Thursday, July 21, 2016

OBAMACARE IN MELTDOWN - But was it only a handout to Obama's cronies at big pharma?

AMERICAN THINKER:


A report from the Commonwealth Fund shows why so many insurance companies are abandoning the Obamacare exchanges. Simply put, they can't make any money. Washington Free Beacon: Two-thirds of the insurers failed to turn any profits from...




Health care costs in the United States are 

currently the highest in the world, with per 

capita spending reaching nearly $10,000 per 

individual. Yet the US population suffers 

from more disease and obesity and has shorter life spans than other industrialized countries—problems that disproportionately impact the working class and poor.


Obamacare insurance rates set to spike in California in 2017

Obamacare insurance rates set to spike in California in 2017

By Toby Reese 
21 July 2016
Halfway into the third year of the Affordable Care Act, commonly referred to as Obamacare, average premium rate increases of 13.2 percent have been announced in California for 2017.
The rate spikes come after a four percent or more average increase in both 2015 and 2016, leading to a three year average increase of seven percent. California is the first state to announce the official costs although similar leaps in premiums are expected throughout the nation.
Over the first three years, around 1.4 million individuals have signed up on the state's health care exchange, Covered California. Another 12-13 million individuals are enrolled in Medi-Cal, California's Medicaid program for those who are below the income limits for insurance on the exchange.
Insurance companies and state officials largely attribute the increased premiums to rising health care costs and prescription drug costs. Next year also marks the end of a federal funding measure known as “reinsurance,” which kept the prices from drastically increasing during the first three years of the Affordable Care Act (ACA).
The ACA has been heralded by President Barack Obama and virtually every Democrat as a means of providing affordable universal health coverage. This lie must once again be exposed. What is becoming clearer each year is a prognosis the WSWS made in 2013 as the legislation was about to go into effect.
At the time we wrote, "The ACA will cut costs dramatically for employers and the government while reducing and rationing medical services for millions of ordinary people—while boosting the profits of the health care industry."
According to Kaiser Family Foundation (KFF), the share of insured workers in plans with a general annual deductible has increased from 55 percent in 2006 to 81 percent in 2015, and the average deductible amount has increased from $584 to $1,318 over the same period.
Another report from KFF states that between 2004 and 2014, the average payments made towards deductibles by enrollees rose 256 percent (from $99 to $353) and average total costs for patients, including coinsurance and copayments, rose by 77 percent—meaning that the upfront costs increased over three times faster than the total spent on insurance.
During the same period, wages only increased 32 percent. The trend has been steadily turning towards insurance companies collecting more money in the form of deductibles and premiums—before any services are provided.
Plans purchased through the ACA exchanges have annual deductibles of up to $5,000 and out-of-pocket maximums can be as high as $6,850 for single coverage and $13,700 per family in 2016. The plans include additional expenses to individuals through increased copayments and coinsurance for prescriptions and hospital & outpatient visits (depending on the plan, from 10 to 40 percent of the total cost of service).
What this all means is the shifting of the health care costs from the corporations squarely onto the backs of the working class, while at the same time, gutting the quality of care. Numerous media outlets have proclaimed that Obamacare has caused the total rates of those insured to fall to all-time lows. This claim is deceitful. Most working class individuals and families that have enrolled are paying exorbitant amounts for what is really only “catastrophic” coverage.
The section of the population enrolled in the ACA plans, roughly 11-12 million across the nation at present, are of the lowest paid layers of the working class—those earning between 138-400 percent of the Federal Poverty Level. In 2016, this is an annual income of $16,242 to $47,080 for an individual and $33,465 to $97,000 for a family of four.
Over the past three years, many individuals and families, who previously had health coverage with their employers, have been cut off of plans and pointed in the direction of the health exchange with the threat of being fined by the Internal Revenue Service each year they fail to purchase coverage that meets the ACA guidelines.
The IRS fine, referred to as the “individual mandate,” increased to 2.5 percent of adjusted gross income in 2016—or $695 per adult and $347.50 per child—whichever amount is greater. The fines are assessed when taxes are filed each year, often completely wiping out long awaited tax refunds or leaving a balance due for already struggling families.
One of the touted benefits of the insurance “marketplaces” is that competition between the different companies will keep prices lower. In reality, plans that offer the cheapest insurance one year may be the most expensive the next and in order to keep the monthly expenses from skyrocketing, households are often required to switch plans or insurance companies each year during the open enrollment period.
This is along the lines of the advice given by Covered California Director Peter V. Lee on California's exchange web site, CoveredCA.com.
In an article published Tuesday, Lee stated, “Shopping is going to be more important this year than ever before, almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”
In addition to the increased bureaucratic burden placed on families, switching insurance often means changing doctors, health care facilities, or in the case of changing between the various tiered plans, changing copays and benefits actually covered by the plan. Furthermore, after not seeing lucrative enough profits some companies have left the exchanges altogether and enrollees in these plans are forced to seek new coverage.
Lee goes on to say, “Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance…we can be confident their rate increases are directly linked to health care costs….”
According to the Covered California web site, some insurance companies have claimed the increased rates are due in part to “consumers who may be enrolling in health insurance only after they become sick or need care.” The site goes on to state, “the exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances.”
Along with the IRS fine through the Individual Mandate, one of the main tenets of the ACA when it was pitched to Congress was the enrollment of a high number of young healthy individuals who were previously uninsured to help cover the costs of the elderly and sick. Essentially, the insurance companies are seeking to enroll more individuals who won’t actually need insurance but will pay the costly premiums in order to offset the costs.
Cost increases will be announced throughout the country leading up to the vote for the presidential election in November. Both candidates stand for the further enrichment of the health care industry at the expense of the working class, albeit by different means.
Donald Trump’s initial call relating to Obamacare in replacing it with “something terrific” has been more formally defined along the typical right-wing lines of opening the industry up more broadly to the free market and implementing Medicaid block grants to the states, a way of reducing government spending.
Hillary Clinton would like to further enshrine the reactionary Affordable Care Act and, while claiming to support a few modest expansions to Medicaid and Medicare, her statements are almost indistinguishable from Obama’s when the act was first introduced.
Health care costs in the United States are 

currently the highest in the world, with per 

capita spending reaching nearly $10,000 per 

individual. Yet the US population suffers 

from more disease and obesity and has shorter life spans than other industrialized countries—problems that disproportionately impact the working class and poor.


Obamacare Is Failing from Behind


Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.
Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.
We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.
These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”
For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?
Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.
Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.
The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.
What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.
In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.
Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook  and Twitter.
Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.
Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.
Given the run of Obamacare co-op closures, it seems the President is not tending his flock, instead allowing predators, harsh weather, and lack of food to decimate his sheep. This week the Illinois Department of Insurance shut down the Land of Lincoln co-op, leaving nearly 50,000 policyholders high and dry.
For those losing their insurance, there is good and bad news. The good news is, “Policyholders will be able to buy insurance from a different carrier to cover them for the rest of 2016.” The bad news is, “The co-pays and deductibles enrollees have been paying since January will not transfer to new plans.” A double whammy for those who have already met their deductible and out-of-pocket maximums for the year and now have to do it all again now. And then again in January 2017.
We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.
These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”
For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?
Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.
Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.
The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.
What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.
In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.
Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook  and Twitter.


UnitedHealth cuts Obamacare options for tens of thousands

By Kate Randall 
20 July 2016
UnitedHealth, the largest US health insurer, has indicated it is drastically cutting its Affordable Health Care (ACA) public exchange offerings to only three states. This could affect some tens of thousands in the 31 states to be eliminated from the health insurer’s currently served markets. The drastic reduction in its covered health exchange markets comes despite revenues rising by 28 percent in the second quarter of 2016, to $46.5 billion, and profits jumping 13 percent, to nearly $3.4 billion. This is due mainly to profits in the company’s Optum division.
UnitedHealth reports that it has lost more than $1 billion over the last two years on the exchanges run by what is commonly known as Obamacare. This includes an estimated $200 million in losses in “ACA-compliant individual products” in 2016, Forbes reports.
In a telephone call with analysts Tuesday, UnitedHealth CEO Stephen Hemsley said the company now expects to operate “three or fewer exchange markets” in 2017, down from 34 this year. UnitedHealth plans to maintain public exchange offerings only in New York, Nevada and Virginia, pending approvals, Hemsley said.
UnitedHealth cited higher-than-expected enrollment in Obamacare insurance products as the main cause of its projected $200 million losses for 2016. According to Investor’s Business Daily, the insurer had 820,000 exchange customers at the end of June, up by about 25,000 from the end of March. These figures were surprising, as enrollment typically declines for most companies as the year progresses.
UnitedHealth ACA enrollees since March have tended to be sicker, including customers with chronic conditions such as HIV, diabetes and hepatitis C. Under Obamacare, insurers are prohibited from discriminating against those with preexisting conditions. The moves by UnitedHealth to dump the vast majority of their ACA products demonstrate, however, that insurers are free to exit the market if they determine their profits are threatened.
Under the ACA’s “individual mandate,” individuals and families without health insurance from their employer or a government program such as Medicare or Medicaid must purchase coverage from a private insurer on the exchanges or pay a substantial tax penalty. But the insurer companies are under no such obligation to actually provide such coverage.
For UnitedHealth, the real driver of profits and revenue has been the company’s Optum division, which saw revenues soar by 52 percent in the second-quarter, to $20.6 billion. The Optum unit includes OptumRx, a pharmacy benefit management company, which saw a 69 percent growth in revenue in the second quarter, to $15.1 billion, due to growth and acquisitions, according to Forbes .
Through urgent care centers and doctor’s practices it owns, Optum also provides technology services to doctors and hospitals as well as a business providing outpatient care.
The giant insurers can pick and choose where to do business, letting profits and revenue be their guide, as Obamacare is based on the for-profit model. The insurance companies make no pretense that their involvement in the ACA marketplace is driven by altruistic motives.
When insurers do choose to participate in the ACA marketplace there is little meaningful oversight on the prices they charge for premiums. While premiums and the scope of plan networks vary from state to state, a recent Kaiser Family Foundation report showed that the average cost of the second-lowest-cost “silver” plan on the Obamacare marketplaces will rise by 10 percent in 2016, double last year’s rate.
The most affordable ACA plans also come with large deductibles, which must be paid in full before any coverage, except that deemed “essential,” kicks in. Many of the lowest-cost “bronze” plans come with deductibles as high as $5,000 and more.
The Los Angeles Times reports that Obamacare premiums in California will rise by an average of 13.2 percent in 2017, according to state officials. This follows increases of 4.2 percent in 2015 and 4 percent in 2016. Officials had previously boasted that the state’s Covered California program had insured hundreds of thousands of people while keeping costs relatively low.

THE OBAMA ASSAULT ON AMERICA'S YOUTH CONTINUES - The White House Coucil of Economic Advisors used to be an independent group of scholars and economists who were supposed to give the president non-partisan advice on economic issues.But during the Obama presidency, the Council has become a s...

The White House Coucil of Economic Advisors used to be an independent group of scholars and economists who were supposed to give the president non-partisan advice on economic issues. But during the Obama presidency, the Council has become a s...

The massive student loan debt 'boosts the economy' says White House

The White House Coucil of Economic Advisors used to be an independent group of scholars and economists who were supposed to give the president non-partisan advice on economic issues.
But during the Obama presidency, the Council has become a slave to the political agenda of the White House. To that end, the learned men and women on the Council have issued a report that unsurprisingly claims that the massive student loan debt held by graduates is actually a good thing because it boosts the economy.

Student loan debt has nearly doubled under President Obama, from $664 billion to $1.3 trillion. So how does being buried under a mountain of debt help the economy?
It doesn't.
Washington Free Beacon:
“The main macroeconomic impact of student loans, particularly over the long run, is via the boost to output and productivity from a more educated workforce,” the report stated. “While it is still important to monitor in overall leverage, on net, student loan debt is still likely to be a boost to the economy over the longer run by increasing educational levels and workers skills.”
Additionally, the report said that students with loan debt are in a better position to buy homes or start businesses because they are associated with additional income.
“Higher education, even paid for by debt, raises the likelihood of owning a home because of its impact on future earnings,” the report said. “By age 26, households with student debt are more likely to buy a house than those that did not attend college.”
Mary Clare Reim, a research associate in education policy at the Heritage Foundation, refuted the White House’s claim. She said that just because students who attend college typically have higher earnings, it doesn’t mean that the current sticker price of education is necessarily worth the economic benefits down the line.
“The argument that student loans won’t harm the economy because it’s an investment in our future falls apart when you look at student loan default rates and factor in loan forgiveness and grants,” Reim said. “Around 14 percent of student loans are currently in default, half of recent graduates are unemployed or under employed, and loan forgiveness programs are only growing, leaving taxpayers on the hook. Not to mention that all students who receive Pell Grants don’t need to pay taxpayers back.”
Reim said students get a loan regardless of what the student is interested in studying, where they want to go, and what their work ethic is like. Federal lending programs don’t do any sort of economic analysis to determine future earnings potential as a condition of the loan, she said.
“I think it would be very tough to argue that a Bachelor of Arts in dance is actually worth $200,000, but that’s what we’re subsidizing,” Reim said. “The feds now control 93 percent of all student loans and as a result we are subsidizing students and degrees of questionable value, a phenomenon that would not occur in a free market.”
The report is supposed to buttress Obama's efforts to make student loans even easier to get. Just what the world needs; more dance majors and art history lovers.
There has been talk in Washington - even among some Republicans - of forgiving all or part of the student loan debt burden as a way to stimulate the economy. By putting more money in the hands of college graduates, more money will be spent on consumer products, the thinking goes.
It's a dubious thought process given what we've seen from other "stimulus" programs. Besides, no one has mentioned the moral hazard of such a course of action. And what of students today? Why should they try to repay the loans when in a few years, government will step in and forgive them?
The magical thinking from the economic advisors in the White House is instructive. It shows how far from reality the Obama administration is basing its policies on.

The White House Coucil of Economic Advisors used to be an independent group of scholars and economists who were supposed to give the president non-partisan advice on economic issues.
But during the Obama presidency, the Council has become a slave to the political agenda of the White House. To that end, the learned men and women on the Council have issued a report that unsurprisingly claims that the massive student loan debt held by graduates is actually a good thing because it boosts the economy.
Student loan debt has nearly doubled under President Obama, from $664 billion to $1.3 trillion. So how does being buried under a mountain of debt help the economy?
It doesn't.
Washington Free Beacon:
“The main macroeconomic impact of student loans, particularly over the long run, is via the boost to output and productivity from a more educated workforce,” the report stated. “While it is still important to monitor in overall leverage, on net, student loan debt is still likely to be a boost to the economy over the longer run by increasing educational levels and workers skills.”
Additionally, the report said that students with loan debt are in a better position to buy homes or start businesses because they are associated with additional income.
“Higher education, even paid for by debt, raises the likelihood of owning a home because of its impact on future earnings,” the report said. “By age 26, households with student debt are more likely to buy a house than those that did not attend college.”
Mary Clare Reim, a research associate in education policy at the Heritage Foundation, refuted the White House’s claim. She said that just because students who attend college typically have higher earnings, it doesn’t mean that the current sticker price of education is necessarily worth the economic benefits down the line.
“The argument that student loans won’t harm the economy because it’s an investment in our future falls apart when you look at student loan default rates and factor in loan forgiveness and grants,” Reim said. “Around 14 percent of student loans are currently in default, half of recent graduates are unemployed or under employed, and loan forgiveness programs are only growing, leaving taxpayers on the hook. Not to mention that all students who receive Pell Grants don’t need to pay taxpayers back.”
Reim said students get a loan regardless of what the student is interested in studying, where they want to go, and what their work ethic is like. Federal lending programs don’t do any sort of economic analysis to determine future earnings potential as a condition of the loan, she said.
“I think it would be very tough to argue that a Bachelor of Arts in dance is actually worth $200,000, but that’s what we’re subsidizing,” Reim said. “The feds now control 93 percent of all student loans and as a result we are subsidizing students and degrees of questionable value, a phenomenon that would not occur in a free market.”
The report is supposed to buttress Obama's efforts to make student loans even easier to get. Just what the world needs; more dance majors and art history lovers.
There has been talk in Washington - even among some Republicans - of forgiving all or part of the student loan debt burden as a way to stimulate the economy. By putting more money in the hands of college graduates, more money will be spent on consumer products, the thinking goes.
It's a dubious thought process given what we've seen from other "stimulus" programs. Besides, no one has mentioned the moral hazard of such a course of action. And what of students today? Why should they try to repay the loans when in a few years, government will step in and forgive them?
The magical thinking from the economic advisors in the White House is instructive. It shows how far from reality the Obama administration is basing its policies on.


Read more: http://www.americanthinker.com/blog/2016/07/the_massive_student_loan_debt_boosts_the_economy_says_white_house.html#ixzz4F4cZGO5y
Follow us: @AmericanThinker on Twitter | AmericanThinker on Facebook

Obamacare insurance rates set to spike in California in 2017 AS LA RAZA GOV JERRY BROWN HANDS BILLIONS IN WELFARE TO THE MEXICAN OCCUPIERS

Health care costs in the United States are 

currently the highest in the world, with per 

capita spending reaching nearly $10,000 per 

individual. Yet the US population suffers 

from more disease and obesity and has shorter life spans than other industrialized countries—problems that disproportionately impact the working class and poor.


Obamacare insurance rates set to spike in California in 2017

Obamacare insurance rates set to spike in California in 2017

By Toby Reese 
21 July 2016
Halfway into the third year of the Affordable Care Act, commonly referred to as Obamacare, average premium rate increases of 13.2 percent have been announced in California for 2017.
The rate spikes come after a four percent or more average increase in both 2015 and 2016, leading to a three year average increase of seven percent. California is the first state to announce the official costs although similar leaps in premiums are expected throughout the nation.
Over the first three years, around 1.4 million individuals have signed up on the state's health care exchange, Covered California. Another 12-13 million individuals are enrolled in Medi-Cal, California's Medicaid program for those who are below the income limits for insurance on the exchange.
Insurance companies and state officials largely attribute the increased premiums to rising health care costs and prescription drug costs. Next year also marks the end of a federal funding measure known as “reinsurance,” which kept the prices from drastically increasing during the first three years of the Affordable Care Act (ACA).
The ACA has been heralded by President Barack Obama and virtually every Democrat as a means of providing affordable universal health coverage. This lie must once again be exposed. What is becoming clearer each year is a prognosis the WSWS made in 2013 as the legislation was about to go into effect.
At the time we wrote, "The ACA will cut costs dramatically for employers and the government while reducing and rationing medical services for millions of ordinary people—while boosting the profits of the health care industry."
According to Kaiser Family Foundation (KFF), the share of insured workers in plans with a general annual deductible has increased from 55 percent in 2006 to 81 percent in 2015, and the average deductible amount has increased from $584 to $1,318 over the same period.
Another report from KFF states that between 2004 and 2014, the average payments made towards deductibles by enrollees rose 256 percent (from $99 to $353) and average total costs for patients, including coinsurance and copayments, rose by 77 percent—meaning that the upfront costs increased over three times faster than the total spent on insurance.
During the same period, wages only increased 32 percent. The trend has been steadily turning towards insurance companies collecting more money in the form of deductibles and premiums—before any services are provided.
Plans purchased through the ACA exchanges have annual deductibles of up to $5,000 and out-of-pocket maximums can be as high as $6,850 for single coverage and $13,700 per family in 2016. The plans include additional expenses to individuals through increased copayments and coinsurance for prescriptions and hospital & outpatient visits (depending on the plan, from 10 to 40 percent of the total cost of service).
What this all means is the shifting of the health care costs from the corporations squarely onto the backs of the working class, while at the same time, gutting the quality of care. Numerous media outlets have proclaimed that Obamacare has caused the total rates of those insured to fall to all-time lows. This claim is deceitful. Most working class individuals and families that have enrolled are paying exorbitant amounts for what is really only “catastrophic” coverage.
The section of the population enrolled in the ACA plans, roughly 11-12 million across the nation at present, are of the lowest paid layers of the working class—those earning between 138-400 percent of the Federal Poverty Level. In 2016, this is an annual income of $16,242 to $47,080 for an individual and $33,465 to $97,000 for a family of four.
Over the past three years, many individuals and families, who previously had health coverage with their employers, have been cut off of plans and pointed in the direction of the health exchange with the threat of being fined by the Internal Revenue Service each year they fail to purchase coverage that meets the ACA guidelines.
The IRS fine, referred to as the “individual mandate,” increased to 2.5 percent of adjusted gross income in 2016—or $695 per adult and $347.50 per child—whichever amount is greater. The fines are assessed when taxes are filed each year, often completely wiping out long awaited tax refunds or leaving a balance due for already struggling families.
One of the touted benefits of the insurance “marketplaces” is that competition between the different companies will keep prices lower. In reality, plans that offer the cheapest insurance one year may be the most expensive the next and in order to keep the monthly expenses from skyrocketing, households are often required to switch plans or insurance companies each year during the open enrollment period.
This is along the lines of the advice given by Covered California Director Peter V. Lee on California's exchange web site, CoveredCA.com.
In an article published Tuesday, Lee stated, “Shopping is going to be more important this year than ever before, almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”
In addition to the increased bureaucratic burden placed on families, switching insurance often means changing doctors, health care facilities, or in the case of changing between the various tiered plans, changing copays and benefits actually covered by the plan. Furthermore, after not seeing lucrative enough profits some companies have left the exchanges altogether and enrollees in these plans are forced to seek new coverage.
Lee goes on to say, “Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance…we can be confident their rate increases are directly linked to health care costs….”
According to the Covered California web site, some insurance companies have claimed the increased rates are due in part to “consumers who may be enrolling in health insurance only after they become sick or need care.” The site goes on to state, “the exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances.”
Along with the IRS fine through the Individual Mandate, one of the main tenets of the ACA when it was pitched to Congress was the enrollment of a high number of young healthy individuals who were previously uninsured to help cover the costs of the elderly and sick. Essentially, the insurance companies are seeking to enroll more individuals who won’t actually need insurance but will pay the costly premiums in order to offset the costs.
Cost increases will be announced throughout the country leading up to the vote for the presidential election in November. Both candidates stand for the further enrichment of the health care industry at the expense of the working class, albeit by different means.
Donald Trump’s initial call relating to Obamacare in replacing it with “something terrific” has been more formally defined along the typical right-wing lines of opening the industry up more broadly to the free market and implementing Medicaid block grants to the states, a way of reducing government spending.
Hillary Clinton would like to further enshrine the reactionary Affordable Care Act and, while claiming to support a few modest expansions to Medicaid and Medicare, her statements are almost indistinguishable from Obama’s when the act was first introduced.
Health care costs in the United States are 

currently the highest in the world, with per 

capita spending reaching nearly $10,000 per 

individual. Yet the US population suffers 

from more disease and obesity and has shorter life spans than other industrialized countries—problems that disproportionately impact the working class and poor.


Obamacare Is Failing from Behind


Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.
Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.
We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.
These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”
For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?
Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.
Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.
The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.
What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.
In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.
Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook  and Twitter.
Leading from behind is a business concept where leaders steer their organizations much as shepherds guiding their flocks, from behind. It is contingent on a basic reality, “One can lead from behind only if one knows what lies ahead and what it will take to get there.” President Obama’s foreign policy style has been described as “leading from behind” particularly in the Middle East. Another view of Obama’s style: “A foreign policy of hesitation, delay and indecision.” One look at the current Middle East shows how that is working out.
Shifting from foreign to domestic affairs, how has the President’s leadership worked with Obamacare? Does Mr. Obama know what lies ahead and how to get there in the world of healthcare? Or have the past six years since passage of the Affordable Care Act been one of hesitation, delay and indecision? Has the President’s signature piece of legislation, bearing his name, been shepherded forward in a thoughtful and logical manner, responsive to the needs of patients, providers, and the insurance entities footing much of the bill? It’s quite obvious that just as with foreign policy, Obamacare is failing from behind.
Given the run of Obamacare co-op closures, it seems the President is not tending his flock, instead allowing predators, harsh weather, and lack of food to decimate his sheep. This week the Illinois Department of Insurance shut down the Land of Lincoln co-op, leaving nearly 50,000 policyholders high and dry.
For those losing their insurance, there is good and bad news. The good news is, “Policyholders will be able to buy insurance from a different carrier to cover them for the rest of 2016.” The bad news is, “The co-pays and deductibles enrollees have been paying since January will not transfer to new plans.” A double whammy for those who have already met their deductible and out-of-pocket maximums for the year and now have to do it all again now. And then again in January 2017.
We all remember the President’s big lie, “If you like your health care plan, you can keep it.” Except when insurance companies go broke due to a variety of unfavorable business conditions and regulations. These include essential benefits, making everyone purchase insurance to provide coverage they don’t want or need. Then there is guaranteed issue, allowing one to purchase insurance after they are sick, not quite the concept of insurance. And adverse selection where sick people purchase insurance and healthy people don’t, leaving the insurance companies covering a sick and expensive group of individuals.
These forces choked the Illinois exchange. They lost $90 million in 2015 with incoming premiums far below the outgoing healthcare costs of its enrollees. They ran into Captain Obvious, “The newly insured were sicker than carriers had expected.”
For all the hype and fanfare, only 11.3 million people have signed up for health insurance under the Affordable Care Act, just over 3 percent of the US population. And in the process, how many more have had their lives and wallets disrupted by Obamacare?
Higher premiums are a fact of life under Obamacare. And they continue to go up each year. But that’s only the beginning. Pay the premium to have insurance, not to use it. That carries another cost, the deductible, which must be paid in full before any insurance benefits kick in. Even after you pay the deductible your healthcare is still not free. Don’t forget the copay, anywhere from 10 to 40% of your bill that you must pay, on top of the deductible and monthly premium. This also assumes the doctor or hospital you choose is in-network, otherwise insurance may not cover anything.
Imagine a monthly premium of $500 for your family, a $6000 deductible and a 20 percent copay. Pay $12,000 out of pocket to reach the point of having to pay 20 percent of prescriptions, lab tests, doctor visits or hospitalizations. Fortunately, most policies have an out of pocket maximum, but if it’s tens of thousands of dollars, you may be bankrupt before ever reaching the maximum. And this is for the year. Ring in the New Year and the financial clock starts all over again.
The Illinois co-op was one of 23 co-ops created under Obamacare. Only 7 remain open for business. Three-quarters of the co-ops have gone the way of Donald Trump’s primary opponents. And of those still open, for how long? What happens when they close? Obama the shepherd has a rapidly thinning flock of insurance co-ops, which he is leading from behind, assuming he even knows where it is going or how to get there. Most of the flock already have been led off a cliff.
What if he does know where he is going? What if his goal is well beyond Obamacare into the realm of single-payer? It struck out in Vermont, but is on the ballot in Colorado. Obama is a fan of single-payer plans. Could he actually and cleverly be leading the country from behind into a national single-payer plan, one that Bernie Sanders enthusiastically supports and Hillary Clinton dances around depending on her political audience at the moment.
In 2003, as a state senator, Obama said of single-payer, “We may not get there immediately.” As President, has his shepherding of Obamacare been “failing from behind” as it looks to the casual observer? Or is he truly, but craftily, “leading from behind”, using Obamacare to create chaos and financial collapse to the point where the only solution is for a government rescue? It’s looking more and more like the latter option.
Brian C Joondeph, MD, MPS, a Denver based retina surgeon, radio personality, and writer. Follow him on Facebook  and Twitter.


UnitedHealth cuts Obamacare options for tens of thousands

By Kate Randall 
20 July 2016
UnitedHealth, the largest US health insurer, has indicated it is drastically cutting its Affordable Health Care (ACA) public exchange offerings to only three states. This could affect some tens of thousands in the 31 states to be eliminated from the health insurer’s currently served markets. The drastic reduction in its covered health exchange markets comes despite revenues rising by 28 percent in the second quarter of 2016, to $46.5 billion, and profits jumping 13 percent, to nearly $3.4 billion. This is due mainly to profits in the company’s Optum division.
UnitedHealth reports that it has lost more than $1 billion over the last two years on the exchanges run by what is commonly known as Obamacare. This includes an estimated $200 million in losses in “ACA-compliant individual products” in 2016, Forbes reports.
In a telephone call with analysts Tuesday, UnitedHealth CEO Stephen Hemsley said the company now expects to operate “three or fewer exchange markets” in 2017, down from 34 this year. UnitedHealth plans to maintain public exchange offerings only in New York, Nevada and Virginia, pending approvals, Hemsley said.
UnitedHealth cited higher-than-expected enrollment in Obamacare insurance products as the main cause of its projected $200 million losses for 2016. According to Investor’s Business Daily, the insurer had 820,000 exchange customers at the end of June, up by about 25,000 from the end of March. These figures were surprising, as enrollment typically declines for most companies as the year progresses.
UnitedHealth ACA enrollees since March have tended to be sicker, including customers with chronic conditions such as HIV, diabetes and hepatitis C. Under Obamacare, insurers are prohibited from discriminating against those with preexisting conditions. The moves by UnitedHealth to dump the vast majority of their ACA products demonstrate, however, that insurers are free to exit the market if they determine their profits are threatened.
Under the ACA’s “individual mandate,” individuals and families without health insurance from their employer or a government program such as Medicare or Medicaid must purchase coverage from a private insurer on the exchanges or pay a substantial tax penalty. But the insurer companies are under no such obligation to actually provide such coverage.
For UnitedHealth, the real driver of profits and revenue has been the company’s Optum division, which saw revenues soar by 52 percent in the second-quarter, to $20.6 billion. The Optum unit includes OptumRx, a pharmacy benefit management company, which saw a 69 percent growth in revenue in the second quarter, to $15.1 billion, due to growth and acquisitions, according to Forbes .
Through urgent care centers and doctor’s practices it owns, Optum also provides technology services to doctors and hospitals as well as a business providing outpatient care.
The giant insurers can pick and choose where to do business, letting profits and revenue be their guide, as Obamacare is based on the for-profit model. The insurance companies make no pretense that their involvement in the ACA marketplace is driven by altruistic motives.
When insurers do choose to participate in the ACA marketplace there is little meaningful oversight on the prices they charge for premiums. While premiums and the scope of plan networks vary from state to state, a recent Kaiser Family Foundation report showed that the average cost of the second-lowest-cost “silver” plan on the Obamacare marketplaces will rise by 10 percent in 2016, double last year’s rate.
The most affordable ACA plans also come with large deductibles, which must be paid in full before any coverage, except that deemed “essential,” kicks in. Many of the lowest-cost “bronze” plans come with deductibles as high as $5,000 and more.
The Los Angeles Times reports that Obamacare premiums in California will rise by an average of 13.2 percent in 2017, according to state officials. This follows increases of 4.2 percent in 2015 and 4 percent in 2016. Officials had previously boasted that the state’s Covered California program had insured hundreds of thousands of people while keeping costs relatively low.