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Even setting aside the debacle surrounding the rollout of HealthCare.gov, last fall was a bad time for the Affordable Care Act (ACA).
Millions lost their current coverage despite the president’s promise: “If you like your healthcare plan, you can keep it.” Millions more found that their doctor was not part of newly defined insurance networks. On top of that, middle-class families across the country encountered sticker shock as they saw their premiums increase.
With a new year and most of the website problems more or less fixed, ACA supporters are hoping the worst is behind them. They are in for a rude awakening.
By next fall, the “glitches” of 2013 will seem like the good old days. Here’s why.
More canceled policies: As of December 2013, roughly 5.4 million Americans with individual policies had their current plans canceled because they didn’t meet ACA requirements. Another 3 million to 8 million people are at risk of losing their policies in the coming months. However, this is only the tip of the iceberg.
Because the president delayed the employer mandate, the 55 percent of Americans who get their insurance through work haven’t felt the pain. They will soon. That’s because the same ACA provisions that caused the cancellation of individual policies will start to affect employer-sponsored plans by late 2014. In a nutshell, if a plan doesn’t meet “minimum coverage requirements” such as maternity care or alcohol counseling, it can no longer be offered. This could affect as many as 78 million workers.
That means that sometime around September or October, cancellation notices will be going out again. Most workers with canceled policies will end up with similar employment-based plans, but they could end up paying more for fewer choices. Others will be pushed into the exchanges, losing their employer-provided plans altogether.
The adverse selection death spiral: The ACA’s success hinges on enough young and healthy people entering the insurance pool at inflated prices to offset the costs of covering previously uninsured, high-risk individuals.
If, however, the insurance pool is composed largely of the old and sick who use more, and more expensive healthcare, insurance prices will necessarily rise to cover the cost.
This would lead to more young and healthy people dropping their insurance, which would then lead to pools even older and sicker than before. The cycle would go on and on in what actuaries refer to as the “adverse selection death spiral.”
In order to avoid such a death spiral, the Obama administration estimated that it will need roughly 38 percent of people buying insurance through the exchanges to be under the age of 35.
But this week, the administration released enrollment data suggesting that just 24 percent of those signing up were between the ages of 18 and 35. While it is certainly possible that younger Americans may disproportionately enroll late, right now the program is far short of what is needed to keep it from crashing and burning.
And all of this likely leads to an insurance bailout: If TARP and the bank bailouts were unpopular, just wait until voters learn that Washington will be covering billions of dollars in insurance company losses.
The ACA contains a $ 25 billion “reinsurance fund” to protect insurers from losses due to the aforementioned adverse selection. Taxpayers pick up the tab for 78 percent of claim costs between $ 45,000 and $ 250,000 per insured individual.
Considering that the health law already directs more than $ 1 trillion of taxpayer funds to insurance companies in the form of subsidies to help people buy their products, this latest bailout is further proof that the ACA is one of history’s great examples of crony capitalism.
Still in court: The 2012 Supreme Court decision upholding the individual mandate was widely seen as the last major legal challenge to ACA.
That’s not true. Several important challenges are still making their way through the courts.
So far, most media attention has been focused on the group of cases involving the law’s contraceptive mandate. But far more significant is a case currently pending before the United States District Court of the District of Columbia: Halbig v. Sebelius. The case challenges the availability of subsidies on federally run exchanges, and several other provisions such as the employer mandate that extend from those subsidies.
A decision is expected this spring, but regardless of the outcome, the losing side is expected to appeal, and the case is likely to reach the Supreme Court in 2015 or 2016.
All in all, this looks like another bad year for the ACA.
Michael Tanner is a senior fellow at the Cato Institute and the author of Obamacare: What We Know Now, a policy analysis coming out Jan. 21.
One of the leading talking points of Israel-bashers these days is the treatment of African economic migrants who have illegally crossed into the Jewish state. Nearly 60,000 of these people who are for the most part from the Sudan or Eritrea and have no ties to the country or claim on its people have made their way to Israel in the last several years. In a nation of only seven million people living in a country the size of New Jersey, that’s the equivalent of about 2.7 million illegal immigrants showing up in the Garden State. As such, a group of this size arriving uninvited present a huge problem for any nation, even one whose entire identity is based on immigration, as is Israel’s.
But instead of sympathy or perhaps a helping hand from an international community that surely bears more responsibility for the plight of people from the Horn of Africa than Israel, its struggles to deal with this insoluble problem have become yet another club with which anti-Zionists seek to delegitimize the Jewish state. This is hypocrisy of the first order and the inordinate attention given these Africans by the Western media—such as the article published today by the New York Times—in a world where tens of millions of refugees and economic migrants are to be found, once again illustrates the double standard by which Israel is judged on any conceivable issue.
It is to be conceded that not everyone in Israel has behaved appropriately toward the migrants. Anger, insults, and threats from people in neighborhoods where illegals have concentrated, as well as from a few rabble-rousing politicians, hasn’t helped the country’s reputation. The plight of people stuck in limbo without legal status where they are and nowhere else to go should arouse the sympathy of any decent person. But the notion that it is somehow Israel’s responsibility to cope with the impact of economic distress in the Horn of Africa is not a defensible or reasonable position to take.
Were that many people to show up in virtually any country in the world, especially all the other countries of the Middle East which are ruled by various kinds of tyrants, it doesn’t take much imagination to consider the kind of treatment they would get. But in democratic Israel where Jewish religious values about welcoming the stranger are part of the culture, these African newcomers have been spared the sort of abuse they would have gotten anywhere else in the region. Indeed that, and the fact that Israel has a booming First World economy, is the only reason why so many have tried to sneak into Israel to find work. Were they just a few, they might well have been allowed to stay. But once the number reached the tens of thousands, with many working illegally and with some committing crimes, that wasn’t an option. Since deportation back to their home countries would likely result in dire consequences for the migrants and no one else wants them, Israel is stuck with them until someone can come up with a solution.
For Israel-haters, the scattered sentiments of some Israelis in South Tel Aviv neighborhoods that found themselves hosting thousands of desperate illegals and suffering the normal increase in crime as a result is proof that racism is normative behavior in the state. But anyone who knows anything about Israel’s history knows that this is bunk. Israel absorbed tens of thousands of black Jews from Ethiopia in the last 30 years. Though their absorption has not been seamless or without incident, they are now part of the fabric of the country, serve in the army, and even in the Knesset.
But under what distorted sense of morality is Israel held to be particularly at fault for treating people who cross its borders illegally as having committed a criminal act and therefore subject to detention? Even if you are deeply sympathetic to the migrants, as many Israelis are, is there a sovereign nation in the world that does not feel entitled to control its borders, especially when those frontiers also need to be defended against terrorists and hostile powers? Do those who protest Israel’s treatment of these people, in which many are kept in open detainment centers think that other democracies, such as the United States, would treat such people any better? Under those circumstances how can any reasonable person criticize Prime Minister Netanyahu’s pledge to defend his country’s borders and to enforce its laws.
Many of the migrants claim they are seeking political asylum rather than just jobs, but this is patently untrue of most of them, as their behavior has suggested. If Westerners would like to help them, they are free to welcome them into their own countries. Failing that, Israel deserves either some constructive help, such as an international diplomatic initiative that would force Sudan and Eritrea to guarantee their safety upon their return home, or be allowed to deal with the situation as best they can. Until they do either of those things or come up with a solution that doesn’t involve Israel being forced to accept economic refugees as legal immigrants in a manner that no other nation on the planet would ever consider, Western critics should pipe down.
Financial woes hit UK hospitals hard http://isbigbrotherwatchingyou.com/wp-content/uploads/2013/11/f67bc__p-89EKCgBk8MZdE.gif
A British parliamentary committee has been warned that a third of hospitals across the UK are going into the red amid a crippling financial crisis created by unprecedented cash squeeze, media reports say.
The warning by the Nuffield Trust health think tank cautioned members of parliament (MPs) in a bleak assessment of the National Health Service (NHS)’s financial difficulties, saying one in three hospitals could end up unsustainable with the current system not equipped enough to face the growing problem, British media reported.
The House of Commons health select committee launched the probe into the NHS’s ongoing £20bn savings drive, and it was warned by the think tank that ministers should be prepared to face any possible scenario.
“Many hospitals face severe and potentially unsustainable financial pressures”, the trust told the MPs, adding that its analysis of official data about the NHS’s financial health puts a question mark over its future viability.
According to the trust’s assessment, smaller hospitals which are operating semi-autonomously of NHS and the government’s control face a greater risk because they are not given foundation trust status.
The trust added that those hospitals in “regional clusters of financial stress”, such as outer London and the West Midlands, are also going into the red.
The foundation trust status would not be given to 83 NHS trusts from among 246 trusts which are providing care in England because they are not earning enough, or generating a sufficient surplus from their work, said the Nuffield Trust.
According to Monitor, the NHS’s economic regulator, those trusts include 40 of the 146 foundation trusts and 43 of the 100 trusts which have not achieved that status.
Meanwhile, the NHS would not be able to bail out hospitals in trouble because “hospital trusts could start becoming unsustainable in larger number than the current system is designed to address”, according to the trust.
The main opposition Labour Party used the think tank’s analysis to blame the coalition government for failing to address hospitals’ financial woes.
“Ministers lack a plan to deal with trusts in serious financial difficulties and cannot guarantee that the quality of patient care will not be affected. With hospital trusts facing a financial challenge, the government should be focusing on sorting the situation out,” said Andy Burnham, the shadow health secretary.
Anita Charlesworth, the trust’s chief economist, said: “We need to monitor the signs that this challenging situation could lead to an unsustainable financial squeeze on hospital trusts. The weakest hospitals appear to be getting weaker.”
FILE – In this April 10, 2013, file photo, Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner speaks during a news conference at the Health and Humans Services Department in Washington. Tavenner, the senior Obama administration official closest to the implementation of the health care law’s dysfunctional website faces tough questions Tuesday, Oct. 29, from Congress at the start of a pivotal week. Tavenner will be questioned by the House Ways and Means Committee on what went wrong with HealthCare.gov, and whether she saw any of it coming. (AP Photo/Manuel Balce Ceneta, File)
FILE – In this April 10, 2013, file photo, Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner speaks during a news conference at the Health and Humans Services Department in Washington. Tavenner, the senior Obama administration official closest to the implementation of the health care law’s dysfunctional website faces tough questions Tuesday, Oct. 29, from Congress at the start of a pivotal week. Tavenner will be questioned by the House Ways and Means Committee on what went wrong with HealthCare.gov, and whether she saw any of it coming. (AP Photo/Manuel Balce Ceneta, File)
This screenshot made Monday, Oct. 28, 2013 shows the U.S. Department of Health and Human Services’ main landing web page for HealthCare.gov. With website woes ongoing, the Obama administration Monday granted a six-week extension until March 31, 2014 for Americans to sign up for coverage next year and avoid new tax penalties under the president’s health care overhaul law. (AP Photo/U.S. Department of Health and Human Services)
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WASHINGTON (AP) — Stressing that improvements are happening daily, the senior Obama official closest to the administration’s malfunctioning health care website apologized Tuesday for problems that have kept Americans from successfully signing up for coverage.
“I want to apologize to you that the website has not worked as well as it should,” Medicare chief Marilyn Tavenner said as she began her testimony before the House Ways and Means Committee. It was the most direct mea culpa yet from a top administration official.
The first senior official to publicly answer questions from lawmakers, Tavenner is being grilled not only on what went wrong with HealthCare.gov, but also whether lawmakers can trust promises to have things running efficiently by the end of November.
She firmly refused to provide current enrollment numbers, saying repeatedly they will not be available until mid-November.
Tavenner’s appearance follows the testimony last week of outside contractors who said there wasn’t enough time to test the complex online enrollment system. It froze up the day it was launched, Oct. 1.
At stake is what the Republicans’ partial government shutdown could not achieve: a delay of President Barack Obama’s law expanding coverage for uninsured Americans. As a result of widespread sign-up problems, even some Democrats have joined Republicans in calling for a one-year postponement of the law’s tax penalties for the remaining uninsured. The insurance industry warns that would saddle the new system with too many high-cost patients.
In prepared testimony, Tavenner acknowledged the initial performance “has not lived up to the expectations of the American people and is not acceptable.” But she also seconded administration talking points that despite the website problems the law is living to its promise of quality, affordable health insurance for those who don’t have access to workplace coverage.
Less well known than Health and Human Services Secretary Kathleen Sebelius, Tavenner was closer to the day-to-day work of setting up the enrollment website, which was handled by experts within her agency, the Centers for Medicare and Medicaid Services, along with outside contractors. Like other administration officials, she previously had assured Congress that everything was on track for a reasonably smooth launch in all 50 states.
“If people can’t navigate such a dysfunctional and overly complex system, is it fair for the IRS to impose tax penalties?” said Ways and Means Chairman Dave Camp, R-Mich. In a concession, the White House has said it will waive penalties for anyone who signs up by March 31, in effect granting a limited grace period.
Tavenner began her career as a nurse and built a successful record as a hospital executive before entering public service. Seen as a businesslike manager, she has enjoyed support from lawmakers across the political spectrum. Indeed, Republicans are calling for Sebelius to resign, not Tavenner. But the Medicare chief’s professional reputation is also at stake.
On Monday, a spokeswoman acknowledged Tavenner’s central role. The Medicare agency “has said we are responsible for the issues the website is currently facing,” communications director Julie Bataille said. As administrator, Tavenner “has been in charge of the overall … implementation effort.”
What Tavenner knew about the potential for problems and whom she told will be key questions from lawmakers. Additionally, some are concerned about the security of the HealthCare.gov site. Others worry about unintended consequences from the feverish, hasty work to repair the site.
Sebelius is likely to face some of the same questions Wednesday when she appears before another powerful House panel, the Energy and Commerce Committee.
Momentum to fix the problems has grown since Obama personally acknowledged the problems last week. He sent in management consultant Jeff Zients to assess the situation. By the end of the week, Zients reported that he had two big lists with dozens of needed fixes, and said he was optimistic they could be completed by Nov. 30.
HHS also announced that an outside company would assume the role of general contractor shepherding the fixes, in effect taking over the coordination job that Tavenner’s agency had been doing.
Although the administration has released a blizzard of statistics on the numbers of people visiting the website, opening accounts and having their income verified by the Internal Revenue Service, it has yet to say how many have successfully enrolled for health insurance.
The website was supposed to be the online portal to coverage for people who don’t have a health plan on the job. Its target audience is not only uninsured Americans but those who already purchase coverage individually. A companion site for small businesses has also run into problems.
Under the law, middle-class people can qualify for tax credits to make private health insurance more affordable, while low-income people will be steered to Medicaid in states agreeing to expand that safety net program.
Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified.
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Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans. Blue Cross & Blue Shield of Nebraska said it had to hire temporary workers to contact new customers directly to resolve inaccuracies in submissions. Medical Mutual of Ohio said one customer had successfully signed up for three of its plans.
The flaws could do lasting damage to the law if customers are deterred from signing up or mistakenly believe they have obtained coverage.
“The longer this takes to resolve . . . the harder it will be to get people to [come back and] sign up,” said Aetna Inc. /quotes/zigman/272706/quotes/nls/aetAET-2.24% Chief Executive Mark Bertolini. “It’s not off to a great start,” he said, though he believes the marketplaces are “here to stay.”
President Barack Obama smile during a news conference in the East Room at the White House in Washington, Friday, Aug. 9, 2013. The president said he’ll work with Congress to change the oversight of some of the National Security Agency’s controversial surveillance programs and name a new panel of outside experts to review technologies.(AP Photo/Charles Dharapak)
President Barack Obama smile during a news conference in the East Room at the White House in Washington, Friday, Aug. 9, 2013. The president said he’ll work with Congress to change the oversight of some of the National Security Agency’s controversial surveillance programs and name a new panel of outside experts to review technologies.(AP Photo/Charles Dharapak)
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WASHINGTON (AP) — President Barack Obama says the housing market is healing, but it’s time to turn the page on the “bubble-and-bust mentality” that led to the market’s collapse.
In his weekly radio and Internet address, Obama calls on Congress to let all Americans refinance at current low rates. He wants more help for first-time homebuyers and expanded affordable rental housing. He’s proposing to phase out mortgage giants Fannie Mae and Freddie Mac so private capital can play a bigger role in mortgages.
At the same time, Obama says the U.S. must preserve access to popular 30-year mortgages.
In the Republican address, Sen. Tim Scott of South Carolina says Obama’s energy policies have failed. He says Republicans want government to get out of the way, including by approving the Keystone XL pipeline.
Winnie Madikizela-Mandela spoke of “a very difficult situation”
US President Barack Obama has landed in South Africa, the second stop in his three-country tour of Africa.
Mr Obama said earlier he did not expect to see former President Nelson Mandela, who is critically ill in hospital.
Leaving Senegal, he told reporters on board Air Force One: “I don’t need a photo op.”
Meanwhile, Mr Mandela’s ex-wife, Winnie Madikizela-Mandela said the former leader had made “a great improvement” in recent days, but was “still unwell”.
But she said she felt it would not be right for the US president to visit Mr Mandela while he was in a critical condition.
Correspondents say security is tight in the streets near Mediclinic Heart Hospital in the capital, Pretoria, where the 94-year old is being treated for a lung infection.
Ministers, politicians, Mr Mandela’s physician and family members were among those visiting the ex-leader on Friday, his 21st day in hospital.
Several hundred people earlier took to the streets of Pretoria in protest against Mr Obama’s foreign policy.
However, the BBC’s James Copnall in the city says Mr Obama does have wide support in South Africa.
‘Hero for the world’
Mr Obama’s plane landed at a military airbase near Pretoria on Friday evening. During his stay, he is scheduled to meet President Jacob Zuma and hold a major speech, correspondents say. He is also expected to visit Robben Island, where Mr Mandela was imprisoned for 18 years.
Outside the hospital where messages of goodwill are swelling by the day sit two paintings – one of Nelson Mandela, the other of Barack Obama.
The symbolism couldn’t be more potent, as America’s first black president arrives on the second leg of his Africa tour.
A brief protest outside the hospital suggested not everyone welcomes his visit – some are angry at what they see as the “militarisation” of US foreign policy – but the mood surrounding the president’s tour is overwhelmingly positive.
However Mr Obama said earlier he did not expect to see the ailing ex-leader during his South African trip.
“I don’t need a photo op,” he said aboard Air Force One after leaving Senegal. “The last thing I want to do is to be in any way obtrusive at a time when the family is concerned with Nelson Mandela’s condition.”
He went on to say: “I think the main message we’ll want to deliver is not directly to him, but to his family – is simply profound gratitude for his leadership all these years, and that the thoughts and prayers of the American people are with him, his family and his country.”
Officials and many South Africans have praised his decision to visit South Africa, our correspondent says.
Mr Obama met Mr Mandela in 2005 when he was still a US senator. Both men became the first black presidents of their nations and have received the Nobel Peace Prize.
The US president has described Mr Mandela as a “hero for the world”, whose “legacy will linger on through the ages”, and who had inspired his own activism as a student.
‘Difficult situation’
Earlier on Friday, Mrs Madikizela-Mandela told reporters outside Mr Mandela’s former home in Soweto: “I’m not a doctor but I can say that from what he was a few days ago there is great improvement, but clinically he is still unwell.”
She also thanked domestic and international media for their coverage, but added that some of the reports had caused the family distress.
“We had no idea of the love for us out there,” she said.
“There may be problems here and there when some of you get carried away and talk about our father in the past tense,” she said, adding:
“If sometimes we sound bitter, it is because we are dealing with a difficult situation.”
Earlier this week, Mr Mandela’s eldest daughter criticised the international media camped outside the Mediclinic Heart Hospital, calling them “vultures”.
There are mixed emotions among the many well-wishers also gathered outside the hospital, the BBC’s Karen Allen reports from the scene. People are anxious about his health but also want to express their pride in the man many consider the father of the nation.
“There is no sadness here. There is celebration. He is a giant,” 57-year-old Nomhlahla Donry, whose husband served time with Mr Mandela, told the AFP news agency.
“We are saying let him live long because we like him and he has done a lot for us in this world. He’s done a lot of amazing things and we really love Tata,” local resident Alfred Makhathini told Reuters.
South Africa’s ruling African National Congress (ANC) said it would hold vigils each day that the former leader remained in hospital, and the distinctive black, green and gold colours of the party are much in evidence.
But the party denied it was exploiting the occasion to canvas for votes ahead of next year’s elections.
“We love our ANC regalia and we have every right to wish Madiba well,” party spokesman Jackson Mthembu said.
Meanwhile, a court in the Eastern Cape has granted an application brought by the Mandela family to exhume three of his children and two other relatives and rebury them in the family cemetery in Qunu, which is where the former leader wants to be buried, their lawyers say.
The BBC’s Pumza Fihlani in Johannesburg says this is one of the reasons why the family held a meeting earlier this week.
