ObamaCare

Times:

ith only a few months remaining before Americans will start buying coverage through the new state insurance exchanges under President Obama’s health care law, it is becoming clear that the millions of people purchasing policies in the exchanges will find that their choices vary sharply, depending on where they live.

States like California, Colorado and Maryland have attracted an array of insurers. But options for people in other states may be limited to an already dominant local Blue Cross plan and a few newcomers with little or no track record in providing individual coverage, including the two dozen new carriers across the country created under the Affordable Care Act.

Maine residents, for example, will not see an influx of new insurers. The state has an older population and strict rules that already have discouraged many insurers from selling policies, so choices will probably be limited to the state’s dominant carrier, Anthem Blue Cross, and Maine Community Health Options.

“What we’re seeing is a reflection of the market that already exists,” said Timothy S. Jost, a law professor at Washington and Lee University in Virginia who closely follows the health care law. ...

As people become aware of the differences among the exchanges, “some of the laggard states are going to end up changing,” said Ron Pollack, the executive director for Families USA, a consumer advocacy group that supports the law.

Let me translate "end up changing" for you, Ron you asshole: Read below the fold...

Politico:

Currently, aides and lawmakers receive their health care under the generous Federal Employee Health Benefits Program. The government subsidizes upward of 75 percent of the premiums for the health insurance plans. In 2014, most Capitol Hill aides and lawmakers are expected to be put onto the exchanges, and there has been no guidance whether the government will subsidize those premiums. This is expected to cause a steep spike in health insurance costs.

Poor babies! Read below the fold...

"It's complicated." Read below the fold...

[I'm stickying this because I have to put together the link dump for Monday while Katiebird grapples with what happens when only the spouse is covered by their employer, and so links from you all would be very helpful. We'll be doing these links every Monday, so do bear that in mind... --lambert]

As part of the PPACA FAQ, we're going to do a link dump every Monday. As the rollout approaches, we'll be forecasting future events for the coming week, but we're also interested in good links from the past week, so please, add those in comments! Read below the fold...

Let us begin our wonderful journey of discovery to find out how the PPACA (Patient Protection and Affordable Care act, commonly known as ObamaCare) is going to work out for you and me and people like us.*

Q: How much are penalties for non-compliance with the ACA's mandate, and how do they work?

A: You pay whichever is less: (1) The national average of the Bronze plan, or (2) a penalty.

For the penalty, you pay whichever is greater: (a) A dollar amount or (b) a percentage of income, pro-rated by the number of months you were not covered. (So, if the dollar amount were $95 -- as it sometimes will be -- and you were not covered for six months, the pro-rated penalty for the non-compliant half-year would be $95 / 2 = $37.50. Details below.)

The dollar amount and the percentage of income are both phased in, starting with the Federal taxes you pay for 2014, in 2015. (The dollar amount, at least next year, is almost certainly less than the Bronze plan, even if we don't have a Bronze plan to look at.) After phase-in, the dollar amount is adjusted for COLA. You pay the penalty at tax time. However, the IRS can't put a lien or levy on you if you don't pay the penalty.

This a little more complicated than the story you read in the press, and may cost you more money than you think. Spoiler alert: You could end up paying more than $95, which is the figure everybody quotes. I'm going to focus mostly on what happens next year, before the complete structure of penalties for non-compliance phases in.

Failure to empathize. Riverdaughter:

[Digby is] cautiously optimistic about how things are going to go. Both [Digby and Krugman] seem to think [or are told to say*] that the increase in premiums are only going to affect a small subset of people and everybody knew this from the start, had they been paying attention. They seem to think the people most irked are going to be relatively well off younger people, like entrepreneurs who work for themselves.

But that’s not really true. I’m not surprised that neither Digby or Krugman are seeing who are going to get slammed by Obamacare most severely because it has become almost a habit not to talk about them. I’m referring to the millions of long term unemployed, many of whom are over 50, who are now forced to cobble together some kind of living as self-employed. That affects just about everyone I know who was laid off since 2008. To these people, the premiums are not just a nuisance. They are extremely burdensome. And if Lambert has been reading the tea leaves correctly, lumping these people into the Medicaid pot puts whatever estate they have left at risk. So, to recap, Obamacare is putting an extra burden on these people who are now forced to a.) work for themselves, b.) pay all of the payroll tax by themselves and c.) pay for their own retirements. ... Read below the fold...

CJR's Trudy Lieberman has an excellent summing up of the media coverage on the CA rate hike story:

Last week the advocacy group Health Care for America Now [HCAN't, die-hard single payer opponents] listed 33 news outlets, mostly marquee brands, that had picked up the exchange’s “important announcement.” California is a bellwether, headlines from around the country suggested, as news outlets from CNNMoney to The Hill signaled that rates in the state’s insurance exchange would be cheaper than expected [The expectations game is an old PR trick. Notice that "cheaper than expected" is not the same is either "cheap" or "good."]. “California Insurance Exchange Rates: Not Too High, Not Too Low,” read the headline on the piece from Kaiser Health News, which quoted the executive director of California’s exchange, Peter Lee: “We’ve hit a home run for consumers. We held insurers’ feet to the fire.” ... No shock had materialized.

But the story the media told was a flawed one, characterized by gee-whiz reporting, a willingness to accept official spin, and failure to ask basic questions. “I don’t see rates going down anywhere I look,” says Robert Laszewski, an industry consultant whose blog was required reading for reporters covering the health reform debate four years ago. “Rates are consistent with what the Society of Actuaries forecasted. The fight emerging is over how to compare rates.” ... Read below the fold...

Kaiser:

This fall is the moment of truth for Oregon’s Health CO-OP and 23 other consumer-owned and run plans created by the Affordable Care Act to increase competition and give consumers a greater say in their coverage. Funded by $1.9 billion in low-interest federal loans, the co-ops were tucked into the law to mollify liberals who had unsuccessfully sought a so-called “public option,” or government-run insurance plan.

But will customers buy insurance from upstart nonprofits? And will the co-op plans be competitive with those offered by industry giants like UnitedHealthcare and Aetna which have the clout to exact big discounts from hospitals and doctor groups? Read below the fold...

Kaiser's Michelle Andrews takes questions. I'm just going to quote the Q&A in its entirety:

Q. I expect the annual premium for my company's group plan to be about $24,000, or 50 percent of my family's income. Will my family be eligible for subsidized coverage on the state insurance exchanges in 2014, provided we meet the poverty-level requirements?

Read below the fold...

I don't know what else to call what Sibelius is doing:

JACKIE JUDD: HHS Secretary Kathleen Sebelius defended herself today against criticism from congressional Republicans about calls she made to outside organizations in support of a group promoting implementation of the health care law.

JACKIE JUDD: According to the secretary, she had made a total of five calls made on behalf of Enroll America, including to three companies that HHS does regulate. What was the nature of the calls?

MARY AGNES CAREY: Two of those phone calls – and these were made to the Robert Wood Johnson Foundation and to the tax preparer H&R Block were to ask for funding to help Enroll America. The other three calls were made to Johnson & Johnson[*], Ascension Health, which is a Catholic health care system, and the insurer Kaiser Permanente (Kaiser Health News is not affiliated with Kaiser Permanente). But the secretary said those calls were simply to discuss the efforts of Enroll America....

Of course they were!

and she did not solicit money from those three groups.

Of course she didn't! She has people for that! Read below the fold...

Huffpo:

Some of President Barack Obama's political appointees, including the secretary for Health and Human Services, are using secret government email accounts they say are necessary to prevent their inboxes from being overwhelmed with unwanted messages, according to a review by The Associated Press. ...

The secret email accounts complicate an agency's legal responsibilities to find and turn over emails in response to congressional or internal investigations, civil lawsuits or public records requests because employees assigned to compile such responses would necessarily need to know about the accounts to search them. Secret accounts also drive perceptions that government officials are trying to hide actions or decisions. ...

The Health and Human Services Department initially turned over to the AP the email addresses for roughly 240 appointees – except none of the email accounts for Sebelius, even one for her already published on its website. After the AP objected, it turned over three of Sebelius' email addresses, including a secret one. It asked the AP not to publish the address, which it said she used to conduct day-to-day business at the department. Most of the 240 political appointees at HHS appeared to be using only public government accounts. ....

The AP decided to publish the secret address for Sebelius – KGS2(at)hhs.gov – over the government's objections because the secretary is a high-ranking civil servant who oversees not only major agencies like the Centers for Medicare and Medicaid Services but also the implementation of Obama's signature health care law. Her public email address is Kathleen.Sebelius(at)hhs.gov.

Kudos to AP for this reporting (and please don't sue me for fair use, mkay?) Now, it would be irresponsible not to speculate, so let's lay down a few dots to connect: Read below the fold...

Yet another way ObamaCare creates second-class citizens by "the luck of the draw." Robert Laszewski in The Health Care Blog:

Are people going to get more coverage for their money? Yes. Do they want more coverage if the premium costs for those plans is a lot higher? Likely yes if taxpayers are paying for most of it. If not, clearly they didn’t want to pay for it before. Come January, lots of California consumers in the small group and individual market are going to get a letter from their existing insurer telling them their current plan is no longer available and the cost of the new required plans will be a lot more.

Simply, the new law is taking plan design choices away instead of letting the consumer decide what is good for them. Does that matter in California?

As the LA Times reported, “The average premium for individual plans sold through EHealthInsurance in California was $177 per month last year. Covered California said the average premium for the three lowest Silver plans statewide will be $321 a month [+81% over two years], albeit for more comprehensive benefits.”

For those insured right now, and the estimated 40% that won’t be eligible for a federal premium subsidy, that sure looks like rate shock to me.

Yep, even worse, the ObamaCare public relations push compared apples to oranges -- or rather, to lemons -- in two different ways: Read below the fold...

Why revive the completely discredited Public Option Zombie Sparkle Pony at this point? (Are we really going to go through the whole bait and switch routine again? Why? Read below the fold...

Because Montana is Max Baucus's home state, that's why.

After his own constituents in Libby, Mont., became uninsurable by private insurance due to industrial pollution with carcinogens and were unable to get the courts to hold the polluters responsible, [Senator Max] Baucus came to the rescue. He simply tucked a little provision into the massive health reform bill making affected Montanans eligible for — you guessed it — Medicare.

No health insurance exchanges for these hardworking folks. Nothing but the best for Libby. By taking the simple, direct and most efficient route to expanding health-care coverage, Mr. Baucus did the right thing by his constituents. But Baucus made sure that everybody else had to settle for Obamacare.

If there's anything I hate more than ObamaCare's horrible system architecture*, it's the way ObamaCare relentlessly creates second-class citizens. Read below the fold...

From selling "hope and change" to selling insurance. How transformative! Kaiser:

President Obama To Hit The Campaign Trail For Health Law
President Obama often tells audiences that he has waged his last campaign. But that’s not exactly true.

Read below the fold...