USian health care

And in the real world

Quote:

Forecasters say a Patient Protection and Affordable Care Act pricing rule may increase premiums for 65 percent of the affected small groups.

The effects of the PPACA pricing rule on large-group plans will be negligible, the forecasters say.

.....
The CMS actuarial office prepared the PPACA impact report to comply with a provision in a 2011 appropriations act.

PPACA includes many provisions that could affect group health prices either directly or indirectly. In the new report, the CMS actuaries looked only at the effects of the PPACA Fair Health Insurance Premiums section. The fair premiums section requires insurers in the small-group market to offer coverage on a guaranteed-issue, guaranteed-renewable basis, with an adjusted community rating system.

The fair premiums section exempts large groups.

Because the Health Insurance Portability and Accountability Act of 1996 already required insurers to sell small-group coverage on a guaranteed-issue, guaranteed-renewable basis before PPACA came along, the community rating requirement is the only fair premiums provision likely to affect small-group rates, the CMS actuaries say.

The PPACA adjusted community rating rules let carriers charge up to three times more for coverage for the oldest insureds than they charge for the youngest, but insurers can no longer use gender, health status or claims as rating factors.

Independent experts told the CMS actuaries that they thought the community rating rules would increase rates for about 60 percent to 67 percent of the fully insured small groups subject to the new rules.

.....
In the real world, the effect will probably be much narrower this year, because so many small groups renewed coverage early and are not yet affected by the PPACA requirements that took effect Jan. 1, actuaries said.

[url=http://www.lifehealthpro.com/2014/02/24/small-groups-may-be-hit-by-ppaca...

But if you want the original report as produced by the Office of the Actuary at the Centers for Medicare & Medicaid Services you can find it [url=http://media.benefitspro.com/benefitspro/article/2014/02/24/2-24-2014-cm...

Quote:

A national union that represents 300,000 low-wage hospitality workers charges in a new report that Obamacare will slam wages, cut hours, limit access to health insurance and worsen the very “income equality” President Obama says he is campaigning to fix.

Unite Here warned that due to Obamacare's much higher costs for health insurance than what union workers currently pay, the result will be a pay cut of up to $5 an hour. "If employers follow the incentives in the law, they will push families onto the exchanges to buy coverage. This will force low-wage service industry employees to spend $2.00, $3.00 or even $5.00 an hour of their pay to buy similar coverage," said the union in a new report.

“Only in Washington could asking the bottom of the middle class to finance health care for the poorest families be seen as reducing inequality,” said the report from Unite Here. “Without smart fixes, the ACA threatens the middle class with higher premiums, loss of hours, and a shift to part-time work and less comprehensive coverage,” said the report, titled, “The Irony of Obamacare: Making Inequality Worse.”

Based on government and private reports, polling and statements from administration officials, the report, to be sent to pro-union members in Congress, charges that low-wage workers are taking the hit under Obamacare, while wealthy insurance companies fatten up on government subsidies.

[url=http://washingtonexaminer.com/big-labor-obamacare-death-spiral-to-worker...

abnormal wrote:

Quote:

A national union that represents 300,000 low-wage hospitality workers charges in a new report that Obamacare will slam wages, cut hours, limit access to health insurance and worsen the very “income equality” President Obama says he is campaigning to fix.

Unite Here warned that due to Obamacare's much higher costs for health insurance than what union workers currently pay, the result will be a pay cut of up to $5 an hour. "If employers follow the incentives in the law, they will push families onto the exchanges to buy coverage. This will force low-wage service industry employees to spend $2.00, $3.00 or even $5.00 an hour of their pay to buy similar coverage," said the union in a new report.

“Only in Washington could asking the bottom of the middle class to finance health care for the poorest families be seen as reducing inequality,” said the report from Unite Here. “Without smart fixes, the ACA threatens the middle class with higher premiums, loss of hours, and a shift to part-time work and less comprehensive coverage,” said the report, titled, “The Irony of Obamacare: Making Inequality Worse.”

Based on government and private reports, polling and statements from administration officials, the report, to be sent to pro-union members in Congress, charges that low-wage workers are taking the hit under Obamacare, while wealthy insurance companies fatten up on government subsidies.

[url=http://washingtonexaminer.com/big-labor-obamacare-death-spiral-to-worker...

 

 

 

Unite is correct. But I get a kick when right-wing sites like the Washington Examiner cite unions, who they are out to destroy.

abnormal wrote:

josh wrote:

Unite is correct. But I get a kick when right-wing sites like the Washington Examiner cite unions, who they are out to destroy.

I just interpret this as saying "even people at the opposite end of the political spectrum from us agree that Obamacare is bad".

For entirely different reasons.  Which makes all the difference.

@Pogo: if you take a look at page 2 of the report that I linked in #154 you will see that that is unfortunately not how it works.

Quote:

Yes, the Affordable Care Act will help many more Americans gain some health insurance coverage, a significant step forward for equality. At the same time, without smart fixes, the ACA threatens the middle class with higher premiums, loss of hours, and a shift to part-time work and less comprehensive coverage. 

• Transferring A Trillion Dollars in Wealth: Most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies, one of the largest transfers of public wealth to private hands ever. Since the ACA passed, the average stock price of the big for-profit health insurers doubled, their top executives were paid more than a half billion dollars in cash and stock options, and in the past 2 years, the top 10 insurers have spent $25 billion on mergers and acquisitions. 

Now this is a little sketchy as a serious analysis, but it indicates that premiums are generally going up.

wage zombie wrote:

The ACA is projected to reduce the deficit, not increase it.  All this wailing about how the taxpayers are going to have to pay the insurance companies (like that wasn't happening before) is lying.  And that's been one of the fundamental flaws in the Republican argument against it-- the deficit hawks who suddenly became so concerned about debt once Obama took office don't actually care about it.

The USA pays more for health care than any other comparable nation.  THe ACA is unlikely to change that, but overall it will bring health care costs as well as the deficit down.

Look at the last page of the following. Net budgetary effect is estimated at approx. $1.3 trillion over the next 10 years. So if you are willing to assert that the CBO is lying, please feel free.

http://www.cbo.gov/publication/44176

wage zombie wrote:

Maybe you should try reading the articles you post:

http://www.cbo.gov/publication/44176

Quote:

The Estimated Budgetary Impact of the ACA’s Coverage Provisions Has Changed Little on a Year-by-Year Basis Since March 2010

When estimates are compared on a year-by-year basis, CBO and JCT’s estimate of the net budgetary impact of the ACA’s insurance coverage provisions has changed little since February 2013 and, indeed, has changed little since the legislation was being considered in March 2010. In March 2010, CBO and JCT projected that the provisions of the ACA related to health insurance coverage would cost the federal government $759 billion during fiscal years 2014 through 2019 (which was the last year in the 10-year budget window being used at that time). The newest projections indicate that those provisions will cost $710 billion over that same period. As shown in the figure below, the intervening projections of the cost of the ACA’s coverage provisions for those years have all been close to those figures on a year-by-year basis; of course, the 10-year totals have changed as the time frame for the estimates has shifted.

Those amounts do not reflect the total budgetary impact of the ACA. That legislation includes many other provisions that, on net, will reduce budget deficits. Taking the coverage provisions and other provisions together, CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade. (We have not updated our estimate of the total budgetary impact of the ACA since last summer; for that most recent estimate, seeLetter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act.)

 

Taking the coverage provisions and other provisions together, CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade.

You're the one asserting that the CBO is lying.  Why am I not surprised?  You have been trotting out lies this whole thread.

And you have been asserting that ACA will bring costs down, which is manifestly untrue, as you can see from the CBO document, since $1.3 trillion is greater than zero.

Please be serious. 

Quote:

And you have been asserting that ACA will bring costs down, which is manifestly untrue, as you can see from the CBO document, since $1.3 trillion is greater than zero.

Please be serious.

Zero isn't what the government is spending on health care now you moron.

From the link you posted:

Quote:

Taking the coverage provisions and other provisions together, CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade.

ygtbk wrote:

When people start insulting you, you know that they've run out of substantive arguments.

I have all the substantive arguments I need and I'm happy to let the reading babblers decide for themselves.

Quote:

OK, since this apparently needs to be spelled out in some detail, here we go:

1) ACA increases spending. You can see, on the last page of the doc I posted, a gross increase of over $1.8 trillion and a net increase of over $1.3 trillion over the next decade.

Please quote the data you're using for your argument.

Again, the relevant information from the article you quoted is this:

Taking the coverage provisions and other provisions together, CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade.

Quote:

2) ACA also raises a whole whack of taxes, so that it is consistent to say ACA reduces deficits - this is because of the increased taxes, not decreased spending - see point 1. It both taxes and spends.

A whole whack, eh?  Can you be more specific?  I thought you valued substantive arguments

Quote:

So to say that ACA decreases health care costs is clearly not true. I did not say that the U.S. government pays zero for health care costs, I said that the increase would be approx. $1.3 trillion (yes that's with a t).

You said that the costs of the ACA over the next 10 years would be $1.3 trillion, and you compared that to zero.  Why would you compare that to zero?

Quote:

And I say that because the CBO says that. And I said $1.3 trillion because I did not want to overstate the case. I could have said $1.8 trillion but that would open a trivial line of attack.

You are lying.

Ok, great.  So we've now established something we agree on!

The ACA will NOT increase the federal deficit.  It will be a net reduction in the federal deficit.  So all those people who are so worried about debt should at least be in favour of that part of it.  Thanks for posting that CBO report which very explcitly states that the provisions of the ACA will have a net reduction on the federal deficit.

We already established several pages back that every time the Republicans trot out the story of poor so-and-so, whose health care premiums are going to jump through the roof thanks to that nasty Obamacare, the story is debunked within days, and it's demonstrated how that person is actually going to be in better shape because of the ACA.

We know that the ACA ensures that those with pre-existing conditions are able to get health insurance.

We know that the ACA allows young people to stay on their parents plan a few years longer.

We know that there are total caps on out-of-pocket expenses that people will have to pay.

We know that insurance companies will be forced to spend at least 80% of their revenues on medical costs delivered.

We know that anyone who would have to spend more than 9.5% of their income to buy a plan from those available in their state will be eligible for a subsidy.

We know that bringing healthy younger people into the system (via the mandate) will push average medical costs down.

We know that states that have jumped on board are meeting their enrollment targets.

We know that Vermont will implement their version of the ACA to provide single payer health care.

So what's not to like?  All that's left is the taxes.

Yes, even though taxes are at the lowest they've been in decades (and yes, I have substantive data to back that up, too), people like ygtbk are taxed enough already(!) even though he's not USian and won't even be subject to these tax atrocities.

ygtbk has already done us the service of listing all these nasty taxes, so I'll let reading babblers decide for themselves how horrific they are.

Quote:

And I don't have enough time to list all the taxes that the ACA raised, but since you want detail, please either google ACA taxes or take a gander at:

• 2.3% Tax on Medical Device Manufacturers 2014

• 10% Tax on Indoor Tanning Services 2014

• Blue Cross/Blue Shield Tax Hike

• Excise Tax on Charitable Hospitals which fail to comply with the requirements of ObamaCare

• Tax on Brand Name Drugs

• Tax on Health Insurers

• $500,000 Annual Executive Compensation Limit for Health Insurance Executives

• Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D

 
• Employer Mandate on business with over 50 full-time equivalent employees to provide health insurance to full-time employees. $2000 per employee $3000 if employee uses tax credits to buy insurance on the exchange (marketplace). (pushed back to 2015)

• Medicare Tax on Investment Income 3.8% over $200k/$250k

• Medicare Part A Tax increase of .9% over $200k/$250k

• 40% Excise Tax "Cadillac" on high-end Premium Health Insurance Plans 2018

• An annual $63 fee levied by ObamaCare on all plans (decreased each year until 2017 when pre-existing conditions are eliminated) to help pay for insurance companies covering the costs of high-risk pools.

• Medicine Cabinet Tax

Over the counter medicines no longer qualified as medical expenses for flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs), and Archer Medical Saving accounts (MSAs).
• Additional Tax on HSA/MSA Distributions

Health savings account or an Archer medical savings account, penalties for spending money on non-qualified medical expenses. 10% to 20% in the case of a HSA and from 15% to 20% in the case of a MSA.

• Flexible Spending Account Cap 2013

Contributions to FSAs are reduced to $2,500 from $5,000.

• Medical Deduction Threshold tax increase 2013

Threshold to deduct medical expenses as an itemized deduction increases to 10% from 7.5%.

It looks then like all the disgreement over Obamacare comes down to...taxes.

Have a nice day. 

@WZ:

I hope that you have a nice day too. I am glad that you now understand that the deficit depends on both taxes and spending.

From the above column:

Clearly, the administration reckons it can weather public rebukes from the unions much better than it can endure the backlash they’d get for helping them. This is potentially an existential threat to the institutions that used to be the backbone of the Democratic Party. Now it's treating them more like the appendix. That tells you something significant about how Obamacare was passed. But it tells you something even more significant about the Democrats and the administration. They’re still willing to deliver symbolic victories such as appointments to the National Labor Relations Board, but as far as policy making goes, private-sector unions are increasingly less relevant. That has huge implications for the future of the Democratic Party, not to mention U.S. economic policy.

ygtbk wrote:

wage zombie wrote:

The ACA is projected to reduce the deficit, not increase it.  All this wailing about how the taxpayers are going to have to pay the insurance companies (like that wasn't happening before) is lying.  And that's been one of the fundamental flaws in the Republican argument against it-- the deficit hawks who suddenly became so concerned about debt once Obama took office don't actually care about it.

The USA pays more for health care than any other comparable nation.  THe ACA is unlikely to change that, but overall it will bring health care costs as well as the deficit down.

Look at the last page of the following. Net budgetary effect is estimated at approx. $1.3 trillion over the next 10 years. So if you are willing to assert that the CBO is lying, please feel free.

http://www.cbo.gov/publication/44176

Your faith in the CBO is completely misplaced.  All you have to do is look at the projections when Medicare was introduced. 

In 1966 Medicare cost $3 billion.  At the time the Ways and Means Committee estimated that it would cost $12 billion in 1990 - instead it cost $107 billion (a factor of 9).

Why do you believe that the CBO is any more accurate than the Ways and Means Committee was then?

abnormal wrote:

ygtbk wrote:

wage zombie wrote:

The ACA is projected to reduce the deficit, not increase it.  All this wailing about how the taxpayers are going to have to pay the insurance companies (like that wasn't happening before) is lying.  And that's been one of the fundamental flaws in the Republican argument against it-- the deficit hawks who suddenly became so concerned about debt once Obama took office don't actually care about it.

The USA pays more for health care than any other comparable nation.  THe ACA is unlikely to change that, but overall it will bring health care costs as well as the deficit down.

Look at the last page of the following. Net budgetary effect is estimated at approx. $1.3 trillion over the next 10 years. So if you are willing to assert that the CBO is lying, please feel free.

http://www.cbo.gov/publication/44176

Your faith in the CBO is completely misplaced.  All you have to do is look at the projections when Medicare was introduced. 

In 1966 Medicare cost $3 billion.  At the time the Ways and Means Committee estimated that it would cost $12 billion in 1990 - instead it cost $107 billion (a factor of 9).

Why do you believe that the CBO is any more accurate than the Ways and Means Committee was then?

You may well be correct. Although I don't think they're lying, they could well be mistaken, and your point is about the directionality of mistakes in cost estimation for government programs.

This is significant:

http://www.cnbc.com/id/101819065

And in the meantime...

http://hosted.ap.org/dynamic/stories/U/US_OBAMA_HEALTH_OVERHAUL_SUBSIDIES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

abnormal wrote:

ygtbk wrote:

And in the meantime...

http://hosted.ap.org/dynamic/stories/U/US_OBAMA_HEALTH_OVERHAUL_SUBSIDIES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

Of course, if the latest ruling stands does it follow that that any affected individuals will have to repay any subsidies they've received?

BTW, the Appeals Court ruling is clear so the "mixed opinions" comment doesn't carry much weight (unless Earnest thinks that the Supreme Court will overturn that ruling because the Justices want to see Obamacare succeed).

I suspect that repayment of the subsidies will not happen - it would be very politically painful for the Administration.

Slightly off topic, does anyone besides me think that a spokesbot going by the the name "Josh Earnest" is pretty much like taping a "Kick me!" sign to your own back?

This just in, the Fourth Circuit rules for the Administration on this very point.

http://jonathanturley.org/2014/07/22/fourth-circuit-rules-for-obama-admi...

So it's off to the Supremes.

Not a given it will go to the Supreme Court. The D.C. case could go
to the entire circuit (en banc) which is majority Democratic. If they come out the other way, there will be no conflict in the circuits and the Supreme Court would not have to take the cases.

Reading the linked Forbes article shows that Jonathan Gruber, the slimeball who is being quoted, was doing a sales pitch for his consulting services at the time. He was apparently helping states set up these exchanges. When he was asked by an audience member whether they couldn't just let the feds do it for them, he gave the answer cited. This was clearly for purposes of inflating the necessity of paying him big bucks for advice on how to set up an exchange.

In the next article down, he is quoted as saying on television recently:

Jonathan Gruber wrote:

Chris [Matthews], it is unambiguous this is a typo. Literally every single person involved in the crafting of this law has said that it’s a typo, that they had no intention of excluding the federal states. And why would they? Look, the law says that people are only subject to the mandate if they can afford insurance, if it’s less than 8 percent of their income. If you get rid of these subsidies, 99 percent of the people who would get subsidies can no longer afford insurance, so you destroy the mandate. Why would Congress set up the mandate and go through all that political battle to allow it to be destroyed? It’s just simply a typo, and it’s really criminal that this has even made it as far as it has.

A truly disgusting example of the warped individuals who succeed brilliantly in the capitalist economy.

The ObamaCare/IRS Nexus: The supposedly independent agency harassed the administration’s political opponents and saved its health-care law.

One of the big questions out of the IRS targeting scandal is this: How can an agency that engaged in such political misconduct be trusted to implement ObamaCare? This week’s Halbig v. Burwell ruling reminded us of the answer. It can’t.

[i]snip ...[/i]

The office of the IRS chief counsel—one of two positions appointed by the president—drafted a memo telling the group that it should read the text to mean that everyone, in every exchange, got subsidies. At some point between March 10 and March 15, 2011, the reference to “Exchanges established by the State” disappeared from the draft rule.

Emails viewed by congressional investigators nonetheless showed that Treasury and the IRS remained worried they were breaking the law. An email exchange between Treasury employees in the spring of 2011 expressed concern that they had no statutory authority to deem a federally run exchange the equivalent of a state-run exchange.[/quote]

http://online.wsj.com/articles/kim-strassel-the-obamacare-irs-nexus-1406...

josh wrote:

More right-wing WSJ bullshit. What about the states who subverted the law by refusing to set-up exchanges? Or does that not matter in the right-wing fever swamp narrative of victimization.

How is that subverting the law?  The ACA did not mandate that states set up their own exchanges so it's up to the states to make that call.

So the states didn't set up exchanges - the law didn't require them to.  But the law was intentionally drafted with a reference to state exchanges in an attempt to [s]blackmail[/s] encourage states to set up their own.  

Sorry but there is nothing implicit about the words state and federal when describing exchanges.  The language is clear and unambiguous.  It was contained in numerous drafts - it was definitely not a drafting error.

And let us not forget that in 2010, Nancy Pelosi famously claimed that Congress needed to pass Obamacare in order to find out what’s in it.  Well, a federal court just read Obamacare and found out what wasn’t in it: tax credit subsidies for federal exchange health plans.

josh wrote:

The law didn't require them to because the Supreme Court wouldn't have let them so require. And you didn't answer the question of whether congress intended to set up a law that would cover only half the country.

According to one of the architects of the law (previously quoted) the answer to that question is yes.  It was designed to blackmail the states into setting up their own exchanges.

But more to the point, it's not clear that intent even matters.  The wording of the law is clear.

Quote:

“There are specific rules about when and how the IRS can deviate from the plain language of a statute,” Cannon explained to National Review Online, arguing that the subsidies regulation fails to comply with those rules.

The IRS can deviate from “absurd” laws, in theory, but the subsidies language is not absurd. “It might be stupid, but that’s not the test for absurdity,” Cannon says. Similarly, the IRS can deviate in the case of scrivener’s errors — typos, basically — but this is not a typo, Cannon says, because the language was written into repeated drafts of the law.

“They not only keep that language in there, but they even inserted it, this same phrase again, right before passage while the bill was in [Senate Majority Leader] Harry Reid’s office,” Cannon says. “So, it’s not a scrivener’s error, either.”

Finally, the IRS could fill in ambiguous gaps in a law. The problem for the IRS, though, is that the subsidies language is not ambiguous. Even Tribe acknowledged that the language is clear, according to the Fiscal Times.

“Yet in drafting the law, Tribe said the administration ‘assumed that state exchanges would be the norm and federal exchanges would be a marginal, fallback position’ — though it didn’t work out that way for a plethora of legal, administrative and political reasons,” the Fiscal Times writes.

To repeat:

Quote:

[b][color=green]“They not only keep that language in there, but they even inserted it, this same phrase again, right before passage while the bill was in [Senate Majority Leader] Harry Reid’s office,” Cannon says.”[/color][/b]