Fix Health Care Policy

Administration Rules Out “Deals” on Medicaid Expansion

Newscom

Last Friday afternoon, the Centers for Medicare and Medicaid Services (CMS) issued a short frequently asked questions (FAQ) document that should remove any remaining belief that the federal government will give state lawmakers flexibility on the Obamacare Medicaid expansion. The message is clear: The only thing a state that agrees to the Medicaid expansion will get is a bigger Medicaid program.

The CMS reiterated the position it took in an earlier FAQ that the Obama Administration considers the expansion to be an “all or nothing” proposition for states.

Read the rest on The Foundry…

Tags: burdensome, CMS, flexibility, HHS Secretary, Kathleen Sebelius, Medicaid Expansion, ObamaCare, States

Obamacare at Three Years: Increasing Cost Estimates

Newscom

Today marks three years since Obamacare was signed into law, and taxpayers probably aren’t celebrating.

Over the last three years, the Congressional Budget Office (CBO) has revised its cost estimates for Obamacare’s new entitlements—the Medicaid expansion and exchange subsidies—many times, and they have more than doubled since 2010.

The first estimate in 2010 pegged the gross cost at $898 billion from 2010 to 2019. But this projection was deceptive, because it included only six years of spending on these provisions, since they don’t begin until 2014.

However, CBO’s latest estimate in February 2013 provides a more accurate cost projection, finally encompassing 10 years of full spending. The 11-year estimate places spending on these provisions at $1.85 trillion from 2013 to 2023.

Read the rest on The Foundry…

Tags: CBO, cost estimates, exchange subsidies, higher than projected, Medicaid Expansion, ObamaCare, three years

Obamacare Medicaid Expansion: States Should Be Realistic, Not Optimistic

Months since the Supreme Court ruling that made the Obamacare Medicaid expansion optional, the state costs associated with expansion still remain highly uncertain—making expansion a dicey course for states and their budgets.

Indeed, states should not lose sight of the fact that the original Medicaid expansion was coercive for a reason. As Nina Owcharenko, director of Heritage’s Center for Health Policy Studies, points out, “The fact that the authors of Obamacare felt the need to threaten states with total defunding tells you that they knew many states would resist expanding their programs—even with 100 percent federal funding.”

States are still weighing their options. Many of them have commissioned studies to project the state costs of expanding. However, all cost estimates reflect the assumptions used to construct them, and using different assumptions can result in estimates varying wildly between (and sometimes within) states.

Read the rest on The Foundry…

Tags: defunding, different assumptions, Medicaid Expansion, ObamaCare, States, Supreme Court, voluntary

12 Days of Obamacare Surprises: Deficit Reduction?

Not all surprises are good. When it comes to Obamacare, the original projections are turning into unfortunately different realities. For the next two days, Heritage is going to highlight one of the various changes in Obamacare projections (e.g., cost, enrollment, etc.) from when the law first passed until now.

Obamacare was passed into law under the guise that it would expand access to health coverage while simultaneously reducing the federal deficit.

In 2010, the Congressional Budget Office (CBO) estimated that Obamacare would result in deficit reduction totaling $143 billion from 2010–2019.

In 2012, the CBO estimated that Obamacare would result in deficit reduction totaling only $109 billion from 2013–2022, $34 billion less than in 2010. Among other updates, this is due to the rising costs of subsidies in the exchanges.

Surprise: The CBO lowered its deficit reduction projection by 24 percent, revealing that Obamacare will cost the American public far more than anticipated. Turns out, the best things don’t come in big, Obamacare-sized packages.

12 Days of Obamacare Surprises:

10. Unelected bureaucrats on IPAB…

9. Increased employer penalties…

8. More cuts to Medicare…

7. Loss of employer-sponsored insurance…

6. A 50/50 split on enrollment estimates…

5. More uninsured Americans…

4. Increased exchange subsidies…

3. Big tax increases…

2. The small business tax credit…

1. And the individual mandate.

Tags: "deficit reduction", CBO, Medicaid Expansion, Obamacare surprise, rising costs, subsidies

Deadline for States to Claim Their Role in Obamacare

Tomorrow is an important day for Obamacare. It’s the deadline for states to declare their intentions about setting up their own health insurance exchanges for residents to purchase insurance under the new regime.

If a state does not set up an exchange, the federal government will come in and set it up, according to the law. So far, 22 states have said they are not going to set up state exchanges. Only six states have received conditional approval from the Department of Health and Human Services (HHS) to operate their own exchanges.

Why leave it up to the federal government? Well, to begin with, it’s an extremely costly undertaking. Heritage health care experts Nina Owcharenko and Ed Haislmaier explain:

[T]here will be no steady flow of federal dollars to the states. The law specifies that starting in 2015, any state implementing a state exchange must develop its own revenue source to fund the exchange’s annual operations. That puts the long-term costs squarely on the states. Moreover, the recent announcement by the Department of Health and Human Services (HHS) that it will levy a 3.5 percent administrative fee on coverage sold through the federally run exchanges indicates there are significant costs if a state agrees to run its own exchange.

And what would be in it for them? Certainly not increased control over how the exchanges are run. Owcharenko and Haislmaier explain that “regulations promulgated by HHS allow states no meaningful flexibility or advantage by operating their own exchanges, relative to a federal exchange. Those states would simply be acting as vendors to HHS.”

Read the rest on The Foundry…

Tags: federal intervention, health insurance exchanges, Medicaid Expansion, ObamaCare, States

Six Reasons States Should Be Skeptical of Medicaid Expansion Cost Estimates

As states weigh their options regarding the Obamacare expansion of Medicaid, many have sought out cost estimates to assist them. However, in a new paper, Heritage experts Ed Haislmaier and Drew Gonshorowski caution state lawmakers that state cost estimates rest on key assumptions, some of which may be questionable.

There are six reasons state cost estimates could be unreliable:

Read the reasons on The Foundry…

Tags: bad deal, higher costs, Medicaid Expansion, ObamaCare, repeal the law, taxpayers, voluntary

Top Five Reasons Obamacare Is Bad for Doctors

The Supreme Court’s Obamacare decision is expected next week, but it’s important to remember that the constitutionality of the law’s individual mandate isn’t the only concern. Several surveys have revealed that doctors have a negative view of the law and its impact on the practice of medicine. Here are five ways Obamacare will harm doctors:

1. Adds more patients to Medicaid. Beginning in 2014, Obamacare dumps an additional 19.6 million Americans into Medicaid. On average, Medicaid physician payments are only 56 percent of what private insurance pays. Lower payment rates already discourage doctors from accepting Medicaid beneficiaries, which has lead to access issues and hospital emergency room overcrowding. As more patients enroll in this broken program, it will place even more financial strain on physicians who treat them. Doctors will be faced with the decision to either discontinue treating Medicaid patients or accept even more patients at the lower payment rate.

(Read the rest on The Foundry…)

Tags: doctor-patient relationship, doctors, harmful, IPAB, Medicaid Expansion, Medicare cuts, ObamaCare

Side Effects: Under Obamacare, 29.4 Million Americans Will Change Health Plans Each Year

Obamacare’s massive Medicaid expansion—combined with its new system of subsidies for government-defined coverage for additional millions of Americans—will force 29.4 million Americans to move from one form of health coverage to another each year, a recent study shows.

The effect, called “churning,” is the involuntary movement of individuals from one type of coverage to another. While some churning existed before Obamacare, the health law makes the problem much worse, making continuous coverage less likely for many Americans.

New research by the Robert Wood Johnson Foundation and the Urban Institute concludes that 29.4 million Americans under the age of 65 will be forced to change their coverage from year to year under Obamacare. That represents 31 percent of the estimated 95.9 million people that will either be in Medicaid or receive subsidies in the exchanges in any given year.

(Read the rest on The Foundry…)

Tags: government-defined coverage, Medicaid Expansion, ObamaCare, Robert Wood Johnson Foundation

New Report Shows Health Spending Spikes Under Obamacare

The Centers for Medicare and Medicaid Services Office of the Actuary (OACT) just released its projections for national health spending through 2021. The picture isn’t pretty, as health spending will continue to increase at a much faster rate than the gross domestic product (GDP), consuming 19.6 percent (almost one-fifth) of the nation’s economy in 2021.

Growth in health spending will remain modest until 2014, when Obamacare expands Medicaid to an additional 19.6 million Americans and creates exchanges to regulate private insurance and administer new federal subsidies. Once these changes go into effect, Medicaid spending will increase by 18 percent, and private health insurance spending will increase by 7.9 percent, since more people will gain coverage through the government-run exchanges. According to OACT, “Together, Medicaid and private health insurance spending contribute to an overall acceleration in projected national health spending growth to 7.4 percent, which is 2.1 percentage points faster than would be expected in the absence of health reform.”

The Obama Administration clearly chose to wear rose-tinted glasses to interpret the projections. In an interesting twist on the CMS report, Secretary of Health and Human Services (HHS) Kathleen Sebelius touts “No increase in national health spending as a percent of GDP for five years.” But the Secretary backdates the projections, going on to say, “From 2009 through 2013, national health spending will not increase as a percent of the economy.” Of course, she knows that the major provisions of Obamacare don’t begin until 2014.

(Read the rest on The Foundry…)

Tags: CMS, GDP, Medicaid Expansion, national health spending, ObamaCare

Side Effects: Obamacare Expands Medicaid, Makes A Big Problem Worse

In 2014, Obamacare’s key provisions will kick in, and among them is a huge expansion of Medicaid. Obamacare extends eligibility to almost everyone with income below 138 percent of the federal poverty level under the age of 65.

A report released by the Centers for Medicare and Medicaid Services shows the impact the expansion will have: “This expansion, together with greater participation by individuals eligible under current rules, is projected to add 14.9 million people to enrollment in 2014 and 25.9 million people by 2020—26 percent and 44 percent, respectively, compared to pre-[Obamacare] estimates.”

This means that by 2020, Medicaid enrollment will reach 85 million, or approximately one in four Americans. This level of dependence distorts the original purpose of the government program, which was intended to serve as a safety net for only the most vulnerable.

Read the rest on The Foundry…

Tags: bankrupting America, failing program, Medicaid Expansion, Obamacare provisions