10 ObamaCare fumbles

By Sam Baker and Elise Viebeck 07/04/13 10:20 AM in The Hill

This week’s stunning delay in the Affordable Care Act’s (ACA) employer mandate was hardly the first time that ObamaCare’s implementation effort has stumbled, as the president’s signature domestic policy initiative has suffered several self-inflicted wounds on the path toward full implementation.

Democrats say the law will work well once it’s fully implemented, and President Obama has acknowledged that there will be more “glitches and bumps” as key provisions start to take effect.

While many of the administration’s challenges stem from entrenched Republican opposition to anything that would help the law function better, plenty of the bumps in the road so far have also arisen from the law itself.

As officials work to implement the law’s biggest provisions, which also happen to be the policies that provide the clearest and most direct benefits to consumers, here is a recap of some of ObamaCare’s biggest stumbles so far.

1. The CLASS Act

The healthcare law included a new insurance program for long-term care, known as the CLASS Act. The problem? It couldn’t be implemented as written. In October, 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius announced she would indefinitely suspend work on the program, stating that it could not be financially viable.

With the death of CLASS, the law lost about 40 percent of its total deficit reduction. And Republicans criticized the program as an accounting gimmick, noting that budget analysts predicted before the law was passed that CLASS wouldn’t work.

It was formally repealed last year.

2. The federal insurance exchange

The ACA provides a literally unlimited budget to help states set up their own insurance exchanges — and no budget whatsoever for the federally run backup. So while HHS has shelled out billions of dollars to help 17 states build their own exchanges, it has had to scrape together money from other programs so that it can build the remaining 33 marketplaces.

Most observers say the lack of funding was simply an oversight. But the implications are real. HHS has come under fire from congressional Democrats for some of the cuts to programs to help pay for the federal marketplace, and it has said it needs another $1.5 billion for the exchanges — money Congress is highly unlikely to provide.

3. The employer mandate

The most recent stumble came on Tuesday, when the White House announced that it would delay enforcement of ObamaCare’s employer mandate by one year. The mandate isn’t especially important to the law’s coverage expansion, but the delay fueled questions about whether the overall implementation effort is on track.

4. The small-business exchange

Before delaying the employer mandate, the administration pushed back another provision for business owners. HHS delayed by one year a part of the new insurance exchanges for small business. Although the exchanges will be up and running next year as planned, employers will have to wait another year before they can let their workers choose from a range of plans, rather than selecting just one for the entire company.

5. Waivers

Once again, a political headache for the administration stemmed from an effort to give businesses more flexibility.

HHS approved more than 1,200 waivers from a provision of the healthcare law that gradually eliminated annual caps on benefits. The waivers themselves weren’t scandalous — they were specifically authorized by the statute, and they dealt with a relatively minor requirement. But they turned into a messaging problem as Republicans used each new batch of waivers to argue that the law was unworkable.

HHS updated its waiver figure every month until last year, prompting a political firestorm each time. Finally, it quit the monthly updates and granted a long extension that put the issue to rest.

6. 1099

This widely criticized “1099” reporting requirement, named for the tax form it would have used, was the first ObamaCare provision to be repealed. The mandate compelled businesses to report nearly all transactions worth more than $600 to the IRS.

Business groups characterized the provision as red tape, and lawmakers worked for nearly eight months to kill it. Repeal passed with broad bipartisan support in both chambers, and as Obama signed it, he said the provision was an example of a problem in the healthcare law that Republicans and Democrats could work together to fix.

7. Child-only plans

A glitch in the healthcare law prompted insurance companies to quit selling policies in several states that only covered children. Starting in 2010, insurance companies had to cover children’s pre-existing conditions if they sold child-only plans — but they weren’t required to sell child-only policies in the first place. So, rather than take on the additional cost, some insurers quit writing new policies just for children.

Again, state insurance regulators said the gap in children’s coverage looked like an oversight — the kind Congress might have fixed in conference, if there had been a conference on the healthcare bill.


The $5 billion Pre-Existing Conditions Insurance Plan (PCIP) offered health coverage to sick patients waiting for full implementation of ObamaCare. But the program initially failed to enroll as many people as expected, and was plagued by high costs. In February, HHS stopped accepting new applicants into the program to ensure it would have enough money to cover the people already enrolled.

“Running out of money before the end of the year is something we’re trying to avoid,” said Gary Cohen, director of the federal Center for Consumer Information and Insurance Oversight, in congressional testimony.

9. The Basic Health Plan

Democrats and state-level advocates were incredibly frustrated with HHS’s decision to delay a program known as the Basic Health Plan. The provision would let states bargain directly with insurance companies to create a scaled-down plan for people who aren’t eligible for Medicaid but might not be able to afford the more expensive private plans sold through the exchanges.

Its implementation was pushed to 2015 — another casualty of the intense focus on exchanges and the Medicaid expansion. Sen. Maria Cantwell (D-Wash.) had threatened to block a top healthcare nominee until HHS answered her questions about the delay and pledged to have the program up and running in 2015.

10. ObamaCare for congressional staff

During the legislative debate, Democrats accepted a GOP amendment saying members of Congress and their staffs had to use ObamaCare. But no one is quite sure how to implement the provision without putting staffers at a huge disadvantage.

The federal government, like all large employers that offer health benefits, pays for a portion of its employees’ healthcare costs. The question now is whether staff can put that contribution toward the purchase of an ObamaCare-compliant policy.

Forcing staffers to lose their employer contribution would treat them as if they didn’t work for an employer that offers health benefits, even though they do, and it would make jobs on the Hill much less attractive to young and mid-level staffers. But Republicans say they won’t help staff keep their employer contributions, even to buy a policy through an ObamaCare exchange.


Why Healthcare Costs Are About To Explode

6/30/2013 @ 10:00AM

By Louis Goodman & Tim Norbeck in Forbes

Senate Passes Insurance Industry Aid Bill

(Photo credit: Mike Licht, NotionsCapital.com)

Word out of Washington is that Obamacare is finally fulfilling its promise to bend the nation’s healthcare cost curve. Unfortunately, it’s bending it the wrong way.

Forty-one months after its passage, data are beginning to emerge questioning whether the Accountable Care Act (ACA) can actually provide care to more Americans for less. These data appear to be surprising to its advocates, but they’re merely old news to those analysts who repeatedly questioned how adding 32 million people to the insurance rolls could possibly lower costs – especially when many of them will need treatment for illnesses such as diabetes, heart disease and cancer which have gone undiagnosed for years.  Furthermore, the population of those over 65 will have doubled between 2000 and 2030.  Not surprisingly, compared to young people, older Americans use more healthcare, largely because they are more likely to have diabetes, heart disease, arthritis and cancer. 

And many remember the first year of Medicare in 1966, when the cost of the program was $3 billion.  Projections for the cost of Medicare in 1990 were $12 billion.  The actual cost in 1990: $107 billion.  Cost estimates of government programs are always underestimated, as will be the case with the ACA.

This increasing cost of care, which has taken a breather during the recession, is projected to rise dramatically as the ACA is fully implemented. In California, for example, it was recently reported that the cost of insurance on the ACA-mandated health insurance exchange will be more than 100 percent higher, than current rates, for the healthiest young adults.  Several large insurers have already announced their intention of not selling policies in that state, an action that will certainly reduce consumer choice.  What if they do likewise in other states as well?  Less competition almost always translates into higher premiums / costs.

The expected increase in healthcare use, coupled with an increasing demand and federal government requirement to use more and more expensive technology, can be expected to add another percentage point to our bulging 18 percent of GDP devoted to healthcare. Even in an era of sequestration, federal government mandates will continue to thwart our ability to meet the nation’s healthcare needs.

Consider, for example, one of the many aberrations in the U.S. system that unnecessarily cost us billions of excess dollars: hospital site of service differentials. Medicare pays far more for physician services delivered in a hospital or hospital-owned facility than for the exact same services delivered or procedure performed in a private practice physician office. This happens because the government pays hospitals a so-called facility fee (Medicare Part A) to cover the costs of their buildings in addition to a professional fee (Medicare Part B) for actually providing medical care to patients.

Eliminating this aberration in our system would save billions of dollars every year with absolutely no reduction in quality or access to services. But the ACA, with its incentives for integrated care, is actually driving more physicians to hospital employment, pushing more services into the more expensive hospital-owned facility. It’s a consequence of the health law that the industry acknowledges needs to be resolved, as evidenced by MedPAC’s June report, which recommended Congress “move immediately to cut payments to hospitals for many services that can be provided at much lower cost in doctors’ offices.”

As we’ve reported previously, the government’s incredible red tape and reporting burden on medical practice have cast an emotional pall on the profession. They also add significant cost to every service delivered – with no demonstrable benefit to the patient. A majority of physicians (64 percent) we surveyed last year responded that more government regulation was a “very negative” solution to the health system’s cost and access challenges. It comes as no surprise then that many physicians complain that the ACA and various incentives force them and healthcare systems to spend considerable funds on electronic medical records that hurt productivity and do little to improve patient outcomes.

In a recent study for the Physicians Foundation, health policy analyst Jeff Goldsmith found that paradoxically, while physicians direct almost 80 percent of all healthcare spending, many of them feel powerless to change the conditions that generate unnecessary costs and create red tape. In fact, 82 percent of physicians feel they have little ability to change the healthcare system, according to the Foundation’s 2012 Biennial Physician Survey. By purpose or design, the ACA is driving physicians from the best and most cost-effective place to provide care – their private offices – to the most expensive place to provide care: the hospital.

Unless and until this trend is reversed, the cost of American healthcare will continue to rise at an increasing rate without any demonstrable improvement in access to quality healthcare services.  The worst of both worlds.

Immigration reform meeting Obamacare – $5,000 Penalty To Hire Citizens

This is one of those many instances when we realize how dangerous (and stupid) big government really is. If there is one thing we can almost always depend on, it is that any legislation that is passed by Congress and signed into law by the President will have unintended consequences. Many times, legislation is used for purposes for which it was not intended. Immigration reform meeting Obamacare fits that description nicely. It is also a good example of what happens when the people we vote into Congress fail or refuse to do their jobs. Would it be too much to ask them to read the legislation they are voting on?

Senator Ted Cruz has turned many heads since he first walked into the United States Senate. He may not be well liked by many of his colleagues, but he doesn’t seem to care about the “traditions” of the esteemed body to which he was voted. What he does care about is doing the business of the people who elected him to that office. As such, he actually took the time to read the immigration reform bill that passed out of the Senate on Thursday. He voted against it, along with 13 other Republicans. I just wish more of the GOP had the will and fortitude to stand against the rush to pass an immigration reform bill that is rotten to the core.

There are many things included in the immigration reform bill to dislike. At the top of my list is that it grants amnesty to the millions of illegal immigrants living within our borders, with little more than a slap on the wrist. The border provision included in the bill is a joke. I could go on, but many of my concerns deserve their own space, if I can find the time to write them. Let’s look today at how immigration reform, coupled with Obamacare, is very bad medicine for American citizens.

Freedom Outpost – We can’t possibly expect our Senators to read a 1200 page bill before voting on it. Can we? Well Thank God Ted Cruz read it. Not only did Cruz read it but he schooled anyone who would listen from the Senate floor on Tuesday. Cruz found a loophole that actually penalizes an employer $5000 for hiring a citizen over a legalized alien. Seriously. You can’t make this stuff up.

You may ask, to what am I referring. Is this a late amendment that has been inserted into the immigration reform bill? Actually, it is not. First, here is what Senator Ted Cruz had to say about his amendment to fix this glaring problem in the bill.

Human Events – “I filed an amendment that would have corrected one of the most egregious aspects of the Gang of Eight bill as it intersects with Obamacare legislation, namely a penalty imposed on U.S. employers for hiring U.S. citizens and U.S. permanent residents,” Cruz explained from the Senate floor.  ”This bill says if an employer hires a citizen or a legal immigrant, the IRS can impose a $5,000 penalty on that employer. But if the employer instead hires someone with RPI [Registered Provisional Immigrant] status, that penalty will go away. That is utterly and completely indefensible.”

Immigration Reform Meet ObamacareWhen we track down the story, we find it is not something that was inserted into the bill towards the end of the Senate debate. Instead, we find that the problem has been known for several weeks, even months. Investor’s Business Daily first reported on this complication in April. It has been established that more than one Senator involved in crafting the legislation knew about the issue then. That includes Marco Rubio, but he said the legislative process was designed to fix address such issues. That’s what Ted Cruz was trying to do with his amendment, but it failed to gain enough votes to be included in the legislation.

This is what some people like to cal a technical problem. Technically, that’s correct. In reality, it is a loophole that has been created by two intersecting pieces of legislation. One of those bills, Obamacare, was crammed down our throats, never minding our protests. The second, an immigration reform bill that is nothing like what we need to deal with our illegal immigration problem, is out of the Senate and headed to the House of Representatives. At this point, I wouldn’t even wager a guess about how it will fare in that particular body of Congress. What is clear is the absolute and total disaster that is headed our way, should the immigration reform bill be signed into law, as it now stands.

I fall back to what I wrote in the first paragraph. Big government is both dangerous and stupid. Immigration reform is about to meet Obamacare and the law of unintended consequences is about to come down on the heads of the American people with full force. Except, I’m not so sure the consequences are unintended. No matter, the results will be the same and the American taxpayer will bear the brunt of the cost. I am sure this is a far cry from how the Founding Fathers envisioned the future of the country they established. We should all be ashamed for disturbing their rest and making them roll over in their graves. It is a very poor way to run any country, especially America.