Only 23% of Doctors in New York Will Take ObamaCare Patients

A poll conducted by the New York State Medical Society finds:

• 44% of MDs said they are not participating in ObamaCare
• 33% say they're still not sure whether to become ObamaCare providers
• 23% of the 409 physicians queried said they're taking patients who signed up through health exchanges

"This is so poorly designed that a lot of doctors are afraid to participate," said Dr. Sam Unterricht, president of the 29,000-member organization. "There's a lot of resistance. Doctors don't know what they're going to get paid."

• 75% of doctors who are participating in the program said they "had to participate" because of existing contractual obligations 
• Only one in four "affirmatively" chose to sign up for the exchanges
• 77% - said they had not been given a fee schedule to show much they'll get paid if they sign up

The survey invited doctors to anonymously share opinions about the new health care law, and many took time out of their busy days to vent. 

Source: Carl Campanile, "Docs Resisting ObamaCare," New York Post, October 29. 2013.

Four Months Ago Government IT Personnel Bragged About How Great Healthcare.Gov Was

From Greg Scandlen at John Goodman's Health Policy Blog:

Today it is impossible to get anyone involved in the ObamaCare website to say anything. Four months ago they were bragging about how brilliant they were in an interview in The Atlantic:  

“It’s fast, built in static HTML, completely scalable and secure,” said Bryan Sivak, chief technology officer of HHS, in an interview. “It’s basically setting up a web server. That’s the beauty of it.”

“This is such a lean site,” said Jon Booth, head of the web and new media group at the Centers for Medicare and Medicaid Services (CMS), in an interview. “HHS had a blanket contract when we when awarded this. Aquilent got creative and brought people on with powerful skills, like Ed and Jessica, a designer at Teal Media, and Development Seed. Most of my team is working on this site; we have internal UX, information architects, designers, developers, and infrastructure people that stood up the cloud environment. Their collaboration is one of the high points of this process.” 

“The work that they’re doing is amazing,” said Sivak, “like how they organize their sprints and code. It’s incredible what can happen when you give a team of talented developers and managers and let them go.”

The entire article is worth reading as an example of unbridled hubris.  

ObamaCare Exempt-A-Palooza: More on the 20 Individual Mandate Exemptions from Forbes

We wrote about ObamaCare's 20 exemptions to the Individual Mandate four months ago here   Anyone possessing even a hint of vulnerability will not be fined by the federal government resulting in the CBO's projection that less than 2% of Americans will ever face this penalty I mean tax.  Political expediency would make it undesirable for the Administration to spank its supporters for not wallowing in government healthcare like pigs in slop. 

This is why I've maintained that they will delay the Individual Mandate ultimately for public relations appearances but whether they do or not really is insignificant. 

Here was my discussion of that with Armstrong and Getty on July 25th: 

Here's is a more recent account of The ObamaCare Exemption-Palooza from Forbes.  This is Mike Patton (no, not the best musician on the planet. A different Mike Patton.) 

The HealthCare.gov insurance exchange internet site. (Image credit: AFP/Getty Images via @daylife)

There are few contemporary issues which have garnered as much attention and created as much frustration as the Patient Protection and Affordable Care Act, a.k.a., Obamacare. In addition, given the recent website snafus, this frustration has risen substantially. Obamacare also ranks high on the political scale chiefly because it bears the name of our president. However, if it were to fail, it would likely leave a rather unpleasant legacy. Therefore, we can expect that President Obama will do everything possible to insure its success.

Obamacare is also a highly charged political issue. Moreover, there are individuals on both sides of the debate who seem incapable of engaging in an objective dialogue. Rather, when confronted with the facts, the typical response is often nothing beyond a few “talking points” or some irrelevant debate strategy designed to deflect the original issue. It’s been said that good debate makes good TV, but it also detracts from the true issue and only serves to confuse the public. Due to an abundance of misinformation, confusion abounds. Also, constant partisan bickering has caused Americans to hold Congress in record low esteem. But I digress.

In previous articles, we have discussed Obamacare’s provisions, taxes, and a few other aspects. However, we have yet to discuss the exemptions which certain individuals may be able to claim to avoid its punitive, non-compliance penalties. In this article, we’ll examine the penalties as well as the exemptions.

Obamacare Penalties

A law without consequences is like a Chihuahua without teeth. It may bite you, but it probably won’t do much damage. Obamacare most certainly contains teeth and for those who don’t comply, and fail to obtain an exemption, penalties will be imposed. The following table contains the tax penalties or what proponents prefer to call a “shared responsibility fee.”

Beginning in 2014, absent a qualified exemption, you will be required to obtain health insurance. If you fail to comply, you will be subject to a penalty of 1.0% of your annual income or $95.00, whichever is greater. In 2015, the penalty increases to the greater of 2.0% of annual income or $325 per person. The following year it becomes the greater of 2.5% of income or $695 per person. After 2016, it will be indexed to the cost of living. It should also be noted that the maximum penalty is capped at three times the per person penalty. For example, if you earn $28,500 in 2014, 1.0% of your income would equal $285. Therefore, if you earn more than this, your maximum penalty would remain the same. All penalties will be due and payable with your annual federal income tax return. Hence, the penalty for 2014 would be due by April 15, 2015 and the IRS will be the collection agency used.

Exemption From Non-Compliance Penalties

Certain individuals will be exempt from Obamacare. According to the website, healthcare.gov, you may qualify for an exemption if:

1. You’re uninsured for less than 3 months of the year;
2. The lowest-priced coverage available to you would cost more than 8% of your household income;
3. You don’t have to file a tax return because your income is too low;
4. You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider;
5. You’re a member of a recognized health care sharing ministry;
6. You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare;
7. You’re incarcerated, and not awaiting the disposition of charges against you; and
8. You’re not lawfully present in the U.S.

It should also be noted that if your income is less than 133% of the federal poverty level, you will be relieved of this penalty. At first blush, the exemptions seem to focus on the poor, those in prison, Native Americans, and illegal immigrants. There is, however, another list of qualified exemptions.

Hardship Exemptions

This is the list I suspect holds the greatest potential for loop-hole abuse. You may qualify for a hardship exemption if:

1. You were homeless;
2. You were evicted in the past 6 months or were facing eviction or foreclosure;
3. You received a shut-off notice from a utility company;
4. You recently experienced domestic violence;
5. You recently experienced the death of a close family member;
6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property;
7. You filed for bankruptcy in the last 6 months;
8. You had medical expenses you couldn’t pay in the last 24 months;
9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member;
10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child;
11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace; and
12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.

Exemption Loopholes?

When laws are passed, clever avoidance strategies often follow. Let’s consider hardship exemption number three. A person could delay payment to their utility company, receive a shut-off notice, pay their bill before their service is disconnected, and use the shut-off notice to apply for a hardship exemption. I checked to see if this would negatively impact ones credit score. The answer depends on whether your utility company reports shut-off notices to the credit bureau. Then, I called a major utility company and was told they only report disconnect information to the credit bureau, but not shut-off notices. Therefore, as long as the customer pays their bill before the utility company disconnects their service, they could conceivably use the shut-off notice as a hardship exemption without impacting their credit score or having their service interrupted. However, if enough people did this, I could envision Congress passing a law requiring utility companies to report all shut-off notices to the credit bureau. More regulation often begets more regulation.

Let’s consider exemption number eight. You go to the doctor or hospital, incur a medical expense not covered by insurance, and fail to pay it. Of course, this would affect your credit score. But how would the federal government determine if you’re reason for nonpayment was due to  financial inability? Will they audit your cash flow for the previous two years? In short, there would have to be a massive expansion in federal government employment to properly monitor the tremendous number of rules and regulations contained in Obamacare. Remember, the population of America is over 316 million!

What To Expect

We haven’t even discussed the expansion of the Medicaid system which will certainly increase the demand for medical services. Demand will also rise as more people are insured under Obamacare. At the present time there is a shortage of primary care physicians which is expected to increase. A primary reason is that medical students graduate with hundreds of thousands of dollars in student-loan debt and most cannot afford to take the less lucrative general practitioner route. Instead, most choose a career as a specialist which is indeed more financially rewarding. The combination of higher demand and fewer family doctors will translate into longer wait times and higher costs for medical services. The evidence can be found in the Northeastern United States. Consider what happened in Massachusetts after 2006, when its mandated insurance requirement took effect. According to an annual survey from the Massachusetts Medical Society, since the mandate, the time it takes to secure an appointment with a doctor has risen substantially. This is somewhat remarkable considering the fact that Massachusetts has the second highest physician-to-population ratio of any state in America.

Summary

The road ahead seems wrought with potholes filled with uncertainty. Higher medical costs? Likely. Shortage of Doctors? Probable. Longer wait times for appointments? Almost a certainty. What would happen if many of today’s health insurance companies were to exit the business? The government would likely intervene and install a Single-Payer,  government run, health care system. At times, I wonder if anyone in Washington actually understands what’s occurring. Of course, there are also times when I fear they do. Trying to incorporate a highly-complex health care law when the economy is weak is like trying to sell a heavy coat to someone in the Sahara Desert. Of course, pragmatism has not always been a strong suit amongst policy makers.

Shared via Obamacare: Penalties And Exemptions - Forbes.  

And since we referenced Señor Patton (aka Vlad Drac): 

Sex Workers in San Francisco are Celebrating and Selling ObamaCare with a "Healthy Ho's Party"

From Erica Fink at CNN Money:

A burlesque dancer dressed as a nurse taunts her co-performer with a toy syringe, dangling the medicine seductively in an act that's meant to reflect the cat-and-mouse game of U.S. healthcare. They shimmy and eventually end up topless. 

The risqué performance was part of an Obamacare registration drive last week in San Francisco, dubbed the "Healthy Ho's Party." 

Organized by "Siouxsie Q," a Bay Area sex worker, the event was meant to encourage other sex workers to enroll in the new insurance exchanges. It was a rousing success: Nearly 40 men and women attended and almost all of them filed enrollment paperwork. 

In the all-cash, off-the-books sex industry, workers can be particularly high risk and insurance is often out of reach. Many sex workers -- a broad term that can refer to a number of services, including sexual massage, prostitution, and escort and dominatrix work -- consider themselves self-employed entrepreneurs who can't afford to purchase healthcare. But that could all change with the Affordable Care Act. ... 

Obamacare Exchanges Only Enrolled 6 People on Day 1 & Saturday Night Live Actually Called It in a Skit

From Mitch Miller at WTOP:  

A "Saturday Night Live" parody of Obamacare and the healthcare.gov website got a lot of laughs when "SNL"'s Kate McKinnon portrayed Health and Human Services Secretary Kathleen Sebelius. 

Little did the cast know how accurate its over-the-top satire would be. 

"Millions of Americans are visiting healthcare.gov, which is great news," McKinnon said during the opening of last week's show. "Unfortunately the site was only designed to handle six users at a time." 

While the audience laughed, it turns out the satire wasn't that far off.

By the afternoon of Oct. 2, the number of enrollments was "approximately 100," CBS says.

Obama Admin. Predicted in 2010 that 93 Million Americans Wouldn't be Able to Keep Their Existing Health Plans

On October 31, 2013, Avik Roy spoke to Megyn Kelly about his Forbes article describing how the Obama administration predicted in 2010 that around 93 million Americans would not be able to keep their existing health insurance plans, contrary to President Obama's promise. The Forbes article is here: http://www.forbes.com/sites/theapothe...

Less Than 1% of Applicants Contain Sufficient Information

From Avik Roy at Forbes:

It gets worse. Even if you managed to create an account on healthcare.gov—a painstaking and time-consuming task to say the least—you’re not assured of actually being able to buy the plan you like. One insurer told Dan Mangan of CNBC that “about half” of the applications they’ve received are “corrupted” due to “incomplete data.” 

According to Sumit Nijhawan, CEO of health IT company Infogix, “‘1 in 100’ enrollment applicants being sent from the federal marketplace have provided sufficient, verified, information.” Continued Nijhawan, “It is extraordinary that these systems weren’t ready…it could be a public relations nightmare.” Added Dan Mendelson of Avalere Health, “This is not a traffic issue. Right now, the systems aren’t working.”

Obamacare's Website Is Crashing Because It Doesn't Want You To Know How Costly Its Plans Are

• A growing consensus of IT experts, outside and inside the government, have figured out a principal reason why the website for Obamacare’s federally-sponsored insurance exchange is crashing. Healthcare.gov forces you to create an account and enter detailed personal information before you can start shopping. This, in turn, creates a massive traffic bottleneck, as the government verifies your information and decides whether or not you’re eligible for subsidies. 
• HHS bureaucrats knew this would make the website run more slowly. 
• But they were more afraid that letting people see the underlying cost of Obamacare’s insurance plans would scare people away.

• An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.

• A Manhattan Institute analysis found that, on average, the cheapest plan offered in a given state, under Obamacare, will be 99% more expensive for men, and 62% more expensive for women, than the cheapest plan offered under the old system. And those disparities are even wider for healthy people.

• IT and insurance experts have been saying for at least eight months that implementation of the exchanges was going badly, that as early as February officials were warning of a “third world experience.” The Times’ sources are just as blunt. 
• “These are not glitches,” said one insurance executive. 
• “The extent of the problems is pretty enormous. 
• At the end of our [conference calls with the administration], people say, ‘It’s awful, just awful.’”

• If 50 million people are uninsured today, mainly because insurance is too expensive, why is it better to make coverage even costlier?

Full story from Avik Roy at Forbes, Hat Tip to Ryan Kennedy.  

Who Can Take Your Money and Give It to Other People? The Government Can (Candy Man Parody)

Who can be a failure
in so many ways
and instead of getting fired, hey
we'll give ourselves a raise.  

The Government Can - they make it all taste good.   

A little Friday fun.

 

Avoidable Emergency Room Visits

Reinsurance Fees—Possible Exemption for Certain Self-insured Plans

The Affordable Care Act (ACA) creates a transitional reinsurance program to help stabilize premiums in the individual market for the first three years of Exchange operation (2014-2016) when individuals with higher-cost medical needs gain insurance coverage. The program imposes a fee on health insurance issuers and self-funded group health plans.

On Oct. 24, 2013, the Department of Health and Human Services (HHS) released an advance copy of a final rule under the ACA. In the final rule’s preamble, HHS states that it intends to issue a proposed rule that would make the following changes to the reinsurance program:

• Exempt certain self-insured, self-administered plans from the reinsurance fees for 2015 and 2016; and
• Modify the collection deadlines for the fees to reduce the upfront burden to plans and issuers.

REINSURANCE FEES

Contributions to the reinsurance program are required for health plans (fully insured and self-insured) that provide major medical coverage. Certain types of plans are exempt from the requirement to pay reinsurance fees, such as health flexible spending accounts (FSAs), health reimbursement arrangements (HRAs) that are integrated with major medical coverage, health savings accounts (HSAs) and coverage that consists solely of excepted benefits under HIPAA (for example, limited-scope dental and vision plans).

For insured health plans, the issuer of the health insurance policy is required to pay the reinsurance fees. For self-insured health plans, the plan sponsor is liable for paying the reinsurance fees, although a third-party administrator (TPA) or administrative-services only (ASO) contractor may be used to make the fee payment at the plan’s direction.

The reinsurance program’s fees are based on a national contribution rate. The reinsurance fee mainly consists of amounts collected to cover reinsurance payments and administrative costs, but it also includes funds that must be deposited into the general fund of the U.S. Treasury.

For 2014, the national contribution rate is $5.25 per month ($63 per year). The national contribution rates for 2015 and 2016 have not been established yet. The reinsurance fee is calculated by multiplying the number of covered lives (employees and their dependents) during the benefit year for all of the entity’s plans and coverage that must pay contributions, by the national contribution rate for the benefit year.

HHS has indicated that issuers and plan sponsors will be required to submit an annual enrollment count to HHS no later than Nov. 15 of 2014, 2015 and 2016 based on enrollment data from the first nine months of the year. Within 30 days of this submission or by Dec. 15, whichever is later, HHS will notify each issuer or plan sponsor of the amount of its required reinsurance contribution. The issuer or plan sponsor would be required to remit this amount to HHS within 30 days after the date of HHS’ notification.

POSSIBLE CHANGES

In the preamble to the final rule, HHS states that it intends to propose in future rulemaking to exempt certain self-insured, self-administered plans from the requirement to make reinsurance contributions for the 2015 and 2016 benefit years. At this point, it is not clear which self-insured plans will be covered by the proposed exemption.  However, it appears that self-insured plans will be required to pay the reinsurance fees for the 2014 benefit year.

HHS also intends to issue a proposed rule that would change the collection method for the reinsurance fees. Under the revised collection method, the fees would be collected in two installments to reduce the upfront burden to plans and issuers. The fee for reinsurance payments and administrative expenses would be collected at the beginning of the year and the fee for payments to the U.S. Treasury would be collected at the end of the year. Under this payment schedule, a larger payment would be due in January 2015 and a smaller one would be due in December 2015 for the 2014 reinsurance fee.

These changes will not become effective until HHS issues additional guidance.

The 21st Exemption to the Individual Mandate: The 'Dysfunctional Exchanges' Delay

Beginning in 2014, the Affordable Care Act (ACA) requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. This rule is often referred to as the “individual mandate.” Individuals may be eligible for an exemption from the penalty in certain circumstances.

We've written about the extensive 20-exemptions already in place for the individual mandate here.  Think of this as number 21.

On Oct. 28, 2013, the Department of Health and Human Services (HHS) released a frequently asked question (FAQ) that provides an additional hardship exemption for individuals who enroll in coverage through an Exchange during the initial open enrollment period.

Specifically, an individual who enrolls in an Exchange plan at any time during the initial open enrollment period will not be subject to an individual mandate penalty for the months before the coverage takes effect.

This additional exemption was necessary to avoid penalties for anyone who waited until the end of the open enrollment period to enroll in an Exchange plan, as the existing exemptions would not have protected them from liability.

HHS plans to provide additional details in 2014 on how to claim the exemption.

Exchange Initial Open Enrollment Period

The initial open enrollment period for the ACA’s Affordable Health Insurance Exchanges (Exchanges) began on Oct. 1, 2013, and continues until March 31, 2014.

For individuals who enroll on or before Dec. 15, 2013, coverage will be effective Jan. 1, 2014.

For individuals who enroll between the first and 15th day of January, February or March 2014, coverage will be effective the first day of the following month.

For individuals who enroll between the 16th and last day of any month between December 2013 and March 31, 2014, coverage will be effective the first day of the second following month.

The ACA already provided an exemption for anyone experiencing a short gap in coverage (less than three full calendar months). However, if an individual enrolls in an Exchange plan between Feb. 16, 2014, and the end of the initial open enrollment period, the coverage will not be effective until April 1 or later. As a result, that person would not be eligible for the short coverage gap exemption, because their gap in coverage would be longer than three months.

The New Hardship Exemption

The ACA gives HHS the authority to establish hardship exemptions from the individual mandate penalty. These exemptions are designed for individuals who experience a hardship that affects their ability to obtain coverage under a qualified health plan. In prior guidance, HHS has described several situations that qualify as hardships.

In the new FAQ, HHS acknowledged that it would be unfair to require individuals who enroll in an Exchange plan near the end of the open enrollment period to pay a penalty.

HHS recognized that the duration of the initial open enrollment period implies that individuals have until the end of the initial open enrollment period to enroll in coverage through an Exchange before penalties will apply, when that was not the case. This additional hardship exemption will provide relief for anyone in this situation.

Under the new exemption, if an individual enrolls in a plan through the Exchange prior to the close of the initial open enrollment period, the individual will be able to claim a hardship exemption from the individual mandate penalty when filing a federal income tax return in 2015 for the months prior to the effective date of the individual’s coverage.

This exemption will be provided through the federal income tax filing process, without the need to request an exemption from the Exchange. Additional details will be provided in 2014 on how to claim this exemption.