Scaling back verification requirements for insurance exchanges. Because about 60 percent of people buying in the exchange probably will be eligible for subsidies, exchange officials needed a way to verify if they were indeed eligible; that is their income was low enough and they had no other insurance coverage. But the administration says that they have now encountered “legislative and operational barriers.” The upshot: the government will rely on the honor system to make sure applicants for insurance are telling the truth about their income and insurance status. The government will do a check when people file their income tax returns in 2015. If income and insurance status change during the year, a family could end up with a tax liability or a tax refund, depending on the subsidy they got and whether their incomes went up or down during the year.
WHAT’S IN LIMBOLAND?
The Independent Payment Advisory Board.
The law called for this 15-member board appointed by the president to advise Congress on actions Medicare could take to reduce the growth of healthcare spending. Congress could take an up or down vote on the recommended measures. The board, however, cannot recommend changes in premiums, benefits, eligibility, or taxes, or other changes that would result in “rationing” of care to Medicare beneficiaries. Nevertheless, it has become something of a political football, with Republicans charging that the board could lead to death panels and rationing, because seniors wouldn’t be able to get treatments, especially the costly ones.
The board is in virtually inactive right now. Members have not been appointed, but more relevant is that Medicare’s costs have slowed somewhat, and in April Medicare’s chief actuary declared that that medical cost inflation would not be high enough to trigger the work of the IPAB. It may not see action for a few years, and then what it does will depend on the political winds and the pace of medical inflation.
The National Health Care Workforce Commission.
The Affordable Care Act set up this 15-member body to prepare for the increased demand in primary care needed by all the newly insured people buying in the shopping exchanges. It’s no secret that the US has a shortage of primary care doctors. The commission was to examine such issues as the right mix of primary care docs and specialists, and whether pharmacists could help coordinate care. The administration requested $3 million for the commission to begin its work, but Congress has not appropriated the money. Federal officials have told commission members they cannot even meet to discuss its work. The stalemate is not about money; $3 million dollars is a droplet in the federal budget. The commission is tied up in the Beltway’s larger political struggle.
Tomorrow: Obamacare Scorecard Part 2—The hits and misses and mixed reviews of the Affordable Care Act.
Follow @USProjectCJR for more posts from Trudy Lieberman and the rest of theUnited States Project team, including our work on healthcare issues and public health at The Second Opinion. And for Trudy’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s new July/August issue.
Related content:
Fast-tracking the truth in IPAB coverage
Setting aside the fact that this article has nothing to do with journalism, it's amusing that Lieberman simply passes along the administration's press-release terminology about "system limitations" and "operational barriers" without even attempting to explain what's really happening. This just emphasizes that the goal here is to publicize the administration's spin on events, and not to look behind it.
#1 Posted by Tom T., CJR on Tue 30 Jul 2013 at 07:12 AM
All of the confusion could be avoided with a Medicare-for-All plan, 100% funded by the federal government.
And for all those who believe our Monetarily Sovereign government "can't afford" to fund Medicare for every man, woman and child in American, look up the meaning of Monetary Sovereignty at http://mythfighter.com/2013/07/27/i-just-thought-you-should-know-lunch-really-can-be-free/
#2 Posted by Rodger Malcolm Mitchell, CJR on Tue 30 Jul 2013 at 09:38 AM
The Republican v. Democrat angle is a diversion. Both parties and the entire corporate elite support the austerity Obamacare will usher in (not to mention more corporate welfare).
One concrete example of the sleight of hand: how many media sources reported spouses can now be dropped by employers under Obamacare? Very few. This change in the law will be of huge importance to families, especially during the next downturn when employers use the "exchanges," er "marketplace" (or whatever PR tested word they go with), as an excuse to drop spouses.
Dropping spouses will have a much larger effect on households than allowing a 21 year old to stay on his parents' policy, which is one of the "good" changes in Obamacare (i.e. 21 year olds will not use or need health care coverage like a 55 year old spouse will).
And of course the media plays up the R v. D angle re spousal coverage by pushing the lie that the Democrats overlooked the change when they passed Obamacare and now they really, really, (really!) want to change the law but the meany Republicans won't allow them to.
The media gets an F for complicity in my book. This austerity and corporate welfare is being foisted upon us by a corrupt political process and media.
#3 Posted by Walter W., CJR on Tue 30 Jul 2013 at 02:42 PM
As to subsidies for out-of-pocket costs, be sure to read the fine print. It is my understanding that the subsidy will be available to holders of silver plans--not the cheaper bronze plans.
Oh--for single payer Medicare for all. Everybody In--nobody out--no meed to read the fine print.
Today 7/30 in DC, Physicians for a National Health Program (pnhp.org), Public Citizen, Rep. John Conyers and Sen Bernie Sanders will discuss single-payer and how it could be funded.
#4 Posted by Harriette Seiler, CJR on Tue 30 Jul 2013 at 03:01 PM
"For starters, after all those changes, what is Obamacare, exactly?"
Unfortunately, I don't think this article answers the question.
Here's my attempt (sorry for the length but I'm trying to be concise while describing the change in law and it is a complicated subject):
Obamacare is a bipartisan neoliberal approach that putatively provides near-universal health insurance coverage to citizens. The individual mandate requires citizens to purchase a bare minimum insurance policy from an industry that still enjoys exemption from anti-trust laws and is largely exempt from other consumer protection laws (like bad faith torts per ERISA). Citizens that do not purchase insurance will be fined by the government and millions will still go without insurance under this near "universal" system. Employers will have to pay a small fine for not providing benefits for full time employees but will still enjoy huge tax breaks on the insurance they do provide.
The insurance companies get substantial subsidies based on a citizen's ability to pay. But the citizen is responsible for predicting his income, and therefore his subsidy, under pain of penalty, as well as theoretically choosing the best product in a confusing "marketplace" that is sponsored by the government (but run mostly by private contractors). In exchange for this captured market share insurance companies will be forced to provide basic policies (how basic is in flux but it looks pretty meager--if you get seriously sick you still go bankrupt). Insurance companies will be forced to provide wellness visits, cover children of insureds under 25 years of age, and not be allowed to deny coverage based on pre-existing conditions (but the ability to rescind policies based on "fraud" remains). Health insurance companies, drug companies, and hospital stocks are all rising in anticipation of the huge profits to be gained. The U.S. health care system will most likely continue to be the most expensive in the world while offering middling results to its citizens in terms of health care (despite the misnomer, "Affordable" in the title of the legislation).
Also, Medicaid will be expanded under Obamacare, but on a practical level it looks like many states will cut back on Medicaid benefits and coverage--so more citizens may qualify for Medicare but those already on it may be worse off than before (not to mention the other services states are cutting because of increased Medicaid expenses). Another practical effect of Obamacare is that employers are cutting employee hours to under 30 hours to avoid health care coverage requirements. Also, employers will now have an incentive to hire undocumented immigrants as they will not be required to provide the same medical coverage benefits as for citizen employees.
All in all, austerity will increase health care costs, raise profits for insurance companies, drug companies, and hospitals, while still not covering all citizens. Most other citizens will have to pay more for a shoddy product and will still go bankrupt if they ever get seriously sick on their basic coverage.
#5 Posted by Walter W., CJR on Tue 30 Jul 2013 at 03:24 PM