Obamacare Is Coming Undone

Peter Suderman

Obamacare is coming undone. You can see it happening day by day, provision by provision, as the administration postpones or scales back key parts of the law, and other signs continue to suggest that the law as written simply won’t work.

Last Tuesday, in what was apparently intended to be a pre-July 4 holiday news dump, the administration made the embarrassing announcement that it would delay by a year the health law’s requirement that employers with 50 or more workers offer health coverage or pay a penalty. The administration also said it would delay the law’s reporting requirements for employers who offer health coverage.

That raised a major operational question about the law’s health insurance exchanges. How would those exchanges be able to determine whether someone applying for subsidies to buy individual coverage on an exchange already had access to employer coverage? The law says that people whose employers provide coverage aren’t allowed to get subsidies.

Late on Friday, we get another news dump—and an answer. The 16 exchanges run by states won’t have to verify an individual’s health insurance status at all. Nor will the state-run exchanges have to verify an individual’s income level.

Instead, they’ll rely on “self-reported” information. And then subsidies will be available to anyone who simply attests that they do not get qualifying, affordable health insurance from work, and that their household income is low enough to be eligible for subsidies.

As Ben Domenech writes in this morning’s Transom, what this means is that “the most significant entitlement increase since the Great Society will be operating on the honor system.” And as Yuval Levin says, it may turn out to be “an open invitation to fraud.” Even if outright fraud does not become a major issue, the combination of the delays may increase the cost of the law relative to what it would have been: No employer penalty, and no health status or income verification, means that more people will end up on the exchanges, receiving subsidies. And more subsidies means a more expensive law. The deficit reduction it was supposed to have achieved, already significantly reduced, is almost certainly reduced further—and perhaps gone entirely.

The delays also constitute an admission that the administration simply could not make the law’s verification technology—the infrastructure that is arguably the core functionality for the exchanges—work properly before the October 2013 launch of the exchanges. Doing so, according to the rule issued by the Department of Health and Human Services last Friday, “would involve a large amount of systems development on both the state and federal side, which cannot occur in time for October 1, 2013.”

The postponements were unexpected—even, apparently, to the officials running the exchanges at the state level. But trouble with the verification technology should not have come as a surprise. Obamacare’s critics have warned about the potential difficulties practically since the law was passed. In my October 2010 feature on implementating the law, for example, I noted that “fast, accurate income verification presents a particularly serious difficulty,” and spoke to several health policy experts who warned of difficulties ahead. Nor were critics the only ones seeing trouble. It’s been clear from the reporting for over a year now that officials in charge of implementing the law were having serious problems making the exchange technology work. By the time that the official in charge of the exchange technology told insurers that he was “pretty nervous” and had resorted to working to “make sure it’s not a third-world experience,” it was pretty clear that the project was a mess.

The delays aren’t only recent sign that Obamacare is struggling.

Just a few days before the employer mandate was postponed, Bloomberg News reported that a third of the hospitals involved in a high-level test of the law’s most vaunted health care savings programs—its Accountable Care Organization (ACO) program—are threatening to cease participation. The 16 hospitals were part of the ACO “pioneer” program, which was intended to show off how some of the law’s most ambitious health care payment reforms would work. Right now, however, it looks suspiciously like they aren’t.

The same goes for a lot of Obamacare. Earlier this year, officials in charge of the law delayed the essential functionality of the law’s small business exchanges. The law’s early retirement program ran out of money and shut down early. The law’s high-risk pool program signed up far fewer people than anyone predicted—and yet, thanks to unexpectedly high per-beneficiary costs—still had to cut payments to providers and cease enrollment in order to stay afloat. The availability of national health plans that were supposed to be part of the exchanges is in doubt, probably because of insurer reticence. Large swaths of rural, low-income Mississipi may end up with no insurers at all to choose from in the exchange. Officials in states that are building their own exchanges continue to say they are struggling to meet deadlines. The list goes on.

None of this means that Obamacare will collapse under its own weight. The most likely scenario at this point (though not the only one) is that the exchanges will still open on time, enrolling all who claim eligibility in subsidies. But the law’s rocky implementation continues to reveal the significant flaws in both the law’s legislative design and management. There’s still much that’s unclear about the inner workings of the exchange-creation process, but the fact that the administration is jettisoning key provisions this late in the implementation calendar suggests that it is not going well, and it is reasonable to suspect that the bad news for the law will continue. The big question, then, is which piece of the law will come undone next?

This is a link to the official paperwork available right now from the authorities in Marshall County, KY with respect to the arrest of Evansville City Councilman John Friend. The Marshall County District Court currently has no record of the arrest and no court date scheduled on the docket. Councilman Friend was released without bond on three charges.

FRIEND ARREST

Voting San Bernardino’s elected officials out of office will achieve little if only the faces change. Real reform involves far more comprehensive shifts: The city needs candidates for office who put the public good ahead of petty politics, and an engaged electorate that demands a serious approach. And San Bernardino needs to alter a city charter that hinders a fiscally stable and effective city government.

Residents are legitimately frustrated with city officials. The city sought bankruptcy protection in August, after finding that budget reserves were gone and San Bernardino was nearly $46 million short of the money needed to cover $166 million in expenses planned for that fiscal year. And after pledging cooperation on solutions, the City Council quickly reverted to the bitter stalemate that has hampered the city for years.

The city’s voters will not change that pattern, however, through unfocused expressions of disgust. In May a group of civic and business leaders announced a sweeping recall targeting the mayor, the seven-member City Council and the city attorney — even though the mayor and three council members are up for re-election in November anyway. The group this month narrowed its approach to target only those elected offices not on the November ballot: four council members and the city attorney. Trying to recall people who will face the voters soon anyway is not a way to build consensus for pragmatic solutions.

Besides, changing the players will matter little if the city continues the same old political games that have blocked progress in San Bernardino for years. Even the city’s insolvency was not enough to shock the council into cooperation. Instead, the public got time-wasting obstruction and special-interest pandering while the city’s finances imploded.

San Bernardino needs candidates who will put the city’s interests first, instead of engaging in the personal vitriol, self-serving politics and grandstanding that often have typified San Bernardino government. A recall effort is pointless if proponents cannot offer voters a better alternative.

Voters also need to hold elected officials accountable for their performance. The city’s government will not change as long as residents elect and re-elect candidates who contribute to the city’s dysfunction. Voters need to be informed about issues, and ready to support candidates committed to making necessary fixes at City Hall. And voters should reject candidates bankrolled by employee unions and other special interests that put narrow agendas ahead of public needs.

San Bernardino also should scuttle charter provisions that block responsible government, such as the automatic salary formulas that forced the bankrupt city to hand out nearly $1 million in pay raises in March. The charter should scrap the elected city attorney position, to remove the incumbent’s power to divide and paralyze city government.

Superficial changes will not suffice. The city needs to transform a noxious political atmosphere and a dysfunctional government structure. And a recall can help only if it is part of a more comprehensive overhaul.

Source: California Political Review

St. Mary’s Pulmonary Support Group will hold a picnic fundraiser Saturday, August 17th from 11:00 a.m. – 4:00 p.m. at American Baptist East Fellowship Hall, located at 6300 Washington Avenue in Evansville.

The event will include bingo games, a K9 demonstration from the Evansville Police Department, jewelry making, a Tai Chi class, a cornhole competition, live music by The Fraley’s, and lots of great door prizes, including a big door prize drawing at 2pm. Those attending the picnic are encouraged to bring an item from their home to include in a White Elephant auction and a homemade dessert to enter into a competition.

The cost is $10 per person, $18 per couple, or $30 for a family of four and includes a two-piece chicken meal complete with mashed potatoes and gravy, macaroni and cheese, green beans, a dinner roll, dessert, and a beverage. All proceeds benefit the St. Mary’s Pulmonary Rehab Support Group, which offers educational and social opportunities for adults diagnosed with lung diseases.

To reserve your tickets, please call 812-485-5230. Payment is required with reservation.

Deaconess received Magnet designation under the name Deaconess Hospital, Inc., which includes three hospitals – Deaconess Hospital, Deaconess Gateway Hospital and Deaconess Cross Pointe.

Deaconess earned Magnet designation after a thorough and lengthy application process. The process included documenting and reporting clinical results and patient outcomes as well as a four-day, on-site visit by a team of appraisers. Designation lasts four years after which time the organization must apply for re-designation.

The American Nurses Credentialing Center (ANCC) ® is the most prestigious distinction a health care organization can receive for nursing excellence and quality patient outcomes. Organizations that achieve Magnet recognition are part of an esteemed group that demonstrates superior nursing practices and outcomes.

Congratulations to everyone at Deaconess for this amazing achievement!