Category Archives: Obamacare

Justice Tells Court Obamacare Unconstitutional, Could Strike Down Entire Law

WASHINGTON, DC – The Trump-Barr Department of Justice (DOJ) informed a federal appeals court on Monday that it agrees with Texas and the other states suing over Obamacare that President Donald Trump’s repealing of the individual mandate renders the entire law unconstitutional, and therefore should be struck down in its entirety.

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(Ken Klukowski) This all turns on the legal doctrine of severability. Much of the time when a statute is unconstitutional it is actually only partially unconstitutional. Typically a court will strike down that part of the law, but sever it from the rest of the statute and uphold the remainder.

Pundits who have never studied or litigated severability will surely show up on television now posing as experts, and criticizing DOJ’s position. But writing as a former law school faculty member who authored the largest academic work on severability doctrine ever published, permit me to describe the argument and why it should be taken seriously.

President Barack Obama signed the Affordable Care Act (ACA) in 2010 when a Democrat-controlled Congress passed that statute without a single Republican vote in either the House or Senate. Various plaintiffs immediately filed suit. In the biggest lawsuit, a majority of states in the nation – along with the National Federation of Independent Businesses (NFIB) and several private individuals – filed suit in Florida, arguing that the ACA was unconstitutional.

The plaintiffs raised multiple constitutional issues. At the heart of the legal challenge is the doctrine of enumerated powers: The Constitution gives the federal government only limited powers, and so every provision of every law Congress passes must be authorized by one of the provisions of Article I, Section 8 of the Constitution.

One constitutional objection to the ACA was that Section 1501 of the ACA – which is the individual mandate that requires Americans to buy health insurance – is unconstitutional, because Congress’s constitutional power to regulate interstate commerce in Article I, Section 8, Clause 3 of the Constitution does not include the power to order human beings to buy something, thereby entering into the commercial realm where the government can regulate them.

Section 1201 of the ACA is the preexisting condition provisions of “guaranteed issue” and “community rating,” which ensures that no person attempting to purchase insurance can be denied coverage, and that a person cannot be charged more because of preexisting conditions. Section 1501 mandates that everyone buy insurance to offset the effect of the multi-billion-dollar costs arising from Section 1201.

Another count of the lawsuit brought by the states and NFIB was that the individual mandate section could not be severed from the other 450 sections of the 1,000-page ACA statute, and therefore that the whole statute must fail with the mandate section.

Judge Roger Vinson of the U.S. District Court for the Northern District of Florida agreed, holding it was unconstitutional. Vinson also held that the individual mandate could not be severed from the remainder of the statute, and therefore struck down the ACA in its entirety. (Disclosure: Vinson quoted this author’s legal brief in the case when he ruled that the individual mandate is nonseverable.)

The U.S. Court of Appeals for the Eleventh Circuit agreed that the individual mandate was unconstitutional, and noted that even the Obama DOJ admitted to the court that Section 1501 could not be severed from the statute, but nonetheless severed that section anyway, and upheld the rest of the law.

The Supreme Court in 2012 took the historic case of NFIB v. Sebelius to decide four issues: (1) whether a different federal statute – the Anti-Injunction Act – even permitted federal courts to decide this case before the individual mandate went into effect in 2014; (2) whether the individual mandate is not authorized by Congress’s authority under Article I, Section 8; (3) whether the ACA’s enormous expansion of Medicaid unconstitutionally coerces the states; and (4) whether the statute can be severed from any sections that are unconstitutional.

The justices unanimously agreed that it had jurisdiction to decide the case immediately. By a 7-2 decision, the Court agreed that the Medicaid expansion was unconstitutional under the Tenth Amendment, but a separate 5-4 lineup held that the expansion would be constitutional if it was optional for the states, and effectively rewrote Section 2001 of the ACA.

Four justices – conservatives Antonin Scalia, Clarence Thomas, and Samuel Alito, joined by moderate Anthony Kennedy – wrote that the individual mandate exceeded Congress’s Commerce Clause power and was therefore unconstitutional. They also wrote that the Medicaid expansion exceeded Congress’s Spending Clause power, and could not be rewritten, and thus those core provisions must both be struck down.

Justice Ruth Bader Ginsburg wrote a dissent for the four liberal justices, claiming what many claim to be unlimited federal power under the Commerce Clause over the lives of American citizens. She and Justice Sonia Sotomayor also insisted that the Medicaid expansion was constitutional.

Justices Scalia, Kennedy, Thomas, and Alito also wrote that both the individual mandate and the Medicaid expansion were critical to the entire ACA. They concluded that the provisions could not be severed from the statute, and that without either one, all of Obamacare must go down.

Breitbart News published a five-part series on “The Great Dissent,” quoting the justices in their own words, explaining through those five articles their reasoning that (1) Obamacare must be struck down, (2) the individual mandate violates the Commerce Clause, (3) the individual mandate is not a tax, (4) the Medicaid expansion violates the Tenth Amendment, and (5) both unconstitutional provisions are nonseverable from the ACA, and so the entire law must be struck down.

Then came a historic surprise. Chief Justice John Roberts agreed that the individual mandate was not authorized by the Constitution’s Commerce Clause. However, he concluded that even though only a couple paragraphs in 980 pages of legal briefs discussing Congress’s power to tax, and even though only a couple minutes was spent on that issue during six hours of oral argument, that the individual mandate was authorized by the Constitution’s Tax Clause, and was therefore constitutional.

Roberts admitted that the individual mandate looked like a commercial regulatory law, and thus would normally need to be authorized by the Commerce Clause. However, he wrote that there were several factors that, taken together, permitted courts to view the mandate as a tax. These included that (1) it was codified in 26 U.S.C. § 5000A, which is part of the Tax Code; (2) it was enforced by the IRS, (3) proof of complying with the mandate is reported along with a person’s annual Form 1040 tax return, and (4) failure to comply results in a tax penalty that goes to the U.S. Treasury along with normal tax money.

Years later, President Trump signed the Tax Cuts and Jobs Act of 2017. Part of that historic tax reform repealed 26 U.S.C. § 5000A in the Tax Code, which is the operative part of the individual mandate.

Texas Attorney General Ken Paxton immediately sued, joined by 19 other states. Their argument is that the factors Roberts relied upon to uphold the individual mandate as a tax no longer existed. As such, the only relevant constitutional provision is the Commerce Clause, and a five-Justice majority already held in NFIB that the individual mandate would be unconstitutional if it relied upon Congress’s commercial regulatory power.

Texas went on to argue that the individual mandate still cannot be severed from the rest of the ACA, and therefore the entire statute must be struck down.

Consider Congress’s findings on the role the individual mandate plays in the entire Obamacare system. Those official findings are found in Section 1501 itself, and those findings from Section 1501(a) were permanently codified in the United States Code in 42 U.S.C. § 18091(a).

Congress said at 42 U.S.C. § 18091(a)(2)(A) that without the individual mandate, “some individuals would make an economic and financial decision to forego health insurance,” and thus would endanger the whole Obamacare system. Paragraph 18091(a)(2)(C) says that “together with other provisions of this Act,” the individual mandate is what will add people to the insurance market. Paragraph 18091(a)(2)(D) says the individual mandate will result in “near-universal coverage.”

Paragraph 18091(a)(2)(H) adds:

The [individual mandate] requirement is an essential part of this larger regulation of economic activity, and the absence of the requirement would undercut Federal regulation of the health insurance market.

And finally, Paragraph 18091(a)(2)(I) adds that:

… if there were no [individual mandate], many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the requirement, together with the other provisions of the Act, will minimize adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets …..

The Obama administration admitted during the big Supreme Court case that the individual mandate was the essential “linchpin” to keep the entire ACA from imploding due to unsustainable costs. It is a compelling argument against severability.

The Supreme Court has held that courts must look to congressional intent when determining whether part of a statute can be severed to salvage the rest. Courts must ascertain the original “legislative bargain,” and then ask two questions: First, does the remaining statute “function in a manner consistent with the intent of Congress.” And if so, second, would Congress “have enacted them standing alone and without the unconstitutional portion.”

If the answer to either question is “no,” then the unconstitutional provision is nonseverable, and the court must strike down the entire statute.

Paxton’s team representing the 20 states – initially led in the courtroom by Texas Solicitor General Scott Keller and now continued by Keller’s successor, Kyle Hawkins – set forth all this material to Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas.

The defenders of the ACA argued that when Congress amended the Tax Code through President Trump’s new law, that reset the clock as to the point in time a court should look at for legislative intent. They say that a court should ask if Congress meant to repeal the whole Obamacare system when it enacted the Trump tax cuts. If not, they say the individual mandate can now be severed.

But the states’ counter argument is that Congress removed the part of the mandate that was a tax, but did not remove the congressional findings that the individual mandate was still essential to the ACA being able to function as Congress wishes.

Judge O’Connor accepted Paxton’s arguments. The district court held that without taxing power support, the individual mandate is an unconstitutional mandate under the Commerce Clause, and that the rest of the ACA cannot be severed from it.

The case is now on appeal before the U.S. Court of Appeals for the Fifth Circuit. The head of DOJ’s Civil Division, Assistant Attorney General Jody Hunt, filed a notice with the Fifth Circuit on Monday informing the court that the Trump administration agrees with Texas that the individual mandate is unconstitutional and nonseverable, and thus that the entire ACA is unconstitutional. DOJ therefore will be filing briefs in support of the legal challenge. (Liberal states have intervened as the defendants in the case.)

What so many talking heads derided as an absurd lawsuit suddenly looks like a pretty serious case after all.

President Trump has had a major impact on the Fifth Circuit through his judicial appointments. Proven constitutional conservatives like Judges Don Willett, Jim Ho, Andy Oldham, and Kyle Duncan now sit on that court, under the mentoring of the fearless originalist Edith Jones and the libertarian-leaning Jerry Smith.

Regardless of how the Fifth Circuit rules in the case, the fact remains that the fifth vote to win at the Supreme Court is still Roberts. Many believe that his reasoning was such a stretch to save Obamacare the first time that he would find another rationale to do so now.

While that might be true, it does not need to be true. It is possible that the chief justice could play it straight from his 2012 reasoning, in which case the ACA should be struck down without the tax authorization.

It is also possible that President Trump will fill another Supreme Court vacancy before this case is decided by the Supreme Court – a decision that could come in 2020 but is more likely to come in 2021 – in which case Roberts’ vote might not even be necessary.

Suddenly, Obamacare is back in the legal crosshairs. If it falls under this legal challenge, President Trump would have a clean canvas on which to design fundamental market-based reforms to provide healthcare security and freedom for millions of Americans.

The case is Texas v. United States, No. 19-10011 in the U.S. Court of Appeals for the Fifth Circuit.

Source: by Ken Klukowski | Breitbart

California Passes Ban on Any Short-Term Health Insurance That Cost Less Than Obamacare

The Democrat-controlled California legislature urged Gov. Jerry Brown on Tuesday to sign a ban on bargain-priced short-term health insurance plans sponsored by the Trump administration for being cheaper than Obamacare.

The legislature passed SB 910 on August 21 to prevent what the bill’s author, Sen. Edward Hernandez (D-Montebello), referred to in a tweet as “junk” healthcare. Hernandez urged Gov. Brown to sign the bill to prevent going back to a time when insured patients could be denied care and be forced into financial ruin.

The Trump administration rescinded a rule in late July issued during the Obama years that extended short-duration health insurance policies from three months to 364 days. Trump also allowed insurers the right to offer short-term health plans that are automatically renewable up to 3 years.

Obama restricted the term of short-term insurance, and required every adult to buy coverage, to force healthy young consumers to buy expensive Obamacare comprehensive policies to subsidize the cost of insurance for older and sicker consumers with pre-existing health conditions.

U.S. Department of Health and Human Services issued the new rule to offer an affordable option for limited coverage due to skyrocketing prices for Obamacare.

The Heritage Foundation’s Doug Badger said in a research paper that limited duration health plans “offer broader choices of providers and lower premiums for people in good health than Obamacare policies.” He added that that the short-term policies were “offering a lifeboat enabling them to escape Obamacare’s sinking ship.”

Covered California, the Golden State’s Obamacare exchange, announced in July that the cost of health coverage for 2019 would rise by 8.7 percent. Although that is over 4 times the 2 percent U.S. inflation rate in 2017, the spike in health insurance premiums for the state-run marketplace was 12.5 percent in 2017.

The 2018 healthcare monthly premium for a single consumer purchasing a mid-level Silver policy on Covered California’s exchange was about $400 in Southern California and $500 in Northern California. That compares to the advertised price for a short-term policy of $91 per month.

Currently there are only about 10,000 Californians that are enrolled in 90-day short-term healthcare plans, according to the San Francisco Chronicle. But with the Trump administration ending the “individual mandate” penalty for failing to buy health insurance equivalent to Obamacare, the number enrolling in short-term policies may spike higher.

California has the authority to regulate healthcare within its borders, but as the Sacramento Bee reported, it would be the first state to pass legislation specifically banning short-term healthcare policies.

Source: by Chriss W. Street | Breitbart

Justice Department Says Obamacare’s Individual Mandate Unconstitutional

The Justice Department argued in court Thursday that key pieces of Obamacare, including the individual mandate are unconstitutional.

The 2012 Supreme Court ruling which upheld Obamacare’s individual mandate under Congress’s power to tax is being challenged by the DOJ.

Since the individual mandate was repealed by Congress last year, the DOJ argued the mandate is no longer technically a tax, therefore unconstitutional.

The liberals are going ballistic over this news arguing the Justice Department is supposed to defend laws, not make them.

These same liberals were silent when Obama instructed his Justice Department (AG Holder) to stop defending DOMA (Defense of Marriage Act).

The Department of Justice (DOJ) argued in court Thursday that key parts of ObamaCare are now unconstitutional, siding in large part with a conservative challenge to the law.

The lawsuit in question was filed in February by Texas and 19 other conservative states, arguing that ObamaCare is unconstitutional and should be overturned.

The DOJ argues that ObamaCare’s protections against people with pre-existing conditions being denied coverage or charged more should be invalidated, maintaining that the individual mandate that people have insurance or face a tax penalty is now unconstitutional.

The conservative states and DOJ point to the Supreme Court’s 2012 ruling that upheld ObamaCare’s individual mandate under Congress’s taxing power. Now that Congress has repealed the mandate penalty as part of last year’s tax bill – while technically keeping the mandate itself in place – they argue the mandate is no longer a tax and is now invalid.

They also argue that the key pre-existing condition protections cannot be separated from the mandate and should be invalidated. The DOJ argues the remainder of the law can stay.

The chances for that argument succeeding are viewed with deep skepticism by legal experts, in part because Congress itself indicated that the rest of ObamaCare could still stand without the mandate when it moved to repeal the tax penalty last year.

The case is currently before a federal district court judge in Texas, Reed O’Connor, who was appointed by former President George W. Bush.

Obamacare is a complete disaster and is predictably imploding.

Of course Obamacare is unconstitutional; it was one giant transfer of wealth.

Americans are furious because their premiums and deductibles have skyrocketed while doctor choice and care has dwindled.

President Trump recently railed against Obamacare’s individual mandate calling it “cruel” and a “punishment.”

Source: By Christina Laila | The Gateway Pundit

New Study: Cheapest Obamacare Plans Are “Unaffordable” In 94% Of American Cities

We’ve frequently warned that Obamacare is locked in an inescapable death spiral that will result in its inevitable failure.  The problem is that the folks who make too much to qualify for subsidies (currently defined as roughly $80,000 for a family of 3) are increasingly being priced out of the market for individual insurance by Obamacare’s 30%+ price hikes that consistently come year after year.  Meanwhile, those “rich” families making $80,000 a year are the ones expected to overpay for their health insurance so that a portion of their premiums can be “spread around a little bit” (as Obama likes to say) to subsidize the premiums of others.  Of course, it’s easy to see the circularity here as higher premiums equals less “full-paying” customers and less subsidies equals higher premiums…until the whole system collapses.  

Luckily you no longer have to take our word for it as eHealth.com has just published a new study that finds that, even by Obamacare’s own definition of “affordability”, residents in 47 out of 50 cities surveyed can’t afford the cheapest Obamacare plan.

According to a study released today by eHealth, Inc., which operates eHealth.com, the average family of three earning slightly too much to qualify for subsidies in 2018 would need to increase its household income by nearly $29,000 before health insurance became “affordable” based on Obamacare criteria.

The Affordable Care Act (ACA or Obamacare) considers health insurance to be “unaffordable” when annual premiums for the lowest-priced plan in a market cost more than 8.16% of a household’s modified adjusted gross income (or MAGI). When health insurance is unaffordable by this standard, individuals and families may qualify for an exemption from Obamacare’s individual mandate to buy health insurance.

“Coverage under the Affordable Care Act is becoming seriously unaffordable for many families, even by Obamacare’s own rules,” said eHealth CEO Scott Flanders. “I find it hard to believe that the framers of the law ever intended the cost of family health insurance to rival that of a second mortgage. Without the introduction of lower-cost options into the market or expanded government subsidies, many middle-income Americans are in danger of being priced out of the health insurance market entirely.”

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Meanwhile, if anything, the study conducted by eHealth was somewhat conservative as it only assumed a 10% premium increase in 2018.

In preparing its analysis, eHealth reviewed the lowest-price 2017 plan available for families of three comprised of two adults age 35 and one child. The same family model was analyzed using data from Healthcare.gov in 40 cities, data from eHealth.com in 9 cities not utilizing Healthcare.gov, and data from the New York state exchange for New York City.

After applying a relatively modest annual rate increase of 10% to 2017 rates to project 2018 rates, eHealth discovered the following:

  • In 47 of 50 cities surveyed, the lowest-priced plan would be officially unaffordable under Obamacare affordability standards for families earning 401% of the federal poverty level (about $82,000 per year in the contiguous US, making them ineligible for Obamacare subsidies).
  • Among these, the average three-person household would need to earn an additional $28,939 per year before the lowest-cost plan becomes affordable according to Obamacare rules.

To put eHealth’s findings in perspective, a family of 3 in Charlotte, NC, with an annual income of $81,884, would have to spend 18% of their gross income in 2018 just to purchase the cheapest Obamacare plan for their family.  On a post-tax basis, that expenditure would be well over 20%.  Moreover, as eHealth points out, that family of 3 would have to find a way to make an extra $102,245 per year to meet the “affordability” test included in the Obamacare legislation.

Here’s how other cities compared on Obamacare “affordability”:

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Steve Bannon famously said, “If you think they’re going to give you your country back without a fight, you’re sadly mistaken.” This is a long war. The alt-right would be wise to think about how to win a long, low grade culture war. That means building up the intellectual and cultural side, while also systematically throwing sand in the gears of the colonial machine. The path to victory is to make neo-liberalism too expensive to maintain and too unappealing to support.

Source: ZeroHedge

 

Death Spiral: 6.5 Million People Choose To Pay Tax Rather Than Buy Obamacare

For those who still aren’t convinced that Obamacare is trapped in an inescapable death spiral that will inevitably end in nothing short of an epic collapse of the federal and state health insurance exchanges, perhaps you should consider the following facts from the National Review and Mark Farrah and Associates.

–  Four heavily promoted open enrollments have taken place run by the Obama administration and the state exchanges.

–  Federal law has required people to purchase insurance or pay a fine — and the individual mandate was administered through 2016 by the Obama administration. In fact, in 2015, 7.5 million people paid the fine, while 6.5 million paid the fine in 2016, according to the IRS.

–  Every one of the people in the insurance market earning less than 400 percent of the federal poverty level were eligible for premium assistance — and those below 250 percent of the poverty level were also eligible to have their deductibles and co-pays subsidized.

–  After all of this, only about 40 percent of those eligible for subsidies have signed up for coverage. In what other business or government program would such a dismal acceptance by those it was targeted to serve be considered a success?

–  The number of insurance companies participating is on track to shrink by 38 percent in 2018.

And then there is the chart below…if people really saw “value” in Obamacare wouldn’t you expect that more than 2% of the people who don’t qualify for subisidies would sign up?

Finally, I will suggest the real test of whether a health-insurance program is stable is whether the consumers for whom it is intended believe that it provides them with value. Here is a chart of the take-up rate on the federal exchanges under the Affordable Care Act; excluding the “Over 400%” category, all of these individuals are eligible for subsidies. This chart represents data from last year, but with only a 4 percent reduction in those purchasing on the exchanges between 2016 and 2017, it should remain a fair indication of consumer approval of the program.

The health-insurance industry has long considered a 75 percent take-up rate to be the gold standard in evaluating whether an insurance pool is stable — i.e., whether there are enough healthy people signed up to pay the claims of the sick. While the exchanges appear to have achieved this for the lowest-income consumers — those who get the biggest premium subsidies and also have their out-of-pocket costs subsidized — only 17 percent of those making 301 to 400 percent of the poverty level have signed up.

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Still not convinced, how about this?  The “off-exchange market” (i.e. people who make too much money to quality for subsidies and whose premiums are required to subsidize everyone else who does qualify) contracted by 2.1mm in 2016, or a 29% drop.  With those kind of declines, it’s only a matter of time until there are no more rich fools in the pool willing to continue subsidizing a broken system.

Also, MFA published the same report in 2016, facilitating a year-over-year comparison. The on-exchange market fell from 12,681,874 to 12,216,003 individuals, a reduction of 465,871 or 4 percent. However, the off-exchange market fell from 7,520,939 to 5,361,451, a reduction of 2,159,488 or 29 percent. In other words, enrollment is steady among those who receive subsidies but declining dramatically among those who do not.

Much has been made of the question of whether the individual markets are in a “death spiral.” Given that the on-exchange market enrollment is relatively stable, there is clearly not a death spiral in the subsidized market. However, with a reduction in the unsubsidized market of 29 percent in just one year, that pattern certainly looks like one we would expect in a market spiraling down.

Meanwhile, of course, that 29% drop exactly why insurance companies are expected to hike their rates by 20-40% in certain markets again in 2018…

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…and why rates have soared an average of 113% over the past 4 years, or nearly 30% per year.

Source: ZeroHedge

Covered California Plans To Jack 2018 Premiums Up 12.5%

Covered California announced this week that its 2018 rates will increase about eight times faster than the rate of inflation, as the Obamacare law and the state’s liberal legislature continue to destroy private insurance in California.

Despite the latest United States Department of Labor Consumer Price Index for the month of June estimating that inflation rose by only 1.6 percent over the last twelve months, Covered California, Obamacare for the state, just announced that the average health insurance premiums on the California insurance exchanges would rise by 12.5 percent, or about 7.81 times faster than the rate of inflation.

Covered California’s spiking prices are actually a relative bargain compared to the even worse Obamacare price increases insurers are about to extract across the rest of the nation. The Wall Street Journal recently reported that “big insurers in Idaho, West Virginia, South Carolina, Iowa, and Wyoming are seeking to raise premiums by 30 percent or more.”

The insurance industry lobbied the Democrat-controlled Congress in 2010 to design Obamacare to be more expensive than traditional private insurance by dramatically expanding services covered in the health benefit packages.

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Section 1302 of the law granted also the Department of Health and Human Services the right to periodically revise an “essential health benefits package” of minimum health insurance coverage requirements. That allowed insurance companies to lobby federal bureaucrats to add more benefits and eliminate the standard lifetime caps on spending for wildly expensive treatments, such as inpatient drug rehabilitation.

Since the 2013-4 launch of Obamacare, premiums have risen by about 15 percent per year, despite inflation averaging only about 2 percent a year.

Not only were insurance companies making huge increases in revenue during the Obamacare years, their gross profit margins jumped from 22 percent, when Obamacare was passed in 2010, to 26 percent in the last quarter of 2016. Healthcare stocks have been the second-hottest sector in the seven-year bull market for stocks. Since Obamacare was passed on March 23, 2010, the healthcare stock index has risen by 248 percent.

The Trump presidential win appeared to represent an existential threat to the healthcare industry’s Obamacare bonanza. But with the Republican Senate failing to pass any type of Obamacare repeal, the healthcare stocks hit another all-time-high on July 31.

Many major healthcare companies that supported the expansion of Obamacare benefits and costs over the last seven years are now dropping out of the program as customers begin to take full advantage of the expanded and unlimited benefits.

United Healthcare, America’s largest healthcare insurer, announced in March 2016 that it was exiting all Obamacare exchanges after stating that Obamacare claims would reduce 2016 earnings by about $850 million. Still, four months later, United Healthcare recorded all-time-record quarterly revenues of $46.5 billion, a $10 billion increase over the prior year.

Covered California had been able to keep healthcare premium growth to around 10 percent per year because 11 healthcare insurers were participating. But Aetna dropped out at the end of 2016, and Anthem Blue Cross just announced they are dumping 153,000 customers and shutting down California operations in all regions except the rural north state, Central Valley, and Santa Clara County, according to the Orange County Register.

The 12.5 percent Covered California statewide increase is just an average. Abandoned United Healthcare subscribers can still buy coverage from Blue Shield, but their annual premium cost is expected to leap by 24 percent.

Covered California premium rates could jump statewide by another 16.6 percent if the Trump administration does not contest the May 12, 2016 ruling by U.S. District Judge Rosemary M. Collyer in United States House of Representatives v. Price that the Obama administration improperly amended Obamacare in January 2014 to pay billions in cost-sharing subsidies to insurers without congressional approval.

By Chriss W. Street | Breitbart

 

More Rural Hospitals Across Tennessee At Risk Of Closing

PARSON, Tenn. – With barely 11,000 residents you could consider Decatur County to be on the front lines of a battle being fought across rural America right now, one that small town hospitals are repeated losing putting patients in life or death situations.

Built in 1964, Decatur County General Hospital lies just a few blocks from the center of the town of Parsons. The “L” shaped building is currently running with a bare minimum staff, 80 full time employees and just one doctor. Hospital officials have worked tirelessly over the last few months, trimming the staff of nurses and lab technicians down from 110 people in an effort to minimize costs. The county mayor here estimates Decatur General lost about $200,000 last year, this life line to so many is currently on life support and in danger of closing.

“If this goes away there are so many people who won’t get the care they need,” says Paulette Johnson who was at the emergency room on a recent Tuesday having x-rays done on her neck.

The 67-year-old lives in Scotts Hill, Tennessee, a town that lies about 20 minutes away from the emergency room at Decatur County General Hospital. If this hospital shuts its doors, it would take more than an hour for Paulette to get to the next closest emergency room.

That kind of drive could mean the difference between life or death in an emergency.

“They can save your life here, you’re gonna lose your life if you have to go further,” Paulette says.

Decatur County General is hardly alone in the struggle to stay open. Nationwide 81 rural hospitals have closed since 2010. Nine of those closures have happened in Tennessee, county run hospitals from the eastern mountains to the Mississippi River have disappeared. The only state with more rural hospital closures than Tennessee is Texas, where in 2013 an 18-month old died after being rushed to an emergency room that her parents didn’t realize had closed.

Here is a list of the eight facilities that have recently closed in Tennessee:

  • Riverview Regional Medical Center North (August 2012)
  • Gibson General Hospital (January 2014)
  • Humboldt General Hospital (January 2014)
  • Haywood Park Community Hospital (August 2014)
  • Methodist Healthcare-Fayette Hospital (March 2015)
  • Medical Center of Manchester (July 2015)
  • Tennova Healthcare McNairy Regional Hospital (May 2016)
  • Pioneer Community Hospital of Scott, formerly Scott County Hospital (July 2016 but slated to reopen August 2017)

Source: NewsChannel5

Sen. Rand Paul: Senate GOP Decide to Keep Obamacare

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I miss the old days, when Republicans stood for repealing Obamacare. Republicans across the country and every member of my caucus campaigned on repeal – often declaring they would tear out Obamacare “root and branch!”

What happened?

(Breitbart) Now too many Republicans are falling all over themselves to stuff hundreds of billions of taxpayers’ dollars into a bill that doesn’t repeal Obamacare and feeds Big Insurance a huge bailout.

Obamacare regulations? Still here. Taxes? Many still in place, totaling hundreds of billions of dollars.

Insurance company bailouts? Those, too. Remember when Republicans complained about Obamacare’s risk corridors? Remember when we called the corridors nothing more than insurance company bailouts? I remember when one prominent GOP candidate during a presidential debate explicitly called out the Obamacare risk corridors as a bailout to insurance companies. Does anyone else?

Now, the Senate GOP plan being put forward is chock full of insurance bailout money – to the tune of nearly $200 billion. Republicans, present company excluded, now support the idea of lowering your insurance premium by giving a subsidy to the insurance company.

Remarkable. If the GOP now supports an insurance stabilization fund to lower insurance prices, maybe they now support a New Car stabilization fund to lower the price of cars. Or maybe the GOP would support an iPhone stabilization fund to lower the price of phones.

The possibilities are limitless once you accept that the federal government should subsidize prices. I remember when Republicans favored the free choice of the marketplace.

The Senate Obamacare bill does not repeal Obamacare. I want to repeat that so everyone realizes why I’ll vote “no” as it stands now:

The Senate Obamacare bill does not repeal Obamacare. Not even close.

In fact, the Senate GOP bill codifies and likely expands many aspects of Obamacare.

The Senate Obamacare-lite bill codifies a federal entitlement to insurance. With the Senate GOP bill, Republicans, for the first time, will signal that they favor a key aspect of Obamacare – federal taxpayer funding of private insurance purchases.

The bill will transfer billions of dollars to people who will then transfer billions of dollars to insurance companies. What a great business model – encourage the federal government to use taxpayer money to buy a private company’s product. Great business model, that is, if you are Big Insurance. Remarkable.

The Senate Obamacare-lite bill does what the Democrats forgot to do – appropriate billions for Obamacare’s cost-sharing reductions, aka subsidies. Really? Republicans are going to fund Obamacare subsidies that the Democrats forgot to fund?

Doesn’t sound much like repeal to me. One might even argue it’s worse than Obamacare-lite because it actually creates a giant superfund to bail out the insurance companies – something even the Democrats feared to do.

I was first elected in the heady days of the Tea Party Tidal Wave, when tens of thousands of citizens gathered on the central city lawn to protest Big Government, Big Debt, and a government takeover of health care.

This citizenry won in four elections. Each time, the GOP establishment told conservatives, “We can’t repeal Obamacare until we have all three branches of government.” Finally, in 2016, that came to pass. Republicans now control all three branches of government.

And . . . the best that is offered is Obamacare-lite: keeping the Obamacare subsidies, keeping some of the Obamacare taxes, creating a giant insurance bailout superfund, and keeping most of the Obamacare regulations.

Shame. Shame on many in the GOP for promising repeal and instead affirming, keeping, and, in some cases, expanding Obamacare. What a shame.

Aetna Pulls Out Of Obamacare

Health insurer Aetna Inc (AET.N) said on Wednesday it will exit the 2018 Obamacare individual insurance market in Delaware and Nebraska – the two remaining states where it offered the plans.

Aetna has now “completely exited the exchanges,” the company said in an emailed statement.

Republicans in the U.S. House of Representatives last week voted to undo the Affordable Care Act, often called Obamacare, the signature domestic achievement of former President Barack Obama.

But even if the Republicans’ bill – known as the American Health Care Act – is passed by the Senate it would not solve a critical outstanding issue for insurers looking at 2018: Will the government continue to fund the cost-sharing subsidies that help individuals pay for care?

By Deena Beasley | Reuters

To Remove ObamaCare We Must First Remove The UniParty “Big Club”…

By Sundance | The Conservative Treehouse

President Trump is the first political entity in our lifetime that not only comprehends the faces of the false arguments (the personalities of false choice), but more importantly sees the architects behind the Potemkin villages represented by those faces.  When it comes to domestic economic policies, the architects are the BIG CLUB.

So, what is “The Big Club“?

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..What “Deep State” is to intelligence, military intervention and foreign policy – The “BIG CLUB” is to matters of domestic economics…

Politicians do not write laws.  Paul Ryan, Nancy Pelosi, Mitch McConnell and Chuck Schumer do not sit in their offices writing out scripts of laws and legislation; no politician does.  Politicians are the faces who sell legislation that unseen hands create.  The Big Club are the hands that create the legislation.

As such, it makes no sense to argue about the salesmanship of Ted Cruz or Elizabeth Warren when neither Cruz nor Warren are creating the legislative constructs they are selling.

Indeed, it makes much more sense to focus the attention on the unseen hands that are never discussed – These are the roots of the issues, the politicians are merely the expendable and interchangeable sales force.

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The Big Club are massive and complex networks of lobbying groups who actually write legislation.  What follows, depending on their own evaluation of importance therein, are payments to the politicians to go and sell their construct.

The amount of payment varies depending on how valuable the construct is to the interests of the Club.  Big legislative constructs that provide the Club large income increases are worth more than smaller ones.

This is the accurate background framework to consider ObamaCare.

Within The BIG CLUB there are, essentially, two larger factions with interest: Big Labor and Wall Street (big crony-business).  There are other factions like Big Green (Al Gore) etc. However, for the sake of ObamaCare the two that matter are “Big Labor” (AFL-CIO, SEIU, AFSCME, UFCW etc), and Wall Street (U.S. Chamber of Commerce, Tom Donohue).

The Big Club has paid for ObamaCare’s construct, and they are not going to allow their sales force to walk away from it.  From their position, this is a massive ‘multi-multi-hundreds-of-millions’ expenditure that has already taken place.

Tom Donohue (U.S. CoC) already lost hundreds of millions when his construct (his team actually did the writing) of TPP was lost due to Donald Trump.   Donohue’s TPP loss followed the loss of Comprehensive Immigration Reform (2014 Dave Brat), and his loss of Common Core Education standards, again with Donald Trump.

Donohue spent hundreds of millions on Gang of Eight, Common Core, TPP and ObamaCare.

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Donohue paid off AFL-CIO’s Richard Trumka to get him to stop being public about his opposition of TPP.   The quid-pro-quo was transparently most evident when Trumka endorsed candidate Hillary Clinton who was supporting Donohue’s TPP.

Having lost TPP, Go8 and Common Core, there is no way Tom Donohue is going to accept losing his biggest investment to date, ObamaCare.

♦ Big Labor support ObamaCare for a few reasons.  #1 it granted fiscal stability to their retirement programs which were failing with the increased costs of providing healthcare coverage.  #2 it creates additional profit margin space within union companies for more lucrative compensation contracts.  And #3 ideologically it was constructed to eventually end up with a single-payer system.  All three points are great for Big Labor.

♦ Wall Street supports ObamaCare because it:  #1 removes the cost of providing healthcare from the cost of producing products in the U.S. [However, you’ll note the consumer price of manufactured goods never actually decreases, instead the savings go to the profit margin.] #2 allows the manufacturing cost equity to streamline globalization efforts.

Both primary factions within the BIG CLUB stood to gain substantially if they could shift the cost of healthcare from their individual ledgers into the personal checkbooks of the U.S. consumer.  Hence, they looked at the lobbying cost of ObamaCare as a long-term legislative investment with a massive upside.

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After the GOPe wing of the UniParty was voted into the majority in both houses (2014), the Big Club sales people (politicians) needed to give the illusion of “repeal” or “removal”, but not actually do anything which would remove it.  So long as Obama was in office the optical games were easy; with Clinton later in office the games would be no longer needed.

Big Club spends to make sure Clinton wins the Presidency.

#NeverTrump making sense now?

Rut Roh.

Now, fast forward to 2017 and President Trump is in office on a promise to repeal and replace ObamaCare.

Oh snap, NOW what is the Big Club going to do?

Stall for time…. Quick construct plan to deal with the unexpected.  Stall, block cabinet and down-stream confirmations… Activate astroturf to provide Sales Force cover…  Paul Ryan lies to Sean Hannity… etc.

More things reconciling now?

Meanwhile, President Trump understands exactly what they are doing.

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President-Elect Trump met with Richard Trumka and outlined larger administration pro-jobs objective assurances.

Once in office, President Trump works around Donohue and goes to the manufacturing and business community directly.

Now Trump is highlighting how deregulation, tax policy and other pro-growth America-First objectives will more than compensate them for any ObamaCare recall.

The battle/negotiation you see in the media is the visible stuff going on amid the Big Club’s sales people, the politicians.  However, the REAL ObamaCare removal negotiation is going on behind the scenes where the Trump Administration is taking on The Big Club directly…

Once you see the strings, it’s almost impossible to watch the marionettes and not see them.

However, that doesn’t mean the puppet show has to be less enjoyable….

….Specifically because we have President Trump, it is entirely possible to simultaneously watch the show, and yet still look up toward the scaffolding and see the shadows of the hands controlling them.

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Lobbying Ban – Executive Order

Thanks For Nothing … And Everything

During this season of Thanksgiving, I would like to express my overwhelming gratitude…

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Thank you, President Obama. Thank you for not upholding your oath to the U.S. Constitution to protect America’s southern border. Thank you for illegally granting amnesty via executive action and avoiding the unnecessary hassles of passing the legislation through Congress. And thank you for your efforts in turning the United States of America into a third-world refugee camp.

Thank you, Obama, for your broad support of Islam and for labeling American citizens as bitter, xenophobic racists clinging to their guns and religion. I would also like to express my gratitude to you, your enablers, and all of the sycophantically corrupt, establishment politicians for near doubling the national debt of the United States these last eight years.

Another heartfelt expression of gratitude goes out to all of the media pundits, talking heads, newspaper columnists, Silicon Valley moguls as well as the proprietors, purveyors and contributors of actual fake news websites who contort themselves daily to support leftist politicians and the progressive agenda. Without the blind commitment of those who have facilitated the Cloward-Piven strategy of sacrificing America to the global elite banking establishment, it would have been far more difficult for Obama to fundamentally transform our country over the last eight years.

Indeed, without the help of the punditocratic media commentariat, the Obama administration might have been held accountable for the Fast and Furious scandal, NSA overreach, the IRS scandal, veteran death panels and illicit prisoner trades with America’s sworn enemies; not to mention the blaming of Benghazi on a YouTube video. Thanks for sweeping all of that under the proverbial rug. You should be proud.

Also, thank you President Obama for quietly signing your Executive Order 13603 in March of 2012, which nationalizes: “All commodities and products that are capable of being ingested by either human beings or animals”, “all forms of energy”, “all forms of civil transportation”, “all usable water from all sources”, “health resources: drugs, biological products, medical devices, materials, facilities, health supplies, services and equipment” as well as the forced “induction” of civilians in the event of “military conflicts, natural or man-caused disasters, or acts of terrorism within the United States.” Thanks for looking out for us and we appreciate you’re providence and protection.

Thank you, as well, to all of the uninformed voters and apathetic citizens who have supported their favored government bureaucrats either by demand or default, respectively, as our healthcare system was nationalized. This wonderful legislation not only required citizens to purchase a product for the first time in history as mandated by government decree, but it also diminished our personal and private relations with our chosen physicians as it simultaneously increased the cost of insurance on working individuals and families.

Thank you to all of the Hollywood movie stars, producers, directors and writers who, in their fanatical hubris, were so willing to share with us fans, plebs and serfs their enlightened wisdom both before and after the election. Without the guidance of film and TV actors, movie business minions and other self-perceived west coast luminaries who vastly overestimate both their intelligence and their importance; America would be far less prosperous and free today.

Thanks to all of the elderly hippies, aging boomers, welfare moochers; unicorn chasers, transgendered bathroom rights crusaders, shrieking feminists, rainbow dancing socialists; Black Lives Matter advocates of only select black lives, Never Trumper’s and the Millennial snowflake generation. Thank you for swallowing hook, line and sinker everything you have ever learned from television programming and propagandized news as you riot in the streets over a losing candidate whose vagina you valued more than honesty.

Thanks to those of you as well within the U.S. Department of Education for dumbing down a majority of the American generations over the last several decades while vastly increasing your taxpayer funded budgets over the same time period.

And how about those George Soros sponsored, Moveon.org election protesters rioting in the streets of American cities because their candidate lost an election? According to the Craigslist ads, some of them were paid $1,500 a week and even received bus rides to the staged areas. Isn’t America truly the land of opportunity? I have never been so proud. And we all should be very obliged to President Obama for supporting these protesters when he said:

“So, I would not advise people who feel strongly or who are concerned about some of the issues that have been raised during the course of the campaign, I wouldn’t advise them to be silent.”

And we should also be extremely grateful to former presidential candidate, Hillary Clinton, for encouraging the rioters with her own words of support as follows:

“For the sake of our children and our families and our country, I ask you to stay engaged on every level. We need you. America needs your energy, your ambition, your talent and that’s how we get through this. That’s how we make our contribution to bend the arc of the moral universe towards justice. “

Thank you, Hillary, for helping the violent rioters to “get through” the next four years under Donald Trump until they can “bend the arc of the moral universe” back “towards justice”. You truly are an inspiration.

Thank you, mainstream media, for focusing so much more intently on Donald Trump’s unproven misogyny and phony Russian espionage in lieu of the treasonous obstruction of justice regarding Hillary Clinton’s State Department e-mails on her personal server and Anthony Wiener’s laptop. Thank you for not reporting on the mysterious financial shenanigans of the Clinton Foundation and thank you for daily crucifying James Comey and Julian Assange for revealing the facts that you super sleuths and modern day Edward R. Murrow’s refused to report. We the people definitely owe all of you a gigantic debt of gratitude for abnegating your solemn responsibilities as keepers of the Fourth Estate. You have served your globalist masters well. Thank you.

Furthermore, a great big “thank you” goes out to Google and various social media companies for their attempts to influence the U.S. presidential elections on behalf of Hillary Clinton and for recently announcing their plans to punish the internet websites they deem as propagators of “fake news”. Whew. We are all breathing a sigh of relief as you remove your adware from these dangerous sources of information all throughout the blogosphere. Thank you.

And, thank you, Deep State, for spying on citizens from all over the world while failing to prevent terrorism both at home and abroad. In spite of your failures to prevent Islamic massacres in places like Fort Hood, San Bernardino, Orlando, Paris, Nice and London; we feel very secure knowing your 1.5 billion-dollar, one million square-foot Utah Data Center and your recently revealed spy hub in New York City watches over us even as we sleep. I am very confident you will one day have the resources and technical savvy to hack an iPhone. You’re awesome.

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And thank you, the corporations that spy on American citizens for the United States National Security Agency (NSA) including: AT&T, Verizon, Centurylink, Hewlett-Packard, Intel, IBM, Microsoft and so many more. Not only do we get great products and services at a full price, but we also get to have our Fourth Amendment rights violated at the same time. What a deal. Thank you.

Also, another huge “thank you” goes out to the Transportation Security Agency (TSA). Thank you, blue smurfs, for fondling little children in airport lines while feigning political correctness so you will never falsely profile any potential Islamic extremists. Great job.

Thank you Federal Reserve for reducing the value of the American dollar to a mere fraction of its original value since your creation in 1913. Excellent work. And what is totally amazing today is how you can so easily make money out of thin air without fear of ever being audited. You’re fantastic. Truly.

Thanks to Ford Motor Company for conceding to president elect Donald Trump by choosing not to move jobs to Mexico at the last minute. I haven’t seen such fear and trembling since the Iranians released the hostages on January 20, 1981 immediately after President Ronald Reagan’s inaugural address.

I would also like to personally thank all the turncoat RINO (i.e. Republicans in Name Only who not only lacked the balls, vision and desire to stand up to the tyranny of Globalism, but who were at the same time, so brave to stab their presidential candidate in the back during the 2016 election. Nice work.

There are so many others to thank during this season of gratitude. Time or space does not permit. Who am I forgetting?

In any event, I guess I just wanted to thank all of those mentioned above who have worked so hard to reduce the liberty of the American people as well as the future prospects and prosperity for our children. Thank you so much.

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We definitely have come a long way from when the pilgrims first stepped off the Mayflower for the “Glory of God and the advancement of the Christian faith.” Just 395 years ago, the first Thanksgiving celebration took place. I wonder if Governor William Bradford’s campaign manager at that time had any interest in Spirit Cooking? Probably not. What a long, strange trip it’s been.

Finally, in closing, and most importantly: I would like to thank my fellow Americans who peacefully rejected Hillary Clinton at the polls this year and thus allowed Donald Trump, at the very least, an opportunity to make America great again. Thank you.


Liberals are mind control victims of major corporations and the establishment media … but real help is right here.

Source: ZeroHedge

Obamacare Sticker Shock: Average 2017 Health Tax Premium Surges 24%:

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It’s going to be real bad. Note: These calculations were done by Charles Gaba just before Aetna dropped out of 536 markets. Thus, these projections underestimate the premium increases.

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One of governments greatest Oxymoron’s –  THE AFFORDABLE CARE ACT

Congress and the White house had absolutely no control or idea what the cost of Obamacare would be ……..none, except that the premiums would rise.    It has become affordable only to those that never had it.   Those that did, were lied to about keeping their doctors, the cost continues to rise.   Funny thing, 2017 will be have an even greater increase.   Even with medical insurance, many can no longer afford to go to the doctor, let alone hospital.   Deductibles are higher, and coverage less.  Services or items covered have risen in cost and often no longer covered by your insurance.   People are beginning to not seek treatment, they can not afford to be ill; insurance or not; especially those retired, Medicare won’t cover it all either.

The Affordable Care Act: America’s greatest OXYMORON created and passed by MORONS.   “We have to pass it before we can read it.”   Nancy Pelosi    (California’s favorite moron).

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source: Arlin Report

Thirteen of 23 Co-Ops Created Under Obamacare Have Now Failed

Ohio’s InHealth Mutual co-op announced last week that it is going out of business, making it the 13th co-op to fail out of the 23 that were created under Obamacare.

The Ohio Department of Insurance asked to liquidate the company, saying that the company was in a “hazardous financial condition.” The co-op served nearly 22,000 consumers who now have 60 days to find another policy offered by another company on the federal exchange.

“Our examination of the company’s financials made it clear that the company’s losses would prevent it from paying future claims should its operations continue,” said Ohio Director of Insurance Lt. Gov. Mary Taylor. “Under Ohio law, we acted with certainty to protect the consumers.”

The company recorded an underwriting loss of $80 million in 2015 despite the $129 million in taxpayer-backed loans granted to the co-op by the federal government. InHealth Mutual was also placed under “enhanced oversight,” one of three tools the Department of Health and Human Services has to monitor co-ops in financial distress. When a co-op is placed under enhanced oversight, it means the company is consistently under performing and allows the department to give detailed and more frequent reviews of the loan recipient’s operations and financial status.

According to Columbus Business First, medical claims were coming in at a rate of $3 million per week and the company would have had to raise premiums by 60 percent in 2017 to keep up. If InHealth Mutual were to stay in business through the end of 2016, projections show that the company would have posted losses of $20 million.

Ohio’s failed co-op is added to the list of 12 co-ops that have already failed in Arizona, Michigan, Utah, Kentucky, New York, Nevada, Louisiana, Oregon, Colorado, Tennessee, South Carolina, and a co-op that served both Iowa and Nebraska.

Centers for Medicare and Medicaid Services chief operating officer Mandy Cohen told lawmakers in February that eight of the 11 remaining Obamacare co-ops in operation were selected for “corrective action plans” and “enhanced oversight.” She did not disclose which co-ops were placed on these plans.

A professor who specializes in economics and health insurance told lawmakers in March that closures of the remaining co-ops seem likely.

“The future of the 11 co-ops still providing coverage in 2016 is uncertain, but future closures seem likely,” said Dr. Scott Harrington. “The 10 co-ops still operating with June 30 financials reported a cumulative loss of $202.3 million.”

“Very little, if any, of the $1.24 billion in federal start-up and solvency loans to establish those co-ops will be repaid, and at least several will be unable to meet all of their obligations to policyholders and health care providers,” he said.

The Department of Health and Human Services did not respond to requests for comment by press time.

by Ali Meyer | The Washington Free Beacon

Is This The Beginning Of The End For The Affordable Care Act?

Largest US Health Insurer Ditches ObamaCare

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Tracking the slow motion train wreck of Obamacare has become one of our preferred hobbies: below is just a random sample of headlines covering just the most recent tribulations of the “we have to pass it to find out what’s in it” Unaffordable Care Act:

But the most surprising article we wrote was our explanation from three weeks ago explaining why “Your Health Insurance Premiums Are About To Go Through The Roof” showing that even insurance companies have been unable to earn a profit under Obamacare, as shown in the following chart:

This was a stunning revelation because, after all, the Affordable Care Act was largely drafted by the insurance industry itself, and if for whatever reason, it itself was unable to capitalize on Obamacare, then it has truly been a disaster.

Today we got confirmation of this when none other than the U.S.’s biggest health insurer, UnitedHealth, cut its 2015 earnings forecast with a warning that it was considering pulling out of Obamacare, just one month after saying it would expand its presence in the program.

According to Bloomberg, “UnitedHealth Group would scale back marketing efforts for plans it’s selling this year under the Affordable Care Act, and may quit the business entirely in 2017 because it has proven to be more costly than expected.

This was precisely what we cautioned on November 2.

Fast forward to today when UnitedHealth said in a statement that “the company is evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017.”

Needless to say, the implications for Obamacare – which has seen a surge in tangential problems in recent months – are dire: “A pull-back would deal a significant blow to President Barack Obama’s signature domestic policy achievement. While UnitedHealth has been slower than some of its rivals to sell Obamacare policies since new government-run marketplaces for the plans opened in late 2013, the announcement may indicate that other insurers are struggling, said Sheryl Skolnick, an analyst at Mizuho Securities.

“If one of the largest and presumably, by reputation and experience, the most sophisticated of the health plans out there can’t make money on the exchanges, then one has to question whether the exchange as an institution is a viable enterprise,” Skolnick said.

UnitedHealth further said it suspended marketing its individual exchange plans and is cutting or eliminating commissions for brokers who sell the coverage.

What is surprising is that for UnitedHealth, its Obamacare-facing exposure is relatively limited: the company covers fewer than 550,000 people on the Obamacare exchanges. About 9.9 million people had insurance through the U.S.- and state-run insurance markets as of June 30. This means that all other insurance companies must be getting crushed, something which the market also noticed earlier today hitting the stocks of not only hospitals, such as CYH, HCA, LPNT, THC and UHS but also home health care providers as well such as AFAM, AMED, GTIV and LHCG.

What is perhaps even more perplexing is the abrupt shift in posture: just last month, UnitedHealth had struck a more optimistic note. I think we’ll see strikingly better performance on the insurance exchange business” next year, Chief Financial Officer David Wichmann told analysts on an Oct. 15 conference call.”

Perhaps he had not seen the P&L? Oh well, he certainly did in the subsequently 4 weeks.

The rest of the story is well-known and has been covered here extensively in the past: the inability of businesses to turn a profit from Obamacare has meant that about a dozen non-profit “co-op” plans created under the Affordable Care Act have failed, after charging too little to cover the cost of patients’ medical care, and because an Obama administration fund designed to stabilize the market paid out just 12.6 percent of what insurers requested. And Anthem last month said some rivals were offering premiums too low to provide the coverage patients require and book a profit.

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At the end of the day, the worst news is not for the corporations, since Obamacare is not going away any time soon. It simply means that what until now were supposedly Affordable plans under Obamacare, will soon become (even more) Unaffordable as insurer after insurer hikes premiums dramatically in order to make the biggest US governmental intrusion into the private sector in recent decades profitable to shareholders.

Or, as we explained three weeks ago, “Your Health Insurance Premiums Are About To Go Through The Roof


UnitedHealth CEO Regrets Entering ObamaCare

The CEO of UnitedHealthcare on Tuesday said he regretted the decision to enter the ObamaCare marketplace last year, which the company says has resulted in millions of dollars in losses.

“It was for us a bad decision,” UnitedHealth CEO Stephen Hemsley said at an investors’ meeting in New York, according to Bloomberg Business.

UnitedHealth, the country’s largest insurer, announced last month that it would no longer advertise its ObamaCare plans over the next year and may pull out completely in 2016 — a move that sent shock waves across the healthcare industry.

Hemsley’s remarks double down on his earlier warning that the ObamaCare exchanges remain weaker than expected after two years and that it will take far longer for insurers to profit from the millions of new enrollees. 

The company had already eyed ObamaCare’s federal marketplace cautiously since it launched in 2013. UnitedHealth only began selling plans on the exchanges last year.

Now, UnitedHealth officials have said that move will result in a half-billion dollars in losses over two years.

Hemsley said it was smart to sit out of the exchanges for the first year, but that the company should have held out another year.

“In retrospect, we should have stayed out longer,” he said, adding that he believes the marketplace will take more than “a season or two” to develop.

“We did not believe it would form this slowly, be this porous, or become this severe,” he added.

by Sarah Ferris in The Hill


GRUBER: A lack of transparency was how we got this law through.

 

Colorado Could Become The First State With Universal Health Care

A doctor puts his hand over his chest during a

A doctor puts his hand over his chest during a “House call” rally against proposed healthcare reform legislation at the Capitol in Washington

A plan to make Colorado the first state to opt out of the federal health law and replace it with universal health care, funded by the taxpayer, is going to be on the Colorado ballot in 2016.

Supporters of universal health care gathered 158,831 qualified signatures, which is more signatures than are required to put the measure on the ballot.

Backers of the measure say employers would pay around 7 percent of a worker’s wages into the system. Workers would put around 3 percent into the system. Supporters say the plan would cost around $3 billion a year, but would save $9 billion.

Skeptics of the measure say costs would spiral out of control. It is likely the proposed measure will be discussed in the upcoming presidential election, since Colorado is a battleground state. Groups from both sides are likely going to invest a lot in order to advance the measure or defeat it.

If the ballot is passed, an entirely new government entity would be in charge of running the new health care program. Elected officials in 21 districts would be on the board and would be in charge of raising taxes to fund the new health care system.

Colorado is not the first state to attempt something like this. A few years ago, Vermont got support for a single payer health care system, but eventually the state admitted a large program couldn’t be financed due to a lack of money.

Read the original article on Digital Journal. Copyright 2015. Follow Digital Journal on Twitter.

Source: Business Insider

ObamaCare On The Rocks As Open Enrollment Looms

by Betsy McCaughey in IBD

ObamaCare is heading toward a death spiral. The administration is having trouble selling insurance plans to healthy people. That’s a big problem: When the young and healthy don’t enroll, premiums have to be hiked to cover the costs of older and sicker people, discouraging even more young people from signing up.

Last Thursday, the administration predicted enrollment for 2016 will be less than half what had been forecast in March by the Congressional Budget Office.

Even with subsidies to help with premiums and out-of-pocket costs, most of the uninsured who are eligible for ObamaCare are saying “no thanks.” Only one in seven is expected to sign up. That’s despite a hefty increase in the financial penalty next year for not having insurance.

The administration seems reconciled to failure. Already it has announced it won’t be running the customary nationwide TV campaign to encourage sign-ups, as in previous years.

Remember the young guy in plaid pajamas — “Pajama Boy” to conservatives? Well, he won’t be back this winter.

Bad enough that healthy people aren’t buying. Worse is that the administration is spending billions of your tax dollars covering up the problem, paying insurers to keep offering the plans, even though they’re losing their shirts. But facts are facts — and there’s no hiding these.

Health and Human Services Secretary Sylvia Burwell predicts Obama-Care enrollment will inch up by 1 million or so, to 10 million people — half what the CBO forecast. Open enrollment for the coming year, which begins Nov. 1, “is going to be a challenge,” she said.

David Wichmann, UnitedHealth Group’s president, announced higher premiums last week because enrollees will “require more medical services than original expectations.”

Many states are looking at premium hikes of 30% or more, according to a new Robert Wood Johnson/Urban Institute analysis. The Heritage Foundation estimates that insurers lost 12% selling ACA plans in 2014, with more losses this year.

Don’t shed any tears for the insurance companies. Though they’re losing money on exchange plans, they’re profitable overall, and their stocks are doing well. It’s John Q. Public who’s bearing the brunt. Just as ObamaCare intended.

If you get insurance at work, you’re paying an extra tax to fund “reinsurance” for ObamaCare plans. It’s a fund to defray the cost of their most expensive enrollees.

So far, insurers have collected $7.9 billion. Recent congressional testimony shows the payments kept ObamaCare sticker prices about 11% lower than they otherwise would have been. In short, you pay a tax to make Obama-Care look more affordable than it is.

But even with these hidden subsidies, ObamaCare isn’t working because the design is fatally flawed. The 5% of the population with serious medical conditions consume nearly 50% of the health care. When you try to sell insurance to sick and healthy people for the same price, the healthy don’t sign up. It’s too expensive.

New York State learned that in the 1990s, when one-price-for-all insurance laws pushed premiums to the highest in the nation, crushing the individual insurance market here.

ObamaCare repeats that mistake. Despite slapping the uninsured with penalties — which will jump to 2.5% of household income in 2016 — they’re not signing up. The need to coerce enrollment with penalties is proof the plans are a bad deal.

How long will big insurers play along? There are political considerations, and for most, ObamaCare losses are still just a dent in their overall business. Not so for the 23 co-op insurers set up under the health law. Eight state plans have already failed, including New York’s Health Republic, and most of the rest are bleeding money.

With ObamaCare enrollment floundering and losses mounting, the nation needs alternatives. The Republicans are coalescing around a reform plan, but Democrats are doubling down.

Hillary Rodham Clinton wants to burden the existing, unpopular plans with more “free” goodies and make it harder to dodge the mandate. That won’t work. A real reform should cover the seriously ill — people with pre-existing conditions — in separate plans with separate pricing and subsidies to make them affordable.

Just like the high-risk pools many states used to maintain. That’s the lesson of ObamaCare’s failure.

• McCaughey is author of “Beating ObamaCare” and a senior fellow at the London Center for Policy Research.

‘Playing on stupidity of the American voter is how we got it passed’

Whitehouse.gov Caught Freezing Vaccine Choice Petition To Prevent Signatures From Reaching 100,000 Threshold

by Mike Adams | Natural News

(NaturalNews) A WhiteHouse.gov petition calling for the prohibition of laws requiring mandatory vaccines has been throttled by the White House, buried from public view and finally frozen for over 36 hours to prevent the petition from achieving 100,000 signatures, Natural News can now reveal.

The petition, which was rapidly headed toward the 100,000 signatures needed to trigger a response from the White House, was frozen mid-day Friday and has remained stuck at 56,791 signatures for over 36 hours.

The petition is titled “PROHIBIT ANY LAWS MANDATING THE FORCE AND REQUIREMENT OF VACCINATIONS OF ANY KIND.” It can be found at this link.

The petition reads:

No human being should be FORCED to be vaccinated against their will and/or personal/religious beliefs. I petition against making vaccinations of any kind mandatory. This includes forcing children to be vaccinated to attend public schools, activities, and daycare centers. This also includes adults working in the public or private sector.

The petition still allows people to sign it, and it still sends a confirmation email that claims your signature counts. But the numbers on the petition website never change, no matter how many people sign it.

Petition signatures systematically ignored

As the following screen shot shows, the petition confirmation page claims, “Your signature has been verified and counted.”

But in reality, your signature doesn’t count at all, and the signatures number on the petition page stays frozen:

Throttled to a maximum of 100 per hour before being frozen

Before the petition was frozen by the White House to prevent it from reaching 100,000 signatures, it was throttled to allow a maximum of 100 signatures per hour.

Dr. Rima Laibow of the Natural Solutions Foundation has been monitoring the petition’s numbers for several days. “Counsel Ralph Fucetola, JD, and I were tracking the number of signatures for the petition on our Skype chat and I noted something rather strange: there were many hours when the number increasing on the petition was exactly, EXACTLY, 100,” she told Natural News.

“We realized that although it is really important in this debate to get to the 100,000 signature threshold on this petition, the system was gamed, making it harder than it should be. We knew that if we did not reach that number, the White House juggernaut would claim that only a tiny fraction of Americans were against Mandatory Adult Vaccines and would use that against us.”

“…the White House Petition Site programming is not recording signatures on a petition it disagrees with,” Dr. Laibow concludes in a breaking news warning published at her website.

WhiteHouse.gov buried the petition to try to hide it from the public

Even before the throttling and the freezing of the petition numbers, the White House went to great lengths to bury the petition and make sure it could not be easily found by the public.

Unlike other petitions which are easily found at Petitions.WhiteHouse.gov, the petition opposing vaccine mandates was deliberately hidden from view and could only be accessed if someone knew the direct URL.

On YouTube, this is equivalent to setting a video to “unlisted” status to prevent the public from finding it.

To help people find the petition, Rima Laibow set up a new link that directs people to the correct petition URL:

http://TinyURL.com/VaccinationISViolation

A pattern of systematic deceit by vaccine pushers

This fraudulent attempt by the White House to suppress this petition and prevent it from reaching 100,000 signatures is part of an extraordinary pattern of lying and deceit on the part of today’s medical extremists who demand all people be injected with vaccines, even against their wishes and in blatant violation of the American Medical Association’s code of ethics.

The vaccine industry, we have all observed, is willing to do anything it takes to prevent the public from learning real facts about vaccines or even achieving success with an online petition that calls for the protection of medical choice for mothers and their children.

USA Today, the same publication that ran an article authored by a mentally deranged vaccine fanatic who called for the arrest and imprisonment of “anti-vaxxers,” recently conducted an online survey that asked Americans whether they support the arrest and imprisonment of people who rejected vaccines. The results of that survey reveal that 92% of Americans support vaccine choice and reject government coercion for forced vaccinations.

Jail parents who opt out: 2%
It’s a choice: 92%
Fine parents who opt out: 5%
Inform parents vs. jail: 2%

Only 2% support government coercion against parents who choose to avoid toxic vaccines. Public support for laws prohibiting forced vaccination policies is remarkably high; far higher than public support for President Obama himself.

So in an attempt to destroy the perception that the public strongly opposes the government coercion of medical choice (also called “medical fascism”), the White House has now gone to extraordinary lengths to suppress the online petition that calls for fundamental human rights and medical choice.

This pattern of deceit and coercion is far larger than the White House alone. It includes:

• The CDC’s deliberate burying of scientific data linking vaccines to autism (as confessed by the CDC whistleblower Dr. William Thompson).

• The mainstream media’s blatantly one-sided media coverage of vaccines, where no scientific questions about vaccines are ever allowed to be aired, and any doctor who asks an intelligent question about vaccine ingredients, vaccine safety or vaccination schedules is verbally assaulted with the derogatory, intellectually-bigoted label of “ANTI-SCIENCE!”

• The ongoing delusion of “mercury denialism” where even the Associated Press publishes articles that falsely claim mercury has been “phased out” of all vaccines even though the CDC confirms mercury, MSG, formaldehyde and aluminum are still used in vaccines.

• The Disneyland measles hoax, where the CDC knows full well that the viral strain of measles found in MMR vaccines is different from the strain of measles that has spread among children. The genetics don’t match, which means the MMR vaccine would have done little or nothing to stop the outbreak in the first place.

• The complete suppression of true stories of vaccine-damaged children who have suffered severe neurological harm, painful skin disorders, comas and even death due to vaccines. See horrifying photos here of just some of the children who are being medically mutilated by the very same vaccines that government authorities tell us are “safe.”

• The widespread refusal of the FDA to acknowledge the truth that it does not test vaccines for safety or efficacy and instead relies entirely on Big Pharma’s own self-funded studies to “prove” vaccines work. But those studies have been faked, say the industry’s own scientists, who describe how animal antibodies were used to spike human blood samples in order to defraud the FDA and keep selling vaccines that do not work.

• The publication of a medical extremism article in USA Today which openly called for the government to arrest and imprison so-called “anti-vaxxers.” This article, like nearly all articles on vaccines that appear in the mainstream media, was written by a mentally ill vaccine fanatic with a bizarre desire to incarcerate informed vaccine skeptics who raise intelligent, rational questions about vaccine safety and immunization scheduling. USA Today has no problem giving a platform to mentally ill vaccine fanatics as long as they keep calling for more vaccines.

TAKE ACTION: Sign the petition and watch how your vote doesn’t count at the White House

Want to sign the WhiteHouse.gov petition and see the petition fraud for yourself?

Click here to sign the petition and notice how the number of signatures doesn’t budge even after you sign it.

Or, possibly, WhiteHouse.gov will reactivate the petition after being caught red-handed and exposed by this story, but they will still throttle the petition to make sure it never quite reaches the 100,000 threshold.

This petition fraud, of course, perfectly mirrors every fraudulent tactic of the vaccine industry which is utterly incapable of any behavior at all that resembles ethics or honesty. Every layer of the vaccine fraud now being perpetrated upon the American public is steeped in deceit, fabrication and fraud.

Aborting Black America

The ‘black lives matter’ slogan excludes the unborn

Illustration on the rate of black babies being aborted in America by Alexander Hunter/The Washington Times

“Black lives matter” has become the slogan of anti-police protests across the nation, but the target of the protests is so misplaced that the motives of the so-called civil rights leaders behind the movement must be questioned. Do they really care about black lives? Or are they cynically exploiting isolated incidents, such as the death of Michael Brown, to inflame the black population and advance their own political interests?

Today, on the somber anniversary of the Supreme Court’s Roe v. Wade decision, it’s time for black leaders to face up to the real danger threatening black lives in America. It isn’t the police. According to an anti-police brutality organization, the Malcolm X Grassroots Movement, 313 blacks were killed by “police, security guards and vigilantes” in 2013. It isn’t even black criminals, who, as Rudy Giuliani famously pointed out on “Meet the Press,” are responsible for 93 percent of violent deaths among blacks. Sources estimate that between 6,000 and 8,000 blacks are murdered each year.

No, the greatest danger to blacks is found precisely where we ought to be safest: in our mothers’ wombs. In 2010, the most recent year for which statistics are available, 138,539 black babies were aborted.

Thankfully, abortion is on the decline in America, down 3 percent between 2007 and 2010, according to the Centers for Disease Control (CDC). Strikingly, the number of surgical abortion clinics has plummeted, from 2,176 in 1991 to 551 today. Nevertheless, the CDC report that in 2010, a staggering 765,651 abortions were performed in the United States. Black women continue to have the highest abortion rate of any ethnic group, with a gruesome 483 abortions for every 1,000 live births.

The bottom line? I’ll say it again: 138,539 black babies, nearly one baby in three, were killed in the womb in 2010. According to the CDC, between 2007 and 2010, innocent black babies were victimized in nearly 36 percent of the abortion deaths in the United States, though blacks represent only 12.8 percent of the population. Some say the abortion capital of America is New York City. According to LifeSiteNews, the city’s Department of Health reported that in 2012, more black babies were aborted (31,328) than born (24,758). That’s 55.9 percent of black babies killed before birth. Blacks represented 42.4 percent of all abortions.

Legalized abortion is working out exactly as Margaret Sanger intended. Sanger, the founder of the nation’s largest abortion provider, Planned Parenthood, was part of the eugenics movement back in the 1930s. Her goal was to use abortion to cull what she considered inferior races from the human gene pool. According to Sanger, “Colored people are like human weeds and are to be exterminated.” She opened her first abortion clinics in inner cities, and it’s no accident that even today, “79 percent of Planned Parenthood’s abortion facilities are located in black or minority neighborhoods.”

We mustn’t forget that babies aren’t the only victims of abortion. Sadly, more and more of the mothers are suffering and dying as well. Though many people continue to deny it, the link between abortion and breast cancer has been amply documented, and this deadly consequence of abortion is plaguing greater and greater numbers of black women.Ironically, black women used to suffer from breast cancer less frequently than white women. Not any longer. The Black Women’s Health Imperative notes that according to an American Cancer Society report, black women now develop breast cancer almost as frequently as whites, and are more likely to die from the disease. LifeSiteNews also cites an American Cancer Society report that black women under age 40 now are more likely to develop breast cancer than their white counterparts. They can thank Margaret Sanger — and some of today’s so-called civil rights leaders.

Sanger relied on black ministers to act as Judas goats leading their sisters to abortion mills. According to LifeSiteNews, Sanger wrote in 1939, “We do not want the word to go out that we want to exterminate the Negro population, and the minister is the man who can straighten that idea out if it ever occurs to any of their more rebellious members.”

Some black leaders are still acting as Judas goats today. LifeSiteNews cites black pro-life activist Ryan Bomberger: “Back in 2005, the NAACP praised the high black abortion rate as compared to the percentage of the population at a NARAL fundraising gala. When more black babies are aborted than are born alive in NYC and the NAACP responds by supporting Gov. [Andrew] Cuomo’s radical abortion expansion via the misnamed ‘Women’s Equality Act,’ one can understand how the targeting of minorities continues unabated.”

Abortion is the greatest threat to black lives in America today. People who claim to represent the black community while also abetting the black holocaust — abortion — are hypocrites. Any “civil rights leader” who genuinely believes that “black lives matter” should be working to see that every black baby is accorded the very first civil right — the right to life.

J. Kenneth Blackwell is a policy board member of the American Civil Rights Union.

Cover Oregon Shutdown Leads To 62 Layoffs

Cover Oregon logoSource: KTVZ

Cover Oregon has announced 62 layoffs in connection with the shutdown of the failed health insurance exchange.

Oregon’s Department of Community Colleges and Workforce Development received notice of the mass layoff in a letter dated Jan. 8.

Cover Oregon Executive Director Aaron Patnode told the agency that layoffs will occur in March and April. Most employees being let go work in customer service.

The state abandoned the exchange in April, 2014 after deciding it was cheaper to switch to the federal site than to fix Cover Oregon. At the time, officials warned there would be layoffs in 2015.

Lawmakers plan to pass a bill dissolving Cover Oregon early in the 2015 Legislative session.

Health Care Costs Are Crippling American Middle Class Workers

https://i1.wp.com/www.ldjackson.net/wp-content/uploads/2013/11/Obamacare_realitycheck.jpg
Whiskey Tango Texas Summary:

  • Obamacare is forcing American middle class workers to skip doctor visits, putting off procedures and forcing self rationing or avoidance of necessary prescription drugs.
  • American middle class are forced to pay so much out-of-pocket that it’s as good as not having insurance.
  • When middle class workers are financially forced to skip health care by their government, they’ll enter a downward spiral that imperils their physical and financial health over time.

Authored by Laura Ungar and Jayne O’Donnell for USA TODAY.

Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.

“It’s flip-flopped,” says Arla, who helps his father run a family practice in Hillview, Ky. Patients with job-based plans, he says, will say: ” ‘My deductible is so high. I’m trying to come to the doctor as little as possible. … What is the minimum I can get done?’ They’re really worried about cost.”

It’s a deep and common concern across the USA, where employer plans cover 60% of working-age Americans, or about 150 million people. Coverage long considered the gold standard of health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills — much as the uninsured have done.

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of the cost, and other surveys have found much the same. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation. And a Mercer study showed that 2014 saw the largest one-year increase in enrollment in “high-deductible plans” — from 18% to 23% of all covered employees.

Meanwhile the size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage. Add to this co-pays, co-insurance and the price of drugs or procedures not covered by plans — and it’s all too much for many Americans.

Holly Wilson of Denver, a communications company fraud investigator who has congestive heart failure and high blood pressure, recently went without her blood pressure pills for three months because she couldn’t afford them, given her $2,500 deductible. Her blood pressure shot so high, her doctor told her she risked a stroke.

LaRita Jacobs has severe arthritis and delayed a neckLaRita Jacobs has severe arthritis and delayed a neck surgery until it got so bad she couldn’t lift a fork. Now, she is delaying shoulder surgery that her doctor recommends and opting for less expensive physical therapy and enduring the pain. Here, she readies the needle for her weekly injection of Methotrexate, a type of chemotherapy regularly used for people with autoimmune diseases like rheumatoid arthritis.
(Photo: Melissa Lyttle for USA TODAY)

And LaRita Jacobs of Seminole, Fla., who gets insurance through her husband’s job and has an annual family income of $70,000, says $7,500 a year in out-of-pocket costs kept her from dealing with an arthritis-related neck problem until it got so bad she couldn’t lift a fork. She’s now putting off shoulder surgery.

“How did we get to this crazy life?” asks Jacobs, 54. “We’re struggling to pay our bills like we were struggling when we first got started.”

Why is this happening? Many patients and doctors blame corporate greed — a view insurers and business leaders reject. Some employers in turn blame the Affordable Care Act, saying it has forced them to pare down generous plans so they don’t have to pay a “Cadillac tax” on high-cost coverage in 2018. But health care researchers point to a convergence of trends building for years: the steep rise in deductibles even as premiums stabilize, corporate belt-tightening since the economic downturn and stagnant middle-class wages.

“It’s a case of companies trying to offer workers health insurance and still generate profit,” said Eric Wright, a professor of sociology and public health at Georgia State University. “But whenever costs go up for the consumers across the board … it promotes a delay in care.”

Others disagree, saying that when people pay for their care, they shop more intelligently. Chris Riedl, Aetna’s head of product strategy for its national accounts, says her company’s research does not indicate that insured patients are showing up sick in emergency rooms with long-neglected illnesses — which to her means, “intuitively, they’re not avoiding care.”

But many doctors contend it’s only a matter of time before the middle class begins crowding ERs. They say putting off care can be dangerous, exponentially more costly and, if it continues and spreads, can threaten the health of the nation.

Bullitt County, Ky., family practitioner  Mohana Arla,Bullitt County, Ky., family practitioner Mohana Arla, right, and intern Dominique Rhymes examine Lee Curry, 54. Curry was injured while working to pull a passenger from a wrecked vehicle as a Sheriff’s Department employee when his wrist was slammed in a truck door by a wind gust on Oct. 31, 2014. (Photo: Alton Strupp for USA TODAY)

 Monitoring The Trend

‘Can I stop taking this medication?’

Praveen’s father, Mohana Arla, says being forced to pay so much out-of-pocket “is as good as not having insurance” in an era of ever-rising health care costs. Inpatient care last year averaged $17,553, and insurance plans require people to pay a portion of that even after meeting their deductibles, up to an out-of-pocket maximum that can easily exceed $10,000 a year for families. Median household income in the U.S. is around $53,000, and the average American has less than $6,000 in savings, according to a 2012 report by Pitney-Bowes Software. A quarter have no emergency savings at all, Bankrate.com reported in June.

“Health expenses tend to come up unexpectedly, or if you have a chronic condition, they come up relentlessly,” adds Karen Pollitz, a senior fellow at Kaiser. “People put off care or they split their pills. They do without.”

Mounting evidence backs that up:

• Nearly 30% of privately insured, working-age Americans with deductibles of at least 5% of their income had a medical problem but didn’t go to the doctor, the Commonwealth Fund found. Around the same percentage skipped doctor-recommended medical tests, treatments or follow-ups.

• Nearly half of middle-class workers skipped health care services or fell into financial hardship because of health expenses, according to a survey by the Associated Press and NORC Center for Public Affairs Research.

• Use of hospital care among insured workers has been dropping since 2010, and use of outpatient care, such as doctor visits, dropped slightly for the first time from 2012 to 2013, according to insurance claim data analyzed by the Health Care Cost Institute.

• Medical professionals across the USA see the reality behind the research. The Arlas’ patient load used to be 45% commercially insured and 25% Medicaid; those percentages are now reversed. Stan Brock, founder of Remote Area Medical, which runs free clinics around the nation, says the group’s volunteer workers found that around 7% of patients who came to one of the clinics had job-provided insurance — and some waited for days just to keep a prime spot in line.

Patients often do a sort of medical and financial triage when they get sick. Jacobs, a former college professor, says every time a doctor suggests a new test, procedure or medication for her severe arthritis, she asks herself: ” ‘Is it critical?’ You’re always playing the odds. … And I’m constantly asking my doctor: Can I stop taking this medication?”

When her shoulder started hurting a couple of years ago, she had an X-ray but put off the recommended MRI for two years. It worsened, and she couldn’t move her arm without pain or lift her right hand above her head. She finally got that surgery in October but is now forgoing a shoulder procedure, opting for less expensive physical therapy and planning to “tough out the pain.”

“You don’t want another surgery … another bill,” she says. “It may be more of a problem later, but that’s the risk you take.”

While all out-of-pocket expenses play a role in such decisions, experts say the driving factor is the deductible, which averages $2,000 or more for single coverage for nearly one in five workers and from around $2,000 to $4,500 for families, depending on the type of plan. Companies may help fund health-savings accounts to pay some of these costs, sometimes with only a few hundred dollars.

“I can remember when $1,000 was considered a high-deductible plan. Now that’s become kind of the norm,” Pollitz says. “We’re kind of in high-deductible land.”

The cost shift extends to workers in government jobs, long known for bountiful benefit packages. Lee Curry, a sheriff’s deputy in Bullitt County, Ky., says his county health plan comes with a $1,500 deductible, which keeps him from going to the doctor at all.

“Health insurance doesn’t cover much of anything until you cover your deductible,” says Curry, 54. “It puts a burden on you. You’ve got to have the money to be seen.”

Is Obamacare To Blame?

 Stagnant salaries also skew budgets

Since the ACA took effect, “there’s been an accelerated movement” to these types of health plans, says Brian Marcotte, president and chief executive officer of the Washington, D.C.-based Business Group on Health.

Marcotte, whose group represents 400 large employers, says that the looming Cadillac tax is one factor but acknowledged that managing health care costs is another.

Companies have cited the ACA for cutting medical benefits in other ways. For example, United Parcel Service partly blamed the law when it removed thousands of spouses from its plan because they are eligible for medical coverage elsewhere.

But DeAnn Friedholm, director of health reform for Consumers Union, says she’s skeptical when employers point to the ACA. “This isn’t new,” she says. “Companies have been cutting back on benefits and cutting costs for decades.”

Sara Collins, vice president for Health Care Coverage and Access at the Commonwealth Fund, says two ACA requirements — keeping children under 26 on their parents’ plans and covering preventive care — didn’t add much to companies’ health care tabs, partly because most already covered preventive care such as physicals and mammograms. Pollitz says the ACA actually holds down the consumer burden by capping out-of-pocket expenses at $6,300 a person — which, although that amount is “more than most people have in the bank,” is better than no cap at all.

Experts point out that the ACA requires preventive care to be covered fully and exempt from deductibles — although surveys show many workers still forgo screenings and physicals because they’re unaware of this or know they can’t afford follow-ups if illnesses are found.

Several experts say the consumer crunch has less to do with the health system overhaul than stagnant salaries. The average hourly wage is nearly identical to what it was 50 years ago in today’s dollars: $19.18 in 1964 compared with $20.67 in 2014, according to U.S. Bureau of Labor data analyzed by the Pew Research Center. Meanwhile, U.S. health spending ballooned from 5% of gross domestic product in 1960 to 17% in 2013.

“People are very close to the line in terms of their budgets,” Collins says. “What consumers are really seeing is their incomes have grown even slower than the slower growth in health care costs” in the past few years.

Insurers also blame the cost of care, saying that can’t be absorbed just by premiums. But Wilson and other patients put much of the blame on insurers.

“Insurance is all about the dollar,” Wilson says. The never-ending cost shift to consumers “is something that basically all kinds of people screwed up. … Obamacare is a step in the right direction. But it’s not enough. I expected more out of it than I got.”

The Ugly Side Effects

A spiral of painful debt

When consumers skip care, they enter a downward spiral that imperils their physical and financial health.

Jennifer Ross, an arthritis sufferer in Florida insured through her husband’s job, says she recently made the wrenching decision not to take a medication that might allow her to get around without her wheelchair. The $2,400-a-month medicine would cost her $600 a month out-of-pocket even with insurance, and she simply can’t swing it. To make matters worse, Ross’ 12-year-old daughter was recently diagnosed with arthritis, too.

“It’s a no-win situation,” Ross says.

Surgeon Paul Ruggieri of Fall River, Mass., says his patients with high-deductible plans often blanch at the out-of-pocket cost to electively treat two common ailments he sees regularly — gallstones and hernias — until they become potentially dangerous and costly emergencies.

If the procedures are done electively, patients are required to pay half of the cost upfront; a hernia repair done laparoscopically would cost about $4,000 at a surgery center. That’s often about the amount of some patients’ deductibles, so they would have to pay the full bill out-of-pocket. If the procedure is done at a hospital, even laparoscopically, it can cost as much as $17,000. If patients delay and are rushed to the emergency room for the procedure, the hospital would charge at least two to three times the amount of the surgery, Ruggieri says. It would also mean a two- to three-day hospital stay vs. two hours for the elective procedure, and much longer at-home recuperation.

Paul Ruggieri, with medical assistant Monica DePonte,

Paul Ruggieri, with medical assistant Monica DePonte, is a surgeon who sees a lot of hernia and gall bladder patients who put off care until it becomes an emergency.
(Photo: Josh T. Reynolds for USA TODAY)

‘Skin In The Game’

The push for preventive care

“I’ve worked for 35 years. I never wanted to go on Medicaid,” says Brown, 50. “It’s horrible. I paid for insurance for all those years, and still ended up in this situation.”

But insurers, employers and others say that such stories are the exception and that high deductibles generally encourage consumers to seek the best value for their dollar.

“By having deductibles, it puts skin in the game,” says Divya Cantor, senior clinical director for the insurer Anthem in Kentucky.

Joel Diamond, a Pittsburgh primary care doctor, thinks high-deductible plans are a smart choice for people who can’t afford higher premiums and are generally in good health.

He cites the case of a young woman who couldn’t afford insurance on her own who stopped having periods and went to the emergency room with severe headaches. Diamond discussed doing testing for possible ovarian and endocrine problems. When blood work showed abnormal levels of the hormone prolactin, he recommended an MRI to rule out a pituitary tumor. Her bill for just a few hours in the emergency room was $15,000, something that will take her years to pay off.

If she had had a high-deductible plan, he says, it would have paid for a large chunk of the cost, and her debt could have been a third to half as much.

“We don’t have car insurance for windshield wipers and oil changes, but we need it for the catastrophic stuff, just like our health care,” says Diamond, who is also chief medical officer for the health care IT company dbMotion.

Aetna’s Reidl says her company allows people to compare prices easily on its website. Some tests, for example, could cost hundreds of dollars or less at some hospitals and thousands at others.

Aetna, the first national insurer to move to high-deductible plans — which it coined “consumer-directed plans” — more than a decade ago, says the plans help employees and employers save money.

Reidl says she has heard the criticism that they “may cause some individuals to put off care,” but counters that Aetna members with these plans get routine preventive care and screenings at higher rates than those with other plans. And their employers save an average of $208 per employee per year after they switch to high-deductible plans.

“We’ve seen that over 10 years consistently,” she says.

Aetna recommends companies pair the plans with health reimbursement or savings accounts — which allow employees to set aside tax-free money to use for cost sharing — to ease the burden of out-of-pocket costs on employees.

But Wendell Potter, who used to work in public relations in the insurance industry and has since written a book about the experience called Deadly Spin, says insurers who study high-deductible plans are “not disclosing everything they find.”

“They do these reports based on their populations to try to sell more of these plans to employers,” he says. Population-based reports don’t necessarily reflect the fact that “individuals and families are having to file for bankruptcy because they are in their plans.”

Potter left his public relations job at Cigna in 2008 in part because “I was expected to be a champion” of high-deductible plans. He says these plans are “taking us in the wrong direction … back to a system that we would have thought the ACA prevented.”

The Future

Will time heal all?

There are no signs high deductibles are going away.The Centers for Medicare and Medicaid Services last month cited these plans as one of the reasons health care spending hit a record low in 2013. But CMS statistician Micah Hartman says his office is “not looking forward to what the impact would be going forward” if consumers who delay care need far more expensive emergency care later.

Meanwhile, experts say Americans will need to take further steps to control their health costs.

Wilson, the Denver patient, says that after her doctor scolded her for stopping her blood pressure pills, she now takes them daily. But keeping up with her six medications is a constant struggle given her $33,000-a-year income, so she copes by asking for samples from the doctor, using a prescription discount plan and sometimes buying just a few pills at a time.

Doctors and doctor groups say such individual coping strategies can be helpful, but action is needed on a national level. The American Academy of Pediatrics recently came out with a policy statement saying high-deductible plans “may be a less desirable way to lower health care costs than other means … even if ‘other means’ require more work by government, insurance companies and other health policy participants.”

They say policymakers should consider requiring that the plans cover only adults, not children, as adults may suffer more from reduced care. The group also suggests exempting outpatient care from deductibles and requiring employers to put a lot more money in health-savings accounts that go with the plans.

Oncologist Ezekiel Emanuel, the former special adviser for health care policy to the director of the Office of Management and Budget, says insurers and employers moved to high-deductible plans rather than trying to come up with “a more intelligent plan design.”

Emanuel, who is considered an architect of Obamacare, says that he is “not a fan of high-deductible plans” and that what’s needed are “smart deductibles” that don’t discourage people from using the services they really need to stay healthy. He cites the preventive care visits that aren’t subject to deductibles under the ACA.

Higher deductibles, he says, should apply to “discretionary services” like knee replacements and low or no deductibles should be for important treatment such as for insulin or ophthalmologist visits.

But Wright, the Georgia professor, says he doesn’t see any major changes on the near horizon.

“I wish I could be optimistic, but I’m not sure,” he says. “There’s a lot of reason to be worried about the future.”

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