A Tale of Two Clients

On the one hand, the plural of "anecdote" is not "data;" on the other, I believe that these two clients' recent experiences with the ObamaTax Exchange may be illustrative of a broader set of problems:

Client Number 1 recently lost his employer-based health insurance (the employer made the perfectly sensible decision to cancel the increasingly expensive group plan altogether), leaving himself and his family to fend for themselves on the Exchange.

After fiddling with the Subsidy Calculator, they determined that they were eligible for about $200 a month in subsidies ("premium discount"). That's a lot of cash to leave on the table, so they headed to the Exchange.

Over the course of the past week or so, we've spoken most every day, as he finally decided which plan he wanted. I had quoted this plan both on and off the Exchange; the off Exchange plan allowed him to add a reasonably-priced dental option that included ACA-compliant Pediatric Dental; the on Exchange version required digging through dozens of dental plan options to find one that fit.

We determined that their best bet would be to buy the medical plan on Exchange, and the dental plan as a separate, stand-alone policy. And so, I thought, we're finally ready to go on this one.

Ah, not so fast there, buddy:

This morning, Client 1 called and asked "hey, if I end up the year and it turns out I wasn't really eligible for the subsidy after all (I ended up making too much), do I have to pay it back?"

Well, yeah.

There was a pause, and he replied, "in that case, let's go back and do the off Exchange version - I'd rather forego the subsidy than worry all year about having to pay it back."

Client Number 2 is in no such danger: he definitely qualifies for a subsidy. After shopping on the Exchange, he also picked a plan that fit his needs and budget (well, close enough for gummint work). So he logged on, started the enrollment process, and then promptly stopped and called me: "hey, Henry, do I  have to answer all these Medicaid-related questions?" I replied, "only if you want the subsidy."

Some background on Client 2: he chose not to go the early renewal route, and his current plan expires on April 1st, at which time his carrier will transition him onto (what they deem) an appropriate, comparable ACA plan. Or, he can shop the Exchange for one better suited, taking advantage of the anticipated $300 per month subsidy, as well.

Again a pause, and then, "y'know what? I'm going to just stick with the plan that [his insurance company] has me moving to; I'd rather pass on the subsidy than get cauight up in the Medicaid stuff."

So here are two families that selected a plan, only to leave it twisting in the wind in their Exchange "cart." One wonders how many others whom Ms Shecantbeserious counts as "enrolled" did likewise?

And what does it say about the ObamaTax itself that folks are willing to walk away from significant piles of cash to avoid it?

Just say no?

Here's a thought: what if they gave an Exchange and nobody came?

That's the premise behind a group calling itself the Citizens' Council for Health Freedom, which has rolled out a campaign to dissuade folks from buying plans on the public Exchanges. CCHF offers four rationales:

1.No private insurance – Obamacare is “Medicaid for the middle class” – or as CBO director Douglas Holtz-Eakin calls exchange coverage: “a second Medicaid program.”

2.No privacy – Data enters federal database accessible by IRS.

3.Limited choice – Coverage is “narrow network” policies.

4.High-cost premiums – Income redistribution to pay for exchange operations and subsidizing high-cost individuals.

While we certainly applaud their efforts, someone really needs to debunk some of their premises.

That would be me:

1. While the ObamaTax certainly encourages (and subsidizes) the expansion of Medicaid, the Exchanges themselves are a separate initiative. Conflating the two seems, well, confusing.

2. Anyone who's been paying attention to the news the past few months and still believes they have any privacy left is fooling themselves. The Data Hub doesn't care whether or not you've enrolled via an Exchange: all of that info is shared across agencies [ed: well, supposed to be shared might be more accurate].

3. Agreed: there is little doubt left that Exchange-based plans will employ "skinny" networks in an effort to rein in costs. A futile effort, of course, but an effort nonetheless.

4. This one's a maybe, and based on how one perceives the role of the government in what should be private transactions. On its face, I'd have to agree that the subsidies are simply robbing Peter to pay for Paul's insurance. Others might take a more charitable view.

CCHF also claims that "people still will be able to buy coverage outside the public exchange system, and that PPACA does not impose penalties on individuals simply because they buy coverage outside the public exchanges."

This is simply not true: only folks buying coverage on the public Exchange will be eligible for subsidies; I'd call that a pretty steep penalty for taking a pass.

In any case, it'll be interesting to watch this play out.

ADDENDUM: Bob has a slightly different take on privacy, the Exchanges and the Data Hub.

Cost Sharing Reductions: It's Not Sabotage. It's Not a Bailout: Part 2

In Part 1, we learned the difference between subsidies and the much misunderstood CSR's, and why ending the latter isn't a bailout. Now we learn why it's also not "sabotage:"


It's Not Sabotage

Obviously if the Government won't pay their obligation and an insurer still must offer the better level of benefits they will have to factor these expected claims costs into their standard rates. This will push premiums up substantially. Many studies have been done on the financial impact but for ease of math let's assume it will increase costs to Silver plans by 20%.

Yes, 20% is a lot. But keep in mind rate increases in 2014, 2015, and 2016 all rose by significant amounts too. We didn't hear cries of "sabotage" back then. Instead we heard "this won't impact very many people because subsidies (tax credits) will protect them from the increases." So, how is this different? It's not. In fact, because the increases are on Silver plans it will raise the tax credit amounts and reduce the costs for Bronze, Gold, and Platinum plans to those who qualify for subsidies.

This leaves one income group potentially getting the shaft on Silver plan premiums. Anyone who doesn't qualify for a tax credit/subsidy must pay full price. It's easy to assume that these people will suffer because all the discussion - even in this post - has focused for insurance plans sold ON exchange. It's true that insurers must price the same product equally both on-exchange and off-exchange. But, insurers can also offer plans off-exchange that have slight benefit variations at different prices.

Using my example above, an insurer will offer this plan both on and off exchange. The new plan without CSR funding will cost 20% more. The smart insurer will also create a plan that closely mirrors their original plan with a slight tweak - let's say a $6,200 deductible. Because this plan is only offered off-exchange the insurer doesn't have to include the 20% mark up to fund CSR risk. This solves the problem of the 400% and above person not being able to afford a Silver plan.

So, who does this hurt? Over the next 10 years CSR payments are expected to cost more than $200 billion. It's either going to come from Congress appropriating the funds or through higher premium tax credits given to consumers.

The answer is it hurts everyone. Because those in DC want to focus on political agendas and not the real problem we all suffer. Higher taxes, higher premiums, lesser benefits, market uncertainty. All will continue. Because nobody wants to focus on the 80% side of the equation. That 80% side is the actual costs of care.

ObamneyCare© News Update

Add another to the roster of states taking a pass on setting up an ObamneyCare© Exchange:

"New Jersey Gov. Chris Christie ...  a bill that would create a health insurance exchange, or Web-based insurance marketplace, in his state."

New Jersey joins Alabama on the roster of states choosing to roll the dice.

Cato's Michael Cannon has an interesting take on this:

"Even if you support ObamaCare, there’s no point in creating an exchange today when the Supreme Court could strike down the entire law as soon as next month ... But even if the Supremes uphold ObamaCare, there is no valid reason to create one of these things."

Michael cites the billions of dollars in state revenues that would have to be shunted from useful programs to fund Exchanges, as well as the inevitable tax increases necessary to sustain them.

And there's this: the (unfunded) Employer Mandate penalizes companies that choose not to offer government-approved health insurance plans. But, as Michael notes, there's a nice little loophole:

"[T]hat tax is only enforceable if a state creates an exchange itself. It disappears in states that don’t create exchanges."

That is, there's a real disincentive for any of the 58 states to actually put an Exchange in place.

Guess we had to pass the bill to learn what's not in it.

Exchange News

Now that we're at less than 100 days until the Exchanges (allegedly) open for business, here's the latest from a select few of the 58 states:

■ First up, New Hampshire  has "achieved a dubious distinction," one that has some folks pretty concerned:

"It is the only state so far with just one health insurer that plans to sell its products in the new online marketplace."

It will surprise no one that that carrier is Anthem Blue Cross/Shield.

■ FoIB Jeff M tips us that North Carolina's public Exchange is faring little better:

"Individuals buying health insurance coverage on new online exchange marketplaces beginning this fall will be choosing from products from only two or three carriers"

And businesses in the Tar Heel State will have similar lack of variety in the small group Marketplace: thus far, only the ubiquitous Blues are on-board.

■ We're doing a bit better here in the Buckeye State:

"Lt. Governor Mary Taylor, who also serves as the Director of the Ohio Department of Insurance, has announced that 14 companies filed 214 products intended to be sold on the federally facilitated insurance exchange in Ohio"

That's the good news. The bad is that these new plans represent "an 88 percent increase over the average cost in 2013"

Ooopsies.

■ And, finally, it looks like Iowa may be tied with New Hampshire for "first/last" place (depending on one's perspective):

"The Iowa state insurance commissioner is urging carriers to get into the exchange while there are still lots of potential policyholders ... However, [insurance commissioner] Gerhart has seen only one carrier — and not even the first- or second-largest — sign up for the partnership exchange"

And that one has chosen - ominously - to remain anonymous.

Wonder why.

Tuesday Morning Roundup [UPDATED!]

■ Did you know this? Via email, the folks at Medical Mutual of Ohio alert us that:

"All policies written in 2014, including those with effective dates of June through December using special enrollments, will renew on January 1, 2015."

This applies to any new plans written on or off the Exchange, and folks who believed the lie that they could keep their previous policies, and who were then "mapped" to new, ACA-compliant plans. 

■ Still feeling secure about the ObamaTax Exchange?

"Managers of Connecticut's relatively smoothly running state-based health insurance exchange are having to answer questions about a security breach. Someone found a backpack containing personal information from hundreds of Access Health CT users at a deli in Hartford."

No word yet on whether this included pastrami or corned beef, but it sure was piled high. 

■ Our friends at FlexBank report that the folks in DC have released the new Health Savings Account (HSA) contribution guidelines for next year:

"The new maximum calendar year contribution for HSAs of $3,350/single and $6,650/family."

Compared to this year, that's an increase of $50 for individuals and $100 for families.

Folks aged 55 and up can also make additional "catch-up" contributions of up to $1,000.

■ Oh, this just in (speaking of ObamaTax Exchanges):

"... the Connect for Health Colorado Board of Directors voted for a $13 million increase in taxes for those insured under the Colorado health exchange to help the exchange make up for a budget deficit"

I'm sure that it's a complete coincidence that the Centennial State's Exchange CEO, Patty Fontneau, just received a $14,000 bonus and a 2.5% pay raise (on a nearly $200,000 annual salary).

Great gig if you can get it, no?

Halbig is it?

Last week, we noted that Michael Cannon's years-long coverage of the subsidy vs Federally-run Exchange issue had passed another hurdle:

"A federal judge ... refused to dismiss a case that could fatally cripple the Obamacare health insurance law ... 'The IRS cannot rewrite the law that Congress passed'"

This was a substantial blow to proponents of the ObamaTax, and this week, Michael has more details on why this is, in fact, a very big deal. I highly recommend that you click on through.

But I wanted to highlight a few items. Joel L. McElvain is the government's Obamastration lawyer arguing the case on behalf of his masters. Here he attempts verbal jujitsu, with predictable effect:

"Congress is creating a “legal fiction” that each state has established an Exchange. If a state does not establish an Exchange, “the premise stands” that it has. Therefore, when the federal government establishes an Exchange, it is, fictionally but legally, “an Exchange established by the State.”

I told Michael that this gave me a headache, and wondered how Mr McE could say that with a straight face.

A bit later, we run into our old "friend," Timothy Jost. Esteemed co-blogger Patrick recently skewered Mr J here:

"So tell me Tim, as a law professor which quote of yours is correct?"

Definitely read Michael's piece, it's quite enlightening.

About those "Exchanges"

As we noted regarding abortion coverage, sometimes what isn't said in a particular bill is as important (and perhaps even more so) as what is stated. Which brings us to whether or not illegal aliens would be covered under the America’s Affordable Health Choices Act [ed: nice segue!].

Turns out, not only would they be covered, but they'd be required to buy their insurance from the Exchange mechanism put forth in the bill.

But don't take my word for it; let's see what the non-partisan Congressional Research Service has to say:

"Under H.R. 3200, a 'Health Insurance Exchange' would begin operation in 2013 and would offer private plans alongside a public option…H.R. 3200 does not contain any restrictions on noncitzens — whether legally or illegally present, or in the United States temporarily or permanently—participating in the Exchange.

CRS also notes that the bill has no provision for requiring those seeking coverage or services to provide proof of citizenship. So, absent some major amendments to the legislation and a credible, concrete enforcement effort in action, looks like the myth on this issue is the one being spread by Obama, Reid, Pelosi, et. al."

On the one hand, this would definitely solve much of the problem of the "uninsured:" since illegals comprise some 20% of that group, forcing them to buy coverage through the taxpayer-subsidized Exchange would ameliorate that problem. On the other hand, of course, forcing them to buy coverage through the taxpayer-subsidized Exchange will further drive costs skyward.

As Bob is fond of asking, doesn't anybody in Obamington think these things through?

Aetna Touch-N-Go, and the Big Picture

A couple of days ago, we reported on Aetna's apparent change of heart regarding the sale of individual medical insurance here in Ohio. Today, they're back in the news:

"Aetna Inc. execs remain skeptical about how the [Obamaax] public exchanges will perform ... New and expanded private exchange programs could get off to a faster start"

There are three essential differences between the Public (FFE) and Private Exchange models:

First, only plans purchased on the Public Exchange will be eligible for subsidies (maybe: the subsidy rules keep changing);

Second, plans available on the Public Exchange are expected to have much smaller ("skinnier," in the vernacular) provider networks;

And third, fewer carriers are expected to participate in the Public Exchanges (limiting competition and choice).

It's that third item that's key: absent a robust marketplace, even subsidized plans are likely to remain out of the financial reach of many folks. That's due partly to premiums, and partly to plan design. The least expensive ObamaTax-compliant plans ("Bronze" level) have potential out-of-pocket maximums much higher than many plans available today, further exacerbating the (un)affordability issue.

If (when?) major players like Aetna take a pass on the Public version in favor of the Private, it will cause an even greater strain on the former's sustainability. The Private Exchange model, on the other hand, looks poised to be reasonably successful: for the most part, these will offer more choice (and thus competition) and better service.

Wait, what's that about service, Henry?

Well, it's like this: agents (you know, the folks who are trained and experienced in the actual business of health insurance) are effectively shut out of the Public Exchanges. But a lot of us have signed up for the Private Exchanges. So when a consumer needs an accurate, knowledgeable and credible answer, to where do you think he will turn?

On the other hand, we know that a lot of agents have already thrown in the towel (and/or are planning to do so in the near future), so that may not be a realistic assessment, either.

Yeah, I'm just full of warm fuzzies today.

Ohio Draws a Line [UPDATED]

[Although we rarely do this, I am changing the published headline of this post to more accurately reflect what's actually going on. HGS]

This just in:

"Ohio will let the federal government run its health care exchange, a key portion of health care reform, Gov. John Kasich said today."

Oh, well, guess that means we avoid a nasty state constitutional crisis.

And this is priceless:

"Benefits of a federal exchange start with cost ... annual operating costs of a state exchange would range from $19 million to $34 million, excluding technology. Fees from providers and insurers would pay most of those costs." [emphasis added]

Yeah, be sure to let us know how that works out.

Not to mention: Buckeyes now get the privilege of susbsidizing the folks in states that set up their own Exchanges, forcing up our costs while driving down theirs (at least for a while).

Yippee!

[Hat Tip: FoIB Holly R]

UPDATE: Unlike Ohio's Gov Kasich, Pelican State Gov Bobby Jindal was a bit more forceful in rejecting a state-built ObamaExchange. Co-blogger Mike tips us to the Governor's official rejection:

"The full extent of damage the PPACA causes to small businesses, the nation’s economy, and the American health care system will only be revealed with time. The State of Louisiana has no interest in being a party to this failure by implementing a state based exchange."

That's gonna leave a mark.

UPDATE THE 2ND: And now add Texas to the list:

"Texas Gov. Rick Perry officially notified the federal government on Thursday that the state will not set up an exchange to help people buy health insurance."

I'm wondering if perhaps thinking that my title for this post was inappropriate.

Hmmm....

UPDATE THE 3RD: Thanks to the folks at RedState, here's the latest tally of states which have told Shecantbeserious to take a flying leap off the nearest ObamaExchange:

Centennial State Blunders

This past summer, we learned that "... the Connect for Health Colorado Board of Directors voted for a $13 million increase in taxes for those insured under the Colorado health exchange to help the exchange make up for a budget deficit."

Hard to believe it, but even that baker's dozen of millions was merely a butterfly bandage on a gaping wound:

"A devastating state audit released Monday found a rash of problems with the Colorado health-care exchange’s handling of $32 million in taxpayer funds as well as possible violations of federal law."

Keep in mind, the Colorado Exchange is set to receive almost $180 million in taxpayer funds from all 58 states. But it's rife with (alleged) corruption, cost overruns, bookkeeping errors galore, and more.

In short, a perfect microcosm of the ObamaTax itself.

Kind of fitting, one supposes.

And it's made even more interesting by the #GruberGate hearings going on now in DC: if (and that's a big if) the Halbig/King cases stymie the Federal Exchange subsidies, folks in state-run exchanges (like Colorado) would still be entitled to theirs. Ka-ching!

Exchange THIS

The LA Times reports some major California insurers have built "narrow networks" of doctors and hospitals for plans that will be offered thru the State's Obamacare Exchange.

Insurance companies (and consultants and many large employers) say that these narrow networks reduce costs by increasing the insurers' ability to negotiate price discounts.  Physicians and hospitals say they oppose these narrow networks because they fear patients won't be able to find the doctor or hospital they like, in the plan they like.

As for the State, Peter Lee - executive director of Covered California [the State's Obamacare Exchange] - says "Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need . . . That means if a plan can't serve patients, we'll close it down from taking new enrollment"

So if a plan doesn't provide what the Exchange deems sufficient access, the Exchange will make sure the plan can't provide ANY additional access.

Is that a solution?

The Times goes on to say "Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor."

Isn't that exactly what people say who worry about rationing under Obamacare - and have been relentlessly ridiculed for saying it?

Free Contraceptives aren't that important after all

Interesting fact among a few;

"The top 10 therapy classes by claims volume for exchange enrollees and those in a commercial health plan were largely similar, with a few notable exceptions. The proportion of pain medication was 35% higher in exchange plans; the proportion of anti-seizure medications was 27% higher in exchange plans; the proportion of antidepressants was 14% higher in exchange plans; the proportion of contraceptives was 31% lower in exchange plans." [emphasis added]

As major an issue as Saundra Fluke and free birth control was, those actually buying the plans don't seem to need it. By the time you're signed up for ObamaCare you have already been screwed so they don't need it?

Blue Grass Bevin HIX Blues

Some Obamatax supporters have their knickers in a twist over KY Governor-elect Matt Bevin's plans to shutter his state's ill-conceived and potentially illegally founded health insurance exchange, called (oh so cleverly) Kynect:

"Bevin's plan to end Kynect has brought a strong rebuke from Obamacare advocates and outgoing Kentucky Gov. Steve Beshear"

In fairness, Ben Miller (author of the piece linked above) points out that it's really not clear that one form of Exchange is superior to the other. That is, the jury's still out on whether it's in a given citizen's (or state's) interest whether that state has its own portal or just piggybacks onto the 404Care.gov site.

Talk about damning with faint praise.

Meantime, as FoIB David Adams, proprietor of the Kentucky Progress blog, points out, the whole Kynect effort was actually never anything more than a massive overreach by (shortly former) Governor Bashear:

"Governor Steve Beshear "created" the Kentucky Health Benefit Exchange, Kynect, with an executive order in 2012 and then after the legislature declined to ratify his order as required by law, he tried again in 2013, 2014 and 2015."

So, our first 'rump Exchange.' And one that cost over a quarter of a billion dollars to implement, to boot.

Sounds like it's about time to to dis-Kynect the Blue Grass Exchange.

ObamaTax Exchange Crunch-Time edition

Poor Ms Kathy: the clock keeps on tickin', and her pet project keeps getting a lickin'.

To wit:

■ Capital City itself

"The ObamaCare exchange serving Washington, D.C. is delaying important parts of its operations less than a week before it is scheduled to open for enrollment"

Not only won't potential enrollees be unable to calculate their subsidies (if any), but they can't even determine whether or not they're eligible for Medicaid.

■ Colorado

"Colorado exchange managers revealed Monday ... that customers who want tax credits to make health insurance more affordable will have to call for help, rather than navigating the multi-million dollar computer system on their own."

I'm sure that'll go over big with the 20-somethings that hold the key to the whole train-wreck's "success."

■ Utah

"Obamacare’s insurance marketplace was supposed to have “no wrong door ... Consumers will need to find the right door ... or they will possibly face delays in obtaining coverage"

The whole "No Wrong Door" meme was heavily promoted in the Exchange Certification training. Why am I not surprised that it's DOA?

■ Oregon

When it rains, it pours:

"Oregon ... won’t meet all the requirements for its health-insurance exchange when the online marketplace opens Oct. 1 ... For at least two weeks, people using Cover Oregon won’t be able to complete their purchase without help from a certified insurance broker or community group"

Feature or bug? What difference, at this point, does it make?

Precision Cannon Fire

As we noted a week ago, some Grand Canyon State citizens are going to have a problem this November:

"People in Pinal County are at risk of a health insurance problem that hasn't happened anywhere else in the country: no companies offering marketplace health insurance"

Turns out, Aetna was the sole remaining carrier on that state's Exchange, and they've bailed. That means that, if you live in Pinal County (home of the Boyce Thompson Arboretum) and you want to buy health insurance, you'll have to buy if off the Exchange.

Which also means you get to pay full-freight: no subsidies for off-Exchange plans.

And that most likely means you'll be faced with plans that are unaffordable. No problem: the ObamaTax makes provision for such circumstances, and offers an exemption for folks who can't afford premiums.

Except there's a pretty significant, but under-the-radar, catch: this exemption won't be available to the folks in Pinal County.

Why not?

Well, as FoIB Michael Cannon explains, "[t]he unaffordability exemption applies only if “the annual premium for the lowest cost bronze plan available in the individual market through the Exchange” is unaffordable." But there are **no** plans on the Exchange.

See the problem?

Read the whole thing, you'll be glad (and/or furious) that you did.

Philly Cheese Exchange

Pat and Geno probably won't be fighting over this one:

"After months of study ... [Pennsylvania is] moving forward with a key - and widely supported - option offered by the federal health-care overhaul: a state-run insurance exchange."

Of course, the authors of this piece offer no evidence demonstrating anything like "wide support" for the Exchanges (possibly because none such exists), but no sense letting a few facts get in the way of a good story, right?

The silliness doesn't end there, of course:

"Besides being a one-stop shop for health insurance, the exchange will be the only place where many of the people who will be newly eligible for insurance under the law ... can apply for the tax credits that are intended to make coverage affordable."

Well, sort of: it's true that, as this is a state-run Exchange, Keystone State citizens would be eligible for whatever tax "credits" may be available, and for as long as they're available. But since we know that ObamneyCare© will quickly generate huge deficits, it's a sure bet that this won't be for long. Especially since tax payers in states with federally-run Exchanges won't be eligible for these same credits.

What could possibly go wrong?

In the event, the Pennsylvania-run Exchange is scheduled to go on-line (literally) in 2014, and is expected to draw some 2 million people. How many of those will be eligible for tax credits is not mentioned, but one presumes that it will be a majority of participants.

Which leads to even greater deficits, and thus higher premiums.

More cheese!

More On (Moron?) Those Exchanges

Even as Ohio voters look to shield the state from it, our new Governor has announced that "plans are moving forward to create a statewide marketplace or exchange for health insurance, as mandated by [ObamaCare©] ... the state has received federal money to plan for building an exchange."

Um, John: what part of the word "No" don't you understand?

But it gets worse:

"Taylor, who also heads Ohio's Department of Insurance, is to apply soon for a second round of federal cash."

Um, Mary: same question.

This is really maddening; it's okay to leave money on the table if the purpose of said funds is counter to the wishes of the people. It's also okay when the end result will be less choice, less competition, and higher costs, as the Exchanges will, in fact, produce:

"Health and Human Services Department released draft regulations telling the states how they must run these organizations, which are the core of the new entitlement and are where people will receive heavily subsidized coverage ... HHS, unsurprisingly, envisions the exchanges as 50 (or more) new regulatory agencies designed to let politics run health markets."

Spot on.

Oh, you doubt that last bit?

Heh.

But surely the Exchanges will "afford States substantial discretion in the design and operation of an Exchange," right?

Well, no:

"This is the exchange model that prevails in Massachusetts, where Mitt Romney's "connector" has become a tool for controlling the insurance industry and picking health-care winners and losers."

And we've seen how well that's worked out.

No surprise there, of course. The truth is, the gummint is competent to run a select, specific group of programs. But it is run, after all, by human beings (really!), and we humans are not immune to corruption, greed and failure.

Okay, Henry, that may be true, but what evidence is there to support that claim as regards health care?

I'm so glad you asked:

"For the second time, a federal audit has charged the Louisiana state health agency with mismanaging a $50 million post-Hurricane Katrina grant intended to restore health care access to the New Orleans region."

This wasn't a national program. This wasn't even a state-wide effort. It was focused, laser-like, on one city, and they couldn't even get that right. Earlier today, Bob asked (as regards "waste, fraud and abuse") why in the world we do "we need a new law or program to take care of something that SHOULD BE standard operating procedure?" The answer, of course, is that we don't. What we do need is protection from "our betters."

And just to pile on, HHS Secretary Shecantbeserious sent out new "proposed" rules for the Exchanges. What caught my eye is this (from a Cigna email):

"The regulation does not address all the requirements of Exchanges. Additional guidance is expected later this year regarding:

■ Standards for individual eligibility to purchase Exchange coverage, including premium subsidy information

And

■ The process for receiving an exemption from the individual mandate

And

■ The definition of essential health benefits

So, um, about those subsidies: how're those working out so far?

I can guess about how one receives an "exemption from the individual mandate."

And those "essential benefits?" One can safely assume.

[Hat Tip for Ohio item: FoIB Holly R]

Monday Afternoon LinkFest

Lately, we've had an embarrassment of riches concerning the ObamaTax and other related news. Because there are only 24 hours in a day, it's not really possible to give each one the blog-space it probably deserves, but at least we can give our readers a heads' up on what's hot:

1 - We've been warning folks about the very real probability of fraud in the new Navigator program. From FoIB Holly R here's the latest:

"...officials are watching for look-alike websites that could lead consumers to be the victims of fraud or simply confuse people ... States are on the lookout for websites created by interest groups, private insurance companies and sometimes scammers that have similar web addresses and the appearances of the official state exchange websites."

So-called "phishing" sites have been around for a long time, this seems to be the latest iteration of that phenomenon.

2 - Holly also tips us to this story - surely only one of many to come - about pushback on so-called "wellness" programs. In this case, certain employees at Penn State University are protesting a new requirement that they either participate in one of these, with the added benefit that they'll get to divulge some very personal information, at least some of which seems pretty intrusive (and doesn't seem to be particularly "health"-related):

"The plan requires nonunion employees, like professors and clerical staff members, to visit their doctors ... and submit to an extensive online health risk questionnaire that asks, among other questions, whether they have recently had problems with a co-worker, a supervisor or a divorce"

Cost for declining to participate? $100 a month (or $200 if they're married and have their spouse on the plan).

Potential solution (and probably rationale for the whole exercise): opt out of the Penn State plan and onto the Exchange.

3 - We've noted before that the Public Exchanges seem to be having a problem attracting (and keeping) carriers. Our Friend Jeff M reports from North Carolina that the Tar Heel State is no exception:

"FirstCarolinaCare Insurance abruptly pulled out of the North Carolina market, saying there are too many unknowns about how the Affordable Care Act will play out here."

So what if they gave an Exchange and no carrier came?

We may find out.

4 - And circling back around to Navigators and the likelihood of shenanigans, Florida has banned them from county health departments:

"Local health departments can accept public exchange brochures and other exchange outreach material, but they can distribute the materials only if consumers ask for information"

Florida heath officials wanted to make sure that they're agencies know that Navigators "aren't acting on behalf of the state."

Gee, one wonders why anyone would think that.

Heads' I win...

There's a popular meme circling the 'net that says the rate increases really won't affect most people because their subsidies will cover the spread:

"Yet most Obamacare participants won’t feel the full price hike or anything near it. Nationally, 85% of those enrolled receive a tax credit"

This is why I get so frustrated with the media, which seeks to isolate the Marketplace (Exchange) from the big picture: all ACA-compliant plans are ObamaPlans, not just those on the Exchange. That is, if it's ACA-compliant, then it's ObamaCare. By trying to split "ACA compliant" from "bought on the Exchange" these oh-so-clever "journalists" seek to put daylight between the two that doesn't actually exist.

The reality is that yes, most folks who buy on the Exchange are going to be getting subsidies (aka "a several hundred dollar health insurance gift card from taxpayers"), which is the only reason one should even consider buying there. But this completely misses the point that most folks don't buy on the Exchange or receive subsidies, and thus feel the full brunt of these fully operational Death Stars rate hikes.

And these same reporters also ignore the fact that even those "shielded" from rate hikes are still going to feel the MOOP pinch.

What's "the MOOP pinch," you ask?

That's the newly increased Maximum Out of Pocket limit. Care to see how this works in the real world?

Well, FoIB Jeff M has graciously forwarded his own plan rates and specs for this year and next:

So not only does he have the privilege of paying almost $3,000 a year more in premium, but his out-of-pocket increased by $300.

One supposes he doesn't feel "shielded."

[Hat Tip: HotAir]