IGX

As [HHS] put it, “Dr. Gruber developed a proprietary statistically sophisticated micro-simulation model that has the flexibility to ascertain the distribution of changes in health care spending and public and private sector health care costs due to a large variety of changes in health insurance benefit design, public program eligibility criteria, and tax policy.”

The model, the Gruber Microsimulation Model, is the coin of the realm, in large part because it is similar to the model used by the Congressional Budget Office. That means administration policy-makers could predict with reasonable certainty how CBO would score legislation. Given that legislation in Washington often falls or rises depending on the CBO score, that made this model a very powerful tool for administration officials.

At age 29, Megan Rothbauer imagined herself to be the picture of good health and good finances.

Then, on Sept. 4, 2013, she stood up by her desk at her workplace in Madison, Wisconsin – and collapsed.

"I was lucky that I had a couple of colleagues standing right beside me," she tells PEOPLE. "One of my co-workers caught me. At least that's what I'm being told, because I don't remember anything from about four days before that. That's one of the things that cardiac arrest does – it affects your memory."

Paramedics rushed her by ambulance to the nearest hospital – St. Mary's Hospital, which was outside of her insurance network – rather than three blocks farther to Meriter Hospital, where her workplace insurance would have covered most of the cost for her 17-day stay, including 10 days in a medically induced coma.

The result: Rothbauer is staring at bills totaling $41,350, versus the maximum $1,500 out-of-pocket expense she otherwise would have faced, she says.

"I place no blame," says Rothbauer, now 30, who works as a project manager for a manufacturing company. "Without any of these people I am about to name – without my colleagues, without the ambulance people who spent 45 minutes working on me when they could very well have given up, without the doctors and nurses at the hospital – I would not be here today. They all treated me wonderfully."

But she adds: "I was unconscious. I had no ability to let anyone know what hospital I needed to be at."

The financial hole has forced Rothbauer to put her life on hold, delaying her wedding to fiancé Ben Johnsen, while she contemplates bankruptcy.

And her situation is not unique, according to Channel3000.com, which reviewed Rothbauer's case and found there's no guarantee that patients won't be charged higher rates if they receive treatment outside of their insurance network. It's called "balance billing," and allows providers who fall outside of a patient's insurance plan to charge the balance left unpaid by the consumer's insurer.

"My strong suspicion is this happens more frequently than you think," Meg Gaines, who runs the Center for Patient Partnerships, a consumer healthcare advocacy group at the University of Wisconsin-Madison Law School, told Channel3000.

Rothbauer is not trying to dodge her responsibilities. Her insurer Blue Cross Blue Shield paid St. Mary's Hospital 100 percent of its in-network rate toward the initial $258,000 hospital bill – and Rothbauer notes that St. Mary's subsequently trimmed her remaining charges by 90 percent, to about $10,000. But doctors and specialists bill separately, she says, and that's where her burden now lies, leaving her with the potential out-of-pocket cost of more than $40,000. (She was originally facing bills totaling more than $50,000, until her insurer processed additional claims.)

Open enrollment on the federal HealthCare.gov site kicked off relatively smoothly in many parts of the nation Saturday, although there were reports in some areas that consumers and brokers had problems logging into accounts.

Healthcare.gov launched amid much anticipation after last year's botched rollout.. Department of Health and Human Services reported more than 23,000 people had submitted applications in the first eight hours.

Just as the federal log in issues appeared resolved Saturday afternoon, issues on state-run sites cropped up.

T>1200 wrote:Turd, how do you feel about Gruber receiving $1.5 million in consulting fees for his work on, and promoting of, Obamacare? I think it's a great example of free market capitalism.

Turdacious wrote:

T>1200 wrote:Turd, how do you feel about Gruber receiving $1.5 million in consulting fees for his work on, and promoting of, Obamacare? I think it's a great example of free market capitalism.

His non-disclosure that he was receiving these consulting fees in the articles he wrote is something I have a problem with, but other than that more power to him. If he knew how to keep his mouth shut, he'd be in line to get more.

Bob Wildes wrote:

Turdacious wrote:

T>1200 wrote:Turd, how do you feel about Gruber receiving $1.5 million in consulting fees for his work on, and promoting of, Obamacare? I think it's a great example of free market capitalism.

His non-disclosure that he was receiving these consulting fees in the articles he wrote is something I have a problem with, but other than that more power to him. If he knew how to keep his mouth shut, he'd be in line to get more.

He is set for life with 1.5 million unless his bribery expenses were outrageously high.

Under the Affordable Care Act (ACA), in 2018, an excise tax on high-cost health plans, the so-called “Cadillac tax,” takes effect. The potential impact of this tax is driving employers to fundamentally reassess their health care plans and reconsider what their role and approach to providing health care benefits should be in the future. At the moment, the tax is acting as a catalyst for change. In the future, however, continued medical inflation and regional differences in health
care costs will make it very difficult for employers to continue reducing benefit costs to avoid the tax. Rising health care costs will make it more difficult for employers to provide affordable health care benefits to employees with each passing year, and the inexorable increase in health care costs will eventually cause Chevrolet benefit plans to be taxed as Cadillacs. That, in turn, will result in the
burden of the excise tax falling on a significant number of American employees and their families.
Key findings about the excise tax on employees and employers are as follows:
From 2018 to 2024, the excise tax could cost 12.1 million employees an average of $1,050 in higher payroll and income taxes per year, if employers increase their taxable wages as they reduce the cost of health care benefits. Alternatively, these employees could see up to a $6,150 reduction in their health care benefits and little or no increase in their pay.
Should employers increase the taxable wages of employees, something that is not clear in the current business cycle, a significant portion of the increase in take-home pay may be spent on higher out-of-pocket health care expenses as deductibles and out-of-pocket limits increase.
Large employers subject to the excise tax in 2018 will pay an average of $1.0 million that year, and an average of $2.1 million per year from 2018 to 2024,
or over $2,700 per employee.
In 2018, the excise tax is anticipated to hit 17 percent of all American businesses, and 38 percent of large employers.
Within twenty years, the impact of the excise tax will not be limited to just high value plans. By 2031, the cost of the average family health care plan is expected to hit the excise tax threshold.

Up until this point, most of the attention regarding the failure to disclose the connection between Jonathan Gruber and the White House has fallen on Gruber himself. Far more troubling, however, is the lack of disclosure on the part of the White House, the Senate, the DNC and other Democratic leaders who distributed Gruber's work and cited it as independent validation of their proposals, orchestrating the appearance of broad consensus when in fact it was all part of the same effort.

The White House is placing a giant collective bet on Gruber's "assumptions" to justify key portions of the Senate bill such as the "Cadillac tax," which they allowed people to believe was independent verification. Now that we know that Gruber's work was not that of an independent analyst but rather work performed as a contractor to the White House and paid for by taxpayers, and economists like Larry Mishel are raising serious questions about its validity, it should be made publicly available so others can judge its merits.

Employer-paid premiums are increasing yet again with a 5.5 percent rise forecast for 2015, the biggest such increase in the last few years, according to new analysis. Meanwhile, employees’ share of the cost is growing at a much higher rate.

Aon Hewitt’s analysis showed the average health care cost per employee is projected to jump to $11,304 per employee, from $10,717 in 2014. It’s the highest percentage rate increase since 2011, when employer costs rose 8.5 percent, Aon Hewitt said. The last two increases in 2013 and 2014 were a more modest 3.3 percent and 4.4 percent, respectively.

Employees will be asked to contribute 23.6 percent of the total health care premium, which equates to $2,664 for 2015. That’s up 7 percent from last year.

The increase, Aon Hewitt said, is due to a number of factors, including a more robust economy —meaning employees are willing to spend more on their own health care.

“Over the past few years, the overall economic situation kept consumer spending on discretionary items — including health care — down, and we observed a lower rate of premium increases,” said Tim Nimmer, chief health care actuary at Aon Hewitt. “Now, with employment rates stabilizing, individuals are feeling more secure about their financial situation and have been willing to re-engage in using the health care system. As these utilization rates increase, we expect to see health care cost increases follow.”

In addition to the employee premium, workers on average will pay another $2,487 in out-of-pocket costs, which is up more than 8 percent from $2,295 in 2014. By next year, worker out-of-pocket costs will have almost doubled from $1,276 in 2009.

The bigger picture from the firm’s analysis? All told, these projections mean that over the last five years, employees’ share of health care costs — including employee contributions and out-of-pocket costs — will have increased more than 52 percent, from $3,389 in 2010 to $5,151 in 2015.

Aon Hewitt’s figures are based on more than 560 employers representing more than 13 million insured employees.

The Obama administration has admitted that it inflated Obamacare enrollment numbers twice this year — including in testimony to Congress — thanks to an error in the way health insurance numbers were conflated with dental insurance figures.

The exaggeration, which HHS Secretary Sylvia Mathews Burwell said was an “unacceptable” mistake, inflated the reported number enrolled in Obamacare by 400,000. House Republicans first spotted the issue, and say that blaming the bad numbers on mistaken data “strains credulity.” If you take the dental insurance customers out of the latest administration Obamacare report, the enrollment number is closer 6.7 million now.

Burwell and HHS officials did not publicly explain how the mistake happened. But one administration official told POLITICO a topline number for paid enrollment — different data than HHS usually uses in its enrollment reports — was used for Medicare chief Marilyn Tavenner’s testimony on the Hill in September. She said at the time that 7.3 million people were covered as of mid-August.

The problem was uncovered by House Oversight Republicans after receiving more detailed information from HHS this month.

DrDonkeyLove wrote:

Turdacious wrote:

When millions of people in the individual health insurance market lost their health plans in late 2013, ObamaCare supporters claimed those lost plans were "substandard" or "crappy." However, they failed to support that contention.

This study examines the claim that the policies on the individual market were inferior in quality to those on the ObamaCare exchanges. First, it compares the premiums and the size of the deductibles as well as maximum out-of-pocket costs of policies on the individual market prior to the exchanges to those of current polices on the exchanges. Second, it examines the quality of provider networks by comparing the number of plans that are HMOs versus those that are PPOs in the individual market prior to the exchanges and those now on the exchanges.

The study finds that there were many policies on the individual market that had lower premiums and lower or equal deductibles and out-of-pocket maximums than the cheapest plans now available on the exchanges. It also finds that the individual market prior to the exchanges offered a greater choice of hospitals and physicians since it contained far more PPO policies than HMO policies, whereas the exchanges offer more HMO policies.

http://www.nationalcenter.org/NPA663.html

My Aetna policy is being cancelled and I have until 12/1 to find another carrier. In checking with our doctors as to what carriers they do and don't allow, I learned yesterday that our doctors participate in a variety of networks. However, our doctors generally only participate in plans purchased directly from the insurance company, not the Obamacare Exchange. So, if I buy big name insurance off the exchange, it's meaningless with our healthcare providers.

These are not renowned specialists, just regular doctors who are part of big physician networks and their average level of skills are unattainable to those confined to the exchanges.

The cost and network coverage of my Obama initiated healthcare changes are to be determined in the next week or so. The good news is that I'll definitely get some kind of coverage. The scary part is not knowing if good insurance is affordable or if I'll end up in a substandard network.

DrDonkeyLove wrote:

DrDonkeyLove wrote:

Turdacious wrote:

When millions of people in the individual health insurance market lost their health plans in late 2013, ObamaCare supporters claimed those lost plans were "substandard" or "crappy." However, they failed to support that contention.

This study examines the claim that the policies on the individual market were inferior in quality to those on the ObamaCare exchanges. First, it compares the premiums and the size of the deductibles as well as maximum out-of-pocket costs of policies on the individual market prior to the exchanges to those of current polices on the exchanges. Second, it examines the quality of provider networks by comparing the number of plans that are HMOs versus those that are PPOs in the individual market prior to the exchanges and those now on the exchanges.

The study finds that there were many policies on the individual market that had lower premiums and lower or equal deductibles and out-of-pocket maximums than the cheapest plans now available on the exchanges. It also finds that the individual market prior to the exchanges offered a greater choice of hospitals and physicians since it contained far more PPO policies than HMO policies, whereas the exchanges offer more HMO policies.

http://www.nationalcenter.org/NPA663.html

My Aetna policy is being cancelled and I have until 12/1 to find another carrier. In checking with our doctors as to what carriers they do and don't allow, I learned yesterday that our doctors participate in a variety of networks. However, our doctors generally only participate in plans purchased directly from the insurance company, not the Obamacare Exchange. So, if I buy big name insurance off the exchange, it's meaningless with our healthcare providers.

These are not renowned specialists, just regular doctors who are part of big physician networks and their average level of skills are unattainable to those confined to the exchanges.

The cost and network coverage of my Obama initiated healthcare changes are to be determined in the next week or so. The good news is that I'll definitely get some kind of coverage. The scary part is not knowing if good insurance is affordable or if I'll end up in a substandard network.

So, I may have purchased policies for my wife and myself. I was told by experts that I should give the process two weeks. So, after weeks of rooting around the health insurance industry I got the paperwork to my insurer of choice on 10/29 to give myself a two week cushion. Since then there have been a hiccups in the process and we may have resolved them.....or not. Since the insurer does everything by snail mail, one can't be sure.

There are three working days between now and the day we no longer have health insurance and we can't be sure that we'll be covered by 12/1. I assume we'll be in limbo for days or weeks. I hope to G_d that neither of us needs medical care for the next few weeks. Thanks Obmacare!

Many states are struggling to re-enroll adults and children in Medicaid and the Children's Health Insurance Program, with hundreds of thousands of current beneficiaries at risk of losing coverage, advocates say.

The enrollees who are at greatest risk are pregnant women, children and blind and disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions—the 2014 expansion of coverage to all adults with incomes up to 138% of the federal poverty level, and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard.

The problem in re-enrolling such beneficiaries is that these pre-ACA enrollees do not necessarily understand their states' requests for additional information, which is needed to determine if they are still eligible for Medicaid under the new MAGI standard. Many beneficiaries have not responded to redetermination notices and have been dropped from Medicaid. Beneficiary advocates argue that the notices are too complex and often are not written in an enrollee's primary language. As a result, the ACA's goal of expanding coverage is being undermined, as thousands of pre-ACA enrollees are losing their coverage.

The National Association of Insurance Commissioners has released draft regulations expected to impact the makeup of health plan provider networks on a state and federal level, including on the marketplace exchanges set up under the Affordable Care Act.

NAIC in November released draft updates to its Managed Care Network Adequacy Model Act, a model law routinely used by state and federal lawmakers when creating insurance laws and regulations, particularly in regards to the creation of health carrier networks and the adequacy and accessibility of services offered under a network plan.

The model Act, which hadn’t been updated since 1996, has been highly anticipated due to the changing insurance landscape under the implementation of the ACA. A controversy over the use of narrow networks on the marketplace exchanges has led the Centers for Medicare and Medicaid Services to investigate the adequacy of provider networks more closely; and the agency said it was waiting for NAIC’s revamped model law before proposing changes to its network adequacy policy for products offered on the 2016 exchanges.

Before the A.C.A. was passed, underinsurance was prevalent. Of adults age 19-64 in 2010, 16 percent, or 29 million, met the Commonwealth Fund’s definition of being underinsured: one’s out-of-pocket health care costs exceeding 10 percent of income (5 percent when income is less than 200 percent of the federal poverty line), or one’s insurance deductible being more than 5 percent of income. The number of underinsured Americans had grown by 80 percent from 2003 to 2010.

Some of the A.C.A.'s regulations, such as removing annual or lifetime limits on reimbursements, were aimed at reducing the out-of-pocket spending that people might have to make. When the act went into effect and some people found their policies had been canceled (despite President Obama’s now-infamous assurance that “if you like your health care plan, you can keep it”), it was often because those policies left them underinsured, even if they didn’t realize it.

But the A.C.A. has not done as much as many had hoped it would to reduce underinsurance. In fact, it may be helping to spread it. And proposed modifications to the law, like those that would introduce a new tier of “copper” plans in addition to bronze, silver, gold and platinum, might make underinsurance worse.

This is important, because research shows that those who are underinsured are more likely to go without needed care.

One purpose of the new health law was connecting patients, many of whom never had insurance before, with primary care doctors to prevent them from landing in the emergency room when they are sicker and their care is more expensive. Yet nearly 1 in 5 Americans lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected to keep pace with demand.

The Association of American Medical Colleges projects the shortage will grow to about 66,000 in little more than a decade as fewer residency slots are available and as more medical students choose higher-paying specialty areas.