Because 33 told you so: ObamaCare also a disaster in implementation - NYT

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http://www.nytimes.com/2013/04/02/us/politics/option-for-small-business-health-plan-delayed.html?hp&_r=0


Many of us warned you clowns many times over this

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http://www.huffingtonpost.com/2013/04/02/health-insurance-obamacare_n_2999944.html


Total FAIL

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Obamacare Incompetence

By Joe Klein

April 02, 2013810


JONATHAN ERNST / REUTERS

U.S. President Barack Obama at Port Miami on March 29, 2013.
 



Let me try to understand this: The key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care super-stores—called exchanges. The Administration has had 3 years to set up these exchanges. It has failed to do so.

This is a really bad sign. There will be those who argue that it’s not the Administration’s fault. It’s the fault of the 33 states that have refused to set up their own exchanges. Nonsense. Where was the contingency planning? There certainly are models, after all—the federal government’s own health benefits plan (FEHBP) operates markets that exist in all 50 states. So does Medicare Advantage. But now, the Obama Administration has announced that it won’t have the exchanges ready in time, that small businesses will be offered one choice for the time being—for a year, at least. No doubt, small business owners will be skeptical of the Obama Administration’s belief in the efficacy of the market system to produce lower prices through competition. That was supposed to be the point of this plan.

Certainly, the Republicans who have stood in the way of these exchanges—their own idea, by the way, born in the conservative Heritage Foundation—deserve a great deal of the “credit” for the debacle. But we are now seeing weekly examples of this Administration’s inability to govern. Just a few weeks ago, I reported on the failure of the Department of Defense and the Veterans Administration to come up with a unified electronic health care records system. There has also been the studied inattention to the myriad of ineffective job training programs scattered through the bureaucracy. There have been the oblique and belated efforts to reform Head Start, a $7 billion program that a study conducted by its own bureaucracy—the Department of Health and Human Services—has found nearly worthless. The list is endless.

Yes, the President has faced a terrible economic crisis—and he has done well to limit the damage. He has also succeeded in avoiding disasters overseas. But, as a Democrat—as someone who believes in activist government—he has a vested interest in seeing that federal programs actually work efficiently. I don’t see much evidence that this is anywhere near the top of his priorities.

One thing is clear: Obamacare will fail if he doesn’t start paying more attention to the details of implementation, if he doesn’t start demanding action. And, in a larger sense, the notion of activist government will be in peril—despite the demographics flowing the Democrats’ way—if institutions like the VA and Obamacare don’t deliver the goods. Sooner or later, the Republican party may come to understand that its best argument isn’t about tearing down the government we have, but making it run more efficiently.

Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.



Read more: http://swampland.time.com/2013/04/02/obamacare-incompetence/#ixzz2PR68cP5i

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ObamaCare in Trouble? Exchange provision delayed, as lawmakers push to repeal another

By Jim Angle
 
Published April 03, 2013
 
FoxNews.com



Key piece of ObamaCare set to miss major deadline


 
Parts of ObamaCare are starting to fray, even before full implementation.
 
The Obama administration now says a special system of exchanges designed to make it easier for small businesses to provide insurance will be delayed an entire year -- to 2015.
 
"Lots of small businesses struggle with providing insurance for their workers so this was supposed to facilitate it and make it easier for small business to do this," said Jim Capretta of the Ethics and Public Policy Center. "It was a huge portion of the sale job. When they passed the law in 2010 there were many senators and members of Congress who were saying 'I am doing this because it's going to help small businesses.'"
 
The exchanges were designed to give workers a range of choices supported by dollars from their employers. But now they will have only one choice until 2015, which could mean they can't shop for insurance that includes their current providers. Capretta said the administration is "way" behind schedule.
 
Since insurance is more expensive for small businesses, many of which have no obligation under the law to provide coverage, analysts now fear many might just stop trying and let workers go on the soon-to-be-launched state exchanges.
 
Sara Teppema of the Society of Actuaries -- which did an exhaustive study of ObamaCare -- said that "even if it's just a small change of people who are leaving the employment-based insurance and coming into the individual insurance market, their costs and their numbers will overwhelm those who are currently uninsured."
 
That means costs would increase.
 
Meanwhile, 79 senators including several liberal lawmakers recently voted to repeal a new tax on medical devices contained in the health care law following a similar vote in the House.
 
"The House and the Senate agreeing? This is a harmonic convergence, it doesn't happen," said former Democratic Sen. Evan Bayh. "But on this it's happened because the adverse consequences to our economy and the quality of health care are so apparent."
 
The two separate votes have not become law but show widespread opposition to the 2.3 percent sales tax on medical devices. Critics say the law is unfair to the industry since it's a tax on gross sales -- meaning it adds up to a much bigger percentage of a company's profits.
 
But supporters such as Paul Van de Water of the Center for American Progress oppose any repeal.
 
"I think that repealing the device tax would be irresponsible. We need the revenue and it's not going to be a job killer," he said.
 
The theory was that ObamaCare would insure 30 million more people and that device makers, like pharmaceutical companies, would get lots of new customers and a steady stream of new revenue to make up for the tax. Van de Water predicted that would still happen.
 
"These device manufacturers are for the most part going to be getting a large increase in business thanks to health reform, thanks to ObamaCare," he said. 
 
But the CEO of one company said that's not true for the 7,000 small companies with 400,000 employees who make a wide range of devices.
 
Christine Jacobs of Theragenics said: "We make widgets -- hips, knees, stents, pacemakers, and implants, even, for prostate cancer. Those widgets tend to be used by people that are elderly. As the body parts wear out, we're needed."
 
But Jacobs notes that most people whose body parts wear out are already on Medicare, so ObamaCare does not provide a new revenue stream for her company -- only financial pain.
 
"In the case of a small company, that medical device tax is equal to our R-and-D budget for this year," Jacobs said.
 
Bayh said in his own state of Indiana, one company planned to open up to five facilities over the next five years but had to scrap those plans because of the "uncertainty created by this tax."
 
Jacobs said the huge multinational device makers might be able to handle the burden but not the small companies.
 
"It's just such a disproportionate burden for little guys," she said. "Because we're all being told that it's the little companies that create the jobs. And that's not message that we're getting."
 
The tax will even be applied to sutures used on pets that Theragenics developed for the veterinary market.
 
She sought FDA approval to demonstrate the quality of her products. But now she said "it's hard for me not to get frosted on this one" -- she explained that whoever wrote the regulations said "if you have FDA approval, you will be taxed."   
 
President Obama has vowed to veto any repeal of the tax, but Bayh notes that 79 votes in the Senate would be more than enough to override any veto.


Read more: http://www.foxnews.com/politics/2013/04/03/obamacare-in-trouble-exchange-provision-delayed-as-lawmakers-push-to-repeal/#ixzz2PRI5fV6v

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http://blog.heritage.org/2013/04/02/obamacare-causes-doctor-to-retire

Because 33 warned you - doctors fleeing medicine due to TwinkCare

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It’s easier to apply for green card than Obamacare
Application for new health exchanges includes 61 pages of instructions



By Jen Wieczner
 
Yuri Arcurs / Shutterstock.com


If you thought nothing could be more tedious than filling out your tax forms, just wait until you try to apply for health insurance through the Affordable Care Act’s new exchanges.

The draft of the paper application is 15 to 21 pages, depending on whether someone is applying individually or for their family. See the Application for Health Insurance

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And the instructions for the application run no less than 61 pages. That’s nearly six times longer than the instructions for a green-card application. (There are also videos of the process.)

“If you like IRS forms, you’re going to love this one,” says Ken Hoagland, chairman of Restore America’s Voice, a conservative organization that advocates for the repeal of the health-care law. “These are the kinds of things that are going to drive people crazy.”

Adding to the confusion from this new bureaucracy is that experts say most Americans are still largely in the dark about what the health-insurance exchanges — the new marketplaces for individual insurance stipulated by the health-reform law — even are. Though government officials are hurrying to set them up before open enrollment for 2014 begins this fall, a survey released today by InsuranceQuotes.com found that 90% of U.S. consumers don’t know that the exchanges open Oct. 1, and 22% said they thought the exchanges were already open now.

That lack of knowledge doesn’t bode well for how consumers will actually manage to sign up for insurance on their own, experts say — something they will have to do or else pay a penalty mandated by the health-reform law.

The Department of Health and Human Services recently released the draft versions of the applications consumers will need to fill out in order to get insurance if they can’t get it through their employer or family. But while the point behind the law and the exchanges is to make it easier for Americans to get health insurance, some consumers are complaining that a major barrier now stands in their way: too much paperwork.

“It’s a lot of information that consumers are going to have to provide, and that could deter people from signing up,” says Laura Adams, senior insurance analyst at InsuranceQuotes.com, part of Bankrate.com, which tracks interest rates. “That could be an issue for some people who don’t like paperwork. And who likes paperwork?”

The forms bring to mind the IRS instructions for filing the 1040 tax form, which is 105 pages long. In fact, many of the questions have less to do with health matters than financial ones.

A little-known government disclosure requirement offers a clue, at least, to how much time it will take consumers to fill out the forms. To comply with the Paperwork Reduction Act, the Health Department had to submit an “Information Collection Request” along with the draft forms, detailing why it is seeking the information and an estimate for how long it will take the public to provide. The online application will take 15 to 30 minutes to complete depending on whether consumers are applying for additional government subsidies, according to the ICR.

Click to Play  Opinion: What Obamacare savings?Editorial board member Joe Rago on why it’s indisputable that health premiums will increase under ObamaCare. Photo: Associated Press
Meanwhile, the paper application will take 20 to 45 minutes to finish. (By comparison, the department estimated that applications through the small-business health-plan exchanges, known as SHOP, will only take about 10 to 13 minutes to complete.)

But experts say those time estimates don’t include the many hours of homework consumers will have to do before they will even be equipped to fill out the forms, like gather proof of their income. “Consumers are going to need to be prepared,” Adams says.

Government officials and all kinds of other organizations are now parsing the exchange applications and sending feedback to the Health Department on how to make the forms clearer if not idiot-proof. The Massachusetts Medicaid office, for example, suggested in a letter in February that the phrase “please print” be added to the paper form, “so the written information will be as legible as possible.”

And members of the House Ways and Means committee complained that the forms included too many gratuitous questions, asking about applicants’ voter registration status. “As if the insurance application process will not be complicated enough, HHS’s proposed application includes an inquiry about something totally unrelated to health insurance,” wrote Louisiana Republican Rep. Charles Boustany in a letter last week to the Department.

While the health reform law also provides for a support staff known as “Navigators” to help consumers sign up for insurance in the exchanges, experts worry that the Navigators will be overwhelmed with requests, and consumers who call their inundated phone lines will be stuck on hold for a while. “People won’t be able to get through,” Adams says. (Yesterday, HHS proposed training and ethics regulations for the Navigators, which don’t include specific provisions about answering phones in a timely fashion, but dictate that Navigators “will be fair and impartial and will be appropriately trained, and that they will provide services and information in a manner that is accessible.”)

Adams recommends that consumers start the application process right away when the exchanges open in October, because as 2014 approaches, the deadline for when all Americans must have health insurance, the rush of last-minute applicants may bring the enrollment websites crashing down. “Our fear is that people are going to put it off til New Year’s Eve, and by then the sites will be overloaded and Navigators will be overloaded,” Adams says.

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Small Business Obamacare Delay Means Fewer Choices For Workers


Posted: 04/04/2013 2:03 pm EDT


President Barack Obama addresses small-business owners in 2011. His administration has delayed part of the health care reform designed to give workers better choices of health benefits.


Workers at small companies may have to wait another year to take advantage of one of health care reform's biggest selling points.

As The New York Times first reported, President Barack Obama's administration is delaying until 2015 an Obamacare provision that will enable workers at small businesses to choose their own health insurance plans rather than have their employers select for them. The administration cited "operational challenges" as the reason for the delay.

Contrary to reports by Fox News and others, however, the administration and states will still establish health insurance marketplaces, called SHOP exchanges, that will allow companies with up to 100 workers to comparison-shop for health benefits next year.

Allowing employees of small firms an array of health plans will provide them with the same options often available to people who work at larger businesses. The delay means these workers won't have that choice as soon as Congress intended, which could undercut efforts to reduce the high percentage of people who work at small companies who are uninsured.

The postponement, announced last month, marks a setback for the administration as it rushes to get the health care law's biggest benefits online by Oct. 1, when health insurance exchanges for small companies and for individuals are scheduled to begin selling coverage that will take effect next year.

But it won't change much about how small companies select health insurance for their employees, said Caroline Pearson, a director at the Washington-based consulting company Avalere Health who works on health insurance exchange issues.

"I do not envision that the one-year delay of employee choice is going to substantially alter expectations for enrollment in SHOP exchanges," Pearson said.

Small businesses will still have access to the new exchanges, through which they can compare the benefits and costs of health insurance plans, and that could reduce the administrative burden of choosing workplace health benefits, Pearson said. In some cases, companies could avoid the cost and effort of dealing with an insurance broker by buying coverage directly, she said, and qualifying businesses with fewer than 25 employees can only access tax credits worth up to 50 percent of health insurance costs by using the SHOP exchanges.

Last year, 61 percent of companies with fewer than 200 employees offered health plans to workers, compared to 98 percent of larger firms, according to a survey by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust.

On today's market, small businesses aren't able to secure the volume discounts for health insurance that big companies can get, one reason why employees at smaller companies are less likely to have job-based health benefits. Small companies now typically offer just one plan to workers, so the postponement means employees won't see a change, Pearson said.

Health insurance for small companies also will have to comply with Obamacare rules, including those that guarantee minimum benefits, whether firms buy plans through the SHOP exchanges or elsewhere, Pearson said. Companies with at least 50 full-time employees will have to offer health benefits for 2014 and beyond or face financial penalties under the law.

Pearson said another reason the one-year delay of the employee-choice provision may have little effect is that many small businesses won't buy health benefits on the exchanges anyway and will continue to shop through brokers. And workers may prefer their employers to research and select a health plan rather than doing it themselves, she said.

The federal government will run at least part of the health insurance exchanges for individuals and for small businesses in the 33 states that refused to take on the responsibility, so the delay of the employee-choice provision applies to the state health insurance exchanges under federal control. Seventeen states and the District of Columbia will manage their own exchanges. Some states, including California, Connecticut and Minnesota, aren't putting off this part of the law, while others, including Maryland, will follow the federal government's example.

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ObamaCare takes friendly fire
 
By Sam Baker - 04/06/13 12:17 PM ET





Delays in implementing popular pieces of ObamaCare are hurting it with Democrats.

Ahead of an election year in which Republicans promise to make healthcare an issue again, Democrats are criticizing the White House for delaying policies that could help build support for the unpopular law.

 








< SCRIPT language='JavaScript1.1' SRC="http://ad.doubleclick.net/adj/N6451.3630.247REALMEDIA.COM/B7542175.6;abr=!ie;sz=300x250;click0=http://oasc05134.247realmedia.com/RealMedia/ads/click_lx.ads/HILLthehill/government/1{TIME_DATE_STAMP}/L22/855431174/Middle1/BBN/BCN2013030279_001c_Aflac/Aflac_BBN_300.html/596e536a774645644a587341444a4a7a?;ord=855431174?"> < /SCRIPT>< NOSCRIPT>< A HREF="http://oasc05134.247realmedia.com/RealMedia/ads/click_lx.ads/HILLthehill/government/1{TIME_DATE_STAMP}/L22/855431174/Middle1/BBN/BCN2013030279_001c_Aflac/Aflac_BBN_300.html/596e536a774645644a587341444a4a7a?http://ad.doubleclick.net/jump/N6451.3630.247REALMEDIA.COM/B7542175.6;abr=!ie4;abr=!ie5;sz=300x250;ord=855431174?"> < IMG SRC="http://ad.doubleclick.net/ad/N6451.3630.247REALMEDIA.COM/B7542175.6;abr=!ie4;abr=!ie5;sz=300x250;ord=855431174?" BORDER=0 WIDTH=300 HEIGHT=250 ALT="Advertisement"></A> < /NOSCRIPT> Democrats complained this week about a one-year delay in a key program designed to help small businesses — a central selling point for the healthcare law that now won’t be in place when voters head to the polls next year.

“Senate Republicans will have the opportunity to campaign against Obamacare's rising health care costs, burdensome paperwork and broken promises and could use it to motivate voters against Democrat candidates, especially vulnerable ones in red states,” Republican strategist Ron Bonjean said.

HHS has delayed by one year a provision that would have allowed small businesses in most states to choose from multiple policies for their workers. Although a handful of states will see increased competition next year, most will have just one plan to choose from until 2015.

Sen. Mary Landrieu (D-La.) told The New York Times the delay will “prolong and exacerbate health care costs that are crippling 29 million small businesses.”
 

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Democrats are also complaining more openly about other implementation delays. And the substance of the law itself isn’t immune from bipartisan criticism — 33 Senate Democrats cast a non-binding vote last month to repeal the law’s tax on medical devices, saying it’s a threat to innovation that could raise costs for consumers.
 
The party has long acknowledged that the Affordable Care Act has its flaws. Their new openness about those flaws comes after Obama’s reelection, which ensured that the law would not be repealed before it’s fully implemented.
 
But it also comes just ahead of the 2014 election cycle, when vulnerable Democrats in conservative states will have to defend their votes for the health law.
     
Landrieu is already facing a tough reelection fight next year. And one of the Republicans who has lined up to challenge her, Rep. Bill Cassidy (R-La.), is a doctor who still sees Medicaid patients when Congress isn’t in session.
 
In addition to rank-and-file Democrats who voted for the healthcare law, Republicans this time are hoping to defeat Sen. Max Baucus (D-Mont.) — who was the primary author of the Affordable Care Act in his position as Finance chairman.
 
Senate Republicans’ campaign arm attacked Baucus this week as the “ObamaCare architect.”
 
Flaws in the law’s execution — such as higher premiums or fewer options for small businesses — could be weapons against Baucus.
 
"People already don't like ObamaCare, but they're really not going to like the tax hikes, mandates, fees, penalties, and added red tape bureaucracy that go info effect over the next eight months. It goes from being an abstract discussion to a real life pain," the National Republican Senatorial Committee said.
 
Democratic strategists say they’re not especially worried about healthcare attacks in 2014.
 
Democrats point to their wins in several deeply conservative states in 2012, including Sen. Jon Tester (D-Mont.), who voted for the healthcare law, and Joe Donnelly, who won a Senate seat in Indiana despite supporting the healthcare bill when he was in the House.
 
“Sounds like Republicans plan to continue the same failed message strategies of 2012,” the Democratic Senatorial Campaign Committee said.
 
Most Senate Democrats are by no means running away from their healthcare vote entirely. Landrieu, for example, has criticized Louisiana Gov. Bobby Jindal for refusing to participate in the law’s Medicaid expansion.
 
But they’re more willing to support certain changes to the law, such as repealing its medical device tax. And they’re more open to criticizing the implementation — particularly on an issue like choices for small businesses, which was a key part of the rhetorical push to pass healthcare reform in 2010.
 
The Obama administration has also taken friendly fire from Sen. Maria Cantwell (D-Wash.), a member of the Finance Committee who was heavily involved in crafting certain parts of the healthcare law that gave new options to state governments.
 
Cantwell has said she would not support Marilyn Tavenner, Obama’s nominee to lead the Centers for Medicare and Medicaid Services (CMS), because of her frustration with the delays in a provision known as the Basic Health Plan.
 
The provision would let states bargain directly with insurance companies to create a scaled-down plan for people who aren’t eligible for Medicaid but might not be able to afford the more expensive private plans sold through newly created exchanges.
 
HHS has responded to Cantwell’s concerns over the recess, although in an interview shortly before leaving town, Cantwell said she wasn’t buying the administration’s explanation that it is simply too swamped with other work to implement the Basic Health Plan on time.
 
“Well, Ms. Tavenner definitely will not have my support and I’m not interested in how she’s going to implement the Act,” Cantwell said during a hearing in February. “I’m interested in the commitment to the administration to live up to the way the Affordable Care Act’s provisions say it should be implemented.”



Read more: http://thehill.com/blogs/healthwatch/health-reform-implementation/292157-obamacares-new-enemy-friendly-fire#ixzz2Pt0rBIPX
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