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PPACA Links: 2013-06-17

[This one is by Lambert of Corrente and cross-posted from that site]

Readers: Here’s the first of a series of Monday posts that will collect what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! Oh, and since I’ve turned into a night owl, this is a nominal Monday. We’ll see if I do better next week. –lambert

Obamacare’s big question: What’s it going to cost me? McClatchy 2013-06-17. “Earl Pomeroy, a former North Dakota Democratic congressman and state insurance commissioner, said insurance companies were facing “the most complicated rating challenge” that he’d ever seen. It involves the great unknown,” Pomeroy said. “New systems, new market structures and behavior responses from the population that will be impossible to predict.”

Obamacare Rollout Seen Slowed by Confusion Over Benefits Bloomberg 2013-06-17. “Judith Mayer Lynn, uninsured and battling breast cancer, should be a fan of the Affordable Care Act. Instead, she barely knows about it. Told of the benefits, Lynn remained unconvinced, skeptical of insurers and government alike. ‘It’s a joke,’ she said. ‘There’s going to be loopholes in all of these provisions.'”

Report: 1 in 5 Will Buy Coverage via Private Exchanges by 2017 California Health Line 2013-06-10. “Accenture noted that relatively few U.S. residents understand that private exchanges ‘shift considerable financial responsibility to employees.'”

Exchange Watch: The ongoing game of Spin the Rates Columbia Journalism Review 2013-06-14. “In the end, it’s the price of the insurance policy to a consumer that matters (along with what is in that policy) and the [Ohio] insurance department was not ready to tell the press what those prices will be. At least the Dispatch got the headline right: ‘Insurance prices still unclear.’ They are unclear in most states at the moment, and may be up until close to October 1, when the state exchanges open for business.”

Will the Affordable Care Act’s Health Insurance Exchanges Be Ready On Time? The Obama Administration’s Top Secret Enterprise Health Care Policy and Marketplace Review 2013-06-10. “I continue to be puzzled by the way the Obama administration is developing the federally run exchanges in the 35 states in which they will have to run them. We don’t know any details on just where they are and if they are on track. But why all of the secrecy?”

States running out of time on health insurance exchanges WaPo 2013-06-16. “Integration is a critical component. All states, whether or not they’ll be running their own exchanges, will depend on the federal hub to decide whether consumers qualify for subsidies.”

Impact of National Health Reform and State-Based Exchanges on the Level of Competition in the Nongroup Market Robert Wood Johnson Foundation June 2013 [PDF]. “Across the 10 states, the total number of carriers increased substantially, from 52 to 70, or by 35 percent. Six of the 10 states experienced an increase in the number of issuers applying to be on the nongroup exchange versus the number of significant competitors in the pre-reform, base year; and four states report no change. Among the six states reporting an increase of one or more in the number of competitors, the largest increase is for Massachusetts, which has seen an increase of seven health plans. California, Oregon and Washington each reported increases of three issuers.”

Competition in Medicare programs: Boon or boondoggle? The Union 2013-06-15. “In her research study published in the International Journal of Health Services, [Dr. Ida Hellander, policy director for Physicians for a National Health Program] found that competing insurance programs, called Medicare Advantage plans, did not save money. In fact, since their introduction, the private (mostly for-profit) insurance programs have cost taxpayers an extra $282.6 billion.”

Implementing Health Reform: Program Integrity And Other Exchange And Market-Reform IssuesHealth Affairs 2013-06-13. Review of big HHS NPRM (Notice of Proposed Rule Making) “[R]esolves a host of outstanding issues that must be tied up before the exchanges, premium stabilization programs, and market reforms become fully operational in 2014.”

Enrolling uninsured in Obamacare will be a challenge Journal-Sentinel 2013-06-15. “The Wisconsin Primary Health Care Association’s proposal calls for hiring six full-time navigators statewide as well as two staffers to oversee coordination. It estimates that the six navigators will be able to sign up a total of only 6,000 of those hundreds of thousands of people statewide who may need help. That’s based on each application taking an hour — an estimate that the association admits is optimistic.”

Choice of Health Plans to Vary Sharply From State to State Times 2013-06-13. “People in certain parts of the country may not have the robust choice of insurers that the law sought as a way to keep premiums lower and customer responsiveness high. These people are likely to have few brand-name options to choose from, and they will be gambling on plans offered by insurers new to the individual market as well as brand-new carriers.”

Underinsured in the Age of Obamacare In These Times 2013-06-15. “A 2012 report by the state’s Division of Health Care Finance and Policy found that Massachusetts employers increasingly choose insurance plans with fewer benefits, higher cost-sharing and lesser value. Between the years 2008 and 2010, the percentage of small group enrollees in the most risky, highest cost-sharing and seemingly least attractive plans (the bronze plans) increased from 2 percent to 27 percent, while those in the most comprehensive plans with less cost-sharing declined from 34 percent to 11 percent.”

A SEC for Health Care? The Health Care Blog 2013-06-04. “Even when methodologies are transparent, clinicians, insurers, government agencies and others frequently disagree on whether a measure accurately indicates the quality of care.”

Study finds jump in hospital ER-related admissions Crains Detroit 2013-05-22. “A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4 percent — not even keeping pace with population growth. But ER-related admissions jumped 17 percent.”

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor  Kaiser Health News 2013-06-14. “Changing the program, however, might not be easy. Medicare officials have said that many details were spelled out in the 2010 law, making them difficult to change in light of deep partisan divisions in Congress.”

Should Physician Pay Be Tied to Performance? PNHP 2013-06-13. “An exhaustive analysis of pay-for-performance research by the Cochrane Collaborative, an international group that reviews medical evidence, unearthed ‘no evidence that financial incentives can improve patient outcomes.'”

The Higher Health Insurers’ Claim Denial Rate, the Higher the CEO Pay NNU 2013-04-23. “Blue Cross Blue Shield of Vermont is by far the biggest and the only one based in the Green Mountain State. MVP is headquartered in New York, and Cigna, the for-profit company among the three, is based in Connecticut. Which of the trio do you think denied the most claims on a percentage basis in 2012? If you guessed the for-profit company, as I did, you would be right. …  Of all the claims submitted to it last year by health care providers and policyholders, Blue Cross denied 7.6 percent. Cigna denied 21 percent. MVP was in the middle at 15.5 percent

Affordable Care Act spurs hiring blitz Los Angeles Times 2013-06-06. “The nation’s complicated healthcare overhaul is proving to be a surprising source of work: People are needed to explain the law’s provisions to consumers. … [T]he federal Affordable Care Act is feeding a cottage industry in call centers.”

Could This Little-Watched Court Case Sink Obamacare? California Health Line 2013-06-12. “[Halbig et al v. Sebelius] threatens a key element in the Affordable Care Act: Whether the tax subsidies slated to help many Americans purchase coverage through many insurance exchanges are even legal under the ACA’s language.

Issa subpoenas ObamaCare files The Hill 2013-06-17. “House Oversight Committee Chairman Darrell Issa (R-Calif.) subpoenaed documents from a controversial ObamaCare program on Friday after charging that the Obama administration had denied his request several times. Issa is seeking information on a federal attempt to boost nonprofit health plans, known as CO-OPs (consumer oriented and operated plans), which compete with traditional health insurance.”

Here is the blogroll we have at Corrente for health care blogs. We check these regularly. Please add health care blogs we should read in comments, and we’ll check them out.

Gallows humor about Pharmageddon

Merck recently announced a shakeup- again.  Yeah, yeah, but this time they really mean it.  In response, a commenter at In the Pipeline wrote this Onionesque report:

Subject: FW: Merck in the News

NEW YORK, N.Y. (AP.com) – Merck will reduce its workforce by an
unprecedented 120 percent by the end of 2013, believed to be the first
time a major corporation has laid off more employees than it actually
Merck stock soared more than 12 points on the news.

The reduction decision, announced Wednesday, came after a year-long
internal review of cost-cutting procedures. The initial report concluded
the company would save $1.2 billion by eliminating 20 percent of its
85,000 employees.

From there, said a spokesperson, “it didn’t take a genius to figure out
that if we cut 40 percent of our workforce, we’d save $2.4 billion, and
if we cut 100 percent of our workforce, we’d save $6 billion. But then
we thought, why stop there? Let’s cut another 20 percent and save $7

“We believe in increasing shareholder value, and we believe that by
decreasing expenditures, we enhance our competitive cost position and
our bottom line,” he added.

Merck plans to achieve the 100 percent internal reduction through
layoffs, attrition and early retirement packages. To achieve the 20
percent in external reductions, the company plans to involuntarily
downsize 17,000 non-Merck employees who presently work for other

“We pretty much picked them out of a hat,”.

Among firms Merck has picked as “External Reduction Targets,” or ERTs,
are Quaker Oats, AMR Corporation, parent of American Airlines, Lockheed,
Boeing, and Charles Schwab & Co. Merck’s plan presents a “win-win” for
the company and ERTs, said the Merck spokesperson, as any savings by

ERTs would be passed on to Merck, while the ERTs themselves would benefit by the increase in
stock price that usually accompanies personnel cutback announcements.

“We’re also hoping that since, over the years, we’ve been really helpful
to a lot of companies, they’ll do this for us kind of as a favor,”.

Legally, pink slips sent out by Merck would have no standing at ERTs
unless those companies agreed. While executives at ERTs declined to
comment, employees at those companies said they were not inclined to

“This is ridiculous. I don’t work for Merck. They can’t fire me,” said
Kaili Blackburn, a flight attendant with American Airlines.

Reactions like that, replied the Merck spokesperson “are not very

Inspiration for Merck’s plan came from previous cutback initiatives,
said company officials. In January of 2005, for instance, the company
announced it would trim 15,000 jobs over two years. However, just a year
later, Merck said it had already reached its quota. “We were quite
surprised at the number of employees willing to leave Merck in such a
hurry, and we decided to build on that,”.

Analysts credited the short-term vision, noting that the announcement
had the desired effect of immediately increasing Merck’s share value.
However, the long-term ramifications could be detrimental, said Morgan Stanley analyst Beldon McInty.

“It’s a little early to tell, but by eliminating all its employees,
Merck may jeopardize its market position and could, at least
theoretically, cease to exist,” said McInty.

The spokesperson, however, urged patience: “To my knowledge, this hasn’t
been done before, so let’s just wait and see what happens.”

I laughed at first and then thought, that’s pretty much how they do it.

Well, at least the guy who wrote that has a future at some satirical online newspaper.