Archive for Health Care

Killing More GIs Than ISIS

To be fair, ISIS doesn’t run hospitals:

WASHINGTON — In a contentious hearing before Congress, a senior official from the Department of Veterans Affairs’ watchdog agency acknowledged for the first time on Wednesday that delays in care had contributed to the deaths of patients at the department’s medical center in Phoenix.

The disclosure by an official from the department’s inspector general’s office, coming after more than two hours of tough, sometimes confrontational exchanges with members of the House Veterans Affairs Committee, was a significant development in what has become a heated dispute over the quality of care at the Phoenix hospital, where revelations of secret waiting lists and other schemes to disguise long delays in care turned into a national scandal.

[U]nder questioning by Representative David Jolly, Republican of Florida, Dr. John D. Daigh, the assistant inspector general for health care inspections, conceded that medical-care delays in Phoenix had contributed to some patient deaths.

“Would you be willing to say that wait lists contributed to deaths of veterans?” Mr. Jolly asked.

“No problem with that,” Dr. Daigh replied. “The issue is cause.”

Dr. Daigh did not say how many times he believed medical-care delays had contributed to deaths in Phoenix. In addition to the six veterans who died after experiencing clinically significant delays, the inspector general’s office revealed Wednesday that 293 veterans had died out of 3,409 cases it reviewed in Phoenix.

“We can play with semantics all we want,” Mr. Jolly said, “but right here at the table it was acknowledged by the I.G.’s office that the wait lists contributed to the deaths of veterans.”

Ain’t no ISIS terrorist ever killed an American veteran.

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The “Good” News on ObamaCare

Never let it be said we don’t present both sides:

The ranks of the uninsured plummeted in early 2014, as millions gained health insurance coverage through Obamacare, new government data released Tuesday found.

There were 41 million Americans lacking coverage in early 2014, down from 44.8 million last year, according to the National Health Interview Survey, the first official government look at the uninsured after Obamacare policies kicked in on January 1. The uninsured rate fell to 13.1%, from 14.4%.

Wow…a whole 1.3%. I haven’t seen such a “plummet” since riding the Cyclone at Coney Island.

Take a look:

Untitled

Caught your breath yet?

Just a couple of questions. If ObamaCare was the savior of the uninsured, how come the rate of decline in the uninsured predates the (lewd) act by a year? And if Obama thinks he can legalize five million illegal aliens with the stroke of a pen, why, pray tell, did we have to go through the legislative and bureaucratic train wreck of ObamaCare just to extend insurance coverage to 3.7 million? Throwing millions more off their plans in the process?

President Obama had a Democrat majority in both houses of Congress. He could have expanded Medicaid in his first budget. His “soaring” rhetoric and adoring acolytes could have made anything happen. Heck, they passed ObamaCare.

Which tells you all you need to know. This wasn’t about the uninsured. It was about power. In that, the law (the Constitutional law, b*tches) is a success.

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Illin’ Oy

ISIS beheadings, IRS emails, bad “optics” and poor “theater”—it hasn’t exactly been a fun summer for poor Barack Obama, golf very much aside.

But there’s always ObamaCare!

To say this fall’s 2015 Obamacare open-enrollment has the potential to be problematic is an understatement.

The HealthCare.gov backroom is not built yet––a year and counting after it should have been.

How many people are enrolled in Obamacare? Without a government to insurance company accounting system yet built, no one knows.

Five to ten million people all trying to get through exchange websites between November 15 and December 15? Add however many people are going to sign-up for the first time this November to all of those existing participants re-enrolling for January 1, who will all be hitting the still fragile Healthcare.gov and state exchanges during that four week period, and it is not hard to see how Obamacare could be back in the news.

While the open-enrollment is now scheduled to begin until 11 days after the November election there will be plenty of renewal and cancellation letters going out in October.

Does this all sound confusing? Just wait until we approach the next open-enrollment with millions of people hearing about all of this complexity and having just four weeks to get their enrollment validated for January 1. The Obamacare anxiety index is going to be off the charts well before November 15th.

Add to all of this bigger deductibles for 2015 (those go up with cost trend as well as the rates) and more narrow networks as well as generally larger rate increases for the plans that got the most enrollment and there will be lots to talk about.

Then there is the still unanswered question: How many people are enrolled in Obamacare?

Any bets on how many more months it will be before the Obama administration has the administrative wherewithal to answer that simple question and give us the real number?

A few other coming cluster[bleeps]:

For the roughly 8 million people who signed up this year, the administration has set up automatic renewal. But consumers who go that route may regret it. They risk sticker shock by missing out on lower-premium options. And they could get stuck with an outdated and possibly incorrect government subsidy. Automatic renewal should be a last resort, consumer advocates say.

Elizabeth Warren’s Consumer Protection Bureau would bring up ObamaCare on charges faster than you can say “high cheekbones” if it were a private business.

Proceeding:

Of those enrolled this year, the overwhelming majority received tax credits to help pay their premiums. Because those subsidies are tied to income, those 6.7 million consumers will have to file new forms with their 2014 tax returns to prove they got the right amount. Too much subsidy and their tax refunds will be reduced.

One quirk troubling the industry is that policyholders who want to update their subsidies and stay in the same plan will have to type in a 14-character plan identifier when they re-enroll online. That’s longer than a phone number or a Social Security number, and customers may not know where to find it.

Millions of tax returns and millions of 14-character ID #s—what could go wrong? On a website that’s already been hacked!

Cherry picking:

Tens of millions of people who remained uninsured this year face tax penalties for the first time, unless they can secure an exemption.

“It’s the second open enrollment, but the first renewal and the first tax season where the requirements of the Affordable Care Act are in place,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which advocates for low-income people, and supports the law.

“The fact that it is all going to be occurring within an overlapping and relatively short time frame … means that there will be many issues,” she added.

Issues, she says. Issues. I’ll show you issues:

Rep. Bill Pascrell, D-N.J., said in an interview that he disagrees with making people pay back part of their premium subsidy. That would happen if someone made more money during the year and failed to report it to HealthCare.gov.

“Why should individuals be punished if they got a bump in salary?” said Pascrell. “To me, this was not the ACA I voted on.”

Oh, but it is, Congressman, it is. It is exactly as promised—if you read the bill.

To end on a lighter note:

Alex Stevens, a dishwasher at an Austin pizzeria, got covered this year and said he’s planning to re-enroll. A skateboarding enthusiast in his late 20s, Stevens broke a leg skating with friends this summer. It was a bad break and he had major surgery the next day. But his insurance paid most of the $55,000 bill, and he only owed $750.

So, ObamaCare does work for skateboarding enthusiasts in their late 20s who make a living washing dishes at a pizza shop. So there’s that.

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Broken ObamaCare Promise No. LVXIII

Give or take a I or II:

More people newly insured by Medicaid under ObamaCare are seeking treatment in hospital emergency rooms — one of the most expensive medical settings, a study released Monday concludes.

The analysis by the Colorado Hospital Association found that the average number of ER visits in states that expanded Medicaid increased by 5.6 percent, when the second quarter of this year was compared with the same period in 2013.

The increase was more than three times larger than experienced by hospitals in states that did not expand.

The jump was also outside the range of normal year-to-year fluctuations.

“When this newly insured population is trying to understand the system, they are using the easiest access point, and that is the ER,” said Chris Tholen, a vice president of the hospital association.

You can’t keep your plan, let alone your doctor. It isn’t bending the “cost curve” down, but up. The system, which we were warned was under-secured, was recently hacked. It may (or may not) be Constitutional (bitches).

And the newly insured are still hitting the ER, as they always had. Otherwise, it’s aces.

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Health Care Costs

Obama claims that health care costs are dropping. This guy says they are rising dramatically and will negatively affect the mid-terms. Which is correct?

When the supermajority of Democrats in the Senate passed the ironically named Affordable Care Act in 2009, one of the chief requirements of the bill was to force health insurers, pharmaceutical companies, hospitals and health care centers to share in the staggering $2 trillion cost over the next decade. But once made law, President Obama pushed off the cost until well, just later — certainly not before the 2012 election.

That later is now, or Sept. 30, to be precise. Remember when the president said the 10-year cost for his health care reform would be $850 billion and that no one would pay an additional penny in taxes? Ha. Insurers will have to pony up some $8 billion on the last day of September, and guess where they’re going to get the cash? Straight from your wallet, your purse.

Here are some numbers, straight from my own checkbook register. In October 2011, before the start of Obamacare, I was paying $386 a month. Yes, fairly reasonable, but less so when you factor in my $10,000 deductible (and two teenage children who keep falling off things). The following October, the premiums rose 23 percent to $474.

In October 2013, my monthly rate rose again, nearly 32 percent, to $623. Same exact coverage, just more money. Then, this year, come Sept. 30, my new premiums will be $1,097. That’s a 76 percent increase from the previous year, and, all told, my premiums have risen 184 percent in just three years.

But that’s not all. My deductible has also jumped to $12,000 (but my out-of-pocket expenses are, under some complicated formula my Anthem Blue Cross Blue Shield health adviser couldn’t really explain, going to be higher than that, maybe substantially so).

Now, in order to get a break on my costs (a federal subsidy paid, of course, by other taxpayers), I’d have to make less than $62,000 for a family of three. That means someone making $62,001, which means about $46,500 a year or $3,875 a month after taxes (if he’s lucky), will be shelling more than a quarter of his money for health care.

And back to why. Although Mr. Obama said he would hold those bad old insurance companies accountable and make them pay, pay, pay, there are no mechanisms within the law to keep providers from doing just what they’re doing now — passing the cost on to you in the form of new, much higher premiums.

What’s more, after Mr. Obama uttered what Politifact called the “Lie of the Year” — that if you liked your insurance, you could keep it — implementation of many of the more onerous parts of the law were delayed. Now, though, all those so-called “subpar” insurance policies are being eliminated.

That is putting Obamacare right back on the front burner for this midterm election, just as it was in the 2010 midterms. Then, voters mobbed summer town halls to vent, and Republicans went on to trounce Democrats, pulling off the largest seat swap in any midterm since 1948.

Right about now, across the country, Americans are either getting their monthly bills for drastically higher premiums, or they’ve already got them and are beginning to shop for new insurance in preparation for the coming open-enrollment season this fall. But they’re no doubt finding that the new policies mandated by Obamacare are raising costs sky-high — there’s nothing cheaper.

And there’s more. But here’s a question: Which experience have you had – the one where your costs go down or stay about the same, or the one where they skyrocket? In our household the monthly went up about 20% and the deductible more than doubled (only possible in Massachusetts because of the federal plan; our previous state law kept it to something like $4000 per year for a family). BUT, our co-pay dropped from $40 per visit to $35 per visit. Sweet!!!!

So tell us what you think. I am hoping that the writer is correct, that Americans will move to the Right, but I am not counting on it.

– Aggie

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Jobbed and Jobless

Jane Austen’s novel of bad manners on the state of Americans under the burdens of ObamaCare:

On Thursday the Federal Reserve Bank of Philadelphia reported the results of a special business survey on the Affordable Care Act and its influence on employment, compensation and benefits. Liberals claim ObamaCare is of little consequence to jobs, but the Philly Fed went to the source and asked employers qualitative questions about how they are responding in practice.

The bank reports that 78.8% of businesses in the district have made no change to the number of workers they employ as the specific result of ObamaCare and 3% are hiring more. More troubling, 18.2% are cutting jobs and employees. Some 18% shifted the composition of their workforce to a higher proportion of part-time labor. And 88.2% of the roughly half of businesses that modified their health plans as a result of ObamaCare passed along the costs through increasing the employee contribution to premiums, an effective cut in wages.

Those results are consistent with a New York Fed survey, also out this week, that asked “How, if at all, are you changing (or have you changed) any of the following because of the effects that the ACA is having on your business?” For “number of workers you employ,” 21% of Empire State manufacturers and 16.9% of service firms answered “reducing.”

To complete the triptych, an Atlanta Fed poll earlier this month found that 34% of businesses planned to hire more part-time workers than in the past, mostly because of a rise in the relative costs of their full-time colleagues. ObamaCare may be contributing to that surge to the extent the law’s insurance mandates and taxes increase spending on fringe benefits for people who work more than 30 hours.

Somewhere between one-fifth and one-third of employers are cutting hours for their employees. The Left likes to think of itself as fact-based and scientific. But ObamaCare was built on the promise of sugar plums and unicorns. Define full time workers at 30 hours a week, and that’s what you’ll get, an army of 29-hour a week workers without health care. The Soviet Union learned that a command economy doesn’t work. Now we don’t work.

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How Does ObamaCare Intersect With Identity Theft?

4.5 million people had their records stolen in hospital system hack attack

Community Health Systems, which operates 206 hospitals across the United States, announced on Monday that hackers recently broke into its computers and stole data on 4.5 million patients.
Hackers have gained access to their names, Social Security numbers, physical addresses, birthdays and telephone numbers.

Anyone who received treatment from a network-owned hospital in the last five years — or was merely referred there by an outside doctor — is affected
.
The large data breach puts these people at heightened risk of identity fraud. That allows criminals open bank accounts and credit cards on their behalf, take out loans and ruin personal credit history.

The company’s hospitals operate in 28 states but have their most significant presence in Alabama, Florida, Mississippi, Oklahoma, Pennsylvania, Tennessee and Texas.

Community Health Systems (CYH) hired cybersecurity experts at Mandiant to consult on the hack. They have determined the hackers were in China and used high-end, sophisticated malware to launch the attacks sometime in April and June this year.

This has happened over the past five years – what does it have to do with ObamaCare? Well, the answer is that ObamaCare creates bigger networks and hires “navigators”, some of whom have criminal records. The more centralized the system, the more people will be hurt by an attack like this one. Plus, they promised us that this wouldn’t occur, that security was in place to protect us. I doubt it.

– Aggie

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Where Have All the Health Plans Gone?

When will we ever learn?
When will we ever learn?

Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it.

They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan.

This is the newest challenge facing the Massachusetts Health Connector…

Hey, President Obama! Oh, sorry sir. I didn’t see that you were putting. I’ll wait.

Ohhh! So close!

Anyway, the Boston Glob offers a helpful hint out of your signature fiasco, ObamaCare. The next cluster[bleep] that reaches from the pages of the newspaper and slaps us across the face, call it a challenge. Lost your doctor? That’s a challenge. Premiums spike, deductibles spiral? That’s a challenge. Cancer spread while no one could figure out whether your plan was valid? That’s a big challenge.

Our regular readers may be wondering who this serious, stone-faced BTL is. Why haven’t I dissolved into fits of giggles? Where are the tears streaming from my eyes, the snot from my nose?

Here ya go:

Connector leaders want to get people to log on and choose a plan, starting Nov. 15.

To reach them, the Connector plans to place 2 million robocalls and knock on 200,000 doors, along with making personal phone calls, sending mail, buying print and broadcast advertisements, and holding community meetings and enrollment fairs.

The campaign is estimated to cost $15 million to $19 million, money the state will seek from the federal government.

Thanks, Buck! How generous of you, Judi! And all the rest of you tax-paying Americans who bankroll “the federal government”. Nineteen million dollars for enrollment fairs! I bet they have some pretty cool rides at enrollment fairs. Can I be a judge at the best pig competition?

HAHAHAHAHAHAHA!!!!!!!!!

In a document describing the enrollment push, state officials say that one of their main messages to consumers should be to “squarely acknowledge and apologize for last year’s problems,” when a new website developed to comply with the federal Affordable Care Act failed to work properly, leaving thousands of people unable to sign up for insurance.

Maydad Cohen, a special adviser to Governor Deval Patrick, told the board that oversees the Connector Thursday that the state will request an additional $80 million in Medicaid funds to complete rebuilding of the website. That brings to $254 million the cost of the failed Connector project and its rebuilding, with all but $30 million paid by the federal government.

What’s another $19 million on top of the $224 million you’ve already wasted—I mean, spent—on us?

HOHOHOHOHOHO!!!!!

It’s not like it’s really our fault:

The state established the Connector as the cornerstone of its 2006 health care overhaul. But in 2013, the Connector’s website needed to be upgraded to comply with the Affordable Care Act.

The revamped site never worked properly and could not determine whether individuals were eligible for subsidies or MassHealth, the state’s Medicaid health plan for the poor.

See? We had a working plan (sort of), called RomneyCare, until Obama came along and junked it. Then we got stuck with the POS the rest of you have, ObamaCare. You (the federal government) broke it; why shouldn’t you pay to fix it?

Money well spent!

Cohen expressed confidence that when consumers log on they will find a functioning website able to take them from log-on to health plan choice.

“We are much further along than we were last year at this time,” he said after the meeting.

Give us another year, and we’ll have this thing doing backflips!

HEEHEEHEEHEEHEE!!!!! Anyone have a tissue?

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ObamaCare: Define Best, Define Worst

One of the terrific things about being a liberal is that you get to define the terms, and those terms are flexible:

The liberal attraction to making government the sole source of health-care insurance has not abated even as the deficiencies in ObamaCare, a halfway move toward the single-payer model, have become increasingly evident. The question is whether growing signs of single-payer trouble overseas will be enough to discourage this country’s flirtation with socialized medicine.

The Obama administration showed its hand long ago with the nomination of Tom Daschle, an advocate for Britain’s socialized National Health Service, as secretary of Health and Human Services in 2009. (Mr. Daschle withdrew amid criticism for nonpayment of taxes.) The White House installed another outspoken NHS fan, Donald Berwick, as an interim appointee (2010-11) to run the Centers for Medicare and Medicaid Services.

This summer, the Commonwealth Fund—a private foundation focused on health care that is a favorite of progressive policy types—issued a report ranking the NHS as the best medical system among those in 11 of the world’s most advanced nations, including Canada, France, Germany, Switzerland and Sweden. Coming in last: U.S. health care.

So what makes Britain best and the US worst? Beats me..

Yet the Commonwealth rankings are contradicted by objective data about access and medical-care quality in peer-reviewed academic journals. For instance, Americans diagnosed with heart disease receive treatment with medications significantly more frequently than patients in Western Europe, according to Kenneth Thorpe in Health Affairs in 2007. In Lancet Oncology in that same year, Arduino Verdecchia published data demonstrating that American cancer patients have survival rates for all major cancers better than those in Western Europe and far better than in the U.K.

Personal anecdote: I have a dear friend who came down with an aggressive breast cancer in her 30s. I happened to be in Europe at the time, and read some research that indicated that if she had been a citizen of the UK and reliant on the NHS, her survival rate would have been about 44%. Germany: 63%. US: 88%. This was in the 90s. She’s still with us.

Similar examples concerning the deadliest and most significant diseases abound in medical journals. One may ask why the Commonwealth Fund’s health-care rankings published in June don’t reflect that reality. Theanswer lies in the report’s methodology, which relied heavily on subjective surveys about “perceptions and experiences of patients and physicians.”

Yet even as the single-payer system remains the ideal for many on the left, it’s worth examining how Britain’s NHS, established in 1948, is faring. The answer: badly. NHS England—a government body that receives about £100 billion a year from the Department of Health to run England’s health-care system—reported this month that its hospital waiting lists soared to their highest point since 2006, with 3.2 million patients waiting for treatment after diagnosis. NHS England figures for July 2013 show that 508,555 people in London alone were waiting for operations or other treatments—the highest total for at least five years.

Even cancer patients have to wait: According to a June report by NHS England, more than 15% of patients referred by their general practitioner for “urgent” treatment after being diagnosed with suspected cancer waited more than 62 days—two full months—to begin their first definitive treatment.

In addition to the wait, they are denied state of the art chemotherapy meds until they “fail” on the standard medications. And, natch, the cancer grows at they “fail”. Which is why the top 20% or so of Brits pay for private health insurance. Is that racist?

We will all experience this and real soon. The Baby Boomers dug their own graves when they voted Obama in – twice.

– Aggie

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Romney Got It Right – All Of It.

Iraq, Russia, the economy, health care…

Almost every day, it seems, brings a headline demonstrating how right 2012 Republican presidential candidate Mitt Romney was, and how wrong President Barack Obama was, on the critical issues facing America.

In 2012, Romney warned that Obama’s failure to secure an agreement to keep a residual military force in Iraq would threaten the U.S. gains made at such a high cost in American lives and treasure. “America’s ability to influence events for the better in Iraq has been undermined by the abrupt withdrawal of our entire troop presence,” Romney asserted.

The chaos in Iraq today supports Romney’s view. With no U.S. military presence to constrain Prime Minister Nouri al-Maliki, the Shiite politician persecuted Sunni leaders and gutted Sunni participation in government and the military. Worse, it set the stage for Sunni sympathies to turn to the fanatical Islamic State in Syria and Iraq that has conquered a significant part of the country and waged genocide against religious minorities. Obama has had to order U.S. air strikes to protect U.S. personnel in the Kurdish region and to support Kurdish militia to keep ISIS from capturing all of northern Iraq.

In the 2012 debates, Obama mocked Romney for calling Russia America’s top geopolitical foe. Today, Russia has stolen Crimea from Ukraine, funds and provides weapons and men to Russian separatists in eastern Ukraine and even threatens an invasion of the country. President Vladimir Putin meddles in the Mideast, seeks to expand Moscow’s clout in Latin America, and harbors renegade Edward Snowden.

On domestic issues, Romney in 2011 advanced the idea of giving veterans a voucher to obtain medical care they could not get at a Veterans Administration hospital. This year saw the VA scandal reveal that long waiting lists for hospital treatment were hidden. Legislation Obama signed this week allows vets to seek help outside the VA system.

Romney understood that the nation’s outdated, complex tax code encourages U.S. corporations to park assets overseas and invest in other countries. He recommended tax reform to keep that money and business in America and boost the economy. Obama does nothing about reform but demagogues as “unpatriotic” corporations pressured by the tax code to seek profits and better returns for shareholders overseas.

More at the link. Read it and weep.

– Aggie

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BTL Therapy Session

I hate to burden my subjects with my personal issues, but I had the worst dream last night. I need to share.

It started like this:

Sticker shock is around the corner for many Americans with government-brokered medical coverage, as insurance companies are beginning to apply their first-year costs to next year’s premiums.

In the case of Florida, some consumers will pay as much as 23 per cent more when their plans are renewed in the fall, according to the Florida Office of Insurance Regulation.

The numbers in virtually every state are all across the board, with the biggest rate hikes announced to date coming in states where the federal government runs the Obamacare marketplaces.

I woke up in a cold sweat. Once I had a glass of water, I tried to go back to sleep.

Until…

“The Obama administration on Friday appealed the ruling that some subsidies underObamaCare are illegal,” reports the Hill. “The Justice Department filed a petition with the full D.C. Circuit Court asking the judges to review the ruling in Halbig v. Burwell that overturned some of the subsidies distributed to help people pay for health insurance.”

A day earlier the plaintiffs in King v. Burwell filed an appeal petition directly with the Supreme Court, The Wall Street Journal reports. The cases raise the same question, but a three-judge panel of the Fourth U.S. Circuit Court of Appeals ruled in favor of the government. Both appeals were expected: The Obama administration has reason to expect a more favorable hearing from the D.C. Circuit, newly packed with Democratic appointees, than from the high court.

The Halbig court held that because the ObamaCare law expressly authorizes premium subsidies only for medical-insurance policies purchased on an exchange established by a state, it precludes a 2012 Internal Revenue Service regulation providing subsidies via the federal exchange, HealthCare.gov, as well. Administration supporters seem to have given up arguing that the IRS rule is consistent with what the law actually says, so instead they’ve rested their case on congressional intent.

No! NO!!

Forget dreams about falling or being naked in public, this was petrifying. Somehow, a law was passed that forced rises in medical costs, yet subsidized fewer people. When did our country get taken over by rich, greedy bastards?

Once I convinced myself this was twisted fantasy, I allowed myself to try sleep again.

Big mistake:

[F]ederal health officials are finding themselves swamped as they fact-check a flood of paperwork from applicants seeking taxpayer subsidies.

The Department of Health and Human Services seems to be caught between critics on both sides as it confronts the task.

The department, which oversees the implementation of the Affordable Care Act, has gotten hit by audits showing it hasn’t done enough to crack down on fraudsters trying to scam the system. At the same time, some frustrated applicants say they have played by the rules — signed up on time and submitted the necessary paperwork — only to be caught up in bureaucratic red tape.

The scramble to verify eligibility comes on the heels of a Government Accountability Office report that raised fresh doubt about the ability of the health care program to prevent or intercept costly fraud schemes.

Government investigators posing as fake applicants were able to go online, purchase health plans using fake documents and set themselves up to receive undeserved federal subsidies.

Eleven of the 12 fictitious applicants were able to dupe the system using invalid Social Security numbers as well as inaccurate citizenship information, according to the report. The 11 were given the go-ahead to receive $30,000-a-year in health care credits and subsidies.

STOP! The government caught barely 8% of fraudulent applications? Over 90% of con men and grifters could score an easy 30k without breaking a sweat?

Was I going mad?

I passed out again, feverish:

Vermont, a bellwether for healthcare reform, has fired the main technology contractor behind its bungled health insurance website, dealing the latest blow to CGI Federal, the company that was axed over its disastrous jobs in making the federal healthcare exchange website and a similarly troubled site for Massachusetts.

With Vermont still lacking a fully functioning health website more than 10 months after its glitch-plagued debut last October, Vermont officials said late Monday that they were pulling the plug on CGI’s CGI Technologies and Solutions’ contract. CGI’s Fairfax, Virg.-based subsidiary had stood to make at least $83 million from its work for Vermont but will now make just $66.7 million, a figure that incorporates a $5.1 million penalty levied by the state for shoddy work.

Despite the tangles, Vermont is pushing ahead with plans to become the nation’s first system in which the state foots all health-care bills for all residents — what conservatives call “socialized medicine,” and others call “single-payer” or “universal financing.” Miller told Newsweek that “development of the Vermont universal coverage system is proceeding” and that the Shumlin administration would provide cost estimates and an operational plan to the state legislature in January 2015.

The grand plan will require more federal dollars, in the form of grants, and federal approval to effectively bypass the Affordable Care Act, the very law that Vermont Health Connect was built to comply with. Vermont, Miller told Newsweek, is working with the Centers for Medicaid and Medicare Services, the federal agency overseeing the Affordable Care Act, “to submit requests for the waivers that will be needed.”

I am a changed man, a shell of myself. I went to bed thinking we had a health care system that worked for the vast majority of us. I woke up dizzy with the thought that we had passed some lurid gargoyle of a law that raised prices, cut subsidies, wasted hundreds of millions of dollars on botched websites, and was wide open to fraud.

Please tell me this isn’t so.

Please…?

Many of the eight million sign-ups in Obamacare exchanges nationwide already face more limited choices for physicians and hospitals than those in the private insurance market. But with low physician reimbursement rates, the problem could get even worse.

For a typical quick patient visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer would pay $100 while Medicare would pay around $80. But Obamacare plans are more likely to pay closer to $80, which Gerard says is unsustainable for his practice.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Dr. Gerard told NPR. ”You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

[Whimper... shudder...sob...whimper...]

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ObamaCareless?

So, did the long-awaited, much-anticipated court ruling(s) on ObamaCare actually decide anything? Not yet.

But let’s dismiss the idea that the intent of Congress was plain:

Some argued that the text of the law clearly permitted subsidies to flow to those who purchased plans on the federal exchange—this was the argument offered by the government in court. Others argued that while the text didn’t technically permit those subsidies, that was clearly the intent of the the law, and any textual omission was surely due to a “drafting error.”

That’s right: a drafting error.

Let’s take a step back to see how plausible that explanation is. There are two types of exchanges: state-established, and federally established. The statutory authority for state-based exchanges comes in section 1311 of Obamacare. The statutory authority for a federal exchange in the event that a state chose not to establish one comes from section 1321(c) of Obamacare. Right off the bat, we have two discrete sections pertaining to two discrete types of health exchange. Was that a “drafting error”?

Then we have the specific construction of section 1321(c), which allows for the creation of a federal exchange. Nowhere does this section say that an exchange created under its authority will have the same treatment as a state-based exchange created under section 1311. At no point does it say that section 1321 plans are equivalent. Why, it’s almost as though the exchanges and the plans offered by them were not intended to receive the same treatment. Was that another “drafting error”?

Most important, we have the sections of the law providing for tax credits to help offset the cost of Obamacare’s health care plans: sections 1401, 1402, 1411, 1412, 1413, 1414, and 1415. And how do those sections establish authority to provide those tax credits? Why, they specifically state ten separate times that tax credits are available to offset the costs of state health exchange plans authorized by section 1311. And how many times are section 1321 federal exchange plans mentioned? Zero. Was that yet another “drafting error”?

The specific phrase “established by the State under section 1311? can be found twice in the tax credit title of Obamacare. The first instances relates to the size and the second to the scope of the tax credit subsidy. How many times is the phrase “established by the Federal government/Secretary under section 1321? found? Zero. Was that also a “drafting error”?

The deliberate creation of a separate section to authorize a separate federal entity is not a drafting error. The repeated and deliberate reference to one section but not another is not a drafting error. The refusal to grant equal authority to two programs authorized by two separate sections is not a drafting error. The decision to specifically reference section X but not section Y in a portion of a law that grants spending or tax authority is not a drafting error.

The clear text of the law repeatedly demonstrates that plans purchased via federal exchanges were never meant to be treated the same as plans purchased by state-based exchanges. Despite its assertions, the IRS was never granted the statutory authority to hand out tax credits related to plans purchased via a federal health exchange.

The law expressly and intentionally omits HealthCare.gov from handing out subsidies—yet the IRS decides that it can.

How?

Obamacare was signed into law in March of 2010. It wasn’t until August of 2011 that the IRS decided to make tax credit subsidies available to plans purchased on federal exchanges. That’s a span of 16 months—an awfully long time to recognize and address a “drafting error.” Furthermore, actual “drafting errors” have to be corrected by new laws, not by executive fiat. Even when they are plainly obvious to everyone who sees them, that 3015 that should’ve been 2015 still has to be amended via a new law: passed by both Houses, and signed by the president. Yet, that’s not what this administration did.

In its May 2012 announcement of its official new rule which suddenly allowed subsidies to flow to federal exchange plans, the IRS never claimed it was a drafting error. It claimed the opposite: that the text clearly endorsed the IRS interpretation.

So why did the IRS wait nearly 16 months to spring this new interpretation on the public? That’s also an easy one. As of August 17, 2011, when its rule was first proposed, only ten states had passed laws establishing their own exchanges. Seventeen had outright rejected the Obamacare exchanges. All told, 40 states had by that point failed to do the administration’s bidding and set up state-based Obamacare exchanges.

Without exchanges in every state, Obamacare would surely fail as a policy matter. And without massive subsidies to offset the costs of Obamacare’s health plans, Obamacare would fail as a political matter. The IRS maneuver was a last-ditch attempt to paper over the law’s serious structural flaws.

Big government at work. Give me a sausage.

PS: And then there’s this.

According to the findings of an investigation conducted by the Government Accountability Office which were presented to Congress on Wednesday, some of those taxpayer-funded subsidies are not merely legally problematic but are also subject to extensive fraud.

The GAO found that 11 of 12 applications for federal assistance while applying for insurance provided through the ACA using “fictitious identities” were accepted.

Who was the nimrod (fictitious nimrod) who didn’t get through? That guy wasn’t trying. Here’s a new slogan for EdselCare: 8.33% pure.

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