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Personal Update

Just thought you’d like to know, I got a job. I start next week. Commence the Snoopy Dance.

If I’ve done my calculations correctly, this move to Pgh was the right one from an economic standpoint. Maybe it’s too early to call it a success, since I haven’t started working yet, but I think I will like this job very much.

So, I’d like to roll the credits for those people who helped me stick it out since disaster struck in 2011, including all of you faithful Conflucians. You really get to know who your friends are and what kind of character they have when something like this happens to you. All of these people showed the highest quality:












Randy Scott

Pat and Frannie

Sister Beth

All my Aunts, Uncles and Cousins

Tikva and Dave



and last but absolutely not least and most importantly,


Thank you all. I’m going to spend the rest of the week working on my house and finding work appropriate clothes. I know they’re in a box here somewhere…

PPACA Links: 2013-07-17

Readers: Here’s the latest in a series of posts that 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! I’m afraid I’ve only been able to contribute this on a nominal Tuesday, since I had a very late night on Monday. –lambert

Health Reform Rule Change Will Not Stop Important Verification Judy Solomon, Off The Charts 2013-07-08

In the last several days, some media coverage has seriously misinterpreted changes to how health reform’s new health insurance marketplaces (formerly called exchanges) will verify that applicants are eligible for federal health insurance subsidies.  The changes to verification procedures, which the Department of Health and Human Services (HHS) announced in a new rule on Friday, are really rather modest.  All marketplaces — both state- and federally run — will still conduct important checks of applicants’ income and require applicants to provide information on any coverage that employers offer.

The changes announced Friday apply only to the 16 states (plus the District of Columbia) that will operate their own marketplaces, and the changes — which are optional for these states — are designed to make the process easier for the states to administer as they get their marketplaces up and running.  The changes do not affect the remaining 34 states that will rely on the federally facilitated marketplace to determine eligibility for the health insurance subsidies, which will come in the form of premium tax credits.

Moreover, a rigorous income verification process remains in place in all states, including those that will operate their own marketplaces.  All marketplaces must first check the income level that an individual reports on his or her application against a federal database that contains data on the applicant’s federal income tax returns, as well as information on his or her Social Security benefits if any.

White House scrambles to get ready for ObamaCare implementation The Hill, 2013-07-09

Earlier rules had called for each state’s exchange to independently verify information submitted by people seeking insurance, including their annual income and whether they were able to buy healthcare coverage through their employer. But the Heath and Human Services Department said in new regulations Friday [July 5] that exchanges could accept the information submitted by most applicants and double-check only a limited sample. [George Washington University professor Sara] Rosenbaum said, the exchanges are now relying solely on applicants to determine not only whether they’re eligible for employer-based coverage, but whether that coverage meets the healthcare law’s definition of affordability. “That is nothing that any mere mortal would ever know,” she said.

Lambert here: The forms are filled out under penalty of perjury. And excess subsidies can be clawed back. Surely this new rule is an accident waiting to happen?

People Who Haven’t Filed a Tax Return to Get Unverified Health Insurance Exchange Subsidies Health Care Policy and Marketplace Review, 2013-07-10

The head of the Centers for Medicare and Medicaid, Marilyn Tavenner, is out with a “Myths vs. Fact” clarification memo regarding the waiver of the employer mandate and whether the new health insurance exchanges will verify people’s incomes when calculating subsidies. What everybody is trying to figure out is why the administration has suddenly said they aren’t going to check the vast majority of applicants where the information doesn’t match and the applicant can’t explain it? … Tavenner said in her “Myth vs. Fact” memo that “there have been some mischaracterizations of these regulations,” and “she suggested we needed to do a reality check on some of the myths that have been circulating.” … I will suggest the most important thing the administration could do toward making people understand what’s going on here is to tell us exactly why they aren’t going to make an attempt to verify every applicant’s representation that doesn’t make sense. … And, since they are putting so much faith in the IRS correcting any subsidy problems later when people file their tax returns, they can also tell us what they are going to do about giving people benefits that don’t have a history of filing tax returns.

Obama, Congress shifting billions from public health initiatives to other programs Saint Louis Beacon, 2013-07-11

Unprecedented spending to prevent illness and improve public health is one key promise of the Affordable Care Act. That’s why $18 billion had been set aside for a newly created Prevention and Public Health Fund under Title IV of the law. Its goals include relying on innovative public health policies to address problems such as obesity and tobacco use. The first chunk of money taken from the fund for non-prevention purposes occurred late last year when the Obama administration and Congress agreed to use $6.2 billion from the fund for other purposes over a nine-year period. The reduction was used to offset pending cuts in Medicare payments to physicians. This year, HHS is taking another $500 million from the fund, partly to underwrite insurance exchange activities. Developments like these are raising concerns that most of this money might never get used for its intended focus on public health issues.

Final navigator rule has few concessions for brokers, agents Modern Healthcare, 2013-07-12

Navigators hired to help Americans sign up for expanded coverage under the healthcare reform law must receive at least 30 hours of training, according to a final rule on the navigator program (PDF) issued by the CMS Friday. … “We believe that up to 30 hours of training, as stated in the proposed rule, is sufficient for navigators and non-navigator assistance personnel in federally facilitated exchanges and state partnership exchanges to perform their duties and is in keeping with the number of hours of training many states require for individuals seeking licensure as an agent or broker,” the rule states. … The final rule also makes clear who cannot become navigators, assistance personnel, or counselors. “In all exchange models, entities ineligible to become navigators include health insurance issuers and their subsidiaries, issuers of stop loss insurance and their subsidiaries, associations that include members of or that lobby on behalf of the insurance industry, and entities that receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP insurance product.”

But associations such as chambers of commerce are permitted to have a non-navigator assistance program.

Agents and brokers are permitted to continue to help people individuals enroll individuals and groups with health coverage, including through an exchange, but will be compensated by insurance companies, as allowed by state laws, just as they always have.

Obamacare Delay? What Obamacare Delay? National Journal, 2013-07-12

States and health plans have begun testing some data exchange with the federal hub. But states have been testing “clean” data, meaning that every name is spelled perfectly and every Social Security number is entered correctly. Ultimately, the data hub will need to identify people and their information even with typos and errors. Still, while the public deadline is Oct. 1, HHS and its contractors will realistically have a little extra time to fix IT problems. The insurance plans won’t go live until January, leaving a cushion if parts of the system have to default to paper, or if delays arise in processing applications. Cheryl Smith, a senior practitioner at Deloitte, worked on the Utah small-business health exchange, which launched in 2009. Before the open-enrollment deadline, “I had holes in my stomach,” she says. “We got to that day and I realized, this is not really the launch.” As long as the website goes live in October and people have new insurance plans in January, the administration will have kept its key promises.

Obamacare’s missing mandate Politico, 2013-07-13

The massive coast-to-coast campaign to get people to sign up for Obamacare is light on mentions of one central element: the widely disliked individual mandate. Poll after poll has found that Americans don’t like being told they have to get insurance or face a penalty. So the groups doing outreach don’t plan to draw much attention to it. …. Kevin Counihan, CEO of the Connecticut exchange, known as Access Health CT, has plenty of experience in this area. When he was the chief marketing officer for the Massachusetts exchange, he learned it was OK – imperative, even – to talk about the mandate. “Speaking about a mandate, speaking about a law, gets attention,” he said. Yet the Connecticut exchange’s two-stage advertising push isn’t highlighting the mandate. The first wave, started a few weeks ago, is meant to inform people about new insurance options and federal subsidies. The second stage, coming in September, will highlight stories of real people.

Analysis: Obamacare struggles to meet make-or-break deadline Reuters, 2013-07-14

The White House, and federal agencies including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), must ensure that working marketplaces open for enrollment in all 50 states in less than 80 days, and are responding to mounting pressure by concentrating on three essential areas that will determine whether the most critical phase of Obamacare succeeds or fails. “The administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University professor Timothy Jost, a healthcare reform expert and advocate, told an oversight panel in the U.S. House of Representatives last week. Current and former administration officials, independent experts and business representatives say the three priorities are the creation of an online portal that will make it easy for consumers to compare insurance plans and enroll in coverage; the capacity to effectively process and deliver government subsidies that help consumers pay for the insurance; and retention of the law’s individual mandate, which requires nearly all Americans to have health insurance when Obama’s healthcare reform law comes into full force in 2014. Measures deemed less essential, such as making larger employers provide health insurance to their full-time workers next year or face fines, and requiring exchanges to verify the health insurance and income status of applicants, have already been postponed or scaled back.

“And What If We Don’t Distribute the Exchange Availability Notice?” ACA Review, 2013-07-15

We have been putting off answering this question for two reasons: (1) although employer distribution of these notices is central to the Administration’s plan for marketing the Exchanges, the ACA appears to impose no penalty for employer refusal; (2) we would like to see the Labor Department’s proposed rules to evaluate any contention that there is an applicable penalty. Such rules have been repeatedly promised but never issued, and the deadline for distributing the notice is October 1, 2013. Employers need guidance. Here’s our best guess, as of July 15, 2013. Given the money and effort about to be expended to advertise the availability of subsidized insurance through the Exchanges, most employers should assume that most employees will receive that information, regardless of employer § 218B compliance. Would you like employees to have accurate information from you, or would you prefer them to act based on unknown information obtained from an organization with adverse interests? Making this choice early, some employers already are arranging for their staffing companies, brokers and TPA’s to serve as Exchange guides for employees who choose that alternative. If you make the same choice, you’ll want to take each opportunity to be, and to appear to be, your employees’ trusted source of ACA information.

HHS: ObamaCare rollout ‘on schedule’ The Hill, 2013-07-15

The Health and Human Services (HHS) Department says the implementation of ObamaCare is “on schedule” despite a recent decision to delay the employer mandate. The Health and Human Services (HHS) Department says the implementation of ObamaCare is “on schedule” despite a recent decision to delay the employer mandate. Federal health officials released a Web video Monday titled “HHS is on schedule.” … “In less than six months, historic changes will go into effect, ensuring that all Americans have access to affordable, quality health coverage,” Monday’s video states.

Lambert here: The administration should really stop lying about “all Americans.” The first year of ObamaCare will cover 7 million, tops, and even when ObamaCare’s rollout is complete, approximately 30 million will still not be covered. And that’s before we get to what “affordable” and “quality” mean.

Obama’s Employer Health Care Delay May Goose Exchange Enrollment Bloomberg, 2013-07-15

Former Democratic Party Chairman Howard Dean said increased enrollment in the exchanges will be “an unintended effect” of the employer-coverage delay. “What this means is that if you don’t have insurance, the exchange is your default position, not the employer,” Dean, who is a medical doctor and served as Vermont’s governor from 1991 to 2003, said in a phone interview. “This will drive more people into the exchanges, and that’s good.”

Here Comes The Sunshine Act — And It’s Alright HuffPo, 2013-07-16

The Affordable Care Act (ACA), also known as Obamacare, is one of the most controversial pieces of legislation enacted in the last decade. One reason is certainly going to be evident in the next few weeks when, on August 1, the Physician Payment Sunshine Act (Sunshine Act) goes into effect. The Sunshine Act, created under Section 6002 of the ACA, is designed to highlight the dubious financial relationships enjoyed by many doctors with the manufacturers of medical devices and pharmaceuticals — such as rampant gifts, five-star dinners, trips, and money paid to physicians by drug and medical device companies for decades.

Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care Health Affairs, July 2013

We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use.