US health care mandate (Obamacare) II: The grubering...

[Spendulus]

A lot of people in this forum love 0bamacare no matter what. I expect none of them to complain about those back-taxes...

They'll just turn right wing and small government, after big government comes after them.

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[1715566047]

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[1715566047]

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[Wilikon]

A lot of people in this forum love 0bamacare no matter what. I expect none of them to complain about those back-taxes...

They'll just turn right wing and small government, after big government comes after them.

No doubt. I just wish they could do it publicly and not quietly...

[Wilikon]

Oh my: Harvard profs find ObamaCare’s reforms are costing them more for health care

http://www.nytimes.com/2015/01/06/us/health-care-fixes-backed-by-harvards-experts-now-roil-its-faculty.html?smid=tw-nytimes&_r=0&referrer=


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The definition of liberal academia...

[Inotanewbie]

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A lot of people in this forum love 0bamacare no matter what. I expect none of them to complain about those back-taxes...

From what I have seen many people on the forum are some form of libertarianism which favors small government. Obamacare greatly increases the size of government.

Granted there are a lot of people on here that are unemployed, who tent to be liberal......

[Wilikon]

http://www.nytimes.com/2015/02/01/us/politics/white-house-seeks-to-limit-health-laws-tax-troubles.html



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That was unexpected.. How sad...

[Wilikon]

Mother Jones: America's Largest Health Care Company Tells Supreme Court That Anti-Obamacare Argument Is "Absurd"



If getting rid of Obamacare is such a good idea, why isn't corporate America getting behind King v. Burwell, the Supreme Court case designed to demolish the Affordable Care Act? More than 52 different parties have weighed in with briefs in advance of oral arguments on March 4. Of those, 21 have been filed on behalf of the plaintiffs, who claim millions of Obamacare consumers are receiving illegal health insurance subsidies. The groups filing these briefs include libertarian think tanks, pro-life organizations, Christian legal shops, and some conservative Republican legislators. But not a single business group—not the US Chamber of Commerce, not any of the health industry companies and trade groups that opposed the law when it was being drafted—has presented a brief endorsing this lawsuit.

These outfits are either backing the Obama administration's attempt to defeat the suit or sitting out this case. Briefs in the case help explain why: Obamacare is working. There's no better evidence of this than a brief filed on behalf of the government in King by the Hospital Corporation of America, better known as HCA, the largest health care provider in the country (once run by Obamacare foe Florida Gov. Rick Scott). HCA argues that the legal theory advanced by the plaintiffs is "absurd," but, more importantly, it presents detailed data drawn from its own operations that demonstrate that the health care law is helping patients and the company itself.

http://www.motherjones.com/politics/2015/02/hca-king-burwell-supreme-court-obamacare-amicus-brief



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If getting rid of Obamacare is such a good idea, why isn't corporate America getting behind King v. Burwell, the Supreme Court case designed to demolish the Affordable Care Act?



Because: guaranteed bailout and monopoly from 0bamacare... No $$$ loss, either way, for $$$ America's Largest Health Care Company $$$.

[Wilikon]

Fail: Consumers Discover They're 'Insured, But Not Covered' Under Obamacare



Yes, it's time once again for yet another post illustrating a core criticism of Obamacare, and various forms of government-run or -micromanaged healthcare more generally; namely, the fact that "coverage" or "insurance" does not equalcare. Various media outlets have been reporting on this phenomenon for months, including the New York Times, which published another cautionary piece this week:


WHEN Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle. Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis. But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches. She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.



Here is a staunch Obama supporter who's so ideologically loyal that she refused to become upset when her existing healthcare plan was deemed non-compliant and canceled under Obamacare.  She made her peace with paying higher premiums and higher out-of-pocket expenses. She was even willing to live with her pared-down network of doctors and healthcare facilities.  Being personally betrayed by multiple, major presidential promises wasn't enough to shake her commitment to the president or his signature law.  But the long drives to see an in-network provider and the hundreds of extra out-of-pocket dollars flying out of her bank account finally led to "frustration bubbl[ing] over."  She's now a poster child of discontentment with Obamacare, featured in the nation's most prominent left-leaning newspaper.  The story goes on:


The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say...For some, like Ms. Pineman, narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors...by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.


Higher costs, "constant changes," surprise bills, outright confusion, and the avoidance of seeking care. Devatasting stuff from the Times, which quotes a healthcare industry professional who rejects the happy talk emanating from the administration and its supporters (by the way, I dealt with and debunked virtually every major point attempted in that Newsweek piece):


“I’m always curious when I read this ‘good news’ that health costs are moderating, because my health care costs go up significantly each year, and I think that’s a common experience,” said Mark Rukavina, president of Community Health Advisors in Massachusetts. While much of the focus in the past has been on keeping premiums manageable, “premiums now tell only a part of the story,” Mr. Rukavina said, adding: “A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable.”


True.  And the premiums are still increasing -- by double-digit percentages for some consumers -- across the board, and are likely to push higher over the coming years.  Of course, we were told Obamacare would significantly slash rates.  And the "coverage" those rates are paying for doesn't kick in until deductibles are exhausted -- if you can find an in-network provider nearby, of course.  This is the "Affordable" Care Act at work. And as millions more Americans lose their employer-based coverage over time (again underscoring a major Obamacare deception), they'll encounter the privilege of navigating the cost and access landmines inherent in the individual market plans offered on the exchanges.  Nevertheless, President Obama again declared the law a success in an interview with Buzzfeed, citing "high satisfaction" (not among the general public, not among those impacted by the law, not among the uninsured) and low premiums (see above).  He also slammed office supply retailer Staples for its policy of strictly capping part-time employee hours at 25 percent to avoid compliance with the expensive employer mandate and its 30-hour rule. (This guideline has been in place for years, Staples says, although the new law seems to have added to the urgency its enforcement).  "Shame on them," Obama said of Staples:


https://www.youtube.com/watch?v=U2qA_8sqa6s



http://townhall.com/tipsheet/guybenson/2015/02/12/obamacare-insured-but-not-covered-n1956180?utm_source=BreakingOnTownhallWidget_4&utm_medium=story&utm_campaign=BreakingOnTownhall

[Possum577]

Obamacare

The millions who are renewing their individual market coverage under the Affordable Care Act — or signing up for new coverage — are finding that they have more choices than in 2014, and that the average cost of a policy has risen only modestly.

More insurance companies are competing in the new ACA marketplaces. “There are over 25 percent more issuers participating in the Marketplace in 2015″ than in 2014, according to the most recent official figures from the Department of Health and Human Services.

Meanwhile, the average cost across all U.S. counties for a benchmark (second-lowest-cost) “silver” policy rose only 2 percent, according to the nonpartisan Kaiser Family Foundation. HHS also reported a 2 percent average rise for a benchmark “silver” plan.

The cheaper and less generous “bronze” plans rose an average of 4 percent, KFF said. And it found that premium changes varied widely depending on location, from an increase of 34 percent for a benchmark silver plan in southeastern Alaska, to a whopping 45 percent reduction in Summit County (Breckenridge), Colorado. Also, it will pay for policyholders to shop around: A New York Times analysis of the rate data showed many with existing marketplace plans would see a premium hike (as high as 20 percent) unless they switched policies.

Previously, there were indications the average premium would actually decrease. In our last report, we quoted a preliminary KFF study that showed the average premium had gone down by 0.8 percent. But as we noted at the time, that was based on analysis covering only the largest cities in 15 states and the District of Columbia where information from rate filings was available. KFF later revised the figure when filings from all 50 states and the District of Columbia became available.

The ACA’s second annual open enrollment period began Nov. 15 and will remain open through Feb. 15. So it is still too early to say how many more will sign up for coverage this year, compared with last. So far, enrollment has been brisk, and without the technical foul-ups that plagued the system a year earlier.

There’s solid evidence that the new law has extended health insurance coverage to millions. But how many millions have gained coverage, and how many will remain uninsured, won’t be known for some time. According to the most recent release of the National Health Interview Survey conducted by the Centers for Disease Control and Prevention, the percentage of people without health insurance at the time they were interviewed fell to 12.2 percent of the population during the first six months of 2014, down from 14.4 percent during 2013, before the ACA’s insurance marketplaces took effect (see Table 1).

One thing we can say with certainty is that the law’s basic tax penalty for failing to obtain coverage has doubled for 2015, going from 1 percent of household income for those who were uninsured in 2014 to 2 percent of household income for those who don’t get coverage this year.

The minimum tax penalty, for those with very low income, has more than tripled. It went from $95 per adult for being uninsured in 2014 to $325 for 2015. The penalty amounts have been part of the law since it passed in 2010, and the higher rates went into effect Jan. 1.

Those who were uninsured in 2014 must pay the tax penalty when they file their 2014 income tax returns, which are due by April 15. (The IRS is calling it an “individual shared responsibility payment,” neatly avoiding taking sides on the politicized question of whether it’s a “tax” or a “penalty.”)

http://www.factcheck.org/2015/01/obamas-numbers-january-2015-update/

Personal Impact

My premiums when up about $2 per month, 2%...i'll pay that to get more people covered. But I'll fully admit that Obama made two big errors with it 1) he forced the insurers as the route to get coverage, when he should have made strides to provide state funded care (not state forced insurance coverage), and 2) he outsourced the website construction when he has the best web engineers and designers within the US...what a foolish move!

[Possum577]

Another source to keep you all wise to the rampant ACA "Obamacare" deception: http://www.flackcheck.org/patterns-of-deception/affordable-care-act/

[Spendulus]

Another source to keep you all wise to the rampant ACA "Obamacare" deception: http://www.flackcheck.org/patterns-of-deception/affordable-care-act/

No, you will not be keeping people "wise" by presenting misinformation.

But thanks for revealing your colors.

[Wilikon]

Liberal Cornell Students Outraged At Obamacare Fee, Stage Sit-In


To be filed under: We Told You So!

Via Bizpac Review: Cornell students erupt over healthcare fee; ‘elections have consequences’ messages pour in
Sometimes, the best education is the one life gives you.

Students at the prestigious but liberal-leaning Cornell University found that out the hard way last week, when they stormed the office of school President David Skorton to protest a modern-day example of socialism at work.

On Feb. 5, Skorton posted a memo on the school’s website notifying students that all who opt out of Cornell’s health care program next year will be charged a $350 fee….

http://tammybruce.com/2015/02/liberal-cornell-students-outraged-at-obamacare-fee-stage-sit-in.html

[Wilikon]

Healthcare.gov sent out 800,000 bad tax forms


The Obama administration says it sent about 800,000 HealthCare.gov customers the wrong tax information, and officials are asking those consumers to delay filing their 2014 taxes. …

The errors mean that nearly 1 million people may have to wait longer to get their tax refunds this year.

http://bigstory.ap.org/article/354a9fd9e4d64360b0454f6f3bf90665/govt-sent-800000-healthcaregov-customers-wrong-tax-info




Update: Officials don’t know what happened


The errors disclosed Friday are in new forms that HealthCare.gov sent to millions of consumers receiving coverage through the federal insurance market that serves most states. Those forms, called 1095-As, are like a W-2 for health care. They provided a month-by-month accounting of the subsidies consumers received to help pay their premiums. That information is then used to make sure everybody got the right amount, not too much, or too little.

Andy Slavitt, a top administration official overseeing federal health insurance programs, said the administration is still investigating the root cause of the problem. Slavitt said it had to do with erroneous calculations of a “benchmark” premium that is used to help determine the amount of subsidies that individuals receive.

http://bigstory.ap.org/article/354a9fd9e4d64360b0454f6f3bf90665/govt-sent-800000-healthcaregov-customers-wrong-tax-info


[...]
The incorrect insurance information is used in computing taxes. Consumers can expect to receive corrected data in the first week of March. With the new data, officials warned, some taxpayers will owe more and some will owe less.

Officials said they did not know why the error had occurred.

http://www.nytimes.com/2015/02/21/us/incorrect-tax-information-health-insurance.html?smid=tw-nytimes




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Amateur hour...

[Wilikon]

10,000 People Will DIE If Supreme Court Rules Against Obamacare…



It should go without saying, but health care is not a luxury good. According to a Harvard study, in 2005, before Obamacare became law, close to 45,000 Americans between the age of 18 and 64 died because they lacked health insurance. Diabetics lost their sight and slowly watched their organs fail because they were unable to afford insulin. Mothers delayed care for curable infections until the wait proved fatal. Wives rationed the medication they needed to get out of bed in the morning in order to pay for their husband’s care. Doctors would base treatment decisions for their uninsured patients on which drug company had most recently provided them with free samplesof their product.

A lawsuit called King v. Burwell would take health insurance away from millions of Americans, returning them to the world that existed before Obamacare. The case relies on a few words of the law that, if read out of context, seem to deny tax credits intended to help people pay for their health insurance to people who live in the wrong states. Once those words are read in the context of the entire law, however, it becomes clear that tax credits are available in all 50 states.

A brief filed on behalf of multiple public health scholars and the American Public Health Association, estimates that “over 9,800 additional Americans” will die if the justices side with the King plaintiffs. It reaches this conclusion by starting with an Urban Institute study showing that 8.2 million people will become uninsured in this scenario. As other research examining Obamacare-like reforms in the state of Massachusetts found that “for every 830 adults gaining insurance coverage there was one fewer death per year,” that translates to between 9,800 and 9,900 deaths if the justices back the plaintiffs in King.


http://thinkprogress.org/justice/2015/02/24/3626080/many-americans-will-die-supreme-court-chooses-gut-obamacare/


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[Wilikon]

Surprise: Poorest Obamacare Enrollees Face $530 IRS Tax Bill



The majority (52 percent) of Obamacare enrollees receiving an advance premium tax credit to purchase Obamacare insurance is facing the prospect of paying back $530 of that tax credit to the IRS, according to a new study from H&R Block.  This clawback is reducing the refunds for these taxpayers by 17 percent this filing season.

Under Obamacare, taxpayers earning between 133 and 400 percent of the federal poverty level are eligible to receive a tax credit to help purchase insurance on Obamacare exchanges.  This tax credit is calculated using old tax data of the recipients.  The credit is advanced ahead of time to the taxpayer's insurance company.  The taxpayer must reconcile at tax time the advance credit received with the actual credit she is eligible for.

Families of four earning less than $97,000 are eligible for a credit.  So is a single mother with two children earning less than $80,000 and an unmarried/childless taxpayer earning less than about $12,000.  By definition, these are the lowest income recipients of Obamacare health insurance outside the Medicaid-eligible population.  Higher income taxpayers received no tax subsidy and aren't facing this tax season surprise.

According to the study, a majority of credit recipients--52 percent--have had to pay back the IRS an average of $530, reducing their refunds by an average of 17 percent.

It remains unclear how this information relates to the revelation last week that 800,000 healthcare.gov Obamacare customers (and a further 100,000 in California) received inaccurate 1095-A tax reporting forms.  Doing the reconciliation described here would not be possible for these nearly 1 million families.

Also in the H&R Block report is the news that the individual mandate penalty is averaging $172. This is likely to rise in future years as the penalty for most taxpayers will equal 2.5 percent of their adjusted gross income.  A family earning $100,000 would see a penalty of $2500 for failing to obtain qualified Obamacare health insurance.



http://www.atr.org/surprise-poorest-obamacare-enrollees-face-530-irs-tax-bill

[Wilikon]

Obamacare Architect Jonathan Gruber Under Fire For Cheating Vermont (Video)

https://www.youtube.com/watch?v=in8jaZ1r2nM

Jonathan Gruber’s work for Vermont is done, but the controversy surrounding the health care consultant returned to the spotlight Monday after State Auditor Doug Hoffer released a memo indicating his time cards do not add up.

Gruber drew criticism for his role in national health care reform, which included big pay-days and comments about Americans stupidity — and there were also questions about the work he did for Vermont. The Massachusetts Institute of Technology economist’s computations led the Governor to conclude that Vermont would not be able to afford single-payer health care.

State Auditor Doug Hoffer began looking into Gruber’s contract at the request of two state lawmakers. He says Gruber’s invoices should have included more detail about the work he performed for Vermont. However, Hoffer says the larger concern is that the number of hours billed for Gruber’s sole research assistant strain credibility — 14 hours-a-day, seven days-a-week.

“The one that jumped out was pretty evident, was both of the first two invoices indicated a certain number of hours, both for Dr. Gruber and for the one, sole research assistant. And once I learned that there was only one individual, it became evident that it didn’t really square with what would be normal practice,” Hoffer said

Vermont amended its contract following coverage of his controversial remarks late last year, barring any further payment for Gruber’s time. However, Hoffer’s memo indicates the consultant still presented a bill for his time, and billed more for his assistant’s time than he paid.

   

http://www.wcax.com/story/28177231/auditor-gruber-may-have-padded-bills

[Wilikon]

Treasury Dept Gave $3 Billion To Health Insurers Without Authorization From Congress



The U.S. Treasury Department has rebuffed a request by House Ways and Means Chairman Rep. Paul Ryan, R- Wis., to explain $3 billion in payments that were made to health insurers even though Congress never authorized the spending through annual appropriations.

At issue are payments to insurers known as cost-sharing subsidies. These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance policies. In exchange for capping these charges, insurers are supposed to receive compensation.

What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.



http://www.washingtonexaminer.com/treasury-wont-explain-decision-to-make-3-billion-in-obamacare-payments/article/2560739

[Wilikon]

Morning Joe Mocks White House for Not Being ‘Fully Forthcoming’ on Gruber’s Reportedly Large Role in Obamacare



MSNBC’s Morning Joe panel Monday mocked the Obama administration for not being forthcoming on the large role of MIT economist Jonathan Gruber in the writing and shaping of the Affordable Care Act, also known as Obamacare.

Gruber, one of the law’s architects, caused the Obama administration a huge political headache last November after comments surfaced of him referring to the “stupidity of the American voter” and that it was a “huge political advantage” for the law to be written with a lack of transparency. Gruber later apologized for the remarks before Congress, calling them “glib.”

The White House sought to distance itself from him at the time, with Obama himself calling him “some adviser who never worked on our staff,” but the Wall Street Journal revealed “frequent consultations” between Gruber and top Obama staffers:


[...]
“I owe my Republican sources an apology, because they kept telling me he was hugely involved and the White House played it down,” author Mark Halperin said. “They were right. The Republicans were right … I think the [White House] was not fully forthcoming.”

Former Democratic Party chair Howard Dean laughed, also using the politically safe phrase, “They were not fully forthcoming.”

Host Joe Scarborough appeared to relish the article coming out, asking fellow guest and former Democratic congressman Harold Ford if the White House lied about his involvement.

“I would say they were not fully forthcoming,” Ford said, echoing the others’ remarks to laughter around the table.

“Mika, let me see if one person will talk straight,” Scarborough said. “The White House assured us that Mr. Gruber was a bit player. It appears now that was not true. Did the White House lie about Mr. Gruber’s involvement?”

“It certainly appears they did,” co-host Mika Brzezinski said.




http://freebeacon.com/politics/morning-joe-mocks-white-house-for-not-being-fully-forthcoming-on-grubers-reportedly-large-role-in-obamacare/

[Wilikon]

MEDICARE'S END-OF-LIFE COUNSELING POLICY (A.K.A. THE DEATH PANEL) MAY FIND ACCEPTANCE


WASHINGTON (AP) -- Six years ago, a proposal for Medicare to cover end-of-life counseling touched off a political uproar that threatened to stall President Barack Obama's health care law in Congress. Wednesday, when Medicare finally announced it will make the change, reaction was muted.

At the time, former Alaska Republican Gov. Sarah Palin's accusation that voluntary counseling could lead to government-sponsored "death panels" dictating the fate of frail elders was widely discredited. But for the Obama administration, end-of-life counseling remained politically radioactive, even as the idea found broader acceptance in society.

Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine, called Medicare's move a "little miracle," given the "death panels" furor. He said he believes the controversy has passed.

"I think society's going to get over it this time and see the good in it," said Rotella. "It's really about living in the way that means the most to you to the last moments of your life."

The original sponsor of the idea, Oregon Democratic Rep. Earl Blumenauer, was taking no chances even as he, too, sensed a political shift. Just a few weeks ago at the White House congressional picnic, Blumenauer said he personally lobbied senior officials, handing out pocket-sized cards with his talking points.

"There was a time when the federal government could have been a leader on this, but now it's basically responding to where the rest of America is going," he said.

The policy change, to take effect Jan. 1, was tucked into a massive regulation on payments for doctors. Counseling would be entirely voluntary for patients.

Some doctors already have such conversations with their patients without billing extra. Certain private insurers have begun offering reimbursement. But an opening to roughly 55 million Medicare beneficiaries could make such talks far more common. About three-quarters of the people who die each year in the U.S. are 65 and older, making Medicare the largest insurer at the end of life, according to the Kaiser Family Foundation.

"As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions ... that are critical to high-quality care," said Patrick Conway, Medicare's chief medical officer. "I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so."

Medicare is using a relatively new term for end-of-life counseling: advance care planning. That's meant to reflect expert advice that people should make their wishes known about end-of-life care at different stages of their lives, as early as when they get a driver's license.

The counseling aims to discern the type of treatment patients want in their last days, with options ranging from care that's more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient.

The American Medical Association praised Medicare's decision. "This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning," said Andrew Gurman, the group's president-elect.

Before former Palin ignited the "death panels" outcry, there was longstanding bipartisan consensus about helping people to better understand their end-of-life choices and decisions.

A 1992 law passed under Republican President George H.W. Bush requires hospitals and nursing homes to help patients who want to prepare living wills and advance directives. Similar efforts gained resonance after the 2005 death of Terri Schiavo, the brain-damaged Florida woman whose family fought for years over whether she would have wanted to be kept alive in a vegetative state.

Then-Florida Gov. Jeb Bush got embroiled in the family's ordeal, ordering feeding tubes reinserted for Schiavo against her husband's wishes. The husband ultimately prevailed in a legal battle with Schiavo's parents, who wanted her kept alive.

In 2008, a year before debate over the Affordable Care Act spiraled into tea-party protests, Congress overwhelmingly passed legislation requiring doctors to discuss issues like living wills with new Medicare enrollees.

That history of bipartisanship dissipated almost instantly when Palin said the provision on end-of-life conversations in Obama's health care legislation would result in bureaucrats deciding whether sick people get to live. The language was ultimately removed.

Nothing in the discussions approved by Medicare will be focused on cost, but many experts believe if patients truly understood their alternatives, and doctors listened to them, bills would inherently go down.

A landmark report last year from the Institute of Medicine found that few people make their wishes known and too many deaths are filled with breathing machines, feeding tubes, powerful drugs and other treatments that fail to extend life and make its final chapter more painful and unpleasant. The report was called "Dying in America," and the institute - an independent organization that advises the government - has a section on its website distilling the issues for families.

After the report, Medicare said it would consider a change in policy for 2016.

Supporters say counseling would give patients more control and free families from tortuous decisions. Even so, there are often no simple answers. Patients may want less invasive care if they believe they will soon die, but predicting when death will happen is notoriously inexact. Terminal patients can live for years, potentially complicating a choice of less intensive treatment.

Interested parties will have 60 days to comment on the new regulation before it is finalized.



http://hosted.ap.org/dynamic/stories/U/US_MEDICARE_END_OF_LIFE?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2015-07-09-03-46-45


http://www.latimes.com/nation/la-na-medicare-end-of-life-20150708-story.html



FLASHBACK:

[Wilikon]

More than two-thirds of Obamacare enrollees unsatisfied with coverage: survey


Less than a third of Obamacare exchange customers are satisfied with their plans, according to a survey released Monday that finds enrollees in the signature heath overhaul are less happy than those covered through government programs or their jobs.

Researchers at Deloitte Center for Health Solutions, a research arm of the consulting firm, said cost is a key driver in their findings, which say 30 percent of exchange customers are satisfied with their plans, compared to nearly half of those on the Medicaid program for the poor, 58 percent on Medicare for seniors and the disabled and 42 percent with coverage from their jobs.

The Affordable Care Act of 2010 set up web-based marketplaces, or exchanges, where customers can compare plans and purchase coverage, often with the help of income-based government subsidies.

A recent Supreme Court decision said those subsidies should be paid to qualified customers making between 100 and 400 percent of the federal poverty level no matter where they live, despite contested language in a key section of the law.

As Obamacare nears its third signup period this fall, Deloitte says customers are better off than their uninsured counterparts but unhappy compared to people who hold other types of insurance.

“The exchanges have improved access to care, but affordability remains a problem,” the Deloitte report said. “Enrollees report getting care they may not have been able to afford without their [exchange] coverage and are connecting with primary care providers at twice the rate of the uninsured.”


http://www.washingtontimes.com/news/2015/aug/3/obamacare-enrollees-less-satisfied-others-survey/

[Wilikon]

Millionaires Are Qualifying for Medicaid Under Obamacare



Millionaires living in states that expanded Medicaid are benefiting from government-sponsored health insurance, and taxpayers are footing the bill for it.

In states that expanded Medicaid, people with high net worths and low monthly incomes qualify for Medicaid because of loosened eligibility requirements implemented under Obamacare. And in rural states like Iowa, Americans whom many would consider wealthy are taking advantage of this “loophole” and enrolling in coverage paid for by taxpayers.

Jesse Patton, an insurance broker living in Iowa, has had clients with net worths ranging from $2 million to $5 million, which often stem from farmland or assets from divorce settlements. And those clients, he said, are enrolled in Medicaid in expansion states like Iowa.

“It was designed to help the lower-income population,” Patton told The Daily Signal of Medicaid. “But without the asset test, there are folks that have the financial means and assets there that are good at figuring out how to work the system and capture a benefit they’re entitled to.”

Under the Affordable Care Act, states that opted to expand Medicaid did away with an asset test, which was previously used to determine eligibility in regular Medicaid. To qualify for the program, the government considered a combination of income and net worth.

Now, under the law, eligibility in states that did and did not expand Medicaid is linked solely to modified adjusted gross income, keeping it in line with the tax code.

“This was a move to standardize as much as possible, so you’re bringing in more people, but you’re not complicating the system to where you can’t figure it out,” Joy Wilson, director of health and human services policy at the National Conference of State Legislatures, told The Daily Signal.

Though changing the requirements for Medicaid eligibility put the program in line with the tax code, it also created a “loophole” for those many would consider wealthy to enroll in the government-sponsored program.

“When you get into the Midwest and states with an agriculture market, you can have several million [dollars] in farm ground that you’re not reporting with income,” Patton said.

Patton said he’s encountered Iowans whose net worths top $1 million, and they’ve had no problem enrolling in Medicaid because their annual incomes are below 138 percent of the federal poverty line, or $16,000 for an individual—the new income threshold to qualify for Medicaid in states that expanded the program.

The Iowa broker specifically recalled the case of one woman who had $1.5 million in land and received another $500,000 from a divorce settlement. The land and cash settlements, which went into a trust, were not reported as income, so the woman was able to enroll in the government-run health care program.

“In our market, we’ve got quite a few people people who are either farmers or have gone through divorce settlements where they received considerable amounts of money, but it’s not showing up as income to them at this point in time,” Patton said.

Wilson said that though it’s likely there are some worth millions who are enrolling in Medicaid, they represent a small share of the overall Medicaid population.

“With every system there are issues, and there are always some people trying to help someone who might have a workaround,” she said. “But I would hope that’s not a large number of people, and I suspect if it became big enough, they would have to go and amend the law.”

“It’s safe to say the bulk of the individuals who qualify by income don’t have a lot of assets,” Wilson continued. “There’s always an exception to the rule, maybe someone’s parents died and they got a $1 million house. But that’s not your typical person coming in at the poverty level.”

But those who are asset-rich, like enrollees who own large amounts of land, are not the only population who can qualify for Medicaid under Obamacare.

Ed Haislmaier, a senior fellow in health policy studies at The Heritage Foundation, said that graduate students may find themselves eligible for the program, as many likely qualify for Medicaid based solely on their incomes.

Such was the case for Hartford, Conn., student Brendan Mahoney, who signed up for health care through Connecticut’s exchange when it opened in 2013 and learned he was eligible for Medicaid. Mahoney, a third-year law student at the University of Connecticut, had a school-sponsored health plan prior to Obamacare’s implementation but found he could enroll in Medicaid instead.

“It’s distorting the program away from those whom it was designed to help who are most vulnerable and don’t have other options,” Haislmaier said. “Unlike the farmer or divorcée who could cover it out of dipping into their substantial assets, or the graduate student who could cover it through student loans or a part-time job, the poor kid or the disabled adult, don’t have those options. They’re the ones whom Medicaid was set up for.”

The Obama administration expanded Medicaid under the Affordable Care Act with the intention of expanding coverage for low-income Americans. Under the law—and in the 31 states and the District of Columbia that expanded Medicaid—adults who earn below 138 percent of the federal poverty line, or around $16,000, can enroll in the program.

The federal government will cover all the costs of Medicaid expansion until the end of this year. Participating states are required by cover 10 percent of the costs by 2022.

Haislmaier warned that wealthy Americans who can dip into their assets to pay for health insurance are taking advantage of a program designed for people who don’t share the same lifestyle.

“It has introduced new inequities into the system,” he said.

Questions regarding the population of Americans benefiting from aspects of the Affordable Care Act were raised after CNBC published a report last month detailing how millionaires are able to qualify for subsidies when purchasing coverage on the state-run and federal exchange.

Just like eligibility for enrolling in Medicaid in expansion states, eligibility for the health care law’s subsidies is based solely on income, not a combination of net worth and income.

As a result, the news organization found that a Florida-based financial adviser was helping clients whose net worths were in the millions enroll in coverage through Obamacare and qualified for subsidies.

In one case, one client in Florida received a monthly subsidy of $423, which lowered the price of the client’s coverage to $240 per month. Another client received a monthly subsidy of $737, lowering the premium to $435 per month.


http://dailysignal.com/2016/02/09/millionaires-are-qualifying-for-medicaid-under-obamacare/