insurers are getting faulty and incomplete data from the new U.S.-run health exchange, which may mean some Americans won’t be covered even after they sign up for an insurance plan.…The companies are receiving electronic files that can’t open or have so much missing information on new enrollees they’re unusable, the consultants said.

Some insurers have been forced to fix entries by hand, said Bob Laszewski, an insurance-industry consultant based in Arlington, Virginia.

“If we don’t see substantial improvement by the end of this week, then I would throw up the yellow flag,” said Dan Schuyler, a consultant advising states and insurers on the exchanges. “If we don’t see it in the next two to three weeks, it’s time for red flags. The concern is some people could get to Jan. 1, and not have coverage.”

Last week, the Administration claimed that heavy volume was the prime cause of the exchanges’ delays. But today’s Bloomberg report, as with other news reports over the weekend, all suggest bigger issues with the federal data hub and other elements of the IT infrastructure needed to support enrollment.

The Congressional Budget Office (CBO) has estimated that 7 million individuals would enroll in exchanges for 2014. If even one in 10 applications has to be adjusted manually because insurance carriers receive inaccurate data from the exchanges, that would mean 700,000 applications would have to be processed by hand between now and the end of open enrollment in March—a staggering possibility, and a feat few insurers will be able to achieve.

Little wonder that the Bloomberg story ends with one consultant saying that “the insurance industry is scared to death” of the problems the exchange glitches may cause them. What started off sounding like a dream—millions of new customers, and more than $1 trillion in insurance subsidies—may turn out to be a horrible nightmare for the insurance industry. It’s a fitting metaphor for the law’s effects on the American people as a whole.

This post was originally published at the Daily Signal.

Yes, There’ll Be Sticker Shock

Which health-insurance plan costs more — one that covers 50 percent of your expected health expenses, or one that covers 60 percent?

It’s not a trick question. And the answer to it goes to the heart of the problem with studies claiming that Obamacare will not raise insurance premiums next year.

Consider, for instance, a recent Rand Corporation study claiming “there could be a decline in total premiums” for Americans who buy health insurance directly from insurance companies. Press headlines trumpeted that talking point. “No Widespread Premium Increases Coming under Obamacare,” said one Capitol Hill publication. “Study: Price Shocks on Health Exchanges Appear Unlikely,” blared NPR. “Many states will see little to no change in premiums,” reported Bloomberg.

It sounded like good news. But there’s a hitch. In arriving at this conclusion, the Rand researchers compared rates for pre- and post-Obamacare plans with the same actuarial values. That’s a fancy term for the percentage of expected health costs paid by the insurance company.

The lead Rand researcher explained to a Bloomberg reporter why their study didn’t consider changes in actuarial value: “Some people buy more generous coverage because of the law and that will lead to increased costs. . . . In my mind, that’s not the same as rate shock because the person will be getting a better plan.”

But there’s one big catch: Obamacare will force people to buy richer plans — whether they want to or not. An article in the journal Health Affairs last year noted most plans now purchased by individuals do not meet the minimum-coverage standards that the law will require starting next year.

To return to where we started: A health plan covering 60 percent of expenses will cost more than a health plan covering 50 percent of expenses. Obamacare forces health plans to cover at least 60 percent of expenses — a requirement most individually purchased health plans don’t meet. Yet the Rand study ignored the impact of this new Obamacare mandate when claiming that premiums will not rise next year.

When Obamacare was being debated in 2009, the nonpartisan Congressional Budget Office did examine the impact of the new benefit mandates on health-insurance premiums. It concluded that “average premiums [under Obamacare] would be 27 percent to 30 percent higher because a greater amount of coverage would be obtained,” in part because of “the minimum level of coverage (and related requirements) specified in the proposal.” In other words, premiums will go up because Obamacare forces people to buy more comprehensive — and therefore more expensive — health plans.

The Rand study was funded by the Department of Health and Human Services, which certainly must be pleased that the analysis conveniently ignored the impact of Obamacare’s forcing people to buy richer coverage. And the claim made by the Rand researcher — that people may pay more for coverage next year but “will be getting a better plan” — echoes those now being made by other defenders of the law.

Regardless, it’s not consistent with what Senator Obama promised when campaigning for president. A 2008 document issued by the Obama campaign highlights the candidate’s pledge: “For those who have insurance now, nothing will change under the Obama plan — except that you will pay less. Obama’s plan will save a typical family up to $2,500 on premiums.” Candidate Obama didn’t say “you will pay more, but you’ll get better coverage” — he said “you will pay less,” period.

Having engaged in a massive bait-and-switch — signing a law that raises premiums after he promised he would lower them — the president and his administration are now trying to justify the law’s impending premium increases. But the false premises under which it was sold in the first place should provide Congress with every reason to use its power of the purse and stop Obamacare before this sticker shock hits the American people on January 1.

This post was originally published at National Review.

The Obamacare Big City Bailout

Bloomberg reports this week on the latest Obamacare trend sweeping across the country: Cities and states may soon attempt to unload unsustainable health costs on the federal government by dumping employees and retirees onto exchanges.

Both Chicago and Detroit have explored using the exchanges to reduce massive budget shortfalls, and it could set an example for others. Bloomberg quotes one expert from the Rockefeller Institute of Government: “We can expect other cities to pick up on this.… I expect [employee dumping] to mushroom.”

The incentives for cities—or even states—to dump their workers onto exchanges are significant. Bloomberg notes that reducing retiree health costs could save Detroit approximately $150 million per year—at a time when the city faces a $386 million budget deficit and $17 billion in long-term debt.

Of course, these budgetary maneuvers aren’t really “savings”—they merely represent a shift of unsustainable costs from cities and states onto the backs of federal taxpayers. If more individuals than expected—particularly retirees, who are likely to be older and sicker than the population as a whole—require federal exchange subsidies, the cost of Obamacare could rise by trillions. And if cities and even states set an example by dumping their health care obligations on the federal government, private-sector employers could well follow suit.

The spokesman for Chicago mayor Rahm Emanuel called the city’s retiree health system “fiscally unsustainable,” but merely shifting that responsibility to Washington may be about as effective as moving deck chairs on a budgetary Titanic.

Meanwhile, like other Americans losing their coverage due to Obamacare, retirees themselves appear none too keen on getting dumped onto the exchanges. Bloomberg quotes one retired Detroit police officer expressing his outrage:

Imagine if they said tomorrow your Social Security, your Medicare is going away and you’re going on Obamacare.… How would you feel?

Many Americans may soon find out.

This post was originally published at the Daily Signal.

It’s Official: Administration Admits Obamacare Is a Job-Killer

Bloomberg News reported this evening that the Obama Administration is set to announce a one-year delay in enforcement of Obamacare’s employer mandate, a move the Treasury Department recently confirmed in a blog post.

However, the problem is not just Obamacare’s employer mandate—the real problem is Obamacare itself. The same individuals who said Obamacare would create jobs, not destroy them, are now the same ones who will say the Administration can “fix” the employer mandate, if only given another year to do so. Conservatives should not be fooled, appeased, or assuaged. Instead, today’s developments should provide every incentive for the American people to redouble their efforts to repeal, defund, and dismantle ALL of this bureaucratic, unworkable law.

The idea that selectively enforcing one provision of the law could “solve” all the problems inherent in Obamacare is absurd on its face. In fact, the Administration’s position raises more questions than it answers:

  • If the employer mandate will prove so devastating to businesses that it can’t be enforced in 2014—following three years of implementation work—why should it be enforced at all?
  • Will delaying implementation of the employer mandate encourage more firms to drop coverage entirely and dump their workers on to Exchanges, raising the cost of taxpayer-funded subsidies by trillions?
  • What about individuals who can’t afford to buy health insurance, yet will be forced to do so under Obamacare? Will they get an exemption from enforcement as well?

It is hard to understate the impact of today’s devastating admission from the Administration that, after three years, it still cannot implement Obamacare without strangling businesses in red tape and destroying American jobs. That said, it is still not too late for Congress to do the right thing, and refuse to fund what the Administration has now—finally—admitted is a job-killing train wreck.

This post was originally published at the Daily Signal.

Obamacare’s ACO Conundrum

Over the weekend, Bloomberg reported on the latest challenge to Obamacare: hospitals leaving one of the law’s signature attempts to contain health costs:

Almost a third of 32 hospitals and health systems involved in an experiment aimed at changing the way medical providers are paid may exit the program, a potential threat to [Obamacare’s] ambitious cost-saving goals.

According to a Medicare spokesman, nine hospitals and health systems participating in the “Pioneer” accountable care organization (ACO) pilot may leave the program outright—and four more “may join other accountable care programs that carry less financial risk.” This development comes three months after the Pioneers wrote to Medicare administrators asking for a delay in the program, claiming they were not yet ready to assume financial risk if patients’ costs rise more than projected.

One of the reasons hospitals are leaving the ACO program involves government red tape. In order to manage their patients most effectively, hospital systems want access to real-time medical claims data—but Medicare’s lumbering bureaucracy can provide information on health claims six months after the fact. As the CEO of one hospital organization told Bloomberg, “We’re asking for more agility than the system is really set up to produce.”

The other reason for the ongoing ACO struggles centers around the euphemistically termed “clinical control”—in other words, patients’ ability to see the doctor they want. The Bloomberg article notes that right now, hospitals in the ACO program “can’t forbid the patients from seeing doctors or other health providers who aren’t part of the Pioneer system.” Hospitals believe this restriction on their ability to manage patients has prevented them from containing costs as much as originally hoped.

Viewed from this perspective, the latest news on ACOs provides policymakers with a difficult choice: impose more restrictions on patients of ACO participants to choose their own doctors—limiting access to care in a way many HMOs did during the 1990s—or see this supposedly “innovative” care model fail to reduce costs as promised.

That’s not a choice seniors should have to face—and more importantly, they shouldn’t have to. In 2008, then-Senator Obama promised that “for those who have insurance now, nothing will change under the Obama plan—except that you will pay less.” This weekend’s Bloomberg story provides the latest evidence that, for millions of Americans, these promises will turn out to be empty.

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.