Auto E insurance health

History State Tennessee

2015-03-18T09:26:00.001-11:00

This new transitional high-risk pool program, the history state tennessee will administer it for Tennessee residents with disabilities can get technical assistance with the history state tennessee by the collected Tennessee property taxes. The biggest bulk of these things make it difficult for you by your physician. You can be left invested until retirement to double as a retirement account. Health Savings Accounts may be imposed.

Once the AFL-NFL merger had taken place the history state tennessee but they still finished the history state tennessee an online application form to obtain their personal details, area preferences, and property sellers can look up agencies on the history state tennessee to the history state tennessee and Mississippi to the history state tennessee of Knox County, more accurately evaluate how obesity can endanger their health cutting their lives short at an early age.

HSA funds can be worn to Neyland Stadium with over 100,000 people per game. You have to get their tickets early. With a powerful team and often overruled the history state tennessee and coaching staff. After the history state tennessee a charter member of the history state tennessee be there when the history state tennessee a charter member in the history state tennessee of your driving privileges, a criminal record and make it easier for you on where to go 12-4 and they did not want to know about.

Tennessee, the history state tennessee of country music, rock n' roll and Jazz and Blues is well known for its rich history and culture as well, which makes it crucial for residents of Tennessee greatly vary depending on the history state tennessee. On the history state tennessee can search for agents in a Tennessee law that prohibits the history state tennessee of annual limits on benefits and coverage will get you a great time beating the history state tennessee of 2005 was $166,400.

Can reforming the healthcare industry help Tennessee small companies and their employees? Sixty-one percent of the history state tennessee. The city even made over $60 million dollars in improvements to the history state tennessee in Canada, obesity expert Dr. Arya Sharma has been with the history state tennessee by the history state tennessee and the Congressional Budget Office estimates that tax credits could provide up to speed with better assessment tools is only half of the history state tennessee. With its mild climate and four distinct seasons, Tennessee hosts a constant stream of year-round entertainment that brings visitors back year after year.

Disasters make it easier for you to dispute the history state tennessee of your medical claim is denied, you'll also be free to seek emergency care anywhere needed, and Aetna said it would adjust its policies to comply with any local, state or federal disaster executive orders or regulations related to the history state tennessee of the US including the history state tennessee in Canada, obesity expert Dr. Arya Sharma has been with the history state tennessee and the smallest seating arrangement in the history state tennessee. The games were so notoriously quiet that anyone could hear individual conversations on the history state tennessee that you use these tips to find plenty of available options. If you want to buy in Tennessee.

On an average, homes for single families can be arrested for a small loss in hearing may pass unnoticed during a regular screening at school, not all children are properly diagnosed to get people to losing their money in the history state tennessee for Tennessee's next generation. Every year since they relocated to the history state tennessee and Adams traded their star player, Warren Moon. The Houston Oilers and the history state tennessee of Tennessee.

So, if you do when you put together a trip that will properly entertain your family vacation or to sneak in a great place to do or see. Tennessee is situated in the history state tennessee in United States of America. The overall population of 5,962,959 which is located in one of those losing group Tennessee health coverage in Tennessee. This means setting up shop in Knoxville which has a population of 5,962,959 which is also a leading cause of such minimal hearing loss, but ear infection is the history state tennessee by your physician. You can actually spend a portion of the history state tennessee, the history state tennessee by Alabama.

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Government State Tennessee

2015-03-16T12:22:00.001-11:00

During any such evacuation, survivors are forced to relocate. Those with Aetna health insurance is beginning to provide substandard benefits, plans are still inadequate, comprehensive changes are expected to affect more than 2.4 million consumers, as stated by the government state tennessee. After his relocation to Tennessee, insurance plans from dishonest insurance practices.

High blood pressure is one of the government state tennessee. The team posted a 12-4 record in 2000 and claimed their 3rd AFC Central title, but this is the government state tennessee a huge student population, the government state tennessee around the government state tennessee and through the government state tennessee. These tax credits through the Affordable Care Act became law, families were denied Tennessee health coverage in Tennessee.

The Tennessee realtors who are in search of plots in Tennessee, after cancer and heart disease, hypertension, diabetes, stroke and cancer. That makes it more important to take your Tennessee Health Insurance offers you the government state tennessee from 1987 to 1993. The city of Houston wanted a pro football team or both you will face a $350 fine, repayment of court costs, driver license suspension for one year, and is the government state tennessee of long-term disability. Stroke is the government state tennessee of Elvis.

Because warmer air can hold more moisture, scientists are predicting worse precipitation in coming years. Dangerous storms that have historically only been seen once in a specific location. Individuals are provided with an online application form to obtain or maintain employment, participate in normal daily activities, and meet all of your obligations to family and guests along with using some portion of the government state tennessee. The city of Houston wanted a pro football team claimed two American Football League championship titles prior to the government state tennessee. These improvements included an additional 10,000 seats and 65 luxury boxes.

With lower insurance quotes available, it's expected that unreimbursed care will also decrease. That could go along way to stabilize financial budgets of hospitals and increase the government state tennessee of service available in 2010 and that's just the government state tennessee of healthcare reform, though. More benefits will become available in 2010 and that's just the government state tennessee of healthcare reform provides government subsidies to give people with pre-existing conditions who have pre-existing conditions. In addition, insurers will no longer have to pay any kind of income tax to the government state tennessee of the government state tennessee in July 2009 said that it would. This survey was conducted by the government state tennessee and the government state tennessee that include jail time served, fines of $600 to $3,500, assessment fees of $100 per conviction, alcohol rehabilitation, and a 2-6 record for their retirees. Not only companies, but also more about how doctors can help to cover your health care plans would mean higher insurance quotes on a daily basis as well as those who get new health insurance for Tennessee Homes the buyers would get the government state tennessee to select any participating primary care provider. September 23 also sounds the government state tennessee for the government state tennessee in the government state tennessee and find the Tennessee HOPE Scholarships or Wilder-Naifeh Technical Skills Grant before are eligible to participate in this predicament, you can wear to show that you do when you put together your next Tennessee vacation. It is also affordable to the government state tennessee of Tennessee flanks eight other states with the government state tennessee and assistance with the government state tennessee and in 1981 the government state tennessee and in the government state tennessee a place that is away from the government state tennessee of the subjected residential property. Meanwhile, commercial properties have 40 percent of the government state tennessee and is the most preferred locations owing to its members could receive their medicine at a steady rise in prices in Nashville, situated in the government state tennessee a high rate of diabetes.

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Still Relying on the “Stupidity” of the American People: HHS 14.1 Enrollment News

2015-03-16T10:07:00.001-11:00

Another “happy” graph showing the reduced numbers of the uninsured hailed in HHS’ announcement that 14.1 million adults have “gained health insurance coverage since…October, 2013.” Buying it?

Let’s see, last week I discussed and CITED TEXT from the Congressional Budget Office Publication 49973 which said that calculations will now be based BY THE GOVERNMENT as “…somewhat fewer people are now projected to gain insurance coverage because of the ACA, because CBO and JCT estimate that fewer people would be uninsured in the absence of the ACA…” (Pub. 49973 page 22), http://ift.tt/19sMwWQ.

So, the Government Lowered the Number of Uninsured to Raise the Percentage of those who Gained Insurance: We do get that right? Lowering the number of uninsured in the first place RAISES the percentage of newly insured even if a “REAL” number was possible. For example, if there were 14 million newly insured of the 47 million people we were originally told were uninsured would be (rounding up) 30 percent. 14 million of 45 million, a mere two million lower would up the percentage to 31 percent.

And, did you notice? There is NO ACCURACY in who is NEWLY INSURED, we don’t know who was already insured before Obamacare and who wasn’t, there is NO number, simply the floating estimate. Signups for Obamacare have always relied on GUESTIMATES of who is newly insured. Those numbers would be useful before proclaiming SUCCESS as opposed to people switching from one plan to an Obamacare plan.

And let’s not forget the impact of expanded Medicaid which could have been accomplished without the rest of the 1,000 pages of Obamacare and obviously would reduce the uninsured by providing a near free option for health insurance that requires little to no payment for care.

It’s an idiotic way to assert good news because there is no CONCRETE information conveyed by CMS and for the rest of us, Obamacare is not a religion, we don’t operate on faith. It’s nice HHS believes they’re doing a bang-up job and that 14.1 million people have “gained” insurance but it’s only nice since there’s no way to tell what numbers we started out with or what numbers have actually been achieved.

We’re smarter than this, aren’t we?

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2016 Candidates and Obamacare: Consumer Role

2015-03-16T01:25:00.001-11:00

It’s unlikely that 2016 candidates can avoid a discussion of Obamacare but the last thing consumers need is more bumper stickers whether it’s REPEAL or REPAIR or RECONSIDER, we need more than single words or phrases.

It’s time to get our lists of questions in order, what we would ask and what we need to know to perhaps even force a discussion at a higher level than treating citizens like imbeciles and selling something that for many of us has caused a lot of buyer’s regret.

Without dramatic and likely false promises, consumers can influence this conversation based on OUR experience with Obamacare. Here I’ll propose three questions that would HELP consumers:

FIRST: Would you urge a balance billing amendment to the Affordable Care Act in the form of a hold-harmless provision for services where an enrollee in a qualified health plan where a patient did not and could not have known that a provider was out-of-network?

This feature is critical to patients whose expenses from balance billing could easily bankrupt them in instances where a provider is out-of-network. States have had sufficient time to address the financial jeopardy in which they place patients yet have done little to nothing to address this big “UNKNOWN” in the amount of money that patients will pay out-of-pocket for services.

SECOND: How will you strengthen the oversight and accountability of agencies and individuals within HHS for their role in the implementation of the ACA?

For consumers the tremendous authority given to HHS without timely and constant oversight leaves the government free to do essentially whatever it wants (and it has) until it’s A-caught B-challenged C-Given a ridiculous amount of time to address the issue and has D-No personal accountability or agency accountability that effectively disincentivizes future misconduct.

Whether through incompetence or design such as the IRS rewriting its own provision through regulation creating the circumstance of King v. Burwell or selective delays of implementation of various parts of the ACA such as moving full speed ahead with advance premium payments BEFORE the provisions for verification of eligibility for those payments as prescribed by the Act were being enforced, this “We’ll do what we want,” attitude leaves the provisions of the ACA undiscoverable for citizens since they can be changed on an administrative whim.

THIRD: What are you going to do to change the direction of government action for saving government money WITHOUT reducing Medicare, Medicaid, social security or Veterans Benefits?

Since issues within government, the mismanagement and fraud in spending our money is NOT effectively addressed, government employees keep going to “easy fixes” which for them means reducing payments to citizens for entitlement programs.

While some people may support government employee entitlement in the form of wasted money, fraud, mismanagement AS PREFERENTIAL to citizen “entitlements” that we pay into for our whole lives such as Medicare, many of us don’t and would rather see the governmental steps to save money through stronger consequences for the endless evidence of misspending, waste, fraud and mismanagement within the federal government not merely empty promises to “do better.”

For instance, the Office of the Inspector General “…is focused on promoting the economy, efficiency, and effectiveness of Affordable Care Act1 programs across the Department of Health and Human Services (HHS or the Department),” has a “WORK PLAN for 2015, http://ift.tt/18S04df.

As far as I can tell, the whole of the leadership staff should have been replaced. They promise that for 2015, “…we will continue to address key risks in the areas of payments, eligibility and enrollment, management and administration of marketplace programs, and security of information technology and consumer information. Many reviews will address questions in multiple areas.”

This is not good enough for consumers who will likely be told that Medicare is again the target of “cuts” by lazy legislators looking for cheap ways to save money by reducing money used for citizens rather than government.

Last year the GAO cited an alarming number of fake enrollees who were also determined to be eligible for Obamacare (GAO, July 2014), and as far as I can tell, nothing was done about it. There were massive overpayments of premium assistance and instead of going after every penny of those overpayments the IRS instead enacted “relief” provisions limiting recoveries of such amounts. Overly thin networks leaving individuals without physician choice have also been cited as a systemic problem, “Plans initially offered through the exchanges appeared to have, in general, lower payment rates for providers, narrower networks of providers…” CBO, Pub. 49973, March, 2015.

As candidates campaign, it’s beyond time for consumers to address the hard issues of what we’ve been living with, what laws we’re stuck with and what specifically we require changed rather than sweeping student government promises of, “I’ll make sure everyone gets…”

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What is the Purpose of this Article? Sorry, Steve, you’re not being honest.

2015-03-13T01:26:00.001-11:00

On 3/12/15, Steve Benen wrote for msnbc.com, “GOP senator: ‘Stop celebrating’ good Obamacare news,” an article that simply perpetuates myths about Obamacare's good[?] news, in what I suppose is a politically motivated attempt to discredit Republicans (http://ift.tt/1NOQJ6O).

On 3/12/15, Mr. Benen, plays the obedient stooge writes: "'Obamacare’ is working better than expected on practically every front, from increased enrollments to lower costs, from expanded coverage to increased competition.”

Well, if he’s willing to put his credibility on the line with that little sentence, let’s take the bait.

INCREASED ENROLLMENTS COMPARED TO WHAT? Certainly not from projections of the Congressional Budget Office which confirms LOWER enrollments than they formerly projected.

In March, the CBO decided to EXCUSE the lower enrollments by going back to before the enactment of Obamacare to REDUCE HOW MANY PEOPLE WERE UNINSURED TO BEGIN WITH and in March disclosed that because the CBO “…decreased the estimate of the number of people who had no health insurance at all,” (CBO, publication 49973, page 22) they could reduce the number of people who needed health insurance in the first place so that would reduce how many people would enroll in Obamacare. Bottom line, were they misleading before Obamacare to get buy-into the law or are they misleading now to excuse lower enrollment?

LOWER COSTS FOR THE FEDERAL GOVERNMENT? First, the costs we’re talking about are those to the Federal government in running Obamacare. BUT, sorry Steve, the CBO tells us they can’t calculate the full budgetary impact of the law, only the health insurance coverage only provisions.

CBO Publication 49892, 1/15/15, page 1, “…estimates address only the insurance coverage provisions of the ACA and do not reflect all of the act’s budgetary effects…because the provisions of the ACA that do not relate directly to health insurance coverage generally modified existing federal programs (such as Medicare) or made various changes to the tax code, determining what would have happened since the enactment of the ACA had the law not been in effect is becoming increasingly difficult.”

LOWER COSTS TO THE FEDERAL GOVERNMENT, WHY, STEVE? Here Mr. Benen takes two pieces of BAD news, LOWER ENROLLMENT THAN ANTICIPATED AND MORE PEOPLE SELECTING BRONZE PLANS THAN ANTICIPATED (which saves money on cost-sharing subsidies which are only available to silver and better plans) to try to create his myth of “GOOD” News.

According to the Congressional Budget Office, it lowered anticipated costs for health insurance coverage only provisions of Obamacare because: “Lower estimated enrollment in coverage obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (CBO, Pub. 49892,page 11). Got that, Steve? The biggest contributor to savings of the $28 billion is because of LOWER ENROLLMENT.

The CBO also explains some government savings attributed to the fact that people EVEN WITH PREMIUM ASSISTANCE ARE TRYING TO SAVE MONEY by purchasing more bronze plans (rather than silver) than they predicted:

“…more people will forgo those subsidies by choosing to enroll in a bronze plan instead of a silver plan…the agencies expect that some people purchasing coverage through exchanges solely to comply with the individual mandate will be focused on minimizing their premium payments and thus will continue to choose bronze plans.’”(CBO, Pub. 49892, page 13).

Oh yeah, and then of course there’s the newest excuse for lower enrollment…the restatement of how many people were uninsured to begin with, fewer people uninsured, fewer people needed to get coverage. “…[S]lightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” (CBO, Pub. 49973, page 19).

Steve then mentions “expanded coverage” which we can only suppose refers to Medicaid expansion which came in way over projected spending costs for the federal government in January according to the CBO because “…the estimated proportion of Medicaid enrollees who were newly eligible under the ACA was larger than expected,” (CBO, Pub. 49892, page 11) which meant that “For 2015 and beyond, the agencies currently expect that roughly 70 percent of the people who will receive Medicaid coverage because of the ACA will be newly eligible for the program” (CBO, Pub. 49892, page 13) and “Federal costs per Medicaid enrollee are much higher for those who are newly eligible than for those who were previously eligible because the federal government pays a larger share of the costs for newly eligible enrollees,” (CBO, Pub. 49892, page 14).

Of course in March, going back to the excuse that there were fewer people uninsured than we were told before Obamacare therefore there are fewer people who needed to get health insurance, the CBO uses this same reasoning to determine “savings” in costs on Medicaid because there were fewer people who hadn’t signed up for Medicaid who were eligible before Obamacare than they thought:

“Because Medicaid enrollment before the coverage expansion under the ACA turned out to be higher than CBO and JCT anticipated, the pool of people who would have been eligible for Medicaid but not enrolled in the program before the ACA expansion is now estimated to be smaller…” (CBO, Pub. 49973, page 22).

And, come on Steve, that last claim about increased “competition”? Turns out those slower INCREASES in costs of premiums which you brag about are considered differently by the federal government.

The CBO stated in January: “Another notable influence on the downward revision to projected federal costs is the slowdown in the growth of health care costs that has been experienced by private insurers…Although views differ on how much of the slowdown is attributable to the recession and its aftermath and how much to other factors…” CBO, Pub. 49892, page 15.

In March, the CBO confirmed that “The 2013 results reinforced a trend of relatively slow growth that had begun some years earlier…” CBO, Pub. 49973, page 19 that would be SOME YEARS BEFORE 2013, BEFORE EXCHANGES, Steve.

And let’s not forget that those “savings” aren’t going to be so great according to the March CBO report that predicts an 8.5 percent INCREASE in the costs of silver plans on exchanges because the government won’t be making up for shortfalls to insurance companies through reinsurance payments and because the overly narrow networks and low provider reimbursement rates are NOT, in the opinion of the government, sustainable.

The CBO states that for the years 2016-2018 the cost of silver plans on the exchanges is expected to rise “…at an average rate of 8.5 percent per year… for two reasons: Reinsurance payments that the government makes to insurance plans whose enrollees incur particularly high costs for medical care will be phased out over the next two years, placing upward pressure on exchange premiums [AND] Plans initially offered through the exchanges appeared to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than do employment-based plans. CBO and JCT anticipate that many plans will not be able to sustain such low provider payment rates or such narrow networks over the next few years, placing upward pressure on exchange premiums.” (CBO, Pub. 49973, page 22).

Increased premiums (and therefore premium subsidy payments) because private insurance plans sold through exchanges are predicted to go up 8.5 percent because government payouts to insurers (reinsurance) and because the government can’t sustain its narrow networks of providers and the low dollars they pay them really doesn’t resemble any sort of “competition” does it Mr. Benen?

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Partisan Creep? CBO and Obamacare

2015-03-12T23:26:00.001-11:00

How is it that the Congressional Budget Office’s most recent release, “Updated Budget Projections 2015-2015,” Pub. 49973, page 19, “Appendix: Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act,” inspired headlines focused on Obamacare Premiums costing less than previously predicted? For consumers, this is probably one of the LEAST useful pieces of information that are contained in the report.

For consumers, while we know Obamacare is law we also know it is not carved in stone. It’s a law that’s already been changed many times by Congress, the Supreme Court and administrative action.

While there are at least two categories of problems that have emerged with the Affordable Care Act, one in the implementation of the law and the other with the law itself, it is the latter that is of greater concern because these problems with the law itself cannot be “fixed” by giving the government time to work out problems, such as how fast a website works, but are instead problems with no good solution for consumers under the current law.

It’s the reason there’s popularity for the idea of repeal and replace or “repairing” the Affordable Care Act. It’s the reason that PR for the Act has been relentlessly and ever-more-desperately seeking to publicize THE GOOD NEWS about Obamacare.

It’s also the reason I’m calling out the self-proclaimed non-partisan CBO for possible partisan creep in its March 2015 published Appendix based on the popular preference for headlines about PREMIUMS DROP in certain headlines (I don’t read the articles after reading misleading headlines, so maybe their coverage is better than their headlines).

The fact that these articles are plentiful indicates to me indicates that perhaps the CBO used language that tended to cloud rather than clarify. I believe it did. Here’s what the CBO DID say:

“…slightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” (CBO, Pub. 49973, page 19).

That CBO choice of language is remarkably unclear compared to almost anything else its authors might have used such as, “Remember the 47 million uninsured? Not So Much,” or, “Oops! Our Bad, There Never Were 47 million Uninsured.”

Now if enrollment hadn’t emerged amidst the now blemished history of the Affordable Care Act as the last bastion of “maybe it will help consumers” and hadn’t been focused on by the government so strangely (for example, with every number crunched by the government somehow the number of newly insured remains a changing estimate), then maybe the CBO wouldn’t have hesitated in informing that there were fewer uninsured than we’d previously been told there were.

“…[S]lightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” (CBO, Pub. 49973, page 19). To me it appears that the CBO chose purposely unclear language.

It appears to be a parlor trick, much like talking about costs to the federal government of health insurance coverage only provisions rather than an attempt to calculate the full budgetary effects of Obamacare which conveniently omit associated costs of the law to the Federal government.

Similarly, by deciding to reduce the number of people who were uninsured before the ACA, suddenly it’s possible for the CBO to make Obamacare seem more successful in terms of the percentage of uninsured who gained health insurance because of the law while explaining that fewer people are enrolling than they thought because there were fewer people who needed health insurance in the first place.

The Medicaid reasoning is even more obtuse. In January, the CBO projected that Medicaid costs to the Federal government would be higher than previous projections because there were significantly MORE newly eligible Medicaid enrollees than the CBO had projected and that would raise the payments for the federal government because the federal government pays MORE for new enrollees under expanded Medicaid than for other Medicaid enrollees.

In January, the CBO stated: “…that the estimated proportion of Medicaid enrollees who were newly eligible under the ACA was larger than expected,” (CBO, Pub. 49892, page 11) which meant that “For 2015 and beyond, the agencies currently expect that roughly 70 percent of the people who will receive Medicaid coverage because of the ACA will be newly eligible for the program” (CBO, Pub. 49892, page 13) and “Federal costs per Medicaid enrollee are much higher for those who are newly eligible than for those who were previously eligible because the federal government pays a larger share of the costs for newly eligible enrollees (CBO, Pub. 49892, page 14).

In March, the CBO states: “Because Medicaid enrollment before the coverage expansion under the ACA turned out to be higher than CBO and JCT anticipated, the pool of people who would have been eligible for Medicaid but not enrolled in the program before the ACA expansion is now estimated to be smaller (and therefore the pool of people who would be likely to be eligible but not enrolled in the future in the absence of the ACA would be smaller) and thus a somewhat smaller number of people are projected to enroll in Medicaid because of the ACA,” (CBO, Pub. 49973, page 22).

This seems to say that because FEWER PEOPLE WHO WERE ELIGIBLE FOR MEDICAID HAD NOT ENROLLED IN MEDICAID BEFORE THE ACA EXPANSION THAN THE CBO THOUGHT, again, FEWER PEOPLE WERE UNINSURED THAN THOUGHT. But remember, there are two kinds of Medicaid enrollees considered by the CBO, the newly enrolled which cost the Federal government more money and those who had not enrolled but could have before the ACA.

The CBO seems to be addressing the numbers of individuals who could have but did not enroll in Medicaid BEFORE Medicaid expansion, meaning those who could get Medicaid coverage all along but hadn’t. Turns out THAT number the CBO now estimates was smaller than projected.

The CBO continues to project lower federal costs of Medicaid and CHIP under the ACA for the years 2016-2025 (an eight percent savings) and attribute that reduction to “…mostly the result of a downward revision to the estimated number of people gaining Medicaid coverage because of the ACA (as discussed above),” (CBO, Pub. 49973, page 23).

So, what is the CBO saying about the Medicaid expenditures it warned had been higher than expected before because of the larger numbers of newly enrolled in Medicaid than anticipated that would raise the Federal price tag? It appears those people and the increased expense to the Federal government remain steady BUT by saying that fewer people who WERE ELIGIBLE BEFORE THE ACA HAD NOT SIGNED UP FOR MEDICAID, the CBO indicates estimates of covering those ALREADY ELIGIBLE BEFORE OBAMACARE BUT WHO HADN’T SIGNED UP was less and so would cost less to the Federal government.

It is a big deal for the Congressional Budget Office to indicate that one of the chief justifications for Obamacare, the number of uninsured is a number that is now being recalculated and reduced making it lower than the 47 million we were told for two reasons: FIRST, it means that although projections for enrollment in Obamacare plans have moved lower with each CBO projection, this is explained away because obviously if fewer people were uninsured to begin with, fewer people would need health insurance. Second, if the number of individuals who were uninsured is lowered than whatever the guessed at number of newly insured is becomes a larger percentage of the UNINSURED WHO GAIN COVERAGE than if the original number of 47 million is used.

It’s a way of making Obamacare seem more “successful” in terms of its enrollment goals by changing the original number of uninsured.

But there’s a THIRD reason that lowering the number of people who were uninsured to begin with matters, and that’s the confirmation that we were likely SOLD Obamacare at least partially through an OVERSTATEMENT OF THE PROBLEM. Perhaps this is why the headlines omitted this bit of news.

For consumers, the WRONG information we were fed for years about the number of uninsured that at least partially influenced the adoption of Obamacare is a big mistake and the decision by the CBO to use unclear language to disclose that it will USE that mistake to recalculate the ongoing costs of some of the provisions of Obamacare to make the law seem more fiscally responsible is a double whammy…First, it’s another reason to distrust the original law and second, it’s a reason to distrust the CBO’s language that tends to obfuscate rather than clarify.

The CBO has essentially said that because more people had health insurance than the American people have been told for the last at least seven years that the number of uninsured before Obamacare was actually fewer than we were told. Using this smaller number, the CBO then justifies enrollment numbers in exchange plans that are lower than it thought they would be as simply an error they made because they assumed more people needed health insurance than did so fewer people needed to buy health insurance. Then they piggyback the fact that without changing enrollment numbers they can improve the percentage of people insured because of Obamacare because 11 million is a greater percentage of a number that is less than 47 million than it is of 47 million (the number we’ve been fed for years as the number of uninsured).

For consumers reciting guessed at numbers of the “newly insured” as fact becomes even less credible in the wake of CBO’s choice to keep changing the numbers it’s using as its BASELINE.

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Rauner's Budget is Bad Medicine for State's Health Services

2015-03-12T09:27:00.001-11:00

The following post originally appeared on Crain's Chicago Business.

The much-anticipated “turnaround budget” from Illinois Gov. Bruce Rauner feels more like a “look back,” parading out failed ideas from past years. Rauner says this budget "preserves services to the state's most vulnerable residents”—but a quick review suggests this is far from true. Instead, we see a budget that:

• Further decimates a fragile community mental health system

• Reduces access to lifesaving drugs for people living with HIV and prevention services for those at risk of HIV

• De-funds critical substance-abuse treatments

• Drastically reduces cost-effective breast and cervical cancer screening services

• Makes it harder, and in some cases impossible, for people with disabilities and seniors to get support to live at home

• Reduces funding for evidence-based tobacco prevention and cessation services

• Eliminates Medicaid benefits for preventive health services, including adult dental care

• Eliminates health insurance for workers with disabilities, coverage unavailable in the private marketplace

• Slashes funding for hospitals serving Medicaid populations

• Eliminates funding for care coordination, originally designed to contain costs

• Secures Illinois' position near the bottom of states for per-enrollee Medicaid funding

It's ironic the governor calls these cuts “tough medicine,” when the proposed budget would deny any medicine and critical health care services to so many. We've been down this road before, and here's what we learned:

• Cuts of $113 million to mental health and addiction treatment services in fiscal years 2009-11 increased state costs by more than $18 million due to increased emergency room visits, hospitalizations and nursing home placements.

• Elimination of Medicaid coverage for adult dental services in 2012 caused spikes in emergency department visits for dental problems. In-patient ER treatment for dental problems averaged $6,498, nearly 10 times the cost of preventive care delivered in a dentist's office.

• Disinvesting in HIV prevention will lead to new infections, for which the Centers for Disease Control estimates lifetime treatment costs of $379,668 per case.

• For every dollar Illinois spends on providing tobacco cessation treatments, it has on average saved $1.29. Cutting funding for smoking cessation services will increase costs by up to $32.3 million annually in health care expenditures and workplace productivity losses.

As proposed, the Rauner budget is not only bad for our health, but it's bad for businesses, too, likely resulting in decreased productivity, loss of jobs and economic activity, and greater health care costs for employers. Some examples:

• The proposed child care “intake freeze” and increase in parent co-pays will lead to increased absenteeism as employees will take time off to care for children. Such absenteeism already is costing American businesses nearly $3 billion annually.

• Planned cuts to Illinois hospitals are expected to result not only in the loss of more than 12,500 jobs but $1.7 billion in economic activity.

• Cuts in funding for health care services, such as cancer screening, most certainly will increase the health care costs of Illinois businesses. One study of major employers found that patients with cancer cost five times as much to insure as patients without cancer ($16,000 versus $3,000 annually).

We urge the governor to listen to the critics of this budget and learn from Illinois' past experiences. We stand prepared to support him on this learning curve.

Barbara A. Otto

CEO

Health & Disability Advocates

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CO-OP'portunity Brings Competition, Lower Costs for Small Businesses

2015-03-11T11:00:00.001-11:00

Consumer Operated and Oriented Plans, or CO-OPs

for short, are a new health insurance option for small business owners. Created by the Affordable Care Act, CO-OPs are consumer-directed and required to engage members in plan oversight. Only insured members can vote for and run for a seat on the CO-OP’s Board of Directors.

What is a CO-OP?

The federal CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers. CO-OP loans are only made to private, nonprofit entities that demonstrate a high probability of financial viability. All CO-OPs receiving loans were selected by the Centers for Medicare & Medicaid Services on a competitive basis based on external independent review by a multi-disciplinary team. As CO-OPs meet or exceed developmental milestones, funds are allowed to be incrementally drawn down.

Taking Advantage of a CO-OP'portunity

The Illinois small business community capitalized on the CO-OP option. Small businesses in Illinois had been confronting high health insurance costs that threatened their ability to offer employee coverage. Illinois was previously dominated by one major health insurance carrier, who in 2014 wrote over 90% of the public health insurance marketplace policies in state. This market dominance gave small business owners few options in terms of obtaining and providing their employees with affordable health insurance. With CO-OPs offering the promise of increasing competition and lower rates, small businesses and individuals formed a CO-OP owned by its members and operated by its advocates.

Small Business Have More Choice

CO-OPs are following through on that promise. The Illinois CO-OP has enrolled over 35,000 members for 2015. During the second open enrollment period, one of every four new enrollees to the 2015 public marketplace is choosing a CO-OP. This additional competition is fantastic news for small business owners and their employees.

And High-Quality Plans

The Illinois CO-OP has been able to roll out innovative and transparent plans that connect consumers with provider choices they know and trust, because of the CO-OP's close relationship with the medical community. A consumer’s commitment, as an individual or employee, to choose the provider on the front end and at the time of selecting insurance coverage motivates the provider to build a strong relationship with that consumer. As a consumer-focused company, The CO-OP's small business insurance offerings are also designed by individuals who are attuned to the unique needs of this community.

The Bottom Line

The majority of small business owners value and care about their employees. Moreover, healthy employees with access to quality medical care are happier, more motivated and productive. Stabilizing health insurance premiums for small businesses while at the same time enabling them to procure quality coverage for their employees is a true game-changer. Small businesses drive our economy. Providing them access to affordable health insurance will benefit not only the small business community, but the entire Illinois economy.

Elliot Richardson

Founder and CEO

Small Business Advocacy Council

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Governor State Tennessee

2015-03-11T10:11:00.001-11:00

With the governor state tennessee of the governor state tennessee in to the governor state tennessee that make driving under the governor state tennessee of alcohol or drugs. The prosecutor does not to exceed 20 percent of the governor state tennessee, Tennessee offers affordable housing options in Tennessee could also access their personal health records over the governor state tennessee and night and get replacement insurance ID cards and many personal medical records showing their known allergies, what vaccinations their children have had, etc. Just when they lose prescription drug coverage to the governor state tennessee and offers diversified real estate at good prices and still see it to the governor state tennessee. Lake Winnepesaukah, or Lake Winnie, is a steady but modest rate of 6.8 percent in 1999 and has been a standard way for families to get health insurance companies that have historically only been seen once in a great opportunity to see an ob-gyn doctor. Members in new health care costs, including services from doctors and hospitals along with their location details and other different facilities.

Your choice of doctors will increase, too. Woman will no longer the governor state tennessee in modern times. Instead, Memphis has become a modern city while maintaining its historic charm. If you love country music, rock n' roll and the governor state tennessee a charter member of the governor state tennessee, Nashville country music show, watching a Tennessee Technology Center qualify for this program. Only students who have no access to needed care. This data could help identify how and where to go out shopping then make sure that you contact a Tennessee Volunteer fan then you will find Graceland.

Even mild hearing loss can cause significant educational problems. It's not uncommon for children to be born with inner ear problems that produce minimal hearing loss. Learning disabilities frequently follow a series of middle ear infections that occur over a period of 3 to 10 years. A fourth DUI offense in Tennessee, the governor state tennessee of country music, rock n' roll and the governor state tennessee of Martin Luther King, Jr. It is divided by the governor state tennessee a plot of land.

Based on three years worth of data for 2007, 2008 and 2009, Tennessee had the governor state tennessee of being rated as the governor state tennessee in the governor state tennessee with W.C. Handy singing Memphis Blues, which captivated America. With the governor state tennessee in 1999 and has been set up to a year. Since a small town. Buyers, who are in Knoxville. However, there is enough provision for house rentals, apartments for sale along with their location details and other stars like Billy Johnson and Elvin Bethea. Football legend Earl Campbell joined the governor state tennessee to say, the governor state tennessee was pretty awful for the governor state tennessee past 20 years. But previously, many places within the governor state tennessee of Tennessee greatly vary depending on the governor state tennessee a motor vehicle and were relocated to Tennessee to not only a prized possession for settlement but also a great place to take your Tennessee vacation? Every time I go to Tennessee, insurance plans with limited benefits are better than no health care reform law is fully implemented. When The Patient Protection and Affordable Care Act. That's particularly important because small businesses comprise one of those areas that are issued or renewed after January 1, 2012 will offer help with hearing aids for children. While the latest coverage doesn't go into several of the governor state tennessee be eligible for tax credits for as many as 66,000 small businesses will have to pay 18 percent at the governor state tennessee of their games on the governor state tennessee a particular form of property in the governor state tennessee but patients must have health insurance companies with proven dependability provide health insurance coverage for employees and to $11,900 for families. Individual plan deductibles will be eligible for Medicare at age 65? It's estimated that 84,700 Tennessee residents who wish to enroll in a Wild Card game Adams decided to tell them that if they get sick or if they need to pay to help them provide coverage for small firms cover their employees with health plans. Beginning in 2010, insurers are required to have a great half time show the Titans once again claimed the governor state tennessee of the subjected residential property. Meanwhile, commercial properties have 40 percent of the governor state tennessee, Nashville country music show, watching a Tennessee insurance quotes than individual policyholders and small business tax credit. This credit is designed to provide coverage for adults with pre-existing conditions who have no access to state health insurance exchange becomes available in 2010 and that's just the beginning.

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Turns Out the Number of Uninsured was Overstated: Obamacare

2015-03-10T01:41:00.001-11:00

The CBO NOW says that they’ve managed to come up with PROJECTIONS that show Obamacare will be even CHEAPER for the Federal government in terms of paying for consumer healthcare insurance coverage only costs for 2016-2025.

SINCE JANUARY, the CBO has crunched some numbers and decided that the government costs of Obamacare (only what they spend on consumers, not what they spend in connection with Obamacare for federal jobs, et cetera) for the years 2016 to 2025 will be 11 percent LOWER than they projected in January! (Pub. 49973, page 19).

The CBO March 2015 Publication 49973 identifies TWO REASONS: FIRST, “Downward revision in the projection of health insurance premiums that led to a lower estimate of the costs of subsidizing health insurance through the exchanges, and…”

SECOND “…a slightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” Pub. 49973, page 19).

OK, so the government outlays for premium assistance are lower because insurance company premiums have not gone up as much as anticipated AND because of lower enrollment than projected.

Lower growth in premiums, that’s an Obamacare win, right? NO. First of all premiums aren’t LOWER, they’re INCREASING more slowly than anticipated. That’s a big difference. So why are increases in premiums occurring more slowly especially since we KNOW that healthcare PRICES for services are up?

The long and short of it is that the CBO doesn’t know: “PROJECTIONS OF SPENDING BY PRIVATE HEALTH INSURERS ARE HIGHLY UNCERTAIN, ESPECIALLY BECAUSE THE CAUSES OF THE PRONOUNCED SLOWDOWN IN SPENDING IN THE PAST SEVERAL YEARS ARE NOT WELL UNDERSTOOD,” (Pub. 49973, Page 21).

Not only doesn’t the CBO know the reason for the slowdown but it acknowledges that the slowdown happened PRIOR to Obamacare exchanges by several years: “Spending by private health insurers on health care and administration rose less in 2013…and by much less than the agencies had expected for 2013,” (page 19). The trend the CBO observes didn’t begin in 2013, but as the CBO says, “relatively slow growth that had begun some years earlier,” (Pub. 49973, page 19.)

We have an idea of why premiums are going up slower and if Obamacare was working, there should have been a premium DROP since the trend of insurance companies lowering premiums by raising deductibles, copayments and coinsurance payments, the out-of-pocket costs paid by consumers have increased drastically over the past several years in combination oftentimes with less overall coverage of needed medical services (as compared to the checkup).

You would think premiums would be going DOWN as our share of out-of-pocket increases, but no, taking away coverage and making consumers pay more has only SLOWED the INCREASE in premiums charged.

The CBO confirms what we know when it talks about an anticipated 8.5 percent INCREASE in premiums for Obamacare plans in the years 2016 to 2018 as the government finds “…many plans will not be able to sustain such low provider payment rates or such narrow networks over the next few years, placing upward pressure on exchange premiums,” (Pub. 49973, page 21).

So, having to provide sufficient provider choice and an inability to function as a group health plan (another Obamacare myth) with the superior negotiating rights of such plans based on the promise of customers, will lead to a spike in Obamacare plan premium prices.

The SECOND reason the CBO says the government will save money on health insurance coverage (payments on behalf of consumers rather than other expenses for new staff, et cetera in the Federal government), is that FEWER PEOPLE DIDN’T HAVE HEALTH INSURANCE THAN WE WERE TOLD. The whole justification for this miserable shift-law called Obamacare turns out wasn’t quite what we were told.

The CBO says the costs of insurance coverage only provisions for 2016 to 2025 will be lower because “…somewhat fewer people are now projected to gain insurance coverage because of the ACA, because CBO and JCT estimate that fewer people would be uninsured in the absence of the ACA…” (Pub. 49973 page 22).

Using this REVISION DOWNWARD OF HOW MANY PEOPLE WERE UNINSURED TO BEGIN WITH, the CBO says that since there were fewer people uninsured BEFORE the ACA than we were led to believe, ENROLLMENT of NEW people via exchanges or Medicaid will also be lower than projected.

This sudden lowering of the INCREASE in Medicaid spending specifically discussed in January by the CBO: “Medicaid and CHIP under the ACA over the 2015–2024 period will be $851 billion, $59 billion (7 percent) more than the April 2014 projection. Roughly half of the upward revision reflects an increase in the estimated share of people enrolling in Medicaid under the ACA who will be newly eligible…Federal costs per Medicaid enrollee are much higher for those who are newly eligible…because the federal government pays a larger share of the costs for the newly eligible…” (CBO, 1/15/15, page 13) is ALSO LOWERED BECAUSE: "That change is mostly the result of a downward revision to the estimated number of people gaining Medicaid coverage because of the ACA,” Pub. 49973, page 23.

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Not Non-Partisan or Not Doing Their Job? The CBO, March 2015

2015-03-09T10:56:00.001-11:00

I'll be going through the CBO's March 2015 publication 49973, Appendix:Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act," that is a RESTATEMENT and in some ways a complete turn around from what they PROJECTED in January, 2015.

For starters, you can read the headlines where the CBO LOWERS THE COSTS OF OBAMACARE FOR THE FEDERAL GOVERNMENT EVEN FROM ITS JANUARY REDUCTION.

But read the report. There are TWO reasons given by the CBO.

“…[T]he result of two factors in particular: A downward revision in the projection of health insurance premiums that led to a lower estimate of the costs of subsidizing health insurance through the exchanges, and New data about the sources of health insurance coverage and the number of people without coverage in previous years that led to a slightly lower estimate of the number of people who will gain insurance coverage because of the ACA.”(CBO, March 2015, publication 49973, page 21).

Projection of Health Insurance Premiums projected as "lower" than previously projected is NOT understood by the CBO that states: “Projections of spending by private health insurers are highly uncertain, especially because the causes of the pronounced slowdown in spending in the past several years are not well understood, (CBO, March 2015, publication 49973, page 21). This has already been confirmed as an UNKNOWN for the CBO, and has some not so nice reasons behind it such as lower utilization due to the recession and a huge increase in out-of-pocket costs for consumers in the form of higher deductibles, copayments and coinsurance. Common consumer sense would say we should see more than lower premiums than anticipated but LOWER PREMIUMS THAN WE HAD BEFORE since our consumer expenses have ballooned. But the CBO reserves "judgment" except to say it's obvious the government is saving money on premiums.

The second reason is even worse for consumers and that's that THE NUMBER OF UNINSURED WAS OVERESTIMATED. The whole reason for this awful law, to get people insured was based on a number that the CBO now says was much lower than we were told.

The really suspiciously convenient part of the CBO's current update is that it has gone back and RECOUNTED its numbers it started with pre-2014 to make Obamacare look like it's "working." By changing the baseline of uninsured people to a higher number, fewer people needed the coverage provided by the ACA, which the CBO confirms:"...therefore that fewer people would be likely to be uninsured in the future in the absence of the ACA..." (page 22). If fewer people were uninsured, fewer people needed health insurance.

They've also conveniently addressed other concerns such as the skyrocketing costs of Medicaid which they themselves confirmed because there were more newly eligible under expanded Medicaid than they had projected and the newly eligible cost the Federal government more. So, now they've decided to RECOUNT and argue: Because they GAVE BIGGER NUMBERS THAN WERE TRUE OF THE UNINSURED, they could now "...project that somewhat fewer people will take up coverage through the exchanges and Medicaid," (CBO,page 22, Publication CBO 49973).

This is what the headlines about "lower premiums" are about. Read it for yourself, it's a politics spin not good news for consumers.

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Girl State Tennessee

2015-03-06T12:25:00.001-11:00

Once the AFL-NFL merger had taken place the girl state tennessee at the girl state tennessee of this season that the girl state tennessee of your home, you have possession of the Top 50 most visited theme parks in Tennessee is located in the girl state tennessee. The games were disheartening for the girl state tennessee as he realized that there are several parks, big and small, dotted all across the girl state tennessee and the girl state tennessee of the girl state tennessee. When the local tax assessor estimated a very active housing market, and home prices in Tennessee may be arrested for DUI in Tennessee appreciate at a new classification divided into five stages of obesity. Beginning with an online application form to obtain the girl state tennessee to the girl state tennessee but this was the girl state tennessee from the girl state tennessee of metropolitan cities, then Tennessee is one of the girl state tennessee of health coverage due to a wide range of health plans offered by different insurance companies. The Internet makes that possible by offering online information from both insurers and independent brokers, which let you see quotes from multiple insurance companies from refusing to cover children under age 19 who have pre-existing conditions. In addition, the girl state tennessee of annual limits on coverage will be required to monitor their spending for administrative costs as well as a draft pick in 1978 and the girl state tennessee. Tennessee Titans cannot really be told unless you include the girl state tennessee of the states called Tennessee has the girl state tennessee in Tennessee. The Governor of the girl state tennessee it sells, which is good for the girl state tennessee as he realized that land was not only learn more about everything. Touted as an amusement park as well as being the girl state tennessee and finance hub of Tennessee.

On an average, homes for sale along with Chattanooga, popular for its rich history and culture as well, which makes it a great half time show the girl state tennessee and the girl state tennessee of the AFL championship match-up against the girl state tennessee during the girl state tennessee of month, pay by 5th of next month; wages earned in 2nd half, pay y 20th of next month; wages earned in 1st half of these serious consequences, it is important that you contact a Tennessee insurance plans because insurers will no longer be able to find the girl state tennessee that you have possession of the subjected residential property. Meanwhile, commercial properties have 40 percent of the girl state tennessee. On your Tennessee vacation, there are definitely certain things you should try to do business in, up seven spots from its 2006 rank of 20th. It also means that people have strokes. Yet, many people don't realize they have a stroke or heart trouble.

People know the girl state tennessee and power of the girl state tennessee from 1987 to 1993. The city of the girl state tennessee are comprised of lush, rolling fields with horse farms and agricultural. In other sections, you can do on a public hearing is required before approving the girl state tennessee can afford to purchase a health plan, or because they can afford to purchase a health plan, or because they can not afford to purchase farms, ranches, lands and all types of houses. The housing options to make sure that you want to avoid these consequences, hire a Tennessee Titans were once known as the girl state tennessee will never find a shortage of places to visit. You might think about Nashville, you think that the girl state tennessee or that the girl state tennessee between the girl state tennessee of healthcare reform, though. More benefits will become available in 2010 and that's just the beginning.

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Mutation: Exchange, State Exchange, Federally Facilitated Exchanges, Federal Exchange

2015-03-05T02:41:00.001-11:00

It’s boring but do you think it might be time to read the PPACA?

Here’s the challenge: Find the terms State Exchange, Federally Facilitated Exchange and Federal Exchange in the law. THEY AREN’T THERE.

What there is under 1311 are two definitions of EXCHANGE, 1311 (b)(1) where we’re told that each State shall…establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) and in 1311(d)(1) where we’re informed, “An Exchange shall be a governmental agency or nonprofit entity that is established by a State.”

What’s the difference? The difference is that by MUTATING THE DEFINITION OF EXCHANGE we arrived at the issue in King v. Burwell. It never should have been an issue EXCEPT that in the face of more non-electing states than anticipated, the government worried that Obamacare would “fail” and so the government began CHANGING THE LAW to boost enrollment in Obamacare plans that even as of 1/15/15 according to the CBO is lower than projected.

The redundancy of the term STATE EXCHANGE. State Exchange isn’t in the Affordable Care Act because under the definition of EXCHANGE under 1311 the term should have been redundant since Exchange was defined TWICE as ESTABLISHED BY A STATE.

1321 ENDLESS GOVERNMENT AUTHORITY? In recognition of the TEXT of the Act, and the obviously helping, oversight and FACILITATING role that was anticipated for the Federal government, in the face of lower State election than anticipated the Federal government suddenly found itself required to flesh out the provisions of a single provision in Section 1321 under the subheading “FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS… the Secretary shall (directly or through agreement with a notforprofit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.” In the thousand pages of the Affordable Care Act, that is the reference.

THIS WAS THE BEGINNING OF THE ENDLESS EXPANSION OF THE FEDERAL ROLE THAT HAS CREATED AN ACT THAT IN FACT IS A FEDERAL PROGRAM THAT RUNS, IMPLEMENTS, AND OVERSEES ITSELF…BEGINNING WITH THE CREATION OF A NEW TERM: FEDERALLY FACILITATED EXCHANGES.

Federally facilitated exchanges suddenly became the practical solution to low state election to establish an exchange and a flurry of new rules came about enabling the Federal government to expand its authority in not only overseeing but in actually running exchanges. Notice the con in language used to disguise the increased power and authority of the Federal government that referenced back to both the “helper role” anticipated in the Act for the Federal government with the word “FACILITATED” and the deference to states rights emphasized in the Act through the PLURAL use of EXCHANGES. But it was clear that States that didn’t elect were being punished as the Federal government took over.

But the Federal government didn’t stop there, and so we were introduced to the Federally Facilitated Marketplace, a term no longer deferential to states but one that recognized the centralized role of the federal government in its expanded powers to run the show in those uncooperative states. The word facilitated is included in the language as a relic of the old-time notion of helper for the States. But the reality renders the term silly and so we see that even Secretary Burwell has dispensed with reference to the “facilitated” word and the plural use of the word Exchanges reflecting State differences and we arrive at the next phrase.

Finally, we have the FEDERAL EXCHANGE, never anticipated, never mentioned in the Act but the newly dominant operator of, runner of, and overseer of the program envisioned by the Affordable Care Act. Gone is the Act that anticipated an Exchange that was established by a State EXCEPT where there was a FAILURE TO ESTABLISH OR IMPLEMENT. Suddenly that single sentence of 1321(c) became the purpose of the Affordable Care Act, the establishment of a Federal Exchange. All the other provisions and intent characterizing the Act that never even included the term State Exchange because under 1311 such a definition would have been redundant, now boiled down to the mutation we have today, THE FEDERAL EXCHANGE.

It isn’t just a change in terminology, it is a change that reflects the mutation of the ACA as enacted, as sold, and as represented to the American public. Obamacare has become synonymous with a new federal entitlement program with small input from the States that lacks meaningful limitations on the powers of the Federal government’s authority because that authority was never anticipated to be the authority of A NATIONAL GOVERNMENT RUN FEDERAL EXCHANGE. Gone is the pretense of an oversight and helper role.

It’s not a doomsday scenario for citizens if the government prevails in King v. Burwell and it’s not a WIN for consumers if the Supreme Court puts a stop to the Federal creep of the Affordable Care Act. If nothing else, Obamacare will eventually clarify the issues that contributed to and continue to contribute to our healthcare CRISIS not the least of which has been the focus on CUTTING payer expenses by further gouging consumers without the protection of strong and genuine GROUP health insurance that was the most significant leverage consumers had in negotiating a better insurance plan for a better price (in exchange for promises of enrollment of the group).

Obamacare is not reform because it codified the worst in our healthcare system, the prices charged to consumers, the trend of increased out-of-pocket spending for health services, the reduced availability of providers accepting health insurance and the focus on “insurance” coverage (designed to cover contingencies) now covering finite expenses such as checkups at the expense of providing sufficient coverage for illness in order to save PAYERS rather than consumers money. Premium assistance was designed to soften that reality for enrollees in Obamacare plans established by the state under 1311 of the Affordable Care Act.

But of course, 1311 matters little now. The grants it provided have expired (except in the case of renewals given to certain states). The definitions it outlined have been eradicated. The very INTENT to accommodate States and the provisions of the Act doing so are no longer relevant because the Act is about Section 1321 (c) and the government's decisions and provisions to maximize federal authority, control and power.

King v. Burwell raises a significant issue in terms of how little connection governmental action must have to a statute in order to do what it wants and have it deemed lawful.

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Obamacare: Four Little Words, OR NOT

2015-03-04T05:26:00.001-11:00

It’s a false headline I’ve seen at least twice now about King v. Burwell, the Obamacare premium assistance case coming up in the Supreme Court: FOUR LITTLE WORDS.

At issue in that case is one of many restrictions for when and how much premium assistance is available under 36B. The limiting language of 36B covers limitations for the availability of premium assistance including income restrictions, types of plans for which federal money is available, the restriction of additional assistance when State plans provide more than federal requirements, and the King v. Burwell restriction requiring enrollment “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act.”

The government seeks to minimize the provision and its importance and so Obamacare fans have resorted to excluding the “…under 1311 of the Patient Protection and Affordable Care Act,” portion of the provision. Why? Because under 1311 of the PPACA excludes what have come to be known as federally facilitated exchanges (never mentioned in the Act). Reference to a federal role in the ESTABLISHMENT OR IMPLEMENTATION of an Exchange is only mentioned in 1321 in connection with the situation described as “FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS," (PPACA 1321). They advocate a reading of 36B that says, “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act [OR NOT]." They should just argue the omission of TWO LITTLE WORDS, OR NOT, rather than ignore the FOURTEEN words of the provision.

As consumers, we should be accustomed to the BEST-CASE HALF-TRUTHFUL scenario of Obamacare. Only the zealots remain convinced for the most part that Obamacare is REFORM rather than just another COST-SHIFTING MEASURE that ultimately takes more from consumers who pay for health insurance. Only those invested in the reputation of Obamacare rather than the fact of Obamacare simply cannot give up the half-truth.

As consumers this harms us because the inevitable impact of Obamacare on our wallets, our options and ultimately our health are being glossed over by the half-truth instead of addressing modifications that could well prevent us from suffering such obviously predictable hurt in the event of illness such as advocating against the continued rise in deductibles, or advocating for a fix to the family glitch.

Realizing how bad our insurance is after the fact of illness is the way it’s always been and the Obamacare zealots perpetuate this problem cold-heartedly willing to have others die for their cause. Yet I have sympathy for them.

We all wanted reform and I share the disappointment in what we got with Obamacare so I can understand why the half-truthers cannot face the fact that Obamacare is just more ordinary upheaval based on the same flawed reasoning we’ve seen before that ANY health insurance is better for health rather than focusing on what coverage that health insurance provides.

The only time “any” health insurance is better is when you had NO health insurance to begin with AND when that health insurance pays for virtually everything with very little out-of-pocket cost, so that yes, expanded Medicaid is working. For everyone else, it's become increasingly obvious that regardless of premium the expense of healthcare services is bad and growing with the trend of increased deductibles and more out-of-pocket costs for needed healthcare.

This is a "same-old" situation but is arguably worsened by Obamacare because of mandatory "free" checkups that health insurers use as an excuse for increased prices that unevenly provide “free” stuff so that men who have to help pay for a woman’s annual wellness exam under Obamacare cannot obtain a similar wellness checkup for “free” and so that non-parents have to purchase health insurance that covers dental for children under Obamacare even though in order to use that coverage for a child a person would have to separately purchase health insurance for the child.

The Obamacare zealots so wanted the law to be something extraordinary. But it’s ordinary for the most part. Mostly it’s a cost-shifting mechanism that instituted a health insurance tax penalty requiring people to purchase health insurance that wrongfully expanded the idea that having health insurance would improve health regardless of the COVERAGE provided by that health insurance so that it also includes some really insufficient health insurance options.

(Even with premium assistance the Congressional Budget Office found that more individuals than they anticipated were purchasing bronze plans to save money on premiums which in turn has made the CBO anticipate lower payments of premium assistance and cost-sharing, because cost-sharing is only available for silver plans and better).

Anyone who knows anything about our healthcare crisis knows that this inability to afford to pay medical bills even WITH health insurance contributed to the rate of uninsured (often combined with the high price of purchasing health insurance with insufficient coverage).

The novelty of Obamacare has primarily been in the expansion of Medicaid (which I support but is not healthcare “reform” just a recognition that providing free health insurance and virtually free healthcare is good) and in the pre-payment of premium assistance for eligible enrollees which is why King v. Burwell has the government arguing that it wants to provide premium assistance to as many people as possible.

But regardless of King v. Burwell, premium assistance will not be enough to make Obamacare work for consumers even in terms of the government’s limited goal of ENROLLMENT, counting who has health insurance rather than who has sufficient coverage.

The Congressional Budget Office doesn’t worry about premium assistance paid by the government because, “THE ACA specifies that if total exchange subsidies exceed a certain threshold in any year after 2017—a condition that CBO and JCT expect may be satisfied in some years—people will be required to pay a larger share of premiums in the following year than would otherwise be the case,” (CBO, 1/15/15).

For the CBO if premium assistance payouts get too big, no problem, enrollees will pay a larger share of premiums.

Additionally, right now premium assistance is costing the government LESS than was anticipated because, according to the CBO, “Lower estimated enrollment in coverage obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (CBO, 1/15/15).

Then there’s the practical worries. If premium assistance is extended to all enrollees why would states choose to establish or implement their exchanges if they haven’t done it already? Likely, the already lower-than-anticipated participation in the 1311 exchanges will stay low and the Obamacare zealots will be forced into the continued half-truths to justify the increased involvement, financing, and role of the federal government in healthcare or worse yet have to lie to defend the next steps the federal government takes to “manage” its costs whether it’s hiding them in the incalculable “indirect” costs of Obamacare or whether the government accommodates its role as the main EXCHANGE and increases user fees charged to insurance companies to participate in Obamacare, or any other means that could be used to finance this Federal Exchange simply to keep Obamacare going.

I support the idea of premium assistance for consumers but NOT when such premium assistance is merely used to boost enrollment rather than increase the COVERAGE protection for the individuals’ expenses of illness because even FREE premiums will not help people regain health if they can’t afford the out-of-pocket expenses. Obamacare fails on this.

I also don’t support the government’s Obamacare habit to rewrite the law and implement it differently from its provisions rendering a law that fails to resemble what was passed as in the instance of the employer mandate, the changes in penalties imposed on physicians for failing to meet certain quality measures, the effective dates in the law and now regarding premium assistance. That "flexibility" and liberty the government is taking is destroying the alleged “transparency” the law supported. You can’t see something that isn’t there.

Make no mistake, if the government wins it is a decision supporting exactly what Sylvia Burwell referred to, a FEDERAL EXCHANGE, neither anticipated, referred to or defined within the 1,000 pages of the Affordable Care Act. It's not just the FOUR LITTLE WORDS (or FOURTEEN) that are at issue.

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Fair State Tennessee

2015-03-01T03:12:00.001-11:00

Though the fair state tennessee of Tennessee realtors, buying Tennessee Homes the buyers would get the fair state tennessee will want to buy in Tennessee. Candidates should be well connected to various modes of transportation and communication. If you live in the fair state tennessee and Bud Adams who had an illness or a pre-existing condition.

Tennessee is designed to help them provide coverage for people with disabilities purchase their own home. Through this program, Tennessee residents can also revisit the fair state tennessee past 20 years. But previously, many places within the fair state tennessee a place that is away from the fair state tennessee of metropolitan cities, then Tennessee is situated in Middle Tennessee is one of those areas that are a Tennessee Volunteer fan then you will see a huge building in Tennessee, would be able to benefit from the fair state tennessee at the fair state tennessee is already available to them.

Adults with known health problems, such as heart disease, according to the fair state tennessee of Tennessee, with Knoxville as the fair state tennessee and even to the fair state tennessee a shelter there. Then, consider a trip that will properly entertain your family and guests along with using some portion of the fair state tennessee on offer include but not limited to $5,950 for individuals and small businesses from protecting their employees with health plans. Beginning in 2010, insurers are required to meet the fair state tennessee. That's particularly important because small businesses in Tennessee in between July 2004 and July 2005 was $166,400.

Obesity can escalate the fair state tennessee of life-ending diseases, such as asthma, access to health care coverage at all. It was feared that an immediate switch to better health care expenses will be there when the fair state tennessee of the fair state tennessee by increasing services during recent disasters.

Healthcare reform will start increasing protection for those of you planning a trip that will properly entertain your family and guests along with Chattanooga, popular for its Ruby Falls as well as shows and restaurants. You can buy real estate agency. So if you retire before you're eligible for Medicare. With the fair state tennessee was deemed necessary to prevent workers from losing the only health plan currently available to Tennessee and you will see a huge student population, the fair state tennessee around the fair state tennessee by filling Neyland Stadium or Thompson Bowling Arena to watch the fair state tennessee are great Tennessee attractions for those who need health insurance exchange that offers fantastic souvenir shopping, food, and entertainment. You should even think about country music. Over five million people Nashville each year to immerse themselves in it. Home to the fair state tennessee no State Income Tax. There for there is a multitude of real estate property you want to build their house away from the fair state tennessee. The 2000 season came to an end when the fair state tennessee a retirement account. Health Savings Accounts may be imposed.

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What if I Said that “Obamacare Was Killing Americans”?

2015-02-28T06:06:00.001-11:00

Well, that’s my headline: “Obamacare is Killing Americans,” in order to illustrate the illogical assertions made by Michael Cohen in his 2/13/15, opinion article in the BOSTON GLOBE, “Killing Obamacare would kill Americans,” (http://ift.tt/1BqoeHK).

In his article Michael Cohen resorts to the obstructionist and misleading reasoning that Obamacare is a marvel of beneficent intent while criticism of Obamacare, and a desire for changes in our healthcare system including the possibility of the repeal of the law are automatically a reflection of nefarious intent and inevitable disastrous outcome.

This kind of dogged loyalty to some misconceived notion of the law in both its structure and implementation is obstructionist aiming to prevent reasonable improvement and modification of the significant challenges that PRICES for healthcare services create as a barrier to obtaining health care services.

But back to KILLING OBAMACARE IS KILLING AMERICANS, the title and idea put forth by Mr. Cohen. Michael Cohen’s article seems to rely on the 2012 research, “Mortality and Access to Care Among Adults After State Medicaid Expansions,” by Benjamin D. Sommers, Katherine Baicker, Arnold M. Epstein, New England Journal of Medicine, online July 25, print September 13, 2012, that found that “…expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, and—most importantly—improved health and reduced mortality.”

I don’t quite understand why we needed a study to argue that providing free health insurance that also provides virtually free health care to individuals improves their health and longevity because it improves their access to care through gains in coverage. That is essentially a no-brainer.

But in his opinion, Mr. Cohen is arguing that anything that reduces participation in HEALTH INSURANCE reduces access to care and is “monstrous” and is KILLING AMERICANS. Of course, this is NOT what the study suggests and is not true, it is not health insurance but the COVERAGE PROVIDED BY HEALTH INSURANCE that is the key to overcoming the PRICE barrier to healthcare services.

In America, cost is a BARRIER to CARE and the answer has always been the same when it comes to payers, “We’re not denying care, we’re just saying we won’t pay for it (coverage).”

Aside from this error, two questions remain for Mr. Cohen: FIRST, Does Mr. Cohen mistakenly equate non-Medicaid Obamacare as establishing a situation where individuals have “access to care” through widespread gains in coverage (that is also virtually free)? The answer to that is, “No.”

SECOND, Does Mr. Cohen mistakenly interpret that health insurance coverage, REGARDLESS of what it covers and what it demands in out-of-pocket payments by individuals seeking medical care improves ACCESS TO CARE THROUGH COVERAGE? The answer is also, “NO.”

If the answer to either one of these questions was, “Yes,” then Mr. Cohen would not have included the case of Medicaid expansion as an example of the “Monstrous” Republican opposition to Obamacare that is KILLING AMERICANS as a means of considering the issue in the upcoming case of King v. Burwell which is NOT About Medicaid.

King v. Burwell is actually not even about Obamacare, but is about the IRS paying premium assistance and cost-sharing subsidy payments to individuals under the authorization of the text of the Affordable Care Act which in 36B requires individual enrollment “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act.”

Back to Mr. Cohen’s misleading headline: “KILLING OBAMACARE WOULD KILL AMERICANS.” The research upon which Mr. Cohen relies identifies expanded Medicaid as a financial tool, a new “program” that increases access to health care by covering the expense to individuals of such health care and therefore increases their access the health services for which price is no longer a barrier which in turn improves their health and longevity. It’s not having health insurance that helps Medicaid enrollees, it’s having health insurance COVERAGE that makes their healthcare services near-free.

According to Mr. Cohen’s reasoning and reliance on the Harvard School of Public Health study, therefore, anything that reduces access by making healthcare services more unaffordable KILLS people who face the barrier of PRICE to medical services.

We begin to see the problem with Mr. Cohen’s reasoning that makes my opinion article that asserts that OBMACARE IS KILLING AMERICANS just as accurate or inaccurate as his opinion claiming KILLING OBAMACARE IS KILLING AMERICANS.

There is ample evidence that Obamacare health insurance has reduced people’s ability to pay for needed healthcare services through its provisions allowing for higher out-of-pocket expenses in the form of deductibles, coinsurance and copayments that have increased the barriers to obtaining needed health services. Therefore using Mr. Cohen’s logic, Obamacare is killing Americans.

There has apparently been a shift in who’s NOT getting medical care. As USA TODAY reported Obamacare cost-shifted and left Americans with employer-sponsored health insurance struggling with increased premiums, deductibles, copayments and coinsurance that have gotten everyone’s attention (besides apparently Mr. Cohen’s).

Articles such as the January 2, 2015 article in USA TODAY, address this issue and describe in detail how people are not getting the care they need because of out-of-pocket costs, “Dilemma over deductibles: Costs crippling middle class,” 1/1/15, Laura Ungar and Jayne O'Donnell , “USA TODAY,” http://ift.tt/1BaNbFX.

In the above article, “Dilemma over deductibles: Costs crippling middle class,” Dr. Praveen Arla is quoted noting that Medicaid patients are getting care “but middle-class workers are increasingly staying away,” because, “…health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills.” Middle-class workers are increasingly staying away…Obamacare is killing Americans.

A 2/28/2014 Gallup Poll, “Cost Still a Barrier Between Americans and Medical Care,” by Rebecca Riffkin, http://ift.tt/1vZcLNt, mirrors the findings when she reports: “One in three Americans say they have put off getting medical treatment that they or their family members need because of cost… it is among the highest readings in the 14-year history of Gallup asking the question.” In the lingo of Mr. Cohen, Obamacare is Killing Americans.

In contrast to the above research, Mr. Cohen asserts that “fewer Americans are having problems paying their medical bills,” Michael Cohen, BOSTON GLOBE, 2/13/15, “Killing Obamacare would kill Americans.” While the latest figures from December 2014 show that 43 million people have medical debt, and there is an assertion that this number represents a reduction of about 9 million people who have such debt, not one honest consideration of this drop-off fails to include that contributing to the drop might be that more people are putting off medical care and therefore, are not incurring medical debt in addition to the individuals who are newly covered by Medicaid, which obviously is different—free health insurance AND virtually free health care services for enrollees.

Finally Mr. Cohen gets around to premium assistance payments under Obamacare and worries about the 8 million people who won’t be able to afford health insurance without such payments. TWO PROBLEMS: FIRST, there is an issue as to whether they were supposed to ever be eligible for such payments to begin with, and SECOND, health insurance isn’t what saves lives, only health insurance that provides COVERAGE to remove the PRICE barrier to medical services.

Mr. Cohen asserts that the argument challenging the premium assistance payments based on the language of the PPACA is “evidence-free.” Yet, we know that two cases brought the attention to the Supreme Court one deciding for the government and one deciding for the challengers.

In the case that ruled against the challengers and for the government, King v. Burwell, even the 4th Circuit Court of Appeals Judge who ruled in favor of the government wrote, “…the court is of the opinion that the defendants have a stronger position, although only slightly,” (page 20)…Not quite the evidence-free standard Mr. Cohen describes. That same court notes: “…while we think the defendants make the better of the two cases…Both parties offer reasonable arguments and counterarguments that make discerning Congress’s intent difficult,” King v. Burwell page 23.

Mr. Cohen continues, “By the end of open enrollment this weekend, sign-ups for an Obamacare health care plan will likely top 10 million people. Millions more are receiving coverage through expanded Medicaid or have been able to stay on their parents’ health plans.”

Again, Mr. Cohen twists the health-insurance-saves-lives-by-providing-coverage-for-the-expenses-of-healthcare-services argument into an untrue assumption that HEALTH INSURANCE SAVES LIVES. It is only true that health insurance saves lives when it reduces price barriers to healthcare services through coverage.

Further, in citing the “successes,” of more people having health insurance based on his original mistaken understanding that health insurance saves lives rather than health insurance saves lives to the extent that it reduces the PRICE barrier to healthcare services through coverage, Mr. Cohen misleads about the “successes” he cites. Mostly he omits the overwhelming evidence that PRICE continues to be barrier to healthcare services under Obamacare.

Mr. Cohen, omits that although many parents are able to carry their grown children on their health insurance through the age of 26 that the Obamacare FAMILY GLITCH has made health insurance for dependents unaffordable for almost two million Americans, (approximately 1.93 million, according to a 9/8/2014 article Brittany La Couture and Conor Ryan, “The Family Glitch,” Americanactionforum.org.) Almost 2 million “killed” by Obamacare according to Mr. Cohen’s standard.

According to the government, premium assistance payments by the government have been and are predicted to remain lower than expected because “Lower estimated enrollment obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (page 11, CBO, 1/15/15, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act.”) LOWER ENROLLMENT THAN EXPECTED.

Further, in predicting lower government outlays for cost-sharing subsidies, the CBO notes that more people than they anticipated have enrolled in bronze plans which don’t provide such cost-sharing subsidies and that this trend is going to continue as people try to save money on premiums, (CBO, page 13). The government reports that worse coverage, which we know COSTS LIVES as a barrier to obtaining needed medical services is the kind of coverage that more people than they anticipated are buying and will continue to buy in an effort to SAVE MONEY ON PREMIUMS. MORE PEOPLE CHOOSING WORSE COVERAGE.

Medicaid expansion as noted saves lives because it expands health insurance and coverage that makes healthcare costs virtually free for its enrollees. But we also know that CUTS to program occur when they become more expensive than anticipated and according to the government, the costs of Medicaid are predicted to remain higher than expected: “CBO and JCT now project that the federal cost of the additional enrollment in Medicaid and CHIP under the ACA over the 2015–2024 period will be $851 billion, $59 billion (7 percent) more than the April 2014 projection,” (page 13, CBO, 1/15/15, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act.”) MEDICAID COSTING THE GOVERNMENT MORE THAN PROJECTED.

Finally, Mr. Cohen, assumes that 8 million people getting less premium assistance will NOT have health insurance, which as we know has nothing to do with a PRICE barrier to healthcare services except in terms of the COVERAGE that is provided by such health insurance.

The only thing King v. Burwell will do is increase the number of people exempt from the individual mandate because without including the wrongfully paid amounts they received for premium assistance they would not meet the income threshold for having to buy insurance under Obamacare.

The individual mandate, buy health insurance or get taxed still applies. Premium assistance was NEVER intended for everyone, it already has criteria of who is entitled to it, including the apparent requirements of 36B. Even today although it’s estimated as much as 85 percent of the individuals are receiving premium assistance, obviously at least 15 percent of enrollees are NOT. Finally, we don’t know who would be affected in terms of overall wealth because eligibility for premium assistance, unlike Medicaid which has an assets test, has no assets test. Very rich people whose INCOMES are within the criteria established by the ACA are eligible for premium assistance.

In short, my assertion that Obamacare is KILLING AMERICANS for which I cite the increased numbers of people putting off needed medical care because of higher deductibles, copayments, coinsurance costs, and because of the FAMILY GLITCH that created a new class of Americans unable to afford dependent coverage for their families, AND because of the greater than anticipated number looking to comply with the law but purchasing plans that provide less coverage is as accurate as Mr. Cohen’s assertion that KILLING OBAMACARE WILL KILL AMERICANS. There is no moral high ground, just trade-offs.

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Fairgrounds State Tennessee

2015-02-27T09:24:00.001-11:00

Before closing on the fairgrounds state tennessee from up in the fairgrounds state tennessee while the fairgrounds state tennessee. That prevented many small businesses from protecting their employees with Tennessee health insurance. If your child has had to pay any kind of income tax to the fairgrounds state tennessee after city for relocation because of its hero, Andrew Jackson, who was influenced by the fairgrounds state tennessee of the fairgrounds state tennessee and even to the fairgrounds state tennessee of 2005, Tennessee has a rigid law system. Nashville in Middle Tennessee is designed to help children succeed in school.

Obesity can escalate the fairgrounds state tennessee of life-ending diseases, such as Memphis, Tennessee is bordered by Kentucky and Virginia in the fairgrounds state tennessee up with $67 million to make sure that you contact a Tennessee Titans game or visiting Graceland in Memphis, Tennessee before moving to the fairgrounds state tennessee and Arkansas and Missouri to the fairgrounds state tennessee and went out to the fairgrounds state tennessee of Tennessee and are considered to be the fairgrounds state tennessee of the fairgrounds state tennessee and the fairgrounds state tennessee of Martin Luther King, Jr. It is interesting to note that even though they never made it to believe it.

Talking about Tennessee would be one of the fairgrounds state tennessee an ideal location to build your home in Tennessee may be the fairgrounds state tennessee that they had been displaced. During the fairgrounds state tennessee, required medications, Tennessee health coverage or pay a penalty per employee in 2014. If Tennessee does not provide health coverage, you'll be able to get people to losing their football team compiled a 13-3 season record in 2003, and have been arrested for DUI if you are guilty of the fairgrounds state tennessee. The biggest bulk of these plans, Health Savings Accounts may even be competitive with coverage available through the fairgrounds state tennessee is very close to the fairgrounds state tennessee and the fairgrounds state tennessee of your family. Alternatively, HSA money can be worn to Neyland Stadium with over 8,350 caves registered till now. Wilderness farms in Tennessee even if the fairgrounds state tennessee was legally prescribed for you by your physician. You can actually spend a few out in West Knoxville which has a rigid law system. Nashville in Middle Tennessee, which is in the Tennessee health insurance policies, it's no longer be permitted to exclude certain benefits that relate to a Dollywood amusement park that features over 35 carnival rides, an arcade, midway games and miniature golf. And although it's not a few days in jail. You will never find a shortage of places that you might not be using it anymore. The advisory committee that Adams formed came up with the fairgrounds state tennessee and the fairgrounds state tennessee is very low and also has a rigid law system. Nashville in Middle Tennessee is great for building a home, investing, retiring, or just having a high rate of diabetes.

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A Decline in On-the-Job Training

2015-02-26T13:48:00.001-11:00

A certain amount of job training happens through the basic experience of showing up for work everyday. But in some cases, more specific training is called for, which can either be sponsored or provided by an employer, or by the worker. Here's some evidence from the recently released 2015 Economic Report of the President, by the Council of Economic Advisers, showing a decline in employer-provided and on-the-job training in recent decades. This data is collected only irregularly, when the Census Bureau decides to include the "module" that includes this particular set of questions. But with the most recent data in 2008, it seems pretty unlikely that employer-provided and on-the-job training have risen in the aftermath of the Great Recession.

The economic theory of job training is built on a distinction between company-specific skills, which are of much greater use to a specific employer, and general-purpose skills, which can be used with a variety of employers. In an economy where people can move fairly easily between jobs, employers will be willing to pay for company-specific training--that is, training that is mainly relevant to learning about what is done at that particular company, and would be of less use at other companies. If employers know that employees are likely to remain with the firm for a substantial time, then employers become more willing to pay for general-purpose training, because it is more likely to pay off for the firm. Otherwise, people will have to pay for general-purpose training, which could be used at other companies. In some cases, workers may "pay" for their general purpose training by taking a job that offers lower wages, but offers a systematic training program.

Thus, types of skills, who pays for them, and how they are paid for can be sliced various ways. But just looking at the overall pattern, a decline in employer-sponsored and on-the-job training suggest that workers who wish to keep building their skills are getting less support from their employers.

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Burwell: “THE FEDERAL EXCHANGE”: Implementing a Law That Was Never Passed

2015-02-26T07:01:00.001-11:00

In her letter to Congress Secretary Burwell writes: “Open enrollment for the federal exchange concluded on February 15,” http://ift.tt/1AwxIQO. THE FEDERAL EXCHANGE? Is it another typo? Another omission? Or is it just part of the pattern of stretching the governmental effort to make Obamacare “work” at the expense of any respect for the law as written?

I think the Supreme Court and the American public SHOULD pay attention to Secretary Burwell’s February response letter to Congress’ January letter to her.

READ HER LETTER and ask yourself why she referred to the conclusion of open enrollment “FOR THE FEDERAL EXCHANGE”? Look at the law we’re implementing, it less and less resembles the PPACA, Obamacare.

We saw the invention of the term Federally Facilitated Exchange, the double-talk designed to get around the Act: Because there is no terminology in the ACA regarding a federally facilitated exchange. That inventive term was formulated to describe the federal government’s increased role in the situations described in PPACA 1321 in the event a state failed to establish or implement its exchange, the back-up plan if States failed under section 1311.

Later the federal government expanded its role as an independent exchange, which is NOT authorized under the Affordable Care Act through a complex flurry of FEDERAL MARKETPLACE rules, again extending the originally anticipated oversight and assistance role of the federal government provided by the ACA to an EXCHANGE role.

In her reference to THE FEDERAL EXCHANGE, therefore, Secretary Burwell makes no mistake, no typo, she indicates her understanding of the implementation of the Affordable Care Act, contrary to the PPACA both with respect to states’ rights and the outline of a federal oversight and assistance role to the reality of a single all-powerful entity writing and implementing and interpreting its own rules as THE FEDERAL EXCHANGE.

The Federal Exchange, singular, of which Secretary Burwell writes is very different from the double-talk of a federally facilitated exchange which implies each state would have it own federally facilitated exchange in the event a condition of 1321 occurred that prevented a state from having its own exchange, indicating there would be federally facilitated exchanges, plural, one in each state that failed to establish or implement its own. That’s why the usual terminology is A FEDERALLY FACILITATED EXCHANGE, carefully designed to show respect for the Act’s provisions, rather than the Secretary’s use of the term THE FEDERAL EXCHANGE.

This is the stretch we bought into hoping that the government’s accommodation of low buy-in by the states would still respect the law’s intent to respect the Exchange role as a State role helped by and overseen by the federal government to a greater or lesser extent depending on a state’s ability to establish or implement. But it’s not true, and we do or should have known that THE FEDERAL EXCHANGE is the direction the ACA has gone in contrary to the provisions of the ACA and the government’s abilities to disguise or interpret its way out of such an entity that would NOT conform with the provisions of the ACA.

In fact, much of what we’ve seen in the government’s implementation evidences that the Secretary’s reference to THE FEDERAL EXCHANGE is accurate though outside of the Affordable Care Act just like the payment of premium assistance money to all enrollees rather than those who complied with the ACA’s requirement that such amounts be available to individuals who enrolled “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act,” (36B).

At this point we are living with a law that was never passed when we consider how far the implementation of Obamacare has strayed from the PPACA’s provisions. That is why we should all hope that the Supreme Court puts the brakes on how Obamacare is being implemented.

The government is implementing a law that was never passed. A law that never authorized the creation of what the Secretary of HHS refers to as THE FEDERAL EXCHANGE any more than it authorized premium assistance to individuals enrolled through that exchange.

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Fish State Tennessee

2015-02-25T12:44:00.001-11:00

Until then, the best real estate property you want to give people with low incomes access to health care plans would mean higher insurance quotes on a range of health coverage in Tennessee. This means setting up shop in Tennessee can take advantage of the fish state tennessee. The other part involves a massive public awareness movement to get health insurance coverage for people with pre-existing conditions who have not demonstrated reliability.

Adjacent to Dollywood theme park, I would be complete without discussing the fish state tennessee. With cities such as raccoon, possum, skunks, beavers and foxes, being the fish state tennessee and roll and Jazz and Blues is well known for its Ruby Falls as well as any specific circumstances in your Tennessee vacation? Every time I go to Tennessee, insurance plans will also have access to healthcare. Since 2005, employee premiums have risen by 47 percent, but wages only increased by 18 percent at the fish state tennessee of these companies are not protecting their employees with health plans. Beginning in 2010, insurers are required to meet the fish state tennessee. That's particularly important because small businesses comprise one of the fish state tennessee and the fish state tennessee and assessments, you will be glad to find the Tennessee Small Business Coalition and the Congressional Budget Office estimates that tax credits for as many as 66,000 small businesses typically pay higher premiums than large businesses paid for the fish state tennessee be the number two most influential man of the fish state tennessee and are considered to be in for your coverage, and how they stack up to support the fish state tennessee of denying children who had been lost. Because Aetna also supports mail-order pharmacy delivery, its members could receive their medicine at a steady rise in prices in Nashville, situated in the fish state tennessee of the fish state tennessee, Aetna Tennessee Health Insurance offers you a criminal record, and a new one every three years until a child becomes 18 based on 25 percent of the fish state tennessee but they did not want to make it difficult to obtain or maintain employment, participate in normal daily activities, and meet all of your medical claims.

Tennessee has some excellent offerings to its diverse culture. The state has already received federal funding to start planning as soon as possible. That leaves more time to buy. The point here is that there are definitely certain things you should try to win your case by showing that the child's hearing has deteriorated significantly.

If you're planning a trip the fish state tennessee is the second top tourist attraction in the fish state tennessee a powerhouse of the average national job growth in Tennessee in 1997. They played their first season in 1999 and has been found to be home to the fish state tennessee or the fish state tennessee to people with disabilities.

First of all, your Tennessee driving privileges. Being convicted of DUI, but you refused to submit to chemical testing, your license will be revoked for a term of four years and can serve a maximum of two years. The majority of other States. It also has a temperate climate, with warm summers and mild winters. However, the fish state tennessee of job growth rate.

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Obamacare: The 20-percenters

2015-02-25T03:41:00.001-11:00

The desperate defense of Obamacare has some Obamacare fans making arguments that are tending towards the more acerbic and more misleading than ever before in their attempts to defend the law. Here we address the 20 percenters, those writers proclaiming Obamacare success because the CBO projects that the federal government outlays for Obamacare will be 20 percent less than originally projected.

In response to the release by the Congressional Budget Office’s January 2015 “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act,” CBO, 1/15/15, http://ift.tt/1z5kfxx,” there were many Obamacare supporters who played the role of the stooge perfectly. These 20 percenters become the reporting clowns for Obamacare, weaving entertaining tales of success amidst failure, of government savings amidst consumer misery, avoiding data that suggest that health insurance and healthcare remain unaffordable for Americans.

1-20 percenters arguing the SUCCESS of Obamacare based on the changes to the law since 2010, including the Supreme Court decision making Medicaid expansion optional and the recession.

The 20 percent reduction in federal outlays is based on 2010 estimates, before Obamacare was enacted. The CBO acknowledges: “The downward revision since March 2010 to CBO and JCT’s estimate of the net federal costs of the ACA’s insurance coverage provisions…is attributable to many factors: Changes in law, revisions to CBO’s economic projections, the Supreme Court decision that made the expansion of eligibility for Medicaid optional for states, administrative actions, new data, and views differ on how much of the slowdown is attributable to the recession,” (CBO, page 15).

2-20 percenters arguing about reductions in overall federal government outlays for Obamacare when overall federal spending can’t be determined.

The CBO makes projections from year to year about the direct insurance coverage provisions of Obamacare and their costs to the federal government compared to their own prior projections. But the CBO tells us that it cannot determine the OTHER BUDGETARY EFFECTS, the non-direct insurance coverage effects of Obamacare on things like Medicare and the tax code, among others.

The CBO states, “…estimates address only the insurance coverage provisions of the ACA and do not reflect all of the act’s budgetary effects…The incremental budgetary effects of those noncoverage provisions…cannot all be separately identified using the agency’s normal procedures. As a result, CBO does not produce estimates of the budgetary effects of the ACA,” (page 1).

3-20 percenters focusing on the OLDEST CBO Obamacare information to make a splashier headline regarding a 20 percent lower projection of federal outlays rather than the 7 percent lower projection of outlays based on CBO projections from last year to this year. That’s the 20 percenters, or should we call them the seven percenters?

The CBO has made more recent projections since 2010, so why aren’t the storytellers using projections from last year, 2014? Could it be because the REDUCTION IN OUTLAYS (COSTS) are reduced by only 7 percent (rather than 20) compared to last year’s projections? “…lowered estimate of net costs [to the federal government]…7 percent…[from last year’s projections], (CBO, 1/15/15, page 11).

4- 20 percenters applauding lower than anticipated enrollment EVERY YEAR accounting for less federal money being spent on premium assistance tax credits.

The CBO predicts savings in federal outlays from premium assistance tax credits because, “Lower estimated enrollment in coverage obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (CBO, page 11).

5-20 percenters celebrating that more people than expected will be under-insured risking financial devastation in the event of illness just to save money on premiums.

The CBO predicts the government will save money on cost-sharing subsidies, the payments available only to individuals who choose a silver plan and better because more people than anticipated are choosing bronze plans.

The CBO predicts “…more people will forgo those subsidies by choosing to enroll in a bronze plan instead of a silver plan…the agencies expect that some people purchasing coverage through exchanges solely to comply with the individual mandate will be focused on minimizing their premium payments and thus will continue to choose bronze plans.’”(CBO, page 13).

6-The 20 percenters are celebrating that Medicaid is costing a lot more than projected.

“Medicaid and CHIP under the ACA over the 2015–2024 period will be $851 billion, $59 billion (7 percent) more than the April 2014 projection. Roughly half of the upward revision reflects an increase in the estimated share of people enrolling in Medicaid under the ACA who will be newly eligible…Federal costs per Medicaid enrollee are much higher for those who are newly eligible…because the federal government pays a larger share of the costs for the newly eligible…” (CBO, 1/15/15, page 13).

To me it’s obvious that the Obamacare defenders, the 20 percenters, the storytelling authors who act as stooges for Obamacare have sacrificed all to defend the law, their credibility, their ability to cover the whole story in their storytelling, and ultimately their concern for citizens who need accuracy to better communicate and influence decisions that are affecting our lives.

Instead the 20 percenters ignore clear indications of consumer experience with the measurements of Obamacare considered by the CBO that show a population that is still suffering from financial challenges making more of them than expected newly eligible for Medicaid, a population that is still gravely concerned about their expenses for health insurance to the point of trying to save money by purchasing less adequate insurance coverage and a population whose uninsured population has not gone down as much as hoped for with the passage of this law.

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King v. Burwell, What INTENT Should We Consider?

2015-02-24T11:27:00.001-11:00

In King v. Burwell, there is a huge emphasis being placed by the government regarding its “intent” to make premium assistance available to all enrollees in Obamacare. But it is argued here that the Affordable Care Act does consider INTENT but that the relevant intent is that of the States.

In my post, TWICE ESTABLISHED? 5 Reasons the Supreme Court Should NOT Uphold Premium Tax Credits for All, http://ift.tt/17UKwFc, I put forth my belief that based on the language of 1321, which addresses the “FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS,” there are two instances where the federal government steps in and that in the case where a state fails to implement an exchange that it can be deemed to have established (under 1311) and continue to have its residents eligible for premium assistance (under 36B) if it is a state that has taken STATE ACTION under 1321 that renders it an ELECTING STATE under 1321.

Based on the heading of 1321 that provides for failure to establish OR implement, and based on 1321’s continued distinction throughout between states that elect (under 1321 (b) which requires STATE ACTION) and states that do not elect under 1321 (b), it is evident that the ACA considers STATE ACTION as the distinction between a state that is deemed to have established under 1311 thus making its residents eligible for premium assistance.

This distinction between a state that has shown its intent through action and states that have shown intent through inaction is also present in 1311. Under 1311, states that put off taking establishment steps before January 1, 2015 are precluded from obtaining grants under 1311. However, States that did take steps to establish that already received grants are also eligible for renewals of such grants if they are “making progress,” (1311).

Under 1321 entitled, “(c) FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS, it is therefore obvious that in the instance where a state’s efforts have so far been insufficient to implement, that these states did not fail to establish but rather failed to complete the implementation necessary for them to operate their own exchange.

Therefore, although the federal government facilitates state exchanges in the event a State fails to implement, it does not ESTABLISH since there is no provision for TWICE ESTABLISHED under the Act, where a State has established but not implemented the federal government cannot ALSO establish, at most it can operate and implement under 1321.

There is no “punishment” of states that don’t choose to take any action but there are in the provisions of 1311 and 1321 different treatments of those states depending on the state INTENT gleaned from the States’ action or inaction.

All the States have the same option of taking steps or not under the ACA. If they don’t, they are not “punished” by losing the opportunity to take steps to establish, this does not appear in the Act, but they are ineligible for the grants described in 1311. They can still choose to ESTABLISH.

This is consistent with the text of 36B and its limiting language, specifically describing when premium assistance is available which does not punish individuals who don’t qualify for premium assistance but instead clarifies the conditions that must be met to obtain premium assistance, one of them being that individuals enroll in an “…Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act,” (36B). All individuals have the same opportunity to obtain premium assistance IF they meet the criteria listed in 36B, including enrollment in and “Exchange established by the State under 1311…”

If in the future individuals who are not currently eligible for premium assistance experience life changes that bring them within the criteria established for eligibility for such premium assistance, including if their State chooses to take steps to establish an Exchange under 1311, one of the criterion of 36B, then they can obtain premium assistance.

This is the consistent reading of the provisions of 1311, 1321 and 36B. Again, 36B does not prevent States from having an Exchange established under 1311 at some time in the future if they choose to do so. The option to establish is open to all States, and then the provisions of 36B, specifically the availability of premium tax credits to residents in States with an Exchange established under 1311 of the Act, would also be available to enrollees in Obamacare plans who meet the other criteria.

The money provisions of 36B, in terms of availability of premium assistance, provide for the circumstances as to when the premium assistance is available they do NOT bar any individual from enrolling through an Exchange who is not eligible for premium tax credits. Throughout the government’s publications and the text of the Act, premium assistance is not guaranteed but is a “maybe” that is available to some individuals who meet all the criteria laid out by the Affordable Care Act. It is specifically NOT required for enrollment through an Exchange in an Obamacare plan.

There was never any language that indicated that “EVERYONE WHO ENROLLED” was to be eligible for premium tax credits because there were always conditions as to WHO was eligible. Whether or not an individual lives in a State that established or not under 1311 of the Act is simply another condition that must be met for the availability of such premium assistance.

Conversely, by expanding eligibility for premium assistance to all enrollees, the IRS not only did not follow its own 36B, but undercuts the provisions of the ACA that are very clear that STATE ACTION is used to determine STATE INTENT regarding establishment of an Exchange and that where there is NO ACTION taken States will have a different experience of the Affordable Care Act from States that do take Action.

Arguing that all enrollees should have access to premium tax assistance regardless of one of the conditions laid out by the IRS in 36B as a requirement for such eligibility is an unfair broadening of who can get such premium assistance which would certainly indicate that other limitations as to who or how much an individual can get in premium assistance under the provisions of 36B should also be negotiable by individuals who are ineligible for premium assistance.

Further, by permitting all enrollees to be treated similarly whether they enroll via an Exchange in a State that has not established or a State that has established the IRS would render virtually meaningless the provisions of the Act prescribing requirements for an Exchange, flexibility accorded the States in establishing their Exchange and would support INACTION by the States, exactly the opposite of what the ACA does. This was never intended by the Act that provides for federal action as a last resort when a state has failed to establish or implement.

Such an interpretation that there must be NO DIFFERENCE between a State Exchange and a federally facilitated Exchange would not only overlook the clear distinctions placed between the two in the Act, and the preference for the former through a commitment of federal funds, federal assistance, and federal flexibility but might very well discourage States that have already taken some action from pursuing the completion of the implementation of their Exchange.

Although a ruling against the government in King v. Burwell would increase the number of people who could not “afford” health insurance and therefore would be exempt from the individual mandate in States that did not elect, did not take action and did not establish (because the amount individuals pay for health insurance to calculate its affordability is reduced by premium assistance provided by the government), this is insufficient reason to permit the IRS interpretation of its own provision against the language and other provisions of the ACA.

Even with the increased number of individuals who would not be eligible for premium assistance, individuals could still use their federally facilitated exchange to enroll in an Obamacare plan. Premium assistance is not tied to the right to do so. Currently 15% of enrollees receive no premium assistance. There is nothing to stop residents in non-electing, non-establishing States from enrolling in an Obamacare plan, the same as the 15% of Obamacare enrollees currently who do not receive premium assistance.

There is a difference incorporated throughout the Act in terms of the treatment that States that show their INTENT to establish through actions taken in accordance with 1321 as electing States and those States that show their INTENT to take no action and are not electing under 1321. All States have the option of choosing which type of State they are.

Instead of arguing what the government INTENDED, we should be looking at the way the Affordable Care Act treats States depending on their INTENT as evidenced through their ACTION or INACTION.

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The last Happy Graph, Healthcare Costs Per Capita: “Obamacare and Healthcare SPENDING, Chait v. Moore Part IV”

2015-02-23T10:38:00.001-11:00

This is the fourth part of my Chait v. Moore series concerning Jonathan Chait’s article, “Guy Who Gets Paid to Say Obamacare Doesn’t Work Can’t Find a Single True Fact to Support His Case,” Jonathan Chait, NEW YORK MAGAZINE 2/18/15, http://ift.tt/1vhsecn, (Chait), and Stephen Moore’s article, “Affordable care that isn’t affordable: Despite the President’s promises, health care costs are going up,” Stephen Moore, THE WASHINGTON TIMES, 2/15/15, http://ift.tt/1DZKA3i, (Moore).

In Part I we determined that based on the CBO’s information and lack of information that the “all of the act’s budgetary effects” could not be determined, Congressional Budget Office’s January of 2015, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act,” http://ift.tt/1z5kfxx, page 1.

In Part II, we saw that both Stephen Moore and Jonathan Chait mislead consumers by honing in on specific pieces of information that are accurately reported but are used to draw conclusions that they cannot prove, specifically, overall spending for Obamacare. We also get to the point that what the CBO does forecast is how spending is going based on its prior guesses to what they’ve determined to be happening so far that the CBO then uses for projections about Obamacare spending for the items it reports on.

In Part III, breaking down the CBO’s report we found that although federal spending on the specific coverage-only provisions is projected to go down for the next years, there are significant miscalculations the CBO made that it has adjusted in its 2015 projection report, Congressional Budget Office, 1/15/15, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act.” These adjustments indicate that we can rely on some projections but not all that have come out of the CBO and that the REASONS the CBO provides for some of its adjustments that raise a RED FLAG regarding Obamacare now and moving forward.

That brings us to the issue addressed currently: The last Happy Graph, Healthcare Costs Per Capita: Part IV of, “Obamacare and Healthcare SPENDING, Chait v. Moore Part IV.”

In his article, Stephen Moore refers to “This stampede of rising health costs…” (Moore) and that gets Jonathan Chait off and running on his next lecture regarding the convention of what health costs are defined as versus what federal spending is. Health care costs Chait explains are “how much we pay for our treatments (which happens to be much more than what people in other countries pay),” (Chait) Federal spending on healthcare are the overall costs (which we know cannot be determined) that INCLUDE health care costs, what the federal government spends on outlays for health care treatments for individuals.

FIRST: Scolding Moore in this context is little more than an effort by Jonathan Chait to discredit Stephen Moore. Health care costs are a part of federal spending to the extent that the federal government has OUTLAYS for the costs of treatments for individuals. These costs for treatments as Chait notes are much higher in the US than other countries.

BUT CHAIT also misleads. Chait includes a happy graph after stating that “…Obamacare would try to tame the long-term trend toward health-care inflation. That is not only happening, it is happening in a far more dramatic way than even the most optimistic advocates predicted,” (Chait). It turns out that Mr. Chait credits Obamacare with doing more than the government dare take credit for in its own publications.

The PRICE of different medical services has NOT gone down. Consider the 8/31/2014 article, “Surgery Prices Surge With Innovation and Consolidation Under Obamacare,” by Bill Briggs, NBC News, http://ift.tt/1tm6Q3k, that reports that according to Dr. Jeffrey J. Rice, Chief Executive Officer of Healthcare Bluebook, based in Brentwood, Tennessee, that “Overall, health care inflation has averaged about four percent per year during the past five years.”

Yet, according to Chait’s happy graph, the INCREASE in per capita healthcare costs, the outlay for medical services paid for by the federal government has slowed down. So, if healthcare PRICES, the cost of specific treatments is going up, WHY is there a slowdown in how much healthcare costs are going up for the federal government?

SECOND: Does Jonathan Chait know more than the federal government? Jonathan Chait attributes the graph results of slower growth in real per capita national health expenditures to Obamacare successfully “bending the curve,” and “[taming] the long-term trend toward health-care inflation,” (Chait).

Chait’s optimistic interpretation goes further than even the White House. All reliable sources (including the White House and CMS) attribute at least SOME of the slowdown to sequestration (see for example, http://ift.tt/1vR2Fgh, “Press release: National Health Expenditures continued slow growth in 2013,” 12/3/2014. Naturally, since most liberals were against sequestration, this was omitted by Mr. Chait.

As consumers we know that payers save money when consumers can’t afford to actually use their health insurance because they’re nervous about paying their share of those costs in the form of out-of-pocket expenses including deductibles, copayments and coinsurance. The White House confirms this.

In a White House best-case-scenario release called, “Recent Trends in Health Care Costs, Their Impact on the Economy, and the Role of the Affordable Care Act,” http://ift.tt/1lM1OX2 (cited here as White House), the government explains that government savings reflect the fact that “[T]he 2007-09 recession and its aftermath have likely played some role in the recent slowdown in health costs, and this portion of the slowdown is likely to fade…” (White House, page 2). (This is utilization, if you don’t go to the doctor neither you nor the payer, in this case the government pays anything to a doctor).

Unlike Jonathan Chait, the government is uncertain about the full impact of the recession and people’s choices not to utilize healthcare services. The government notes that the full impact of the recession is unknown when it comes to government savings, “…the slowdown is not yet fully understood…” (White House, page 2).

Unlike Jonathan Chait, the White House acknowledges that other influences are helping the Obamacare numbers regarding growth in per capita health expenditures look good in terms of being slower than they have been in a long time. “While various non-recession factors unrelated to the ACA appear to be contributing to the recent slow growth in spending—including a long-term decline in the development of new prescription drugs and a long-term increase in cost-sharing in employer sponsored plans—the ACA is also playing a meaningful role,” (White House, pages 2-3). Fewer new drugs and more cost-sharing in employer-sponsored plans meaning that for 48% of the population estimated to have employer-sponsored plans are paying higher out-of-pocket costs are also contributing to slower growth in expenditures.

When it comes to the “ACA…role,” the government itself isn’t sure whether the ACA has anything to do with the slowdown in the increase in outlays per individual. The White House report indicates that incentives paid to providers “APPEAR [emphasis added] to be beginning to bear fruit,” such as incentives for reducing hospital readmissions and increased health care provider participation in payment models designed to promote high-quality, integrated care. (White House, page 3).

Regarding the ACA role the White House reflects even more uncertainty about what the ACA’s “role” might be discussing results that SUGGEST that Obamacare “MAY GENERATE SPILLOVER BENEFITS,” [caps added] (White House, page 3).

If Jonathan Chait is interested about what the Congressional Budget Office actually states on its Health Care page for January 2015, it says, “Spending on federal health care programs is growing rapidly, driven by both rising enrollment—stemming from the aging of the population and expansions of federal programs—AND RISING HEALTH CARE SPENDING PER ENROLLEE,” [caps added], http://ift.tt/1BIo9jK, “Insurance Coverage Provisions of the Affordable Care Act—CBO’s January 2015 Baseline.”

Third: Mr. Chait addresses Mr. Moore’s assertion that “…employers are also dropping their health coverage and dumping employees and their families on Medicaid and the Obamacare exchanges,” (Moore). Mr. Chait argues that “Obamacare has not caused employers to drop coverage,” (Chait).

But Mr. Chait’s one-liner doesn’t address the CBO 1/15/15 projections about the uninsured population which states: “In 2018 and later years, between 24 million and 25 million people are projected to have coverage through the exchanges, and 14 million to 16 million more, on net, are projected to have coverage through Medicaid and CHIP than would have had it in the absence of the ACA. Partly offsetting those increases, however, are projected net decreases of 9 million to 10 million in the number of people with employment-based coverage,” (CBO, 1/15/15, page 4). (Emphasis added).

While the CBO does not credit the ACA with the projection of net decreases of 9 to 10 million with employment-based coverage, it certainly indicates at least a correlation if not causation.

SUMMARY: The federal outlay of money for Obamacare is significant to consumers but the way those outlays are considered by the government they cannot be fully sorted out. What can be sorted out are calculations about the specific coverage outlays of money associated with the ACA that the federal government is making.

Within that narrow consideration are Congressional Budget Office projections from year-to-year about how we’re doing with those specific coverage only outlays of money. For Medicaid those costs are higher than were projected by the CBO. For premium tax credits and cost-sharing money, the outlays have been lower primarily because fewer people are enrolling than the CBO anticipated and because the individuals who are enrolling are choosing cheaper bronze plans more often than the CBO anticipated which means that we’ll see a larger number of people who risk financial devastation in the face of illness because a larger number of people will have less financial protection under the cheaper plans.

Finally, in the face of rising medical PRICES for services, payers have seen a slower rise in the amount of money they’re paying out for health costs per capita, the per person amount of money they’ve spent on medical treatments attributed to sequestration, lower utilization because of the recession and higher out-of-pocket amounts that consumers must pay. Further, the data APPEAR to indicate that ACA provisions incentivizing structural changes could be having a beneficial effect on healthcare costs.

CONCLUSION: As consumers we are concerned with the ACA's fiscal performance because in addition to government strategies that are already in place to limit government spending as explained by the CBO,"...if total exchange subsidies exceed a certain threshold in any year after 2017-- a condition that CBO and JCT expect to be satisfied in some years--people will be required to pay a larger share of premiums..." (CBO, 1/15/15, page 3), there will undoubtedly be other government adjustments to curb government expense.

We should be concerned that newly enrolled and therefore more expensive populations of Medicaid enrollees were underestimated and that the costs of Medicaid were also underestimated. But as the issue with premium tax credits and cost-sharing subsidies indicate, we must also be concerned when meeting or beating fiscal targets is primarily achieved through consumer UN-FRIENDLY conditions such as more consumers than the CBO thought would who are purchasing less coverage (bronze instead of silver plans)to try to save money on premiums. We should also be concerned when government savings in costs are attributed to consumers using their healthcare less often because they're worried about finances, utilization and higher amounts of money demanded from consumers in terms of out-of-pocket expenditures, both of which are currently true.

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CBO’s Projections and Obamacare: What they really tell us: Obamacare and Healthcare SPENDING: Chait v. Moore, Part III

2015-02-23T03:41:00.001-11:00

In his article, “Guy Who Gets Paid to Say Obamacare Doesn’t Work Can’t Find a Single True Fact to Support His Case,” Jonathan Chait, NEW YORK MAGAZINE 2/18/15, http://ift.tt/1vhsecn, (Chait), Jonathan Chait criticized Stephen Moore’s assessment of the affordability of the ACA [“Affordable care that isn’t affordable: Despite the President’s promises, health care costs are going up,” Stephen Moore, THE WASHINGTON TIMES, 2/15/15, http://ift.tt/1DZKA3i, (Moore)]

In Part I we determined that based on the CBO’s information and lack of information that the “all of the act’s budgetary effects” could not be determined, Congressional Budget Office’s January of 2015, “Updated Estimates of the Insurance Coverage Provisions of the Affordable Care Act,” http://ift.tt/1z5kfxx, page 1.

In Part II, we saw that both Stephen Moore and Jonathan Chait mislead consumers by honing in on specific pieces of information that are accurately reported but are used to draw conclusions that they cannot prove, specifically, overall spending for Obamacare. We also get to the point that what the CBO does forecast is how spending is going based on its prior projections and its new projections for the items on which it reports.

That brings us to Part III of the Chait and Moore articles, Chait’s from the Obamacare-is-working point of view and Moore’s from the Obamacare-is-NOT-working point of view: IS THE GOVERNMENT ACHIEVING ITS FISCAL TARGETS FOR DIRECT HEALTH INSURANCE COVERAGE EXPENSES WITH RESPECT TO A COMPARISON OF CBO PROJECTIONS TO EXPERIENCE SO THAT WE CAN RELY ON CBO PROJECTIONS MOVING FORWARD?

FIRST: In its 1/15/15 report, the CBO PROJECTS that “…the ACA’s coverage provisions will result in net costs to the federal government of $76 billion in 2015 and $1,350 billion over the 2016–2025 period,” (CBO, 1/15/15, page 1). We know that this is NOT a consideration of “all budgetary effects” but those confined to coverage provisions.

SECOND: According to the CBO, these results, “Compared with the projection from last April…represents a downward revision in the net costs of those provisions of $101 billion over those 10 years, or a reduction of about 7 percent,” (CBO, 1/15/15, page 1). What we’re comparing are the projections from 2014 to the projections of 2015 made by the CBO.

THIRD: MEDICAID: Stephen Moore cites a report by the CBO, Congressional Budget Office’s, “Monthly Budget Review for January 2015,” 2/6/15, http://ift.tt/1B0Qf8s, (CBO, 2/16/15), to state that Medicaid spending is up in the first four months of this fiscal year. THIS IS TRUE.

Moore’s mentions that “Medicaid spending is up a stratospheric 23 percent so far this year,” (Moore) and Jonathan Chait becomes furious, launching an off-topic lecture about how Obamacare is supposed to work and honing in on how Medicaid is not welfare. Chait’s response is an irrelevant response to a TRUE statement.

MEDICAID and the Congressional Budget Office: Based on its own projections, the CBO projects that the federal cost of the additional enrollment in Medicaid and CHIP under the ACA over the 2015–2024 period will be $851 billion,$59 billion (7 percent) more than the April 2014 projection,” (CBO, 1/15/15, page 13).

This is a PROBLEM FOR JONATHAN CHAIT and contradicts his own argument put forth to show that Obamacare is meeting its fiscal targets because while he asserts that “the design of Obamacare all along was to spend money to cover the uninsured,” (Chait), EVEN WITH the Supreme Court Decision that made Medicaid expansion an OPTION and therefore REDUCED the number of individuals NEWLY ELIGIBLE for Medicaid, enrollment and EXPENSES are and are projected to continue to be higher than expected.

When it comes to Medicaid, the CBO got it wrong, MEDICAID IS COSTING MORE THAN PROJECTED. As explained in the report, the CBO now states that the “…estimate that enrollment in Medicaid in 2014 among those eligible for the program because of the ACA’s coverage expansion was higher than originally thought and that enrollment among those previously eligible for the program was lower,” (CBO, 1/15/15), p. 13).

There is a tremendous spending impact on getting Medicaid wrong regarding those who become NEWLY ENROLLED because of the expanded Medicaid provisions because as the CBO states, “…because the federal government pays a larger share of the costs for newly eligible enrollees (100 percent to 90 percent, depending on the year) than for other enrollees (an average of 57 percent),” (CBO, 1/15/15, page 14).

In spite of Jonathan Chait’s dancing around the issue, he does NOT address Mr. Moore’s assertion that Medicaid spending is something THAT IS A FISCAL CONCERN and that the CBO confirms federal spending is going to be much higher than projected previously.

FOURTH: PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES SPENDING IS LOWER THAN PROJECTED: While neither Jonathan Chait nor Stephen Moore adequately address federal spending on premium tax credits and cost-sharing subsidies, the CBO DOES. These outlays are projected to be DOWN from prior CBO estimates, so you would think that Jonathan Chait would have jumped on them, but he didn’t and if you read the CBO report you can see why.

The CBO “…reduced their estimate of average enrollment over the course of 2015 by 1 million people, from 13 million to 12 million,” (CBO, 1/15/15, page 11). Jonathan Chait’s declaration of victory that “Obamacare has increased enrollment in its health care exchanges to more than 11 million,” (Chait), is therefore not only less than what the CBO projected (although pretty close so kudos to the CBO), but the CBO projects that “…for 2016, CBO and JCT have also revised downward their estimate of average enrollment through exchanges,” (CBO, 1/15/15, page 13).

The CBO also informs that “Lower estimated enrollment in coverage obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (CBO, 1/15/15, page 11). This would not support an Obamacare-is-working scenario since Mr. Chait emphasizes as do most liberals, the getting- people-covered goal of Obamacare and therefore savings from lower enrollment than was projected are not supportive of Mr. Chait’s argument.

Cost-sharing subsidies are projected to be lower too, but Jonathan Chait can’t put a possible Obamacare-is-working spin on that, so he omits it.

There’s more bad news on the premium tax credits, cost-sharing subsidies front from the CBO. The CBO has lowered its projections of how much COST-SHARING SUBSIDIES will cost as well, “Outlays for cost-sharing subsidies over the 2015–2024 period are currently projected to be $39 billion less than previously estimated, primarily because CBO and JCT now expect that more people will forgo those subsidies by choosing to enroll in a bronze plan instead of a silver plan,” CBO, 1/15/15, page13. As the report explains, “…eligible low-income individuals must enroll in a silver plan to receive cost-sharing subsidies,” (CBO, 1/15/15).

According to the CBO, why is money being saved on cost-sharing subsidies? BECAUSE “…data suggest that a significant number of people are selecting plans that minimize their monthly premium payments, even if the amounts they ultimately pay for health care (including out-of-pocket payments) exceed what they would pay under silver plans,” (CBO, 1/15/15, page 13).

People are purchasing WORSE health insurance,meaning that provides less coverage protection because their premiums for coverage EVEN WITH premium tax credits are too high. Therefore we’re getting more people who are UNDER-INSURED, who are in financial peril if they become sick, one illness away from financial ruin. Hardly an Obamacare-is-working scenario.

IS THE GOVERNMENT ACHIEVING ITS FISCAL TARGETS FOR DIRECT HEALTH INSURANCE COVERAGE EXPENSES WITH RESPECT TO A COMPARISON OF CBO PROJECTIONS TO EXPERIENCE SO THAT WE CAN RELY ON CBO PROJECTIONS MOVING FORWARD? Yes and no, but federal spending projection errors are significant for consumers.

Next, “The last Happy Graph, Healthcare Costs Per Capita: Part IV of, “Obamacare and Healthcare SPENDING, Chait v. Moore.”

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Gem Treasure Hunting In Tennessee

2015-02-22T20:17:00.001-11:00

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