United Health Plans to Kick Out Obamacare Exchanges

U.S. health insurer UnitedHealth stated on the day of Tuesday that it would largely exit the Obamacare individual insurance market in the year 2017, citing expectations for mounting losses from the program.

UnitedHealth is the greatest U.S. health insurer and one of the biggest sellers of plans on the exchanges, which were made as part of President Barack Obama's national healthcare law. UnitedHealth sells these plans in 34 states this year, up from 25 states previous year.

"Next year, we will remain in only a handful of states," UnitedHealth CEO Stephen Hemsley said in prepared remarks as part of the company's first-quarter earnings report.

The company alerted the investors late last year that it was losing money on the new plans and might exit the market. On Tuesday, the company raised its 2016 expectation for losses on the exchanges by $125 million to $650 million.

Greatest Health Insurer Bailing On Much Obamacare Exchanges

UnitedHealth Group, the greatest health insurer in the U.S., will pull out of most states’ Obamacare exchanges next year, the company declared on the day of Tuesday.

UnitedHealth cited about $1 billion in losses over the past 2 years for the firm’s decision to significantly scale back its business on the health insurance exchanges created by the Affordable Care Act.

UnitedHealth offers policies on the exchange marketplaces in 34 states this year, but will merely remain in a “handful” of states in the year 2017, UnitedHealth CEO Stephen Hemsley claimed during a conference call on the company’s quarterly earnings. The company cautioned in the month of November it might bail on the marketplaces nationwide.

The UnitedHealth Group announcement and warning symbols from other health insurers that Obamacare enrollees are costlier than hoped to serve as a reminder of how new and how fragile the health insurance exchange marketplaces are ahead of the open enrollment period for the year 2017 coverage, which begins this fall.

President Barack Obama’s health care overhaul may have extended health coverage to an estimated 20 million persons and brought the uninsured amount to an all-time low, but its future sustains to be uncertain as market dynamics continue to play out. No matter what UnitedHealth Group may be doing next year, it is going to take longer than that to determine whether the regulated, subsidized health insurance exchange market will be viable long period.

Obama's law seems to be driving much nation's gains in health insurance

There is increasing evidence that most of the nation's dramatic jump in health care coverage is because of President Barack Obama's law, and not the gradual economic recovery.

That is going to raise election-year political risks for Republicans who keep campaigning to repeal "Obamacare" without a plausible substitute.

Why? Consider GOP front-runner Donald Trump's "repeal and replace" plan. A nonpartisan analysis claims that it would push twenty million persons back into the "uninsured" category — a recipe for political backlash.

The share of Americans without health insurance has reduced to about 9%, a historic low. But even as the economy extended, major government surveys indicate lackluster improvements in job-based coverage.

The health care law is becoming a major backstop in a transforming or changing economy.

Obamacare Enrollees Are ill And They are Getting Much Health Care

WASHINGTON — the landmark health care reform law called as Obamacare seems to be succeeding in its twin objevtives of extending health coverage to the uninsured and enabling persons to access life-saving treatments.

But this humanitarian victory also underscores the newness and fragility of the remade health insurance market, as a latest report issued on the day of Wednesday by the Blue Cross Blue Shield Association shows. The consumers who flocked to the exchanges are sick and are utilizing a lot of medical care, a trend that could jeopardize Obamacare’s gains by destabilizing the health insurance system.

Greater access to health care for persons with pre-existing conditions who were shut out of the old market and those whose low incomes made health insurance too expensive before the Affordable Care Act’s subsidies became available in the year 2014 was one of the core objectives of the law President Barack Obama enacted 6 years ago.

Cerner, Epic, IBM, Verily, others sign on for Precision Medicine Initiative of Obama

Cerner stated on the day of Thursday that it will pilot an open standardized application as part of the Sync for Science project within President Barack Obama’s Precision Medicine Initiative. And it was merely 1 of the various health IT vendors that hopped on board precision medicine during the President’s Summit.

Driven by the National Institutes of Health and the Office of the National Coordinator for Health Information Technology, Sync for Science is a primary component of the Precision Medicine Initiative in that it targets to recruit 1 million volunteers for a nationwide research project by the year 2019 – an attempt NIH Director Francis Collins, MD, described as "the greatest, most ambitious research project of this sort ever undertaken."

Indeed, a veritable all-star cast of health IT vendors and agencies are included in the project involving Allscripts, athenahealth, drchrono, Epic and Mckesson, as well as as IBM, the Department of Veterans Affairs, and Google’s Verily unit.

IBM, for its part, will join the New York Genome Center to establish an open cancer data repository, leveraging data from Watson to develop new insights into cancer research and personalize treatments through genomic data analysis.

Most Americans accept healthcare perspectives of Democratic candidates

6 out of 10 Americans back the healthcare vision of either Hillary Clinton or Bernie Sanders, the 2 Democratic presidential candidates, in accordance to a latest tracking poll from the Kaiser Family Foundation. Although, Clinton's method of building on the Affordable Care Act carries the most support.
A national telephone poll, which covered nearly 1,200 voting-age adults, discovered that 36 percent of persons believe Congress should make upon President Barack Obama's signature healthcare law “to make better affordability and access to care.” Another 24 percent stated that the U.S. should instead develop a single-payer system, which has been the cornerstone of the Sanders campaign trail.
The survey involved a pretty even representation of Democrats, Republicans and independents.
Particularly among Democrats, 54 percent favored building on the ACA versus 33 percent who need a single-payer, government-run system. Even among independents, 62 percent preferred the ACA or single-payer, in accordance to the poll.

Budget Cuts More Risky to States Than Healthcare Law

(Reuters) Aug 21 - When it comes to healthcare, Congressional attempts to reduce the federal budget deficit pose a greater risk to U.S. states' finances than an expansion of Medicaid, the insurance program for the poor, Moody's Investors Service said on Tuesday.

In June, the Supreme Court struck down part of the 2009 healthcare reform law compelling states to cover more people with Medicaid, and many conservative governors embraced the decision as a way to opt out of the expansion.

Medicaid, which states administer with partial federal reimbursements, can consume up to a third of a state's budget. The healthcare law provides for states to receive reimbursements of 100% for the costs of new enrollees, but the amount tapers off to about 90% in future years.

"States that opt into the expansion of Medicaid under the new law will have greater exposure to the potential risks that will come with efforts to trim federal spending," said Moody's Senior Vice President Kenneth Kurtz in a statement. "The extent of any effects on ratings will depend on how states respond to underlying cost drivers, including any new federal actions."

Ultimately, a state's decision to opt in or out of the expansion will likely not affect its ratings, Moody's said.

Last summer, the U.S. Congress and President Barack Obama agreed to reduce the budget deficit through a series of automatic spending cuts known as sequestration. The cuts are spread across all areas of government, including defense and domestic programs. Recently, pressure has mounted to exclude the military from sequestration.

According to Moody's, though, if the federal government avoids making changes in spending "in other areas, including, for example the avoidance of significant changes in military spending," then it will have to make steeper cuts in programs such as Medicaid.

That could increase pressure on U.S. states, which are already stressed from growing demand for the program.

"Rising healthcare costs and an aging population will continue to increase Medicaid's costs and challenge states' finances, regardless of how federal healthcare reform is ultimately implemented," said Kurtz.

He noted that from 1997 to 2010 total U.S. healthcare expenditures per capita increased at an average annual rate of 5.5%, compared to an average annual increase of Medicaid costs per enrollee of 3.1%.

Nonetheless, states are concerned that healthcare costs will devour their budgets. Recent reports from the National Governors Association, the National Association of Budget Officers and the Government Accountability Office all identified healthcare as the greatest hazard to future state finances.

Obama Deficit Plan Has Medicare Provider, Beneficiary Cuts

September 19, 2011 — A deficit-reduction plan unveiled by President Barack Obama today would wring $248 billion in savings from Medicare over 10 years, in part by cutting special payments to rural physicians and hospitals, requiring prior authorization for expensive imaging services, and reducing support for teaching hospitals.

Another $72 billion in savings would come from Medicaid and other healthcare programs.

In all, the president's plan would trim the deficit by more than $3 trillion through a mix of spending cuts and tax hikes that follow the so-called Buffet Rule (suggested by billionaire Warren Buffett): People making more than $1 million should not have lower tax rates than the middle class. Obama's proposed surgery on the deficit comes on top of roughly $1 trillion excised by the federal debt-ceiling deal in August.

The new proposal will become fodder for Congress and its newly appointed Joint Select Committee on Deficit Reduction, also known as the "super committee." That bipartisan group was tasked by the debt-ceiling legislation to find $1.5 trillion in additional savings that Congress must enact by December 23. Given that Congressional Republicans, who control the House and have enough votes in the Senate to filibuster, have announced stony opposition to tax increases, the Obama plan faces a tough, if not impossible, going.

President Barack Obama called for new deficit cuts of $3.0 trillion. Nicholas KAMM/AFP/Getty Images

However, the president has signaled he will play hardball on the tax issue. He warned today that he would veto any deficit-reduction package that reduces Medicare benefits for seniors but fails to "raise serious revenues" from the wealthiest Americans and biggest corporations.

"We are not going to have a one-sided deal that hurts the folks who are most vulnerable," Obama said today.

Program Cuts Called Modest

The Obama administration characterizes the $320 billion in cuts to Medicare and Medicaid as both modest and necessary for the long-term viability of the programs. Physicians would feel their nick in a number of ways:

• Medicare traditionally has paid physicians and hospitals in underserved rural areas a little extra, but these payments "may be greater than necessary to ensure continued access to care," according to the Obama administration. It therefore wants to end an "add-on payment" for physicians and hospitals in certain low-population states in 2013.


• The dramatic growth of Medicare spending for imaging services has led some experts to question whether such scans are always necessary or reasonably priced. Accordingly, the Obama administration would require prior authorization for the most expensive imaging services, beginning in 2013, along with lower reimbursement for them.


• As part of an initiative to reduce improper Medicare payments, the administration would penalize providers who fail to update their enrollment information.


• Residency training programs could experience pain under a proposal to reduce Medicare subsidies for teaching hospitals, saving $9 billion over 10 years. The subsidies exist because teaching hospitals, by their very nature, are less efficient, and are therefore costlier to operate. However, the administration believes current subsidy payments exceed the extra costs that these hospitals incur by training residents.

The quest for Medicaid savings would target high prescribers. The government wants to require states to track Medicaid drug claims for signs of waste, fraud, and abuse, and prevent it from happening in the first place.

Deductibles, Premiums Would Increase for Some Beneficiaries

Medicare belt-tightening in the president's proposal affects beneficiaries, as well as providers:

• Beneficiaries who are already paying higher Medicare Part B and Part D premiums on account of their high income would pay 15% more beginning in 2017.


• The annual deductible for Medicare Part B would increase by $25 in 2017, 2019, and 2021 for new beneficiaries. The idea here is to motivate seniors to seek "high-value healthcare services"; that is, good care at a lower price.


• Also in 2017, beneficiaries would begin to owe a $100 copayment for home-health episodes with 5 or more visits that are not preceded by a hospital stay.


• The government has determined that seniors who purchase MediGap policies to pay for costs not covered by Medicare — copays, for example — tend to use more healthcare services, driving up Medicare spending. The administration proposes to add a hefty surcharge to Medicare Part B premiums in 2017 whenever beneficiaries buy a MediGap policy that subjects them to little if any cost-sharing. Presumably, the surcharge would discourage seniors from obtaining such generous MediGap policies.

To apply the brakes even more to Medicare spending, Obama today reiterated an earlier proposal to strengthen a creation of the new healthcare reform law, the Independent Payment Advisory Board (IPAB). The job of the IPAB is to counsel Congress on how to slow down Medicare spending if it exceeds growth-rate targets set by the law. If Congress does not implement what the IPAB recommends, it must come up with its own cost-cutting plan, or else let the Department of Health and Human Services devise one.

In 2018, the IPAB target is growth in the gross domestic product plus 1%. Obama wants to make it gross domestic product growth plus 0.5%.

The American Medical Association and other medical societies view the IPAB with hostility because it represents an additional threat to physician revenue. Many Congressional Republicans have advocated repealing the IPAB, saying that it will ration healthcare for seniors, even though the Affordable Care Act prohibits the board from increasing beneficiary premiums or cost-sharing, or restricting benefits.

Deficit-Reduction Math Factors in Doc Fix

The American Medical Association quickly identified at least one thing it liked about the administration's deficit-reduction plan: Obama's numbers assume passage of a "doc fix" to the Medicare reimbursement crisis created by the program's sustainable growth rate formula for setting physician pay. That formula will trigger a 29.5% reduction in Medicare rates on January 1 unless Congress acts to avert it.

Current federal budget projections assume this massive reduction will occur. Repealing the sustainable growth rate and freezing Medicare rates for 10 years would cost $300 billion, which is an amount that must be factored into deficit-reduction math, the Obama administration said. "Failure to do so simply masks the worsening long-run deficit."

In a press release today, American Medical Association President Peter Carmel, MD, commended the president for recognizing that deficit reduction must take sustainable growth rate repeal into account.

U.S. Lays out Incentives in Health Reform Law

WASHINGTON (Reuters Health) Aug 12 - The U.S. government on Friday laid out incentives for states and people to participate in health insurance exchanges, including tax credits and funding grants for the states.

The health regulators also clarified how they will decide who is eligible to participate in the exchanges, a key program under President Barack Obama's healthcare overhaul.

The exchanges are envisioned as open marketplaces of competing insurance plans that allow uninsured people and small businesses to band together to negotiate cheaper rates.

In the guidelines released on Friday, the U.S. Health and Human Services and Treasury departments outlined the premium tax credits to help Americans afford private insurance. They also detailed processes to check income and determine eligibility for federal subsidies such as Medicaid, the state insurance program for the poor.

States, insurance companies and patient groups have been awaiting these details because they are critical to establishing the exchanges.

The HHS on Friday also awarded 13 states and the District of Columbia $185 million in grants to help them build the exchanges. Last year, HHS gave $50 million in planning grants to nearly all states and $241 million in "early innovator" grants to help seven states establish exchanges that other local governments could use as a model.

States are facing a deadline of Jan. 1, 2013 to submit detailed plans for how their exchanges will work, or the HHS would come in and do the work to ensure the exchanges are operational by 2014.

HHS and the Treasury department are soliciting comments on the guidelines, which are here:http://r.reuters.com/zut23s.

Obama budget trims Medicare, Medicaid

In his budget for fiscal 2012, President Barack Obama has proposed $79.9 billion in discretionary spending for HHS, which represents a slight increase from the $79.8 billion discretionary budget authority approved in 2010. Given that none of the full-year appropriations bills for 2011 was enacted, the programs and activities in the president's budget released Monday are operating under a continuing resolution, which results in a comparison with 2010 figures in most cases, but not all.

The president's plan calls for a total of $485.8 billion for Medicare in 2012, which breaks down to $468.5 billion in existing law and a legislative proposal for another $17.3 billion. This compares with $489.3 billion for fiscal 2011.

The budget calls for $279 billion to Medicaid and the Children's Health Insurance Program, compared with $285.4 billion in 2011. That breaks down to $279.3 billion in existing law and a legislative proposal to cut $297 million from Medicaid. The administration said it will focus Medicaid's programs more on lower-cost home and community-based alternatives, rather than institutional settings.

Obama's plan reiterated the president's proposal for a five-year freeze on all discretionary spending outside of security, which he said will save more than $400 billion over the next decade. This is not an across-the-board cut, but rather an overall freeze with investments in certain areas for long-term growth and job creation, Obama said in a message that accompanied his $3.7 trillion budget for 2012. Savings will be achieved through reductions in the community services block grants and home energy assistance, according to the administration, which also said the budget supports the administration's priorities, such as implementation of the Patient Protection and Affordable Care Act, biomedical research and Head Start.

The Obama budget would delay a 25% cut to physicians' Medicare payment rates for two more years—until the end of 2013—through “specific health savings,” although those were not specified.

The American Hospital Association questioned the plan's impact on Medicaid. “While we are pleased that the president's budget does not include any new major reductions in payments for hospitals services to Medicare beneficiaries, we are deeply disappointed that today's budget reduces Medicaid, which funds services to our most vulnerable patients such as the poor and disabled,” according to Richard Umbdenstock, AHA president and CEO.

Meanwhile, funding for the National Institutes of Health would increase to $31.8 billion from $30.8 billion, in part to foster new collaborations among government, academia, and industry that accelerate the development of medical treatments. The Food and Drug Administration would see an increase to $2.7 billion from $2.6 billion. Funding for the Centers for Disease Control and Prevention would decrease to $5.9 billion from $6.4 billion, while HHS' Health Resources and Services Administration would drop to $6.8 billion from $7.5 billion. The Substance Abuse and Mental Health Services Administration would shrink by $44 million to $3.38 billion.

Efforts to control healthcare fraud and abuse would jump to $581 million from $311 million, while the administration would require state Medicaid agencies to track and monitor prescription drug billing, prescribing, and utilization patterns for indications of fraud.

The administrative budget for the Office of the National Coordinator for Health Information Technology would increase to $57 million from $42 million.

Obama gives GOP 6-week deadline to get on board with healthcare package

WASHINGTON – At a White House healthcare summit held Thursday, President Barack Obama urged Republican congressional leaders to consider working on several areas of common interest in the healthcare reform package, giving them a rough 6-week deadline before Democrats may consider using alternative measures to pass the plan.

Obama named health insurance reform, the purchase of health insurance across state lines and medical liability reform among the top three areas where agreement could possibly be reached.

Republicans argued they wanted to scrap all proposals on the table and rework a set of smaller steps to reform healthcare.

For Democrats, starting over is not an option they said, because of the dire situation many Americans face.

According to Sen. Chris Dodd (D-Conn.), 14,000 Americans lose their healthcare daily, while six to eight Americans die per day because of no health insurance.

Democrats said healthcare reform is interconnected and cannot be tackled one step at a time. "We can't handle healthcare incrementally," Dodd said. "It has to be dealt with holistically. You can't get to quality and affordability, if you don't deal with coverage."

Much of the day's debate focused on coverage and whether or not it could be expanded without including more people in the insurance pool.

Sen. Tom Harkin (D-Iowa) said, "If you don't bring more people in together, the only people who get a break are the people who are healthy. People who are sick pay more. Is that what we want in this country?"

Republicans at the summit backed a health reform plan proposed by House Minority Leader John Beohner of Ohio, which would expand healthcare to some 3 million uninsured Americans.

The Democrat House and Senate bills, passed last year, would extend coverage to 30 million.

Sen. John McCain (R-Ariz.) said the unspoken issue overriding the entire summit was the threat of Democrats using an alternative measure to pass a bill with a simple majority, rather than the 60 that would be normally required in the Senate.

The special mechanism, called "reconciliation," was never meant to be used for issues that involve 17 percent of the Gross Domestic Product, as healthcare does, McCain said.

President Obama and Speaker of the House Nancy Pelosi (D-Calif.) would not guarantee that they would not use the method to pass a healthcare reform bill, when asked directly by several Republicans during the summit.

Obama said, "We cannot have another year-long debate about this."

"So the question that I'm going to ask myself and I ask of all of you is, is there enough serious effort that in a month's time or a few weeks' time or six weeks' time, we could actually resolve something," Obama said. "And if we can't, then I think we've got to go ahead and make some decisions and then that's what elections are for."

"We have honest disagreements about the vision for the country and we'll go ahead and test those out over the next several months till November," he said.

---

 

Obama releases his own plan for healthcare reform

WASHINGTON – As Congressional leaders prepare for Thursday's White House summit on healthcare reform, President Barack Obama has released his own version of a healthcare reform plan.

Obama said his plan would put American families and small business owners in control of their own healthcare and build on legislation passed by the House and Senate last year, with a focus on providing health insurance reform "that lowers costs, guarantees choices and enhances quality healthcare for all Americans."

A White House statement on Monday said, "The president has long said he is open to any good ideas for reforming our healthcare system, and he looks forward to discussing ideas for further improvements from Republicans and Democrats at an open, bipartisan meeting on Thursday."

According to the White House, the Obama proposal would make healthcare more affordable, make health insurers more accountable, expand health coverage to all Americans and make the health system sustainable, stabilizing family budgets, the Federal budget and the economy.

"It makes insurance more affordable by providing the largest middle class tax cut for healthcare in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today," according to the White House. "This helps over 31 million Americans afford healthcare who do not get it today – and makes coverage more affordable for many more."

The White House said the Obama plan would also:

• set up a new competitive health insurance market, giving tens of millions of Americans the same insurance choices that members of Congress will have;


• bring greater accountability to healthcare by laying out so-called "rules of the road" to keep premiums down and prevent insurance industry abuses and denial of care;


• end discrimination against Americans with pre-existing conditions; and


• put the budget and economy on a more stable path by reducing the deficit by $100 billion over the next 10 years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

The plan would also provide significant additional financing to all states for the expansion of Medicaid, eliminating any promised favoritism in bills proposed by Congress.