How Obamacare Rations Care for the Sick

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When the health reform debate began more than a dozen years ago, most public health advocates touted the need for universal coverage. By the time Congress passed the Affordable Care Act (ACA), however, it had become predicated on also making care accessible for people with pre-existing conditions. 

Obamacare allowed people with chronic illnesses to buy health coverage at rates no higher than their healthy neighbors. This feature has always been popular. Americans feel sympathy for those who were penalized for conditions like high blood pressure, high cholesterol and heart disease. Less healthy individuals often paid higher premiums to compensate for their higher risk. Prior to the ACA pre-existing conditions could increase premiums as much as 50% or even 100% of healthy individuals’ premiums. Looking back this seems rather cheap compared to the cost of Obamacare today. Prior to Obamacare most state insurance markets required guaranteed renewability. Thus, consumers not covered by employer plans had an incentive to maintain continuous coverage to avoid higher premiums if they dropped coverage and later tried to enroll. Furthermore, the problem of pre-existing conditions was exaggerated by Obamacare supporters. Wharton School economist Mark Pauly estimated only about 1% of the population was unable to get health coverage due to a pre-existing condition before the ACA. 

The ACA did not work as intended. Once health plans were required to accept unhealthy individuals at rates unadjusted for risk, premiums for everyone had to increase. As premiums rose, healthier individuals looked for ways to drop out or reduce their coverage. Unhealthy individuals sometimes tried to game the system, joining when expensive care was needed and dropping soon afterwards. This caused a further increase in premiums. Over time the Affordable Care Act became decidedly unaffordable.

When the ACA became law most Americans naively assumed Obamacare would be similar to employee health plans or the individual policies many Americans had before the ACA. That wasn’t the case. The typical Obamacare plan today bears a closer resemblance to Medicaid managed care plans, but with high cost-sharing. Many of the plans are managed by the same firms who specialize in Medicaid managed care.  Why? Because managed care plans find subtle ways to reduce costs and ration care. This is a competitive advantage among plans not allowed to adjust premiums for risk. The only alternative is rationing care.

Over time average Obamacare deductibles rose as healthy individuals defected to cheaper plans with less coverage. In addition, Obamacare networks also began to restrict enrollees’ choice of doctors and hospitals. For example, one study found nearly three-quarters of insurers (72%) feature narrow networks in the plans offered through the federally managed exchanges (HealthCare.gov). This is in stark contrast to 5% to 7% of employer plans that limit worker choices to a narrow network of physicians and hospitals. A report by health consulting firm Avalere found Obamacare plans typically contract with one-third fewer doctors and hospitals, on average than commercial plans. This equates to 42 percent fewer heart specialists and cancer doctors, one-third fewer mental health and primary care providers and one-quarter fewer hospitals. 

More restrictive networks is one of the ways Obamacare holds costs down. Keep in mind networks also become narrow when doctors refuse to affiliate with Obamacare plans due to low fees. Not only do some insurers reject providers who charge higher fees, at the same time, providers may want to avoid patients whose plans have deductibles that run into the thousands. Cost-sharing under the deductible often goes uncollected when money is tight

One noticeable result is that top hospitals are out of reach for many Obamacare enrollees. For example, the flagship Mayo Clinic is inaccessible to many Obamacare plan enrollees in Minnesota. Many exchange plans also do not include top cancer centers in their networks. The University of Texas MD Anderson Cancer Center is not on any exchange plans in Texas. Memorial Sloan Kettering Cancer Center is not in any of the typical gold, silver, or bronze individual plans on the New York exchange.  

If the ACA marketplace was designed to meet consumer needs like other markets, instead of rationing care for sick enrollees Obamacare would compete to meet their needs. Medicare Advantage plans are an example of a system where expensive enrollees are not shunned because the federal government compensates plans for seniors’ health status.  By contrast, Obamacare subsidizes premiums for low-income Americans but allows no risk adjustment at the individual level. Economist John Cochrane has shown how market-based risk adjustment without government involvement can work. Now we need to design a better system. 

https://townhall.com/columnists/devonherrick/2020/02/03/how-obamacare-rations-care-for-the-sick-n2560606

Garbage In, Garbage Out: Bad Data Led to an Obamacare Disaster

Medicaid was created to be a safety net for the truly needy such as seniors, people with disabilities, and low-income children. Most of us agree: It is important to protect this program for the people who need it most.

Unfortunately, many politicians have lost sight of Medicaid’s intended purpose. In doing so, they took limited resources meant for truly needy individuals and moved millions of able-bodied adults—the majority of whom do not work at all—to the front of the line instead. Meanwhile, hundreds of thousands of people with developmental disabilities and other conditions remain trapped on waiting lists, hoping to someday get access to desperately needed services.

This is happening because of ObamaCare’s Medicaid expansion. Under ObamaCare, lawmakers have the option to expand welfare to able-bodied adults in their states. Far too many states made the tragic decision to expand their Medicaid programs, causing enrollment surges. These enrollment surges far surpassed projections—resulting in far more newly eligible welfare enrollees than policymakers promised taxpayers in their states. Sadly—as is often the case with massive, ill-advised expansions of government—it is the taxpayers who are left footing the (enormous) bill.

When it comes to ObamaCare expansion, policymakers, as well as taxpayers, deserve to know why these over-enrollments keep happening. A new report from the Foundation for Government Accountability (FGA) answers that exact question.

According to the report, the main reason states so badly underestimated enrollment is their reliance on Census Bureau data to make estimations. This data does not work for projecting expansion enrollment for multiple reasons.

First, the Census Bureau defines ‘households’ differently than the Medicaid program. For example, for an able-bodied adult who lives at home with his parents and does not work, Census data counts his parents’ income to determine his poverty status. The result is that Census data would indicate that he is not eligible for expansion. But after ObamaCare expansion, his state might learn the hard way that he is eligible because Medicaid eligibility is based on his personal income only. Oops. The enrollment overruns begin.

The Census Bureau also defines ‘income’ differently than Medicaid does. The Census, for example, considers cash welfare as income. Medicaid, however, excludes cash welfare from income calculations, resulting in more people appearing to have lower incomes and thereby qualifying for Medicaid. Oops again.

Finally, there are differences in how the Census Bureau and Medicaid define poverty because the Census Bureau evaluates more data points that could result in a person no longer being under the threshold required to receive Medicaid benefits under expansion.

But ultimately, perhaps most alarming, are differences in data collection. While Medicaid eligibility is determined by tax filing data—cold, hard facts—Census Bureau data is based on income information that is self-reported in a survey. You read that correctly: Critical decisions about whether or not to expand Medicaid to hundreds of thousands of people are routinely being made based on polling data.

The result of the use of this bad data is a massive undercounting of the number of people who could become eligible for Medicaid under an expansion plan. Altogether, the number of adults made eligible for Medicaid expansion could be more than 72 percent higher than census data suggests. The resulting over-enrollment busts state budgets and consume limited resources.

Medicaid expansion is shattering projections and creating a welfare trap for more than 12 million able-bodied adults. Regrettably, taxpayers and the truly needy will continue to pay the price. The takeaway for states that have rightly rejected expansion is simple: don’t trust the numbers. If your state is looking at expansion enrollment estimates, they are relying on Census data—and they’re preparing to replicate this nightmare

https://townhall.com/columnists/nickstehle/2020/01/29/garbage-in-garbage-out-bad-data-led-to-an-obamacare-disaster-n2560289

Tlaib: Dems Have Discussed Arresting White House Officials Who Refuse to Comply With Subpoenas, Claim Debunked!

Freshman Congresswoman Rashida Tlaib (D-MN) told the Deadline Detroit that House Democrats have talked about arresting and detaining members of President Donald Trump’s administration who fail to comply with congressional subpoenas. While this is something Democrats are contemplating, Tlaib said this is “uncharted territory.”

“If they were to detain someone, where would they go and have them detained so that they can comply with the subpoenas?” Tlaib said. https://townhall.com/tipsheet/bethbaumann/2019/10/13/tlaib-dems-have-discussed-arresting-white-house-officials-who-refuse-to-comply-w-n2554645

1. Times The Obama Administration Fought Subpoenas or Blocked Officials from Testifying Before Congress

Eric Holder refuses to provide subpoenaed Fast & Furious documents

The investigation of the botched Fast & Furious investigation is perhaps the most significant example of the Obama administration using executive privilege to justify their refusal to cooperate with an investigation. Holder refused to provide subpoenaed documents to the House Oversight and Reform Committee. The blatant attempts by the administration to resist cooperating with the investigation ultimately led to a historic vote to hold Attorney General Holder in criminal contempt.

2. Lois Lerner refuses to testify on IRS targeting

Lois Lerner, the director of the Exempt Organizations Unit of the IRS when they were inappropriately targeting conservative and tea party groups, appeared before Congress in May 2013. She gave a statement but refused to answer questions by pleading the Fifth Amendment. Republicans called her back in March 2014, when she pulled the same stunt. At the time, Rep. Elijah Cummings blasted Republicans for wanting to question Lerner. Today, Cummings is the House Oversight and Reform Chairman and has a much different attitude about Congress’s role of oversight when it comes to Trump.

3. Ben Rhodes not allowed to testify on Iran Nuclear Deal

The Iran Nuclear Deal was so bad Obama didn’t even try to get Senate ratification for it, and much of the negotiations were done without Congress being informed. When Congressional Republicans wanted to get answers after Ben Rhodes (the failed novelist turned Obama speechwriter turned top foreign policy adviser to Obama) let it spill to the New York Times that the administration relied on a false narrative to sell the Iran deal to the public, the White House wouldn’t let him testify, using the “separation of powers” excuse. “Specifically, the appearance of a senior presidential adviser before Congress threatens the independence and autonomy of the president, as well as his ability to receive candid advice and counsel in the discharge of his constitutional duties,” explained White House counsel Neil Eggleston. This was after the White House previously claimed they wouldn’t hide behind executive privilege.

4. Treasury officials blocked from testifying on Obamacare subsidies

When Obama started making all sorts of unilateral (and illegal) changes to Obamacare, Republicans were none too happy about the abuse of power. When Obama’s IRS decided to expand Obamacare subsidies to be used in federal exchanges in addition to state exchanges, the Obama administration refused to allow Treasury Department officials to testify on the rule changing process, using the excuse that the issue was soon to be decided in the Supreme Court.

5. White House refuses to allow political director to testify

In 2014, Democratic operatives were concerned that the Obama White House wasn’t doing enough to help in the forthcoming midterms. In response to these concerns, Obama launched the White House Office of Political Strategy and Outreach. This raised eyebrows for some, who were concerned that Obama and his minions were using White House resources for political activity. So, the House Oversight and Government Reform Committee began investigating in order to make sure the White House was complying with civil services laws designed to prevent executive branch employees from engaging in political activity. David Simas, the director of the Office of Political Strategy and Outreach was subpoenaed, but the White House refused to allow him to testify before Congress. In a letter to Congress,  White House Counsel Neil Eggleston claimed Simas was “immune from congressional compulsion to testify on matters relating to his official duties” and thus would not appear before the committee.

Justice Kagan’s Obamacare conflict on interest

Prior to being nominated as a justice for the  Supreme Court, Elena Kagan served as solicitor general for the Obama administration, during which time she was heavily involved in crafting a legal defense for Obamacare. This conflict of interest was important, since issues revolving around Obamacare would be going before the Supreme Court. Federal law dictates that Supreme Court justices must recuse themselves when their impartiality “might reasonably be questioned.”

Naturally, the Obama administration didn’t want Kagan to recuse herself from any Obamacare-related cases. So, when the House Judiciary Committee requested documents and interviews to get a clear understanding of her role relating to Obamacare while she was solicitor general, the Obama/Holder Justice Department refused to comply. When Eric Holder testified before the committee he claimed to have no knowledge of the request.

7. Refusal to provide subpoenaed Solyndra documents

Remember the Solyndra scandal? The Obama administration wasn’t exactly interested in letting Congress exercise their oversight responsibilities when they investigated how the Obama administration could have given them a huge loan when they were going bankrupt. When House Republicans subpoenaed documents for their investigation, the Obama White House fired back claiming their request would put an “unreasonable burden on the president’s ability to meet his constitutional duties.” House Republicans accused the Obama White House of hiding information, and they responded with accusations of a partisan investigation.

8. Refusing to let the White House social secretary testify on party crashers scandal

In 2009, two party crashers successfully got by the Secret Service during a state dinner, succeeding in meeting and shaking hands with Barack Obama. Congress investigated the breach in security, but when White House Social Secretary Desirée Rogers was asked to testify before Congress, the White House refused to let her testify. Obama’s press secretary explained during a press briefing that  “…based on separation of powers, staff here don’t go to testify in front of Congress.” That explanation was questioned by legal scholars. “I’d completely fall out of my chair if they invoked Executive privilege with regards to a social secretary arranging a party,” explained Mark J. Rozell, a public-policy professor at George Mason and expert on executive privilege. For what was arguably a very nonpartisan investigation (and led by Democrats) it certainly makes you wonder what the Obama White House was hiding.

9. Fighting subpoenas in the New Black Panther Party voter intimidation investigation

When the Obama administration inexplicably dropped a voter intimidation case against the New Black Panther Party (NBPP) in Philadelphia, many questions were asked as to why. The NBPP had dressed in paramilitary uniforms outside of polling places in Philadelphia on Election Day 2008, and the case against them, which was started by the Bush administration, and the Obama administration won the case by default when the NBPP didn’t show up in court to defend themselves, but the DOJ decided to dismiss the charges. Former Justice Department attorney (and current PJ Media contributor J. Christian Adams) quit his position in the Justice Department to protest the Obama administration’s handling of the case and confirmed the racial motivation behind the decision to drop the case against them.

Of course, an investigation was launched, which the Obama administration fought rigorously. The investigation was stonewalled, subpoenas were fought, and key players were instructed not to testify. https://pjmedia.com/trending/9-times-the-obama-administration-fought-subpoenas-or-blocked-officials-from-testifying-before-congress/