Thursday, June 18, 2015

Observations From the Back Row!

Why are insurance rate increases so much higher than expected?  Instead of moderate rate increases for one more year, the big rate increases have begun. They are particularly large among the health insurers with the most enrollment--the carriers with the most data. Texas Blue Cross stands out. The health plan commented in its federal government rate filings that it covered 730,833 Obamacare individuals in 2014 with premium of $2.1 billion and claims totaling $2.5 billion--for a medical loss ratio of 119%. The plan further commented that, after the “3Rs” reinsurance adjustments, they lost 17% to 20% of premium in 2014--that would be about $400 million. And, they are only asking for a 20% rate increase......CareFirst Blue Cross of Maryland is asking for a 34% rate increase on its PPO plan and a 26.7% rate increase for its HMO…..The White House has said that about 11.4 million Americans are signed up for private health coverage through Obamacare’s insurance exchanges. But once you unravel the spin, what the latest numbers show is that the pace of enrollment has slowed down by more than half. If previous trends hold, Obamacare exchanges have enrolled roughly 5 million previously uninsured people……In the long term, this is the real failing of Obamacare and the real reason it will require reform no matter which party takes the White House in 2016. When you get down to it, the biggest problem with Obamacare is that it hasn’t been popular enough to work, and it hasn’t worked enough to be popular…..

Obamacare and the Rule of Law - In a speech Tuesday, President Obama said the Affordable Care Act has now been woven into the fabric of America.The president’s remarks come as the Supreme Court is preparing this month to decide King v. Burwell, a case that challenges whether the law ever actually authorized subsidies for health coverage paid out through federal exchanges. The details of Burwell reveal the degree to which the Obama administration’s handling of the ACA is ultimately at odds with ideals and aspirations that really are woven into the fabric of America: the rule of law and the separation of powers under the U.S. Constitution…In other words, the challengers in King v. Burwell contend that the White House illegally authorized billions of dollars of taxes and spending, circumventing Congress and flouting the statutory text of the ACA by administrative decree. The accusation isn’t a stretch……Instead of going back to Congress, which would have meant compromising with Republicans on other changes to the law, the Obama administration circumvented the ACA and attempted to implement the administration’s preferred policy outcome by fiat. This is not a trifling matter.

House, SenateRepublicans Plan for King V. Burwell - Sen. John Barrasso (R-Wyo.) said Tuesday that House and Senate Republicans are closing in on a backup plan for ObamaCare subsidies that they will release should the Supreme Court cripple the healthcare law this month.  Barrasso, who is leading the main Senate planning effort, said the plan would include some kind of temporary assistance for the 6.4 million people who could lose health insurance subsidies because of the case of King v. Burwell..He would not reveal exactly what kind of temporary assistance the bill includes. Johnson has proposed extending the insurance subsidies that already exist, while others like Sen. Ben Sasse (R-Neb.) have instead proposed a system of new tax credits.

Burwell Draws Lineon Subsidies - President Obama will oppose Republican plans that end key Affordable Care Act insurance requirements if the Supreme Court rules against the administration, Health and Human Services Secretary Sylvia Burwell said Wednesday.  Speaking at a House Ways and Means Committee hearing, Burwell specifically rejected a proposal from Sen. Ron Johnson (R-Wis.) that would extend Obamacare subsidies in states with federal exchanges until 2017 but end many insurance coverage requirements. Johnson’s proposal has 31 Republican cosponsors, including Senate Majority Leader Mitch McConnell (Ky.).

Lament For Medicare’s Sustainable Growth - The genius of the SGR was that if doctor’s productivity improved more than the nation’s overall productivity, they got a raise. But if their productivity increase was slower, they got a pay cut, at least they were supposed to. SGR worked fine until 2002. Then practice costs started to increase at a significantly higher rate than the SGR permitted, and doctor’s pay was cut almost 5 percent. Well, that did not last long. Although the gap between overall productivity and physician’s productivity kept growing, along with the pay cuts indicated by the SGR, Congress enacted 17 short-term patches to make sure pay never decreased. The current patch expired on March 31, and doctors would have taken a pay cut of about one-fifth had Obama not signed the permanent fix. No politician has ever been recorded inquiring why doctors are not able to increase their productivity at the same rate as anyone else.   It might have something to do with the way Medicare determines what each procedure is worth Medicare’s centrally controlled system would make a Soviet planner blush…..Bear in mind that entitlement spending is on autopilot - Medicare appropriations are deemed mandatory, or at least they will be until our creditors decide they’ve had enough.

 Why Everything We 'Know' About Diet and Nutrition Is Wrong - For decades, the federal government has been advising Americans on what to eat. Those recommendations have been subject to the shifting sands of dietary science. And have those sands ever been shifting. At first, fat and cholesterol were vilified, while sugar was mostly let off the hook. Now, fat is fine (saturated fat is still evil, though), cholesterol is back, and sugar is the new bogeyman.  Why the sizable shift? The answer may be "bad science."  Every five years, the Dietary Guidelines Advisory Committee, composed of nutrition and health experts from around the country, convenes to review the latest scientific and medical literature. From their learned dissection, they form the dietary guidelines. But according to a new editorial published in Mayo Clinic Proceedings, much of the science they review is fundamentally flawed………

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