Friday, March 28, 2014

That Was The Week That Was - Issue 3

Welcome to the third edition of this newsletter.   Without question, the nearing the end of the first open enrollment period is the story of the week.   Across the country, everyone is pulling out all the stops for the final push Insurers Push to Enroll People as Health Care Deadline Nears.  Although as we’ve known all along, there will be some eligible people who won’t enroll this time around Millions On The Sidelines For Big Health Care Push.

With the inevitable rush during these last few days, the Administration has let us know that if you start the processes before the deadline you don’t need to be completely done by midnight on Monday  U.S. to Extend Sign-Up Period For Insurance.  Contrary to what some would have you believe, this is not an exceptional decision.  When Medicare Part D was rolled out, the same thing occurred: Flashback to 2006: When Bush extended an enrollment deadline.  You can see the list of who can get an extension here: Here Are the 17 Ways You Can Get an Obamacare Extension.

Amidst all this activity, the Administration announced that as of Wednesday over 6 million had signed up for insurance through an exchange:  White House Says Health Care Rolls Top Goal: 6 Million.  We need to take these numbers for what they are, a preliminary indication of a broad national number, but although preliminary, they are a good sign Benefit Experts Agree With Obama That ACA Has Enough Enrolled

A tale of two cities 50 states:  Although the media may focus on the national figure, let’s remember there is no national market for insurance, due to state regulations we have fifty insurance markets that are as different as can be Obamacare's National Enrollment Looks OK, But States Matter More.  In fact, the odds of you knowing about the benefits available to you and taking action depend a great deal on where you live Deadline Near, Health Signups Show Disparity.

Even though we’ve passed the fourth anniversary of the law and nearing the end of the first open-enrollment period, the court battles continue.  This week saw the two most significant remaining challenges back in Court.

First, the Holly Hobby case in the Supreme Court; does a private company have the right to a religious exemption from the contraceptive mandate.  This week saw the oral arguments before the Court – we’ll have to wait a few months for the decision, but that didn’t stop the Court-watchers from trying to guess the outcome:  Birth control rule seems to divide Supreme Court and Supreme Court divided as it hears argument on contraceptive coverage and Hobby Lobby case: Nine justices to watch.

While I don’t want to minimize the importance of this case, even if Holly Hobby wins, the law itself will still stand.  Of possibly greater consequence to the implementation of the ACA is the case arguing that the Federal Marketplace cannot provide subsidies.  Apparently I’m not the only one with that opinion:  Forget Hobby Lobby. The Bigger Legal Threat to Obamacare Still Has Life  and The contraception case is big, but another challenge could really hurt Obamacare

While we watch the enrolment process and the courts, some are watching us – or at least asking us what we think.  There were several new polls released this week.  None of them provide any exceptional new insight but they do serve to reinforce the failure of some of the communication efforts around the law. 

To me, this quote says it all:  “I like the idea that if you have a pre-existing condition you can’t be turned down, but I don’t like the idea that if you don’t have health insurance you’ll be fined,” said Sliger. (Poll: Obama health law fails to gain support)  I can’t blame this person for not understanding that the health insurance market won’t work if you didn’t allow for pre-existing condition exclusions and you didn’t require everyone to get coverage.   I blame myself and others who have been trying to explain that to the public for years for not being able to get the message across. 

There is also a great divergence of opinion on what the impact of the law will be on health care costs – some say lowering costs is a great benefit of the law while some say impact on costs is why they don’t like it Why Americans like Obamacare (and why they don’t) — in two charts.  You can find a complete look at the Kaiser survey results here: Kaiser Health Tracking Poll: March 2014.

Also in the news this week, the Doc Fix was back.  This is the issue around Medicare payment rates to physicians; this year if a fix is not passed they will see a 24% reduction in their rates.  A few weeks ago we thought we’d finally see a permanent fix to this issue, but instead once again at the last minute we’ll see a temporary fix (for just one year) and hope that by next year this annual charade will stop House approves bill to stop cut to Medicare docs.

Four years after its passage, in addition to the continued court challenges described above, the political opposition continues to talk about repeal and replace, although they still do not seem to have figured out what they are replacing it with Four Years Into Obamacare, GOP Comes Up Short On Alternative

For the first time we saw a group of Democrats come together with some suggestions for “fixing” the law 5 Senate Dems back easing small business mandate.  Something that polls continue to indicate most people would prefer to the actual repeal of the law.  To me this is a positive sign.  Even the most ardent supporters of the law (like me) understand that it is far from perfect.  If we could get past the extreme partisanship there are changes that can be made to improve the law.

That’s it for this week – remember this is just a sample of the coverage out there.  And remember, I consider these a work in progress so please let me know what you think!

Thanks for reading!

Funded by support from the Maine Health Access Foundation

*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"