A project of the Galen Institute

Issue: "Business Impact"

Washington Health Exchange Sounds the Alarm, Questions Deloitte

Patrick Marshall, Seattle Times
Tue, 2014-07-22
"One message came through loud and clear at today’s meeting of the Washington Health Benefit Exchange’s Operations Committee: It may not be time to panic about the health exchange’s problem-riddled invoicing and payments system, but it is time to sound the alarm and get all hands on deck. “We are really out of rope on this one,” Chief of Staff Pam MacEwan told the committee. “We need this to be fixed a while ago. We don’t have the patience of the public or the carriers on this anymore.” Software problems have prevented payments for up to 6,000 consumer accounts from posting properly and being reported to insurers, resulting in some consumers being told they don’t have coverage. Beth Walter, operations director, noted the exchange had received a commitment from Deloitte, the exchange’s primary contractor, to “engage additional resources on their side.” “What does that mean?” asked a committee member. “More people,” Walter replied."

BREAKING: D.C. Appeals Court Overturns Subsidies For Federal Exchange

Sandhya Somashekhar, Washington Post
Tue, 2014-07-22
"A federal appeals court panel in the District struck down a major part of the 2010 health-care law Tuesday, ruling that the tax subsidies that are central to the program may not be provided in at least half of the states. The ruling, if upheld, could potentially be more damaging to the law than last month’s Supreme Court decision on contraceptives. The three-judge panel of the D.C. Circuit Court of Appeals sided with plaintiffs who argued that the language of the law barred the government from giving subsidies to people in states that chose not to set up their own insurance marketplaces. Twenty-seven states, most with Republican leaders who oppose the law, decided against setting up marketplaces, and another nine states partially opted out. The government could request an “en banc” hearing, putting the case before the entire appeals court, and the question ultimately may end up at the Supreme Court.

Largest US Insurer, United Healthcare Move Signals Industry Shift

Tom Murphy, AP Business Writer
Fri, 2014-07-18
"The nation’s largest health insurer expects to play a much bigger role in the health care overhaul next year, as the federal law shifts from raising giant questions for the sector to offering growth opportunities. UnitedHealth Group said Thursday that it will participate in as many as 24 of the law’s individual health insurance exchanges in 2015, up from only four this year. These state-based exchanges debuted last fall as a way for customers to buy individual health insurance, many with help from income-based tax credits. They played a key role in helping roughly 8 million people gain coverage for 2014. But UnitedHealth and other insurers approached them cautiously, in part because they had little information about the health of the people who would sign up.

What will Obama do on employer mandate?

Elise Viebeck and Benjamin Goad, The Hill
Fri, 2014-07-18
"The White House needs to make a decision soon on whether ObamaCare's controversial employer mandate will take effect in 2015. With the mandate set to take effect in January, businesses are awaiting final word from the administration on whether they will be required to track and report how many of their employees are receiving coverage. Federal officials are late in delivering the final forms and technical guidance necessary for firms to comply, raising suspicions the mandate could once again be delayed. The mandate has been pushed back twice before, the first time in late summer. The delays to the mandate have angered House Republicans, who are now taking President Obama to court for what they say is his refusal to follow the letter of the law."

Biggest Insurer Drops Caution, Embraces Obamacare

Jay Hancock, Kaiser Health News
Fri, 2014-07-18
"UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year. “We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals. The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now. Even analysts who follow the company closely seemed surprised. “You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in.

Specialty Care Is A Challenge In Some ACA Plans

Carrie Feibel, Houston Public Media
Thu, 2014-07-17
"Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits. But they’re also causing headaches in the day-to-day work of doctors and clinics. “The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,” said Dr. Charu Sawhney of Houston. Sawhney is an internist at the Hope Clinic, a federally qualified health center in southwest Houston, in the bustling heart of the Asian immigrant community. Her patients speak 14 different languages, and many of them are immigrants or refugees from places as far flung as Burma and Bhutan. Most of her patients are uninsured, which means she is familiar with problems of access. But the limited options of some of the HMOs sold on the marketplace surprised even her.

What We Learned About Obamacare July 8-14, 2014

Natalie Scholl, American Enterprise Institute
Tue, 2014-07-15
"1.) AEI’s Joseph Antos and James Capretta present “A health reform framework: Breaking out of the Medicaid model.” Here’s a peek: The Congressional Budget Office (CBO) projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance. Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care…. 2.) “Some still lack coverage under health law,” notes The Wall Street Journal: Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don’t have coverage due to problems in enrollment systems.

Some South Florida Docs Decline to Accept Obamacare

Daniel Chang, Miami Herald
Mon, 2014-07-14
"After being without health insurance for two years, Miranda Childe of Hallandale Beach found a plan she could afford with financial aid from the government using the Affordable Care Act’s exchange. Childe, 60, bought an HMO plan from Humana, one of the nation’s largest health insurance companies, and received a membership card in time for her coverage to kick in on May 1st. But instead of being able to pick a primary care physician to coordinate her healthcare, Childe says she repeatedly ran into closed doors from South Florida doctors who are listed in her plan’s provider network but refused to see patients who bought their coverage on the ACA exchange. “I just felt that I wasn’t being treated like a first-class citizen,’’ said Childe, who eventually found a doctor with the help of a Humana counselor.

Six months into Obamacare, some D.C. insurance brokers still wait to be paid

Mike DeBonis, The Washington Post
Thu, 2014-07-10
"When the District launched its federally mandated health insurance exchange last fall, officials went to great lengths to woo professional insurance brokers — launching a special broker web portal, establishing a “concierge” hotline just for brokers and holding broker-only training classes. Despite those efforts, many brokers have yet to be paid for the policies they’ve sold through the exchange, known as D.C. Health Link — generating frustration among professionals who say their patience in navigating the changes wrought by the Affordable Care Act has not been rewarded. “I’ve been very supportive, I put a lot of work into it, and I’ve gotten nothing,” said Steve Nearman, a Virginia-based broker who says he has helped nearly 100 city residents find and buy insurance through the exchange and is owed thousands of dollars in commissions."

Bosses bash Affordable Care Act: report

Gregory Bresiger, NY Post
Thu, 2014-07-10
"ObamaCare hurts businesses. That’s the result of an exhaustive study polling small to medium-sized businesses. The controversial government health-care reform increases company and employee costs and sometimes stops companies from hiring as well, participants told the International Foundation of Employee Benefit Plans in its new study. “More than half of single employers believe the Affordable Care Act has had a negative effect on their company,” according to the report. The survey, which polled some employers and their health-care pros, found that the majority of respondents, 54 percent, thought the effect of the ACA on their firms had been “negative” or “very negative.” The same respondents also expected that the negative effects from ACA would increase to 66 percent in the near future as the program unfolds."

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