PPACA Links: 2013-07-24

Readers, this should have been Monday, but with painting and other things to do, my schedule has gotten a little out of control. –lambert

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09 Health Affairs, July 2013

In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

Countdown To The Health Insurance Marketplaces: Four Actions Essential To Success Health Affairs, 2013-07-08. Note that the administration has adopted a diametrically opposed campaign strategy.

We recommend four actions that policy makers should take to promote the success of the marketplaces, the structured exchanges where consumers will shop for health coverage under the ACA. Some of these actions can be implemented before the October 1 launch date, while others will need to be initiated now to bring about changes needed by 2015 and 2016.

1. The marketplaces must disallow unreasonable prices from insurers.
2. A unified national campaign should be launched to attract a broad pool of marketplace enrollees.
3. Consumers receiving advanced premium tax credits to purchase insurance should be protected from unanticipated tax liability for the first two years of operation, so that the marketplaces attract as many people as possible.
4. New non-profit consumer-run insurance plans (CO-OPs) sponsored by the ACA should have funding restored. This would enable more CO-OPs to enter the market in 2015 and 2016 to help hold down prices in the 26 states where they do not yet exist. In addition, the Office of Personnel Management (OPM), responsible for contracting with at least two “national plans” to enter each state to spur competition, should focus on developing networks of smaller plans to serve as national plans in 2015; this would avoid giving greater market share to dominant insurers. </li

43% Believe that US Health Care is Corrupt, 64% that Government is Run by a Few Big Interests, Media Shrug Health Care Renewal, 2013-07-10

More than one-third (43%) of [Transparency International] respondents thought that US health care is corrupt. …

For comparison, the proportions of people who thought the health care sector is corrupt were 24% in Canada, 28% in France, 48% in Germany, 47% in Japan, and 19% in the United Kingdom.

Friends with Benefits, Insureblog 2013-07-15. Walking around money.

[Among others:] The advertising firm Porter Novelli was founded by William D. Novelli, who was the CEO of AARP from 2001-2009. Catherine “Kiki” McLean is a senior partner and managing director of Porter Novelli. She is a Democratic Party operative who worked for the campaigns of Al Gore, John Kerry, and Hillary Clinton, as well as the 2008 presidential campaign of Barack Obama. McLean was hired by Porter Novelli in June of 2009. Since 2010, Porter Novelli has been awarded $49 million in HHS contracts.

Health Insurance Marketplace by State Commonwealth Fund

[Handy interactive map.]

Health Insurance Exchanges and State Decisions Health Affairs, 2013-07-18. Neutral evaluation of the state of play.

Although GAO and others have questioned exchanges’ ability to be fully operational in time for open enrollment, particularly given the compressed time frame in which exchanges and supporting infrastructure are being developed, HHS maintains that exchanges will be ready on time. Key milestones to be completed in the months before open enrollment include testing state and federal information technology systems, certifying plans, and training and certifying navigators and in-person assisters.

Are the Wheels Coming off the ACA Wagon? History Suggests Not Center on Health Insurance Reforms 2013-07-18

These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs. …. These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs.

Consumers In Most States Unlikely To See N.Y.’s 50 Percent Reduction In Premiums In Individual Market Kaiser Health News, 2013-07-19

New York’s announcement this week that insurance premiums would drop 50 percent next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the health law, but consumers in most states are unlikely to see similar savings.

That’s because only a handful have New York’s rules, which like the federal law bar insurers from rejecting people with health problems. Unlike the federal law, however, New York does not require consumers to purchase coverage, so over time, mainly older, sicker people, have purchased coverage. That drove up prices and discouraged younger, healthier people from buying policies, as did a requirement that insurers charge the same rates regardless of age or health status.

“ObamaCare” Small Ball––The Republicans Are Winning the Battle Over the Big Idea Health Care Policy and Marketplace Review 2013-07-21

It shouldn’t be a surprise that this administration, now buried in the minutia of injecting an extraordinary amount of micro management into a sixth of our economy, would think a $100 rebate for someone already paying thousands of dollars in health insurance premiums would be a major accomplishment.

GOP support grows to force shutdown over funding ObamaCare The Hill, 2013-07-22

Sen. Mike Lee (R-Utah) said he’s recruited more than a dozen Senate Republicans willing to shut down the government to prevent President Obama’s healthcare law from going into effect.

Lee said the Republicans would block a continuing resolution to fund the government beyond Sept. 30 if it includes funding for ObamaCare.

Lee acknowledged that certain parts of the law were popular, such as coverage for pre-existing conditions and children being able to stay on their parent’s coverage until they’re 26 but said that since these parts had already been implemented, Republicans weren’t looking to do away with them.

Majority of employers already in compliance with ACA mandate Health Reform Talk, 2013-07-22.

The majority of employers (56 percent) said that they are already in compliance with the employer mandate under the Patient Protection and Affordable Care Act (ACA), according to recent research from PricewaterhouseCoopers (PwC). … Overall, 72 percent of private companies said that they were prepared for the ACA’s next wave of requirements, but only 35 percent said that they were well prepared.

Phillip Caper, The end of Obamacare? Think again Bangor Daily News, 2013-07-22

Despite its serious flaws, Obamacare has benefits, some intended and others not. One major barrier to reform of our health care system has been apathy on the part of people who already have good health care coverage (“I’ve got mine”) or who have been lucky enough not to need health care (the young and healthy), and are therefore unaware of our system’s many problems. That’s about to change. Due to its requirement that as many people as possible have health insurance (the individual and employer mandates) the apathetic population is about to become dramatically reduced. Like it or not, many more people in the U.S. are about to become engaged in the health care system.

Q & A – Early Implementation of MAGI HealthLaw.org 2013-07-23

The Affordable Care Act (ACA) requires all states to implement the new income counting methodology, Modified Adjusted Gross Income (MAGI) , for applicable Medicaid eligibility categories beginning January 1, 2014. To help facilitate the transition to MAGI, CMS issued guidance allowing states to implement MAGI on October 1, 2013, coinciding with the beginning of open enrollment in the new health insurance marketplaces (exchanges). The following addresses questions and concerns regarding the early implementation of MAGI.

Q 1 . Why should a state implement MAGI early?

A. Early implementation of MAGI will simplify and streamline state Medicaid eligibility processes. During the open enrollment period from October 1 to December 31, 2013 , states must screen applicants for eligibility for insurance affordability programs using two different sets of rules – the state’s existing Medicaid rules to determine who is immediately eligible , and the new MAGI rules to identify those eligible January 1, 2014. By implementing MAGI early, states can use just one income counting methodology for all new applicants . Early implementation will also ease the transition by allowing states to operationalize new systems before the influx of new applicants expected when new coverage options become available in January 2014.

OFA embraces tea party blueprint for August push Politico 2013-07-23

OFA’s preparing a range of under-the-national-radar tactics in conjunction with heading for town halls. Rallies, distribution of fliers and district office demonstrations will be aimed at drawing the same sort of local attention that tea party groups managed four years ago, hoping to spook members of Congress worried about the 2014 midterms.

[T]he group has grown more quickly than even its leaders anticipated, raised millions of dollars and hired 26 state directors, but they’re still building support staff and volunteers out in the states. Even at the meeting on Monday night, a call from Planned Parenthood Action Fund President Cecile Richards to get involved in Arkansas revealed that none of the prospective action leaders in the room actually lived in the state (though one woman in the crowd shouted that she used to live there).

They’ll begin Aug. 4, marking the president’s birthday with a day of events organized to promote the benefits of Obamacare.