Tag: Obamacare

Vermont Official Foresaw Collapse of ObamaCare Co-Ops

The Daily Caller has an excellent article recounting that it wasn’t just opponents who saw trouble ahead for ObamaCare’s health-insurance cooperatives, of which more than a dozen have now collapsed. 

Susan L. Donegan was commissioner for Vermont’s Division of Insurance in 2013 when she refused to issue a license to the proposed Vermont Health CO-OP, saying it failed to meet state standards. Her action barred the Obamacare non-profit from selling health insurance in the state…

Today, she looks like a prescient state official who likely saved thousands of Vermonters from buying their health insurance from a doomed insurer.

That’s because 13 of the 24 co-ops set up under Obamacare have collapsed, costing the federal treasury $1.3 billion. More than 800,000 co-op customers now find themselves without health insurance coverage and are scrambling to find new policies due to the co-op failures. 

Turns out that some of the biggest problems she identified two years ago in her state also doomed co-ops across the country…

Denying a license to the health co-op was not an easy decision for Donegan, who first joined Democratic Gov. Peter Shumlin’s administration as a deputy insurance commissioner in 2010.

First, she already knew when the co-op’s application arrived at her her office that federal officials in Washington, D.C., had pre-approved the co-op’s plan and allocated to it $33 million in taxpayer funds.

Second, she knew the co-ops were an important part of President Obama’s signature health reform effort. Obama is extremely popular in Vermont, having garnered 67 percent of the vote in his 2008 and 2012 campaigns…

Donegan sensed trouble as soon as she read the co-op’s application. There were optimistic and questionable forecasts, a board filled with friends, sweetheart deals, high salaries, deep conflicts of interest and a staff with little business expertise.

The failure of more than a dozen other ObamaCare co-ops suggests these problems were not limited to Vermont’s proposed co-op. Yet regulators in those states, not to mention CMS, nevertheless approved them.

One might even say the rule is that government regulators either were unable to spot these co-ops’ looming insolvency, or worse, allowed political considerations to trump their judgment; and Vermont is the exception, where regulators both identified the problem and had the courage to pay the political cost of denying that carrier a license. Something to keep in mind when contemplating the costs and benefits of government regulation of insurance-carrier solvency.

Any count of failed ObamaCare co-ops should be sure to include Vermont’s.

H/T: Greg Scandlen.

Wave of Health Insurance CO-OPs to Shut Down in Latest ACA Failure

Hundreds of thousands people will lose their insurance plans as a raft of health insurance cooperatives (CO-OPs) created by the Affordable Care Act will cease operations. Just last week, CO-OPs in Oregon, Colorado, Tennessee and Kentucky announced that they would be winding down operations due to lower than expected enrollment and solvency concerns (although the one in Colorado is suing the state over the shutdown order).  They join four other CO-OPs that have announced that they would be closing their doors. In total, only 15 out of the 23 CO-OPs created by the law remain. These closures reveal how ill-advised this aspect of the ACA was both in terms of lost money and the turmoil for the people who enrolled in them. The eight that have failed have received almost $1 billion in loans, and overall CO-OPs received loans totaling $2.4 billion that might never get paid back. In addition, roughly 400,000 people will lose their plans.

Sources:  Sabrina Corlette et al. “The Affordable Care Act CO-OP Program: Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets,” The Commonwealth Fund, March 12, 2015; Erin Marshal, “8 Things to Know About Insurance CO-OP Closures,” Becker’s Hospital Review, October 20, 2015. Created using Tableau.

Notes: Hawaii and Alaska not shown. Neither state had a CO-OP. CoOportunity Health served both Iowa and Nebraska.

ACA’s Looming IPAB Test

Yesterday, in a move being described as “a major shift,” the American Cancer Society changed its guidelines on when and how often women should undergo professional physical exams and mammograms for breast cancer.

Under previous guidelines that the organization had trumpeted for years, women “of average risk” were to begin both at age 40 and repeat them every year. Now the ACS is recommending annual mammography start at age 45, cutting back to once every two years at age 55, and eliminating the screen altogether when a woman’s future life expectancy falls inside of 10 years. As for the physical exam, the ACS no longer recommends it at all.

The reason for the change is that both screens provide so many stressful false positives that the ACS doesn’t believe regular testing passes a cost-benefit test unless the woman is of “higher than average risk.”

The shift should be welcome news for women. Mammograms and doctor breast exams are charitably described as “uncomfortable,” and probably more accurately described as “painful and embarrassing.” But the ACS change could become painful and embarrassing for the architects of the 2010 Patient Protection and Affordable Care Act (ACA).

One of the most scrutinized provisions of the ACA is the creation of the Independent Payment Advisory Board (IPAB), whose ostensible job is to recommend cost-containment measures if Medicare expenditure projections begin to outpace a previously determined growth rate. In reality, IPAB is to monitor the cost and effectiveness of various types of care to determine which will be covered by Medicare, with the expectation that those decisions will serve as a template for private health insurers and other third-party payers. The hope is that IPAB’s decisions will eliminate coverage of procedures that don’t measure up, thereby “bending the cost curve”—that is, reducing the nation’s overall spending on health care.

IPAB has been derided by critics as a “death panel” that could eliminate crucial care, and criticized by more thoughtful scholars as an unaccountable rationing board that will inject itself in decisions that ought to be private. In contrast, I’ve argued that IPAB is more likely to be a paper tiger that may occasionally block some treatment or another, but will usually cave to political pressure and approve popularly appealing procedures and treatments that pass no reasonable cost-benefit test. Those decisions will then pressure third party payers to also cover the care. That way, IPAB will bend the cost curve—just in the opposite direction from what the ACA writers intended.

So think of the ACS shift as a looming test of IPAB, as not-recommended breast cancer screenings are exactly the sort of Medicare expenditure the board should identify for elimination. So far, the “projected expenditures” provision for the board (or the secretary of health and human services, acting in IPAB’s stead) has not been triggered, so no cost-containment recommendations are currently forthcoming. Thus give IPAB an “incomplete” on this test for now—but don’t expect a good grade later.

King v. Burwell Helps Repeal Obamacare

It’s baaaaaack.

In today’s issue of The Hill, the Heritage Foundation’s “dangerous” director of economic policy Paul Winfree and I explain that King v. Burwell makes repealing ObamaCare about nine Senate votes easier:

As early as this week, the House could consider a reconciliation bill that repeals only parts of ObamaCare, leaving many of its taxes in place. Not only do more Americans oppose that approach than oppose ObamaCare itself, but the Supreme Court’s recent King v. Burwell ruling shows why a full-repeal bill is more likely to reach the president’s desk. Indeed, unlike partial repeal, Senate leaders can all but guarantee that full repeal can pass the Senate with just 51 votes…

A full-repeal bill, by contrast, would recognize that ObamaCare creates a single, integrated program of taxes and subsidies that work in concert to expand coverage, and would eliminate that entire program as a whole. Its primary effect would be budgetary. According to the Congressional Budget Office (CBO), full repeal would eliminate $1.7 trillion of spending and “would reduce deficits during the first half of the decade.” Retaining ObamaCare’s spending cuts would ensure that repeal reduces deficits in perpetuity…

The Senate Budget Committee can further clarify that these provisions create one integrated program. First, it can ask CBO to score ObamaCare as it scored President Clinton’s essentially identical proposal in 1994, with “all payments related to health insurance policies…recorded as cash flows in the federal budget.” Second, it can adopt that score as the baseline against which the Senate considers reconciliation. Using that baseline would show ObamaCare’s regulations are merely components of a larger program, that all financial effects of repeal would be budgetary, and that Congress may repeal those regulations via reconciliation just as it can repeal rules regulating any other government spending Congress zeroes-out through that process.

Read the whole thing.

HHS Expects ACA Exchange Enrollment to Stagnate in 2016

For the second year in a row, the Department of Health and Human Services (HHS) estimates that enrollment in the health insurance exchanges will come in far below earlier projections from the Congressional Budget Office (CBO).

According to the research brief released yesterday, HHS estimates that effectuated enrollment, or enrolled and paying premiums, will be in the range of 9.4 to 11.4 million at the end of 2016. In a conference call with reporters HHS Secretary Burwell said she believes “10 million is a strong and realistic goal… our target assumes something that is probably pretty challenging, which is that more than one out of every four of the eligible uninsured will select plans.” Effectuated enrollment of 10 million for 2016 would be an increase of only 900,000 over the department’s estimate for this year. The department now projects exchange enrollment to stagnate in the same year CBO estimated that average effectuated enrollment would almost double to 21 million. Part of this is due to a slower than expected shift from employer-sponsored insurance, but also due to difficulties in reaching some segments of the uninsured population.

Better Data, More Light on Congress

There’s an old joke about a drunk looking for his keys under a lamp post. A police officer comes along and helps with the search for a while, then asks if it’s certain that the keys were lost in that area.

“Oh no,” the drunk says. “I lost them on the other side of the road.”

“Why are we looking here?!”

“Because the light is better!”

In a way, the joke captures the situation with public oversight of politics and public policy. The field overall is poorly illuminated, but the best light shines on campaign finance. There’s more data there, so we hear a lot about how legislators get into office. We don’t keep especially close tabs on what elected officials do once they’re in office, even though that’s what matters most.

(That’s my opinion, anyway, animated by the vision of an informed populace keeping tabs on legislation and government spending as closely as they track, y’know, baseball, the stock market, and the weather.)

Our Deepbills project just might help improve things. As I announced in late August, we recently achieved the milestone of marking up every version of every bill in the 113th Congress with semantically rich XML. That means that computers can automatically discover references in federal legislation to existing laws in every citation format, to agencies and bureaus, and to budget authorities (both authorizations of appropriations and appropriations).

King v. Burwell and the Triumph of Selective Contextualism

This Thursday, the Cato Institute will release the 14th edition of the Cato Supreme Court Review, covering the Court’s October 2014 and 2015 terms. The lead article, “King v. Burwell and the Triumph of Selective Contextualism,” is by Jonathan Adler and yours truly. Here’s the abstract:

King v. Burwell presented the question of whether the Patient Protection and Affordable Care Act of 2010 (ACA) authorizes the Internal Revenue Service (IRS) to issue tax credits for the purchase of health insurance through Exchanges established by the federal government. The King plaintiffs alleged an IRS rule purporting to authorize tax credits in federal Exchanges was unlawful because the text of the ACA expressly authorizes tax credits only in Exchanges “established by the State.” The Supreme Court conceded the plain meaning of the operative text, and that Congress defined “State” to exclude the federal government. The Court nevertheless disagreed with the plaintiffs, explaining that “the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” The Court reached its conclusion by disregarding portions of the ACA’s text and considering only selected elements of the ACA’s structure, context, and purpose. The King majority’s selective contextualism embraced an unexpressed congressional “plan” at the expense of the plan Congress actually enacted.

Our article—which is available now at SSRN—quotes Darth Vader more often than any previous Cato Supreme Court Review article. (Probably.)

Adler and I will also discuss the King ruling on a panel at Cato’s 14th Annual Constitution Day Conference this Thursday, September 17, from 10:45am-12pm. Click here to register.