Even as leading Democrats offered assurances to the contrary, government experts repeatedly warned that a new long-term care insurance plan could go belly up, saddling taxpayers with another underfunded benefit program, according to emails disclosed by congressional investigators.

Part of President Barack Obama’s health care law, the program is in limbo as a congressional debt panel searches for budget savings and behind the scenes, administration officials scramble to find a viable financing formula.

A longstanding priority of the late Sen. Edward M. Kennedy, D-Mass., the Community Living Assistance Services and Supports program, or CLASS, was spliced into the health care law despite nagging budget worries. Administration emails and documents reveal that alarms were sounded earlier and more widely than previously thought. Congressional Republicans seeking repeal of the program provided the materials to The Associated Press.

“Seems like a recipe for disaster to me,” William Marton, a senior aging policy official in the administration, wrote in an October 2009 email. Marton explained his concern that large numbers of healthy people would not willingly sign up for CLASS, creating a predicament in which soaring premiums for a smaller group of frail beneficiaries would destabilize the program.

Read the rest of the column at the Associated Press

Of all the issues bandied about in the recent debate over the debt ceiling, none generated more contention, more TV ads and more unseemly rhetoric than potential changes to Medicare.

Health economists generally believe that Medicare is on an unsustainable course and is desperately in need of reform. Yet public opinion polls show that most seniors disagree. They not only resist cuts in Medicare to solve the problem of federal deficit spending, they also resisted the spending cuts and delivery of care innovations envisioned by the Affordable Care Act (ACA), as well as the private insurance innovations envisioned by Rep. Paul Ryan (R-WI) and the House Republicans.

In short, most seniors would like to keep Medicare just like it is.

A similar view is held by a small, but vocal group on the left that favors single-payer national health insurance. The Physicians for a National Health Program, for example, claims that Medicare has lower administrative costs than private insurance and is able to use its monopsony (single-buyer) power to suppress provider fees. The group, which is resistant to managed care, favors “Medicare for all” and endorses a bill to do just that by John Conyers.

Paul Krugman, writing in The New York Times, also argues this way. He points to a chart (see Figure I) which seems to show that Medicare per capita spending is growing at a slower rate than private insurance. Krugman, along with others,  touts the slower rate growth in the Canadian health care system (also called “Medicare”).  In recent editorials, both Krugman and Robert Reich have joined the call for Medicare for everyone.

Are these unconventional critics right?

Read the rest of the post at Heath Affairs Blog.

The 11th Circuit Court of Appeals on Friday ruled that the health care reform law’s requirement that nearly all Americans buy insurance is unconstitutional, a striking blow to the legislation that increases the odds that the Supreme Court will have to review the law.

The suit was brought by 26 states — nearly all led by Republican governors and attorneys general. The Department of Justice is expected to appeal.

The 2-1 ruling marks the first time a judge appointed by a Democrat has voted to strike down the mandate. Judge Frank Hull, who was nominated by former President Bill Clinton, joined Chief Judge Joel Dubina, who was appointed by George H.W. Bush, to strike down the mandate.

Read more: http://www.politico.com/news/stories/0811/61218.html#ixzz1UrhBoCKg

Once provisions of the Affordable Care Act start to kick in during 2014, at least three of every 10 employers will probably stop offering health coverage, a survey released Monday shows.

While only 7% of employees will be forced to switch to subsidized-exchange programs, at least 30% of companies say they will “definitely or probably” stop offering employer-sponsored coverage, according to the study published in McKinsey Quarterly.

The survey of 1,300 employers says those who are keenly aware of the health-reform measure probably are more likely to consider an alternative to employer-sponsored plans, with 50% to 60% in this group expected to make a change. It also found that for some, it makes more sense to switch.

Read the rest of the column at MarketWatch.com

From the Washington Examiner

Above the fold on the front page of the New York Times is not normally where one expects to find a news article that lays bare the mortal threat posed by Obamacare to a key segment of the health care industry and hundreds of thousands of its workers. But the pro-Obamacare newspaper pulled no punches Monday in a column-one story titled, “Nursing homes seek a reprieve from health law.”The focus of the piece was that “many nursing homes and home care agencies, alarmed at the cost of providing health insurance to hundreds of thousands of low-wage workers, have started a lobbying effort seeking an exemption or special treatment that would relieve them of the obligation or help them with the expense.” A little further on in the article, Mark Parkinson, president of the American Health Care Association, explained that his industry has to get a waiver from Obamacare because “we do not have much ability to increase prices because we are so dependent on Medicaid and Medicare” for revenue.

Neither of these statements should shock anybody. When government controls an industry, the health of firms within it inevitably becomes dependent on their influence in Washington and state capitals. Competition in a regulated industry is typically focused on hiring well-connected K Street lobbying firms, targeting the “right” congressmen on key committees for hefty campaign contributions and knowing which bureaucratic levers to pull in order to ensure a favorable “business environment.” What is best for patients becomes an afterthought when bureaucratic formulas determine what care is provided and how, instead of private firms competing with each other to offer needed services at affordable prices while making enough profit to stay in business.

Another quote from the Times article points to two more ways in which government regulation of an industry is harmful, usually to the very people it is intended to benefit. Debbie D. Gantz, administrator of a small Oklahoma nursing home, explained that she would offer her employees health insurance but for the fact that “we are a small home. We are not part of a chain. We could not provide health insurance to our employees and still be able to pay all our bills and make the payroll.”

The result, if Obamacare becomes fully operational, will be that thousands of small nursing homes like Gantz’s will either have to fire employees and restrict services, be bought out by nursing home conglomerates, or both. The result will be fewer jobs for people who want them, and fewer care options available to those who desperately need them. President Reagan put it well in 1981: “Government is not the solution to the problem, government is the problem.”

It still is in 2011.

Ways and Means Committee Members Wally Herger (R-CA), Dave Reichert (R-WA) and Charles Boustany (R-LA) today released “Behind the Veil: The AARP America Doesn’t Know,”  a new report exposing the conflict between AARP’s drive for profits, the best interests of its members and the organization’s tax exempt status. 

The report, which is the culmination of more than a year-long investigation, concludes that AARP stands to make upwards of one billion dollars over the next ten years as a result of the new health care law through the sale of their endorsed-Medicare insurance products. 

The Members have now turned over their findings to the IRS to determine if AARP has abused its tax-exempt status, and whether or not that status should be revoked.

KEY FINDINGS

• AARP is in fact a large, complex and sophisticated organization with over $2.2 billion in total assets and had revenues in excess of $1.4 billion in 2009 alone.
   
• AARP has four primary revenue sources: royalty payments (primarily from insurance companies), membership dues, publication advertising and grants (governmental and non-governmental). In 2009, AARP revenues from royalties were two and half times higher than its membership dues.
   
• Since 2002, income generated from AARP membership dues has increased 32%, or $60 million. However, during this same period, income derived from AARP’s business relationships, primarily with insurance companies, has nearly tripled, increasing by $417 million.  Royalty payments from for-profit companies comprised nearly 46% of AARP’s revenue in 2009, while membership dues totaled just 17% of total revenues.
   
• As a result of the new health care law, the Obama Administration estimates more than 7 million seniors will lose their current Medicare Advantage plans, resulting in a massive migration of seniors to Medigap plans.  AARP is the nation’s leading provider of Medigap plans and has a contract in which AARP financially gains for every additional Medigap enrollee.
   
• Based on low, mid and high-range estimates, AARP stands to financially gain, over and above the millions of dollars they currently receive from United, between $55 million and $166 million in 2014 alone as a result of new Medigap enrollees stemming from the health care law’s cuts to MA, which AARP strongly endorsed.
   
• Under the midrange estimate and under their current contract, AARP’s financial gain from the health care law could exceed $1 billion during the next 10 years. This is because AARP will see their royalty payments increase as seniors are forced out of MA plans and buy AARP Medigap plans instead.
   
• Despite a massive increase in revenues, AARP’s cash and in-kind contributions to the AARP Foundation only increased 11% ($3.1 million) while cash and in-kind contributions to AARP’s Legal Counsel for the Elderly actually decreased 9% ($300,000) from 2004 to 2008 (the only years for which AARP provided data). Meanwhile, the AARP Foundation recently committed an estimated $14 million in each of the next three years to become the primary sponsor of NASCAR driver Jeff Gordon.
   
• The AARP Foundation received government grants totaling over $97 million which comprised 81.9% of the Foundation’s total revenue in 2009.

The number of temporary healthcare reform waivers granted by the Obama administration to organizations climbed to more than 1,000, according to new numbers disclosed by the Department of Health and Human Services.

HHS posted 126 new waivers on Friday, bringing the total to 1,040 organizations that have been granted a one-year exemption from a new coverage requirement included in the healthcare reform law enacted almost a year ago. Waivers have become a hot-button issue for Republicans, eager to expose any vulnerabilities in the reform law.

In order to avoid disruption in the insurance market, the healthcare overhaul gives HHS the power to grant waivers to firms that cannot meet new annual coverage limits in 2011. The waivers have typically been granted to so-called “mini-med” plans that offer limited annual coverage — as low as $2,000 — that would fall short of meeting the new annual coverage floor of $750,000 in 2011.

“We don’t want to take away people’s health insurance before they have some realistic other choices,” HHS Secretary Kathleen Sebelius said in an interview with The Hill earlier this year.

Republican lawmakers have seized on the waivers as proof that the law they want to see repealed is flawed, and they have accused the administration of giving them waivers as gifts to union allies. The administration has rejected both claims as Republicans on the House Energy and Commerce Committee have asked HHS for in-depth details about every waiver decision and request.

Read the rest of the story at The Hill.

From CNBC

Nearly two-thirds of U.S. doctors surveyed fear healthcare reform could worsen care for patients, by flooding their offices and hurting income, according to a Thomson Reuters survey released Tuesday.

The survey of more than 2,900 doctors found many predict the legislation will force them to work harder for less money.

“When asked about the quality of healthcare in the U.S. over the next five years, 65 percent of the doctors believed it would deteriorate with only 18 percent predicting it would improve,” Thomson Reuters, parent company of Reuters, said in a statement.

The U.S. House of Representatives began debate Tuesday on efforts to repeal President Barack Obama’s overhaul of the U.S. healthcare industry.

Repeal of the bill is likely to fail in the Senate.

Also Tuesday, the Health and Human Services Department released a study predicting that up to 129 million Americans under 65 who have a pre-existing health condition would risk losing health insurance or be denied coverage if the bill is repealed.

Polls show consumers are divided about the impacts of healthcare reform and the House debate has presented an opportunity for many groups to make their arguments for or against it.

Read the rest of the post.

From the Washington Examiner

OnFriday, the Food and Drug Administration could doom thousands of breast cancer victims. The FDA will be considering the unprecedented step of revoking approval for Avastin, a drug that represents the last hope for women with late-stage breast cancer. About 17,500 women a year are treated with the drug, which cuts off blood flow to tumors. It does not cure cancer, but it does stop its growth and extend life. Unfortunately, medical miracles don’t come cheap — treating a breast cancer patient with Avastin can cost $90,000 a year. In 2008, the FDA’s Oncologic Drugs Advisory Committee put Avastin on a track to “accelerated approval” following a clinical study showing 52 percent of the women on the drug showed improvement in “progression-free survival.” On average, Avastin extended the life of patients by 5 1/2 months, but some survive for years. Subsequent clinical studies showed only 36 percent and 31 percent of women had improved survival rates, a far better outcome than the alternative — death. The FDA confirmed last year that Avastin would be approved pending “improvement in progression-free survival and evidence that survival is not impaired.”Doctors and patients were then stunned last summer when the ODAC ruled, by a vote of 12-1, that the drug did not produce clinically meaningful results. Why did the panel deny the obvious evidence of Avastin’s effectiveness? One member of the FDA’s panel, Jean Grem of the University of Nebraska, said, “We aren’t supposed to talk about cost, but that’s another issue.” If the FDA follows through on the ODAC’s finding and revokes Avastin’s approval, both the government and private insurers will quickly cease paying for its use on breast cancer sufferers.

The Obama administration wants to ration health care in order to help pay for universal coverage and other Obamacare goodies. Donald Berwick, Obama’s controversial nominee to head the Centers for Medicare and Medicaid Services, has explicitly endorsed rationing. The CMS is now considering whether to refuse Medicare payments for Provenge — another expensive but effective late-stage prostate cancer treatment.

Government bean counters were never supposed to determine what your treatment options are, and patient advocacy groups are justifiably outraged. If Avastin and other expensive wonder drugs are denied approval because of costs, proponents of government-run health care will have to no choice but to admit “death panels” have gone from rhetoric to reality.

From Fox News

 

From Bloomberg

The Obama administration’s requirement that most citizens maintain minimum health coverage as part of a broad overhaul of the industry is unconstitutional, a federal judge ruled, striking down the linchpin of the plan.

U.S. District Judge Henry Hudson in Richmond, Virginia, said today that the requirement in President Barack Obama’s health-care legislation goes beyond Congress’s powers to regulate interstate commerce. While severing the coverage mandate, Hudson didn’t address other provisions such as expanding Medicaid.

Hudson, appointed by President George W. Bush found the minimum essential coverage provision of the act “exceeds the constitutional boundaries of congressional power.”

The decision left intact other provisions of the law and only affects the part that requires most U.S. citizens to maintain minimum health coverage beginning in 2014.

The ruling is the government’s first loss in a series of challenges to the law mounted in federal courts in Virginia, Michigan and Florida, where 20 states have joined an effort to have the statute thrown out. Constitutional scholars said unless Congress changes the law, its fate on appeal will probably hinge on the views of the U.S. Supreme Court’s more conservative members.

Supreme Court

“I am gratified we prevailed,” Virginia Attorney General Ken Cuccinelli said in a statement. “This won’t be the final round, as this will ultimately be decided by the Supreme Court, but today is a critical milestone in the protection of the Constitution.”

U.S. health-care stocks extended gains after the ruling. The Standard & Poor’s 500 Health Care Index rose 0.5 percent at 12 p.m. New York time. UnitedHealth Group Inc. and Coventry Health Care Inc. led gains.

Tracy Schmaler, a spokeswoman for the U.S. Justice Department, didn’t immediately reply to voicemail and e-mail messages seeking comment on Hudson’s decision. Reid Cherlin, a White House spokesman, did not immediately reply to an e-mailed request for comment.

‘Prominent Conservatives’

“Some prominent conservative justices will go against it, but there is no serious indication that every single one will go against it,”, Mark Hall, a professor at Wake Forest University School of Law, who serves on a federal advisory board set up to help implement the law, said ahead of the ruling.

“There’s a lot of activity focused now on alternatives to the mandate,” said Dan Mendelson, chief executive officer of Avalere Health, a Washington-based consulting firm. One option might be to provide access to all people, even ones with pre- existing conditions, to buy insurance, and limit the times they could sign up.

“It’s using a carrot instead of a stick,” Mendelson said in a telephone interview last week.

Robert Zirkelbach, a spokesman for health insurers’ Washington lobby group America’s Health Insurance Plans, declined to comment on the record about whether insurers had discussed such an alternative with the administration or whether there was a way to design such a policy in a way that would be sufficient to replace the effects of the individual mandate. Through the individual mandate and expansions of Medicaid and employer-based coverage, the law is estimated to provide 32 million more people with coverage by 2019, according to the Congressional Budget Office.

The case is Commonwealth of Virginia v. Sebelius, 10-cv- 00188, U.S. District Court, Eastern District of Virginia (Richmond).

From the Weekly Standard

The latest Rasmussen poll of likely voters shows that Americans support the repeal of Obamacare by a margin of 21 percentage points (58 to 37 percent), independents support repeal by 24 percentage points (59 to 35 percent), and Americans think that Obamacare is more likely to be repealed than not. Only 39 percent of voters think it’s likely that Obamacare will survive, compared to 47 percent who think it’s likely that it won’t and 14 percent who aren’t sure. Moreover, only 9 percent of voters think it’s “not at all likely” that Obamacare will be repealed. Rasmussen writes, “Belief in the likelihood of repeal has now edged to its highest level to date.”

 

Whether the Obama administration and its allies want to face it or not, wholesale repeal — and replacement with real reform — is a very real prospect going forward.

From Investors Business Daily

Amid all the focus in recent weeks on tax reform and debt reduction, the far-reaching implications of a proposal to scrap the tax-free status of employer-provided health insurance have gone unexplored.

Both President Obama’s Fiscal Commission and the Bipartisan Policy Center’s debt-reduction panel have pitched such a tax reform, which could dramatically erode employer-provided health coverage and shift tens of millions of additional people to subsidized coverage under ObamaCare.

Just how dramatic of a shift is the big “if” in the report from the Bipartisan Policy Center’s panel led by former GOP Sen. Pete Domenici and Clinton White House budget director Alice Rivlin.

“Even with the phase-out of the employer-sponsored insurance exclusion, employers may continue to offer health insurance benefits,” the report says, noting efficiencies that large employers can bring to purchasing health insurance.

“If these advantages prove important, larger employers will continue to provide coverage even without the tax exclusion,” the report says. “Smaller employers … will be less likely to continue to provide coverage.”

Read the rest of the story.

From the Weekly Standard

“[H]ealth care system is coming apart at the seams….On the ground, there is too often a glaring lack of execution: long waits, bed shortages, unequal access to medication. Those failures are compounded by the fact that the ever-rising medicare bill is squeezing out education and other social priorities.”

No, that’s not from an item in the New York Times; rather, that’s from a piece in the Toronto Globe and Mail on Nov 7, 2010 about Canada’s health care system. Its problems provide a glimpse of what a fee-for-service medical care produces in a single payer system: no demonizing of insurance companies, no teeth gnashing about the uninsured, and no end to the concern about how to pay for health care.

Read the article from the Toronto Globe and Mail here.