Showing posts with label ACA. Show all posts
Showing posts with label ACA. Show all posts

Friday, July 31, 2015

More paying ObamaCare fines as subsidies go to people who don’t exist

The IRS fined more than 7.5 million Americans who didn’t have health insurance in 2014, even as Obamacare subsidies flowed to people who didn’t even exist.
The Treasury Department reported last week the number of Americans who faced fines because of the Affordable Care Act’s individual mandate was significantly higher than the Obama administration expected. For 2014, the IRS projected that roughly 6 million would face fines, but the final total was 1.5 million higher.
It was the first year in which buying health insurance was made mandatory under the ACA, with penalties of $95 or 1 percent of total income – whichever was higher – for people who did not comply.
The average penalty collected for the 2014 tax year was about $200, the IRS reported.
“Although we have not yet completed our post-filing analysis, we are committed to conducting additional outreach to taxpayers, including letters to these specific taxpayers who did not have to report or make a payment. These letters will inform them about available exemptions and note that they may benefit from amending their return,” said IRS Commissioner John Koskinen.

Penalties will increase to $395 or 2 percent of income per person in 2015; that will jump to $695 or 2.5 percent of income in 2016.

Those penalties are supposed to force Americans to purchase health insurance — or to at least make it financially wise for them to do so.

Tuesday, July 28, 2015

Rising Cost Of Health Care: Obamacare Insurance Premiums To Increase As State Exchanges Face Losses, Even Closure

RTR4YXVZAs the cost of health insurance continues to rise, the fallout from such increases is becoming ever more evident in state-run exchanges established by the Affordable Care Act. Some states have announced insurance rate hikes for the coming year, while others have said they will shut down all or part of their exchanges as insurers contend with higher costs and lower enrollment than originally anticipated.
The Louisiana Department of Insurance said Friday that it would shutter its state health plan by the end of the year. Only 17,000 people out of Louisiana’s population of 4.6 million had enrolled in that plan, which was operating at a medical-loss ratio of 113 percent. That means for every dollar it earned in premiums, it paid $1.13 in expenses, Modern Healthcare reported. Louisiana’s federally run exchange has five other insurance companies offering plans.
In June, Hawaii, which ran its own marketplace, Hawaii Health Connector, announced it would switch to the federally run marketplace, Enrollment had been too low, at close to 40,000 consumers, and it was unable to generate sufficient revenue to sustain itself. "The viability of state health insurance exchanges has been a challenge across the country," Hawaii Gov. David Ige said at the time, when Hawaii became the third state after Nevada and Oregon to transfer its state-run health exchange to the federal one.
Of the twelve states plus Washington, D.C. that run their own health care exchanges, about half of them have financial difficulties, and several states, including Minnesota, Colorado and Vermont, are considering shuttering their marketplaces and using the federal one instead, the Associated Press hasreported.
Other states have acknowledged that in order to compensate for these costs, premiums will have to increase.
State officials announced Monday that premiums for plans sold on California’s exchange would rise by an average of four percent, slightly less than the average rate increase expected by exchanges in other states. Covered California’s executive director, Peter Lee, hailed it as a victory and as proof that the Affordable Care Act, often nicknamed Obamacare, is working, the Los Angeles Daily News reported.
"The health plans know that if they price their products too high and consumers know it's too high, because it's an apples-to-apples comparison, they will not get enrollment," Lee told The Associated Press. About 1.3 million people buy health insurance through Covered California.
But not all states are experiencing the same relative success as California. Although an analysis by the Kaiser Family Foundation in June found that in 11 major cities, the cost of a “silver” plan—one tier of coverage that consumers can pick—would increase by 4.4 percent from 2015 to 2016, costs are still subject to change, and when broken down by city, the increase in premiums varies widely. Some health insurance companies have requested to increase their premiums by as much as 40 percent in 2016, although state or federal officials must approve those increases before they can go into effect.
In Portland, Oregon, for instance, premiums were slated to rise by 16.2 percent in 2016 over the previous year. In Burlington, Vermont, the increase was 9.2 percent. In New York City, it was just .5 percent. Kaiser’s analysis noted that consumers would have to carefully research their options and possibly switch plans or even health insurance carriers in order to avoid paying significantly more in monthly health insurance premiums.

Wednesday, July 22, 2015

CALIFORNIA: Bill Gives Illegal Immigrants Access to Medi-Cal

California Democrats have ramped up their push to extend health benefits to in-staters who immigrated unlawfully.

High-stakes legislation

Sacramento Democrats have advanced a piece of legislation, authored by State Sen. Ricardo Lara, D-Bell Gardens, that would grant access to Affordable Care Act benefits to unlawful immigrants. SB4, which would open up Medi-Cal enrollment, cleared the Assembly Health Committee on a party line vote, drawing a few dozen opponents at the bill’s hearing.
According to Lara’s website, some “three to four million people in the state will remain uninsured in spite of ACA, and almost a million of those will be undocumented residents eligible for coverage, save for their legal status.”
Last month, the state Senate voted to clear the bill, also known as the Health For All Act, with Lara describing the scheme as “a transformational and decisive step forward on the path to achieving health for all,” according to MSNBC. But Gov. Jerry Brown’s office already intervened once to scale back Democrats’ ambitions.
“The initial bill, which would have allowed all undocumented immigrants to sign up via Medi-Cal, was pared down after it was estimated to cost up to $740 million a year, a price tag Brown said was unacceptable. The governor has not indicated whether or not he’ll sign off on the latest legislation.”
Nevertheless, as Politico reported, Brown did sign off on spending “millions in state dollars to provide health care to undocumented children, mirroring similar efforts in a handful of other liberal states.”
Covered California, the state-run health care exchange, has become an Obamacare keystone, although its second-year enrollment numbers have fallen short of goals. Continued tension between Gov. Brown and state Democrats on the costs of expanding coverage could pose problems for the party on a national level.  “Republicans never trusted Democrats’ repeated assurances while the law was being drafted that the Affordable Care Act wouldn’t cover undocumented immigrants,” Politico noted. “That built up to Rep. Joe Wilson’s infamous ‘You lie!’ moment, when the South Carolina Republican interrupted President Barack Obama’s 2009 health care address to Congress.”

Sunday, July 19, 2015

6.6 Million People Just Learned the Hard Way How Much It Costs to Be Uninsured Under Obamacare

The Patient Protection and Affordable Care Act, known also as Obamacare, was signed into law by President Obama in March 2010, but it didn't go into effect until Jan. 1, 2014. Despite the more than three years for insurers, states, the federal government, physicians, and consumers to prepare for the coming overhaul of our healthcare system, there were still plenty of hiccups (and challenges) when the calendar changed over.
Pretty much from the get-go of the first enrollment period there were technical issues with the online marketplace servers and software that prevented consumers from completing the enrollment process. But even bigger challenges would be fought at the legal level with the constitutionality of the individual mandate penalties coming into question in 2012, and more recently the challenge to the federal government's ability to divvy out subsidies to enrollees on behalf of 34 states. The defense proved victorious in both challenges, which made it to the Supreme Court.
America dislikes the individual mandate penalty
Yet in spite of Congress' ability to levy penalties against consumers, the individual mandate remains one of the most touchy and least-liked components of the healthcare reform law.

The individual mandate is the actionable component of Obamacare that requires individuals to purchase health insurance or face a penalty. The penalty in 2014, the first year Obamacare was fully in effect, was the greater of $95 or 1% of your modified adjusted gross income (MAGI). This year the penalty for not having insurance, which is officially known as the Individual Shared Responsibility Payment (ISRP), jumps to the greater of $325 or 2% of your MAGI. In 2016, another sizable spike to the greater of $695 or 2.5% of your MAGI. In 2017 and beyond the penalties rise on par with the level of inflation.
Why is there even an individual mandate penalty in the first place, you wonder? When Obamacare became the law of the land, one of the stipulations was that insurers could no longer pick and choose who they wanted to become members. In other words, people with preexisting conditions couldn't be turned away. This meant that through the process of adverse selection some sick and elderly consumers who are costly to insurers would be quick to enroll, while healthier young adults, which are needed to help offset the high costs of the elderly and terminally ill, would possibly shun being forced to buy insurance. The individual mandate penalty was put into place in order to encourage younger adults to enroll, otherwise they'd have to pay a penalty come tax time.
Millions of consumers just learned this the hard way
Just how many people were required to pay the penalty in 2014? According to a report released by National Taxpayer Advocate via the IRS, some 6.6 million people owed an ISRP due to not having health insurance. What may have come as a big surprise to many of those who owed was the fact that the penalty was the greater of $95 or 1% of their MAGI, not the lesser. Thus, the average penalty paid by these 6.6 million people was double the lower-bound figure, $190, since their MAGI often came into play when calculating their penalties.

Source: Pictures of Money via Flickr

In addition to the 6.6 million who owed an ISRP, an estimated 300,000 people paid the ISRP unnecessarily. Some $35 million was collected, or about $110 per person, despite these 300,000 individuals qualifying for a low-income exemption. The oddest part of this whole situation is the IRS may not be able to simply give these 300,000 people back their money because it would require an amended tax return, which would probably cost more than $110 if these individuals sought the help of a tax professional. The IRS is undecided on whether to refund these 300,000 people without the need for an amended return, but if it doesn't the $35 million in overpayments may wind up being a "gift" to the Treasury.
National Taxpayer Advocate also noted that some 10.7 million people filed Form 8965, the Health Coverage Exemptions form that allowed them to use one of roughly one-dozen exemptions, such as low income or economic hardships, to get out of having to pay the individual mandate penalty.
It's worth keeping in mind that these figures could change as they were preliminary through the end of April.
Why the individual mandate may not be working as intended
The short story here is that some 6.6 million consumers got a rude awakening of just how much it costs to be uninsured under Obamacare. But the grim reality, in my eyes at least, is that the individual mandate penalty may not wind up working as it was originally intended.

For starters, the IRS is pretty much powerless when it comes to collecting on ISRPs. When an individual doesn't report income on their taxes, the IRS has an entire arsenal of fines and legal tactics it can use to coerce someone to correct the problem. When an individual doesn't pay their ISRP, all the IRS can do is ask nicely to please do so.
Source: Flickr user Reynermedia
You see, the IRS can't garnish wages or seize property to collect on an ISRP, and it isn't likely that the IRS is going to file individual lawsuits against nonpayers and go to court for what amounts to an average of $190 per person. The IRS's only real "weapon" here is that it can withhold the ISRP from a consumer's refund.
In 2014, 91.8 million people received a refund from the IRS out of 126.1 million individual tax returns -- that's nearly three out of four people. Those are pretty good odds for the IRS to collect on ISRPs. But it's also noteworthy that there were three million fewer refunds processed for the most recent tax year despite 500,000 more total returns from the prior year. If there is no refund, there is no way for the IRS to collect the ISRP if a taxpayer doesn't voluntarily pay it. It makes you wonder if we're seeing this shift down in refunds as a result of the individual mandate penalty.
But the bigger issue as I see it is that the cost of paying the penalty, while perhaps a bit higher than some had expected in tax year 2014, is still well below the cost of purchasing health insurance for a full year. In 2015, the average silver plan price across the country was $307. In other words, health insurance for the most commonly chosen tiered plan in the country runs around $3,700 per year without any subsidies. In contrast, the average individual mandate penalty in 2014 was $190. It's a night and day difference.
Source: Flickr user Eric Snopel

Yes, there's the advantage of possibly being able to write off some of your health-premium costs on your taxes by purchasing health insurance, as well as the peace of mind of knowing you're covered in case something happens where you need to seek medical care. But on a comparative basis it's just easier for millions to bite the bullet and take the penalty in order to save thousands of dollars per year. Even in 2016 when the ISRP moves to the greater of $695 or 2.5% of your MAGI, the average payment will still likely be less than half the average cost of a silver plan around the county over the course of a year.
This raises a big question
The big question mark is what this might do to the insurance companies offering Obamacare plans. The individual mandate penalties were expected to begin shuffling the holdouts (which are primarily healthy individuals) toward enrollment by 2015 and 2016, thus helping to offset the higher costs associated with sicker enrollees in the 2013-2014 enrollment period. But with the IRS's hands tied and consumers coming to the realization that the penalties are a drop in the bucket relative to actually purchasing a health plan, I have to wonder if insurers are going to see the margin boost Wall Street has been projecting.

On the flipside, investors should keep in mind that Obamacare enrollment still represents just a small low-to-mid single-digit percentage of the pie for most insurance companies. Employee-sponsored enrollment, Medicaid, and Medicare Advantage plans can often make up a much larger percentage of insurers' total revenue. Thus, even if Obamacare struggles to court younger, healthier adults via the individual mandate penalties, insurers will probably be just fine from the perspective of profitability.

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Wednesday, July 15, 2015

Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion

Health insurance enrollment data show that the number of Americans with private health insurance coverage increased by a bit less than 2.5 million in the first half of 2014. While enrollment in individual market coverage grew by almost 6.3 million, 61 percent of that gain was offset by a reduction of nearly 3.8 million individuals with employer-sponsored coverage. During the same period, Medicaid enrollment increased by almost 6.1 million—principally as a result of Obamacare expanding eligibility to able-bodied, working-age adults. Consequently, 71 percent of the combined increase in health insurance coverage during the first half of 2014 was attributable to 25 states and the District of Columbia adopting the Obamacare Medicaid expansion.
W‌ith enrollment data now available for the second quarter ‌of 2014, it is possible to construct a complete picture of the changes in health insurance coverage that occurred during the initial implementation of the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare. The data show that in the first half of 2014, private health insurance enrollment increased by a net of 2,465,586 individuals. That net figure reflects the fact that 61 percent of the gain in individual coverage was offset by a drop in employer group coverage. During the same period, Medicaid enrollment grew by 6,072,651 individuals. Thus, while a total of 8.5 million individuals gained coverage, 71 percent of that net coverage gain was attributable to the Obamacare expansion of Medicaid to able-bodied, working-age adults.

Changes in Private Coverage Enrollment

Health insurers file quarterly reports with state regulators, and data from those reports for the second quarter of 2014 are now available.[1] The three relevant market subsets for this analysis are (1) the individual market, (2) the fully insured employer-group market, and the (3) self-insured employer-group market.[2] Table 1 shows the changes in private health insurance enrollment during the first and second quarters of 2014, along with the net changes for the combined six-month period.
Obamacare’s initial open enrollment period began on October 1, 2013, and officially ended on March 31, 2014—though in a number of states it was extended into April to give those who had experienced problems enrolling additional time to complete the process. Because enrollment was for the 2014 plan year, the coverage for those who enrolled during the fourth quarter of 2013 took effect in the new year; thus, those individuals are included in the data for the first quarter (Q1) of 2014. The data for Q2 2014 captures enrollments that occurred during the last two months of the open enrollment period, or which were otherwise delayed due to the numerous problems experienced by the exchanges, and so did not take effect until after the end of the first quarter.
The data show that enrollment in individual market coverage increased by over 2.7 million individuals in Q1 2014 and by a further 3.5 million individuals in Q2. Thus, for the first half of 2014, enrollment in individual market coverage grew by almost 6.3 million individuals.
The second-biggest coverage change that occurred during the first half of 2014 was the decline in the number of individuals with coverage through fully insured employer group plans. Enrollment in such plans dropped by 3.8 million individuals in Q1 2014, and by nearly a million more individuals in Q2 2014. Thus, for the first half of 2014, the number of individuals with coverage through a fully insured employer group plan decreased by nearly 4.8 million.
Enrollment in self-insured employer plans modestly increased in both quarters—by 347,000 in Q1 2014, and by about 652,000 in Q2—for a net enrollment gain of a little less than one million during the first half of 2014. Consequently, the combined enrollment changes in the two segments of the employer group market during the first half of 2014 produced a net decrease of almost 3.8 million in the number of Americans covered by employer-sponsored plans.
That net reduction in employer-sponsored group coverage is explained by employers discontinuing coverage for some or all of their workers or, in some cases, individuals losing access to such coverage due to employment changes. While it is not possible to determine from the data the subsequent coverage status of individuals who lost group coverage, there are only four possibilities: (1) some obtained replacement individual-market coverage (either on or off the exchanges); (2) some enrolled in Medicaid; (3) some enrolled in other coverage for which they are eligible (such as a plan offered by their new employer, a spouse’s plan, a parent’s policy, or Medicare); and (4) some became uninsured.
If individuals lost group coverage, but obtained new coverage under either another employer group plan or one in the individual market, they would then be counted in the enrollment figures for those submarkets. Similarly, if individuals transitioned to Medicaid, they would be counted in the Medicaid enrollment figures reported by the Centers for Medicare and Medicaid Services (CMS).

Sunday, July 5, 2015

Yay Obamacare! Health Insurance Companies Seeking Big Increases, 20 To 40% (Or More) In 2016

But we’ll be saving $2500 on premiums, right?
Screen Shot 2015-07-05 at 5.26.58 PM
Washington- Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.
Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.
The Oregon insurance commissioner, Laura N. Cali, has just approved 2016 rate increases for companies that cover more than 220,000 people. Moda Health Plan, which has the largest enrollment in the state, received a 25 percent increase, and the second-largest plan, LifeWise, received a 33 percent increase.Washington- Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

Monday, June 29, 2015

[VIDEO] Obama Goes Grey in Last Week Tonight‘s ‘End of Obamacare’ Montage

To commemorate the Supreme Court of the United States’ Obamacare decision last Thursday, Last Week Tonight put together a nearly two-minute collection of clips featuring people predicting Obamacare’s end. Titled “Five Years of People Prematurely Declaring the End of Obamacare,” the short montage does two things rather wonderfully:
  1. It sums up all of the negative reactions to the Affordable Care Act since its signing into law in 2010.
  2. It demonstrates just how much grayer President Obama‘s hair has become in the past five years.
To top it off, the president’s official address of the SCOTUS decision isn’t actually the final clip. That distinction belongs to MSNBC, whose guest is asked, “Is the fight against Obamacare from Republicans over now?” His answer? “My short answer would be no.”

Sunday, June 28, 2015

John Roberts has the black robes, and the interpretive gifts, too.

In the matter of the so-called Affordable Care Act, the Supreme Court ruled that the law must not say what it in fact does say because it would be better if it were not to say what it says and were to say something else instead. In the matter of same-sex marriage, the Supreme Court rules that the law must say what it does not say because it would be better if it were to say what it does not say instead of what it says. Which is to say, the Supreme Court has firmly established that it does not matter what the law says or does not say — what matters is what they want. 

That texts may be imaginatively interpreted to any end is not news — “The devil can cite Scripture for his purpose,” as William Shakespeare observed in The Merchant of Venice. The legendary constitutional scholar Barack Obama failed to notice, until the day before yesterday, that the Constitution mandates the legalization of homosexual marriage from sea to shining sea, but, to be fair, that is an easy provision to overlook, even for a mind as keen as Barack Obama’s, since the Constitution does not say one word about marriage, much less about the state-level codification of homosexual couplings being a fundamental federal right.

Jiggery-pokery” is putting it generously. 

But scriptural interpretation is a funny business. I grew up on the edges of some wildly entertaining fundamentalist circles in West Texas, and I very much enjoyed hearing mail-order theologians explain how, sometime between turning water into wine at that famous wedding and pouring out a round for the guys at the Last Supper, Jesus very subtly declared alcohol verboten. Put any given text on the rack, and you can prove Ronald Coase’s dictum: If you torture the evidence enough, it will confess to anything. 

Constitutional torture is an art, and Chief Justice John Roberts has emerged as its Andy Warhol: an impresario who will put his name on anything. It is uncomfortable to think about, but our Supreme Court functions in much the same way as Iran’s Guardian Council: It is a supralegislative body of purported scholars, distinguished by ceremonial black robes, that imaginatively applies ancient doctrines “conscious of the present needs and the issues of the day,” as the ayatollahs over there and over here both put it, deciding — discovering! — what is mandatory and what is forbidden as the shifting currents of politics dictate. The main difference is that the Iranians take their sharia rather more seriously than we take our constitutional law: John Roberts’s opinion in Burwell wasn’t just wrong — wrong can be forgiven — it was embarrassing, craven, and intellectually indefensible. Antonin Scalia was right to let him have it with both barrels, but he’d do better to resign from the Supreme Court — it is difficult to see how an honorable man could be associated with it.


 weighed in on Thursday’s divisive Supreme Court ruling, which upheld a key element of the Affordable Care Act (Obamacare) by essentially rewriting the textof the legislation in order to save it, dubbing it a “loss for the Constitution.”

“Today’s Supreme Court decision is a loss for the Constitution and amounts to an egregious expansion of executive power,” Rep. Issa wrote in a statement he published to his website.
Issa also took to Twitter to express his disdain:
His fellow Republicans, 
Rep. Steve Knight (R-CA)
Rep. Duncan Hunter (R-CA)
, remained mum on the ruling.

Issa continued by stating that the wording of the Affordable Care Act “Could not have been more clear or limiting in its scope, applying only to exchanges established by the states.” He continued that the decision essentially hands “President Obama a $4 trillion check to spend as he sees fit, contrary to Congress’ and the states’ clearly expressed wishes.”
Furthermore, “It flies in the face of one of the principles most fundamental to the American form of government: the separation of powers that gives Congress – not the executive branch, and certainly not agenda-driven agencies like the IRS – the sole ability to write laws.”
San Diego’s Democratic House member 
Rep. Susan Davis (D-CA)
 had more decorated words to provide in light of Obamacare’s survival:

Via: Breitbart

Continue Reading.... 

Friday, June 26, 2015

SCOTUS Obamacare Ruling Is an Attack on the Rule of Law

The United States Supreme Court today announced its decision on the landmark Affordable Care Act case, King v. Burwell, which analyzed whether federal premium subsidies issued to residents in states without a state-established exchange are allowable.
The Court ruled that subsidies provided through are indeed lawful, meaning that the federal exchange, which was hastily built after most states refused to build their own exchange, can continue issuing subsidies. This was not how the Affordable Care Act was written.
This disastrous decision is a terrible attack on the rule of law because it sends the message that the rule of law does not matter; whoever has the most power, the strongest attorneys and the biggest voice wins. Without the rule of law, it becomes the rule of power—all up to interpretation. Claims of intent and outside interpretations of intent will now rule, not the actual words written in the law. When we start allowing the loose interpretation of law based on after-the-fact claims of intent, the foundation of the rule of law crumbles.
Citizens’ Council for Health Freedom has been educating Americans for five years about the dangers of Obamacare, which is expensive, intrusive, compromises care and ties the hands of doctors.
Sadly, the Court did not rule on what is actually written in the law. And sadder still, the ruling means that citizens in 37 states, including the 6.5 million Americans receiving Obamacare subsidies, didn’t regain their health freedom today. They will remain trapped in a government health care system of mandates and penalties that does not work, doesn’t look out for their best interests, makes health care unaffordable, and puts their private medical data at risk.
This was an opportunity to save America from Obamacare—to protect their freedoms from government mandates, taxes and penalties, fewer jobs, work hours that have been cut to the bone, and lower wages. But that chance was squandered.
Twila Brase is president and co-founder of Citizens’ Council for Health Freedom (CCHF,, a Minnesota-based national organization dedicated to preserving patient-centered health care and protecting patient and privacy rights. Celebrating its 20th year, CCHF exists to protect health care choices and patient privacy. Brase, a registered nurse, has been called one of the “100 Most Powerful People in Health Care” and one of “Minnesota’s 100 Most Influential Health Care Leaders.”

The Supreme Court Obamacare RX Leaves Doctors and Patients Confused

WASHINGTON, DC - JUNE 25:  People celebrate in front of the US Supreme Court after ruling was announced on the Affordable Care Act. June 25, 2015 in Washington, DC. The high court ruled that the Affordable Care Act may provide nationwide tax subsidies to help poor and middle-class people buy health insurance.  (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC – JUNE 25: People celebrate in front of the US Supreme Court after ruling was announced on the Affordable Care Act. June 25, 2015 in Washington, DC. The high court ruled that the Affordable Care Act may provide nationwide tax subsidies to help poor and middle-class people buy health insurance. (Photo by Mark Wilson/Getty Images)
The Supreme Court just ruled in favor by a 6-3 margin to uphold the Obamacare authorization of federal tax credits for eligible Americans in the 34 states with federal exchanges.
How did this all begin? The case, King v. Burwell, debated whether or the not the Obama Administration ignored aspects of the law regarding provided taxpayer-funded subsidies to Obamacare purchasers in all 50 states, when the law stated this could only happen in the few states that had set up their own exchange. It’s all quite technical, but the main point is upholding Obamacare further confuses doctors and patients, and we’re left with many other issues that haven’t been firmly addressed.
I advocate for my patients every day and I see their frustration and confusion when it comes to their actual coverage under Obamacare as well as the higher deductible. As a specialist in the field of prostate cancer, I observe three major issues with Obamacare.
  1. Narrow Networks: What many patients are unaware of (often until the last minute, or a serious need has arisen) is the massive limitation to the number of doctors, specifically specialists, they are “covered” under. Arguably, patients may find they have no access to the most experienced doctors and surgeons in their respective fields. If you’re someone diagnosed with Prostate Cancer or any cancer, you want the best care and to be in the best hands. Imagine if your insurance limits you from seeing the expert? Obamacare has put into effect extremely narrow networks of doctors, patients have access too, which leads to the question: Is this denying the freedom the patient’s right to choose their own doctor or specialist? The reality is, not every doctor or specialist is going to take every insurance under the sun. With these limitations, Obamacare diminishes the value of experts across many fields.
  2. Satisfaction Survey Scores Puts Pressure on Doctors: One of the major issues with regards to Obamacare mandates is the pressure put on hospitals from Medicare, specifically for patient satisfaction surveys. Now, it’s important for me to note that I appreciate all the feedback, good or bad, that my patients give me. It’s not specifically about the direct feedback; it’s about the penalties and variables that affect the patient’s actual survey answers, and the timing of when they’re presented with these surveys. Imagine, you’ve just had surgery, you’re in pain and you ask your surgeon for pain medications. Based on your surgeon’s experience and judgment, he or she believes it’s not the best medication for you at that moment in the process. As the patient, you feel frustrated—and then you’re handed a survey? You haven’t even fully recovered and in that moment you’re expected to judge all the healthcare professionals you’ve worked with. The art of medicine is compromised. I always say, the PSA blood test for Prostate Cancer screening is only as good as the doctor evaluating it. Doctors need to be able to work one-on-one with their patients, without the added pressure of survey scores and ratings that have little insight into the entire patient experience.
  3. Quality of Care Rating: The fact is you cannot put a number on quality of care. There are far too many factors and variables that affect one patient’s experience and the quality of care they received from another. The 1-5 star rating mandate from Medicare based on patient satisfaction scores—which stemmed from Obamacare—in April is a cause for concern because hospitals are massive entities. How is it possible to slap a one-digit number on the front door of a hospital, which sums up the rating for the work of thousands of healthcare professionals, along with millions of varied patient cases? It’s simple, we can’t.
Dr. Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel and the chief medical correspondent for AM970 in New York City.

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