[ebuddy]

HealthCare.gov’s appointed crisis coordinator, Jeff Zients, announced today that by November 30, he intends for the website to be able to handle 50,000 simultaneous users. National Journal reports, “By the end of the month, the site will be able to handle 50,000 users at once – the goal it was supposed to meet when it launched, Zients said.” He said that will enable the site to handle 800,000 people a day – “a conservative estimate,” he said in a conference call with reporters.

Zients said the site would work “smoothly” for “the vast majority of users” by the end of the month, Obama said “the majority of people who go to the site” will have a good experience.

1. Do you believe the site will conservatively, handle 800,000 people a day "smoothly" for the "vast majority" of these 800,000 users?
2. What is vast majority?
3. What is smoothly?
4. How soon can we get independently-verified numbers?

If I were to be 100% pessimistic in answering the above with regard to the competency of this Administration; how accurate would I be? My answers are;

1. No. It will not provide a smooth experience for the vast majority of conservatively, 800,000 users per day.
2. Vast majority = >51%.
3. It seems fair to define smoothly using Obama's examples including Amazon.com or Kayak.com. Forget for the moment the amount of traffic processed by Amazon's Web Service alone, I'd say my experiences with Amazon.com have been generally, trouble-free. User error notwithstanding. Security is something else entirely and with heightened traffic and enrollment on hc.gov, we'll get a better sense of its robustness.
4. It will take two weeks for independent contractors to have access to the numbers. The WH will "trickle" information to the public through a visibly-anguished Jay Carney in softening expectations over that time.

[turtle777]

I think less and less people will even use the site, because they already know they can't afford it.

In the end, even a non-functional site will not cause much outrage. Total success.

-t

[Snow-i]

You have to buy the plan to know what's in it.

[auto_immune]

The site works, but the product is still a steaming pile of horse dung = win/lose

[ebuddy]

Originally Posted by Snow-i 

You have to buy the plan to know what's in it.

This is kind of true by the way!

One of the modifications to the portal that's supposed to make it run more efficiently is that you will no longer get a hard figure on your premium and subsidies before enrollment. You'll get an estimate and then to get the real rate, you have to enroll. A concern has been expressed that the two will vary wildly causing even more frustration and confusion.

The next challenge will be trying to cancel the sob post-sticker shock.

[BadKosh]

Funny that they ASSumed that young people would "Flock To" the web site and sign up, and they never actually checked to see if their ASSumption was correct. This was to be the main funding aspect that would keep OWE-bamacare from being a real drag on the economy and the Gov't. I think they made lots of assumptions about people that were just fictional stereotypes.

[ebuddy]

^^^ Exactly. Extensive reports were provided to the WH as early as 2010 so they cannot even plausibly deny their awareness of the insurance cancellations. They were going to try to pin it on insurance companies in a way to hasten the Single-Payer scheme they've wanted from the beginning. The problem is, the majority of the public is not viewing this as the fault of the Insurers, but the fault of the Obama Administration's false advertising that would assuredly land any private mogul in prison. Watching the Democrats who had been in lock-step with this Administration from the beginning attempt to weasel out of this next year would be a lot more fun if it didn't include many millions more expected to be dropped from coverage.

[turtle777]

I can't wait for the employer mandate to kick in. Can you imagine how much more we'll find out once that kicks in.

-t

[ebuddy]

Originally Posted by turtle777 

I can't wait for the employer mandate to kick in. Can you imagine how much more we'll find out once that kicks in.

-t

Interesting that almost on a daily basis, a new element of this Law of the Land ® is being pushed beyond next year's election and for just the reason you suggest above. What kills me is this Administration's lack of any foresight. The announcements on cancellations will assuredly have to come before the election to be ready for the beginning of 2015. This Administration must believe the collective intelligence is much lower than even I've given it credit for in voting these morons into office.

[turtle777]

This Potus knows that a certain group of people will always vote for him and believe, that he has their best interest at heart. Bless their naive souls, reality is going to be a real bitch.

-t

[ebuddy]

THIS JUST IN: Titanic sinks at port. Obama has ruled by Executive fiat that November 30th will now begin @ 8:00 AM tomorrow. The website is being brought down for maintenance until then.

So... okay. Turns out my 100% pessimistic analysis lacked imagination. Assume we're talking about an 8:00 AM start. egadz

[Shaddim]

It's not Nov 30th right now (4:45AM EST)? I hate to break it to him, and his ego, but even his orders can't make today into yesterday.

Damn, what a worthless git. He's a complete and utter embarrassment, even makes Dubya seem competent in comparison.

[BadKosh]

I wonder how many will be really late or won't file tax returns this year because of the ACA?
Did they add new questions about how many guns you have as part of the ACA questionaire
(as a way to claim YOU falsified Fed Doc. you now have to pay a big fine/tax)?

[ebuddy]

Apparently, handle and smoothly means you can get an email telling you when you to log on. This, after Sebelius urged people to use the site during off-peak hours and delayed the SHOP exchange for a year.

The website, which the administration promised would “function smoothly” for most people by Nov. 30, remains a work in progress. It is more stable, with many more people able to use it simultaneously than just two weeks ago. But it still suffers sporadic crashes, and large parts of the vital “back end” that processes enrollment data and transactions with insurers remain unbuilt. ~ New York Times

Watch for Insurers to report back on impossibly sloppy applications and non-payments. How in all that is good and green on this earth will Insurers be able to process applications lacking the most fundamentally important enrollment data and funds? We're two months in and the system of processing enrollment isn't finished yet?

[BadKosh]

Looks like they saved a BUNCH OF MONEY by not adding useless things like SECURITY. Who is responsible when someones personal data is acquired by ID thieves? Can they bill/sue HHS?

[Shaddim]

It'll be awesome when all of your information is centrally located, allowing for easier access.

[ebuddy]

And just how important is this new government customer?

Feds reveal 10% error rate

An estimated 10 percent of all enrollments now being made on the federal Obamacare marketplace contain data errors that could delay people from actually getting health coverage, officials disclosed Friday.

And that error rate for enrollments submitted via HealthCare.gov and then sent to insurers before December was an estimated 25 percent, officials revealed.

The rate fell in the past week, officials said, because of repair efforts to HealthCare.gov's, particular the discovery and fix of one particular software problem that was causing an estimated 80 percent of data errors, officials said.

But both past and present error rates are much higher than 1 percent, the rate which insurers considered to be unacceptable when doing business outside the Obamacare exchanges.

And to think my employer manages to five 9's of reliability; 99.999% to protect the customer experience and the insurance industry considered a 1% application failure rate an unacceptable customer experience prior to the ACA. The Federal government announces their decreasing error rates from 25% to 10%.

This is how it works, folks. This is what you get. And that's just what they've leaked out so far.

[Shaddim]

Quality is job one 9:1.

[ebuddy]

healthcare.gov crashed on Friday amid the enrollment deadline today. Nice. This is kind of like the hold-recording reminding you that your call is important to them after 10 minutes of holding. The customer doesn't really feel their importance.

[BadKosh]

They will also wonder what they did to get such a high deductible, making the expensive insurance worthless.

The Democrat gift that KEEPS ON HATING!

[Snow-i]

CNN Poll: Health care law support drops to all-time low – CNN Political Ticker - CNN.com Blogs

Success! Everyone hates it and it's failing, but lets do it anyways!

[turtle777]

Wrong. "Let's make it worse anyways" is going to be the governments response.

Next up: Single Payer system to the rescue.

-t

[ebuddy]

^^ KABOOM! This is exactly what I'm afraid of.

[BadKosh]

Administration Extends Deadline for Obamacare Sign-Up Through Christmas Eve | National Review Online

So where was it where CONGRESS and the President signed off on this? Oh, wait...... This is a fantasy bill brought to you by incompetent dbaggers and the law doesn't matter.

[turtle777]

Originally Posted by ebuddy 

^^ KABOOM! This is exactly what I'm afraid of.

It's a near certainty. Unless some party swoops into office in 2016 and proposes a REAL fix to the healthcare mess.

-t

[turtle777]

Originally Posted by BadKosh 

and the law doesn't matter.

The law hasn't mattered in a while. The assholes in Washington and Wall Street will do as the wish.
They don't care about laws, and the government isn't enforcing the laws for their own.

-t

[BadKosh]

Ready for MORE TAXES? Owe-bamaCARE, the gift that just keeps on hurting the Democrats.

New ObamaCare fees coming in 2014 | New York Post

[Snow-i]

Badkosh save your breath. "Our friends on the left" have no interest in this thread anymore as it has turned out exactly as we predicted, with one massive failure after another and countless taxpayer dollars in the pockets of Obama's friends, while you and I now have to deal with a degrading level of care and higher premiums, not to mention more taxes and fees than I am capable of counting.

Let's not even start the discussion about how he outsourced this project to a foreign company, exactly as he described would be the case if Romney had won the election.

[ebuddy]

UPDATE: CGI Contract expires in February and the Obama Administration doubles-down on another foreign-based, evil outsourcer to take over and will be awarding them an immediate, additional $90 million to get to work on the system.

Obama Administration gives no-bid (sole-source) contract to Accenture. Who is Accenture? They are a multinational management consulting, technology services, and outsourcing company with more employees in India than anywhere else. They originally incorporated in Bermuda, since moved to Dublin, Ireland.

Yes, the same Accenture that in September of 2011 settled a whistle-blower lawsuit with the US Justice Dept in penalty of $63 million for;

• kickbacks for its recommendations of hardware and software to the government
• fraudulently inflated prices
• rigged bids in connection with federal information technology contracts

You can't make up shit this insane ladies and gentlemen, you just can't.

[Shaddim]

How much are Obama and his buddies getting back from that? Holy shit, that's some dirty pool.

[BadKosh]

The dbaggers who wrote ACA should be shot!

"THE MILLIONS WHO ARE ENTERING Medicaid under ObamaCare's expanded eligibility may not know that their assets are at risk, unaware that the federal law allows states to recover health costs after someone's death by seizing assets. "

ObamaCare death debt? States can seize assets to recoup Medicaid costs | Fox News

[ebuddy]

Originally Posted by Shaddim 

How much are Obama and his buddies getting back from that? Holy shit, that's some dirty pool.

That's just it, who could have a clue. If they've already been cited for inflating prices, rigging bids, and throwing kickbacks to their government cronies, you gotta wonder who's in their pocket on this one. It just never ends.

Originally Posted by BadKosh

"THE MILLIONS WHO ARE ENTERING Medicaid under ObamaCare's expanded eligibility may not know that their assets are at risk, unaware that the federal law allows states to recover health costs after someone's death by seizing assets. "

The large print giveth, the small print taketh away.

[Snow-i]

Originally Posted by ebuddy 

The large print giveth, the small print taketh away.

What's so funny and sad about this is it doesn't even deliver on the large print.

Prices - higher
Quality of service - lower
Number of people with health insurance - less than before
Taxes on middle income families - higher
"If you like your plan" - hahahaha
Website backend - not even built
Website front end - not even close

0 for 7. Plus the small print.

[Shaddim]

The CBO is back, with bad news for the ACA. When the news is good, Obama's crew tout the CBO, now... well, they're trying to distance themselves as much as they can.

Dana Milbank: Obamacare’s scorekeepers deliver a game-changer - The Washington Post

[auto_immune]

And this $#@T is supposed to be Hope and Change ? ? ?

More like Despair and Decay, if you ask me!

[BadKosh]

No wonder the Democrats are quitting their day jobs. They don't want to be the minority party. I guess they think the Repubs would treat them as well as they were treated in 2009.

[OAW]

Originally Posted by Shaddim 

The CBO is back, with bad news for the ACA. When the news is good, Obama's crew tout the CBO, now... well, they're trying to distance themselves as much as they can.

Dana Milbank: Obamacare’s scorekeepers deliver a game-changer - The Washington Post

That's not what the White House is doing at all. All they've done is "distanced itself" from the sensationalistic headlines that don't accurately reflect the actual content of the report.

For Republicans, the latest big report on Obamacare has seemed like a godsend for the 2014 elections.

”Obamacare To Print Even More Pink Slips,” Senate Republicans declared in an email blast. ”This Non-Partisan Congressional Budget Office Report Confirms That ObamaCare Will Cost America 2 Million Jobs,” the National Republican Congressional Committee added. The overriding message: Even wonks agree with us that Obamacare is a job-killer.

The problem is, that’s not what the Congressional Budget Office’s (CBO) new numbers are saying.

Here’s the real takeaway from the report: Obamacare will reduce the number of equivalent full-time workers by 2 million in 2017 because employees will be able to receive coverage through Obamacare-subsidized programs and decide to stop working full-time—not because they’re getting “pink slips.” More specifically, the Affordable Care Act contains certain incentives for people not to work full-time because Obamacare subsidies, Medicaid expansion eligibility, and other major parts of the law are calculated according to income.

Some of these workers will decide to go part-time to receive higher subsidies from insurance purchased through the Obamacare exchanges, or to qualify for the Medicaid expansion. Others include workers who will decide to retire earlier than expected, as they’ll no longer be refused coverage because of pre-existing conditions; and disabled workers who will more easily be able to enroll in Medicaid. Overall, these will mostly be lower-wage workers who risk getting priced out of exchange subsidies or Medicaid.

So Obamacare isn’t forcing businesses to hire fewer workers, destroying 2 million jobs in the process. It’s reducing the amount of hours that Americans are choosing to work by about 1.5% to 2%, or the equivalent of about 2 million jobs in 2017 and 2.5 million in 2024. As the CBO explains, “the estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.” So while the health-care law will push down labor-force participation, it won’t change the labor market by increasing unemployment or underemployment of part-time workers who would rather be working full-time, the report concludes.

No, Obamacare isn't handing out 2 million pink slips | MSNBC

So older workers who no longer have to work full-time just to have healthcare coverage can either start working part-time or retire. And lower-wage workers who are presently in the "donut hole" of the ACA as a result of GOP governors refusing to expand Medicaid coverage in their states may work less in order to qualify for Medicaid ... when they otherwise would have continued their present amount of work hours. So this part directly from the CBO report bears repeating ....

Originally Posted by CBO Report

The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.

Of course, major media outlets looking for ratings or clicks will naturally roll with the misleading headline that stokes controversy ... and either bury such details way down in the article or fail to mention them altogether because they don't fit their preferred narrative. Which is to be expected. Exhibit A which is the main headlined story on Fox News at this very moment ...

The head of the nonpartisan Congressional Budget Office delivered a damning assessment Wednesday of the Affordable Care Act, telling lawmakers that ObamaCare creates a "disincentive for people to work," adding fuel to Republican arguments that the law will hurt the economy.

The testimony from CBO Director Douglas Elmendorf comes after his office released a highly controversial report that detailed how millions of workers could cut back their hours or opt out of the job market entirely because of benefits under the health law.

The White House and its Democratic allies accused Republicans, and the media, of mischaracterizing the findings. But Elmendorf backed Republicans' central argument -- fewer people will work because of the law's subsidies.

"The act creates a disincentive for people to work," Elmendorf said, under questioning from House Budget Committee Chairman Paul Ryan, R-Wis.

Ryan clarified that the CBO report found not that employers would lay people off, but that more individuals would choose not to work.

"As a result ... that [lower] labor supply lowers economic growth," Ryan said.

Elmendorf answered: "Yes, that's right."

Ryan fumed that this would mean fewer people would be "joining the middle class."

"It's adding insult to injury," he said. "As the welfare state expands, the incentive to work declines -- meaning grow the government, you shrink the economy."

Elmendorf, who was addressing the House Budget Committee, did say that the subsidies provided under the Affordable Care Act would make lower-income people "better off."

And Rep. Chris Van Hollen, D-Md., top Democrat on the committee, argued that the CBO findings were still being misinterpreted. He pointed to more positive findings in the report, including that health care premiums would go down.

The CBO report on Tuesday effectively found that more people would opt to keep their income low to stay eligible for federal health care subsidies or Medicaid.

The workforce changes would mean nationwide losses equal to 2.3 million full-time jobs by 2021, the report said.

Budget office chief: ObamaCare creates ‘disincentive’ to work | Fox News

Notice how the GOP and right-wing media is now rolling with this "the ACA creates a disincentive to work" narrative. Of course, the fact remains that the ACA as written didn't create this incentive at all for lower income workers. It was the GOP governor's refusal to expand Medicaid coverage out of spite even though it would not have negatively impacted their state budgets ... thereby creating the "donut hole" in the first place which created this disincentive. But naturally the article and Paul Ryan failed to mention that part. Imagine that.

OAW

[ebuddy]

OAW and MSNBC; our last bastions of optimism for the ACA.

The reason so many States opted out of the Medicaid expansion is because they know full well it's another unfunded provision. The Federal government will only reimburse the expansion for the first 3 years, then the match declines. It was going to be another unfunded mandate, but the SCOTUS ruled against the mandate. Anyone here who places this much faith in the Federal government and/or believes the Federal government can or even will continue to fund at 90+% levels through 2020 are kidding themselves. Once the dependents are created, that money will eventually disappear and there's not a damned thing a State is going to do about it other than eat it in driving their own deficits.

Lest we forget that it is the subsidies that enable one to quit their job and pursue their dreams of playing guitar downtown for spare change. No matter how devoted people are to this partisan pipe-dream, this is in fact a disincentive to work. You don't need 12 paragraphs of spin and partisan slander. I don't think it's acceptable that more will work to pay for those who will work less. Make no mistake, that's exactly what's happening here and that's exactly what the CBO report shows.

[Shaddim]

Originally Posted by ebuddy 

OAW and MSNBC; our last bastions of optimism for the ACA.

Yep, they're spinning faster than a Kenmore. I'm pretty sure he works for a DNC advocacy group, he gets the talking points faster than almost anyone.

[OAW]

Originally Posted by ebuddy 

The reason so many States opted out of the Medicaid expansion is because they know full well it's another unfunded provision. The Federal government will only reimburse the expansion for the first 3 years, then the match declines. It was going to be another unfunded mandate, but the SCOTUS ruled against the mandate.

Some have called states implementing the Medicaid expansion a "no-brainer". Others take a more pessimistic view in the long-term. That's a legitimate debate one can have. But be that as it may, this ....

Originally Posted by ebuddy 

Lest we forget that it is the subsidies that enable one to quit their job and pursue their dreams of playing guitar downtown for spare change. No matter how devoted people are to this partisan pipe-dream, this is in fact a disincentive to work. You don't need 12 paragraphs of spin and partisan slander. I don't think it's acceptable that more will work to pay for those who will work less. Make no mistake, that's exactly what's happening here and that's exactly what the CBO report shows.

... is simply inaccurate. It's NOT "the subsidies that enable one to quit their job" .... because A) the working poor who would have benefited from Medicaid expansion don't even qualify for subsidies through the Healthcare Exchange in the first place, and B) those that do qualify for subsidies through the Healthcare Exchange can't "quit their job" because the ACA does NOT provide tax credits toward insurance premiums for those with incomes below the poverty line!

I'll pause for a moment to let you ponder why those facts belie your statement.


.
.
.

But even if for the sake of argument one were to focus on those who qualify for Healthcare Exchange subsidies choosing to work less because their out-of-pocket health insurance costs are lower ... we are still only talking about a minuscule impact on the economy. As in 1%. From the CBO report itself ...

Originally Posted by CBO Report

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall economy will be proportionally smaller than the reduction in hours worked. Specifically, CBO estimates that the ACA will cause a reduction of roughly 1 percent in aggregate labor compensation over the 2017–2024 period, compared with what it would have been otherwise.

A 1% reduction in aggregate labor compensation over a 7 year period weighed against the expanded healthcare coverage to millions and expanded insurance protections for all (e.g. no denials for pre-existing conditions, no cancellations of insurance after one gets sick, etc.)? That's what the GOP is setting their hair on fire about now? Not to mention that the economic impact of this minuscule shrinking of labor compensation will be more than made up for by increased aggregate demand in the economy due to greater utilization of healthcare services. Yeah ok ...

But I will say this. Paul Ryan and a handful of other Republicans are at least making an argument that is based on what the CBO report actually said. I commend them for that. Because it is quite unlike the typical GOP mendacity that exploded all over in the internet in the wake of this report ....

Originally Posted by Eric Cantor (R) House Majority Leader

The CBO’s latest report confirms what Republicans have been saying for years now. Under Obamacare, millions of hardworking Americans will lose their jobs and those who keep them will see their hours and wages reduced.

Here is a sample of GOP reactions to the report. Mitch McConnell’s spokesman claimed that CBO had projected “a loss of at least two million jobs.” A spokesman for the NRCC insisted that “because of Obamacare, there will be 2 million less [sic] jobs in the economy.”
A statement from Senator Chuck Grassley claimed that the CBO had found that the law will “cause the loss of 2.5 million jobs.” Former Romney policy adviser Lanhee Chen claimed the CBO had estimated that Obamacare “will result in 2.5 million jobs lost.”

What the CBO report on Obamacare really found | WashingtonPost.com

.... none of which accurately reflects what the CBO report actually said.

OAW

[ebuddy]

Originally Posted by OAW 

... is simply inaccurate. It's NOT "the subsidies that enable one to quit their job" .... because A) the working poor who would have benefited from Medicaid expansion don't even qualify for subsidies through the Healthcare Exchange in the first place, and B) those that do qualify for subsidies through the Healthcare Exchange can't "quit their job" because the ACA does NOT provide tax credits toward insurance premiums for those with incomes below the poverty line!

No... because they are FULLY SUBSIDIZED!

The CBO report on Tuesday effectively found that more people would opt to keep their income low to stay eligible for federal health care subsidies or Medicaid. The workforce changes would mean nationwide losses equal to 2.3 million full-time jobs by 2021, the report said.

There is no spin here OAW, it is what it is. People want to decrease their hours to either increase their subsidies or qualify for Medicaid.

I'll pause for a moment to let you ponder why those facts belie your statement.

.

.

.

You mean this statement?
- Douglas Elmendorf, CBO Director; "The act creates a disincentive for people to work."

But even if for the sake of argument one were to focus on those who qualify for Healthcare Exchange subsidies choosing to work less because their out-of-pocket health insurance costs are lower ... we are still only talking about a minuscule impact on the economy. As in 1%. From the CBO report itself ...

A 1% reduction in aggregate labor compensation over a 7 year period weighed against the expanded healthcare coverage to millions and expanded insurance protections for all (e.g. no denials for pre-existing conditions, no cancellations of insurance after one gets sick, etc.)? That's what the GOP is setting their hair on fire about now? Not to mention that the economic impact of this minuscule shrinking of labor compensation will be more than made up for by increased aggregate demand in the economy due to greater utilization of healthcare services. Yeah ok ...

I love your passion OAW, but there are few left on the planet who don't see this as shameless party shilling. How many million was the ACA supposed to cover? How many will be covered? No spin, no ducking, dodging, and weaving -- just answer the question. How many will remain uninsured under your guy's signature legislation intended to cover the uninsured?

But I will say this. Paul Ryan and a handful of other Republicans are at least making an argument that is based on what the CBO report actually said. I commend them for that. Because it is quite unlike the typical GOP mendacity that exploded all over in the internet in the wake of this report ....

What the CBO report on Obamacare really found | WashingtonPost.com

.... none of which accurately reflects what the CBO report actually said.

OAW

What exploded all over the internet is the fact that this creates a disincentive to work, confirmed by the CBO Director as plainly and directly as possible. Again, you can't spin out of this man, there's just no wiggle-room for ya.

[OAW]

Originally Posted by ebuddy 

No... because they are FULLY SUBSIDIZED!

The CBO report on Tuesday effectively found that more people would opt to keep their income low to stay eligible for federal health care subsidies or Medicaid. The workforce changes would mean nationwide losses equal to 2.3 million full-time jobs by 2021, the report said.

There is no spin here OAW, it is what it is. People want to decrease their hours to either increase their subsidies or qualify for Medicaid.

And this differs from what I just said how exactly?

To qualify for Medicaid one has to reduce their income to below the poverty line for those states where the Medicaid expansion didn't happen. Or to 138% of the poverty line in those states where it did. The former scenario is absolutely no change from previous policy. The latter scenario could be attributed to the ACA. But hold that thought. In the Healthcare Exchange subsidy scenario ... the subsidies decrease as income increases. As is the case with most means-tested government programs. Not only is this nothing new ... it's the expressly advocated policy of the GOP when it comes to reforming Social Security. So are we catching a case of convenient amnesia here?

Originally Posted by ebuddy 

I love your passion OAW, but there are few left on the planet who don't see this as shameless party shilling. How many million was the ACA supposed to cover? How many will be covered? No spin, no ducking, dodging, and weaving -- just answer the question. How many will remain uninsured under your guy's signature legislation intended to cover the uninsured?

I don't know the exact figure offhand. I could dig it up but I'm not particularly inclined after a long day at work and the fact that I'm in the middle of putting out a fire in our company's production computer system. I'm only responding because I'm waiting to hear back from my DEV team. What I will say is this. The CBO projects people choosing to reduce their labor force participation ... not people "losing their jobs" as the GOP continues to claim despite documented evidence to the contrary ... will amount to approximately the equivalent of 2 million full-time jobs in the 7 year time frame between 2017-2024. So feel free to compare that to the 3 million people who've been covered under the ACA since October 2013. And then tack on those projected to be covered going forward. How many will still be uninsured? There was always going to be some. That's the nature of the beast when utilizing a system fundamentally based upon private insurance coverage. But make no mistake about it .... that number will be significantly increased by GOP governor's refusal to expand Medicaid. There's no arguing that.

Originally Posted by ebuddy 

What exploded all over the internet is the fact that this creates a disincentive to work, confirmed by the CBO Director as plainly and directly as possible. Again, you can't spin out of this man, there's just no wiggle-room for ya.

So you make this claim despite those quotes I provided huh? Ummm ... ok.

OAW

[ebuddy]

Full statement made by Douglas Elmendorf, CBO Director;
"What the Affordable Care Act does, is to provide subsidies focused on lower- and lower-middle-income people to buy health insurance. And in order to encourage a sufficient number of people to buy an expensive product like health insurance, the subsidies are fairly large in dollar terms. Those subsidies are then withdrawn over time -- withdrawn from people as their income rises. "And by providing heavily subsidized health insurance to people with very low income, and then withdrawing those subsidies as income rises, the (Affordable Care) Act creates a disincentive for people to work, relative to what would have been the case in the absence of that Act."

Relative to what would have been the case in the absence of the Act and it's fairly large subsidies. This means it is new, OAW. This is novel. It's an additional 2+ million people opting out of the workforce to qualify for a new, larger entitlement. There's no way around this OAW. It is people paying more for other people who choose to work less to qualify for a handout; another aspect of the law that if made more clearly at the outset would've hindered the law from passage. It's a big deal because it's a big deal and a perfect illustration first-hand of why Republicans complain about entitlements. It just means more coming out of what had become the left's favorite mouthpiece.

And about jobs; do you suppose it's entirely coincidental that part-time employment is at an all-time high of more than 8.2 million people as of the latest jobs report?

• How to reduce fuel usage? Tax it more heavily.
• How to reduce tobacco and alcohol usage? Tax it more heavily.
• Ammo? Tax it more heavily.
• Sugary and fatty foods? Tax them more heavily.
• What will happen with an employer mandate-fee on companies employing people full-time? I don't know, but the ACA won't cost full-time jobs! (queue Price is Right fail audio)

And the answer to my question, OAW is a third. We've upended the entire health care industry to cover one-third the uninsured when it's all said and done. Worse, for now we're still at a deficit of 4+ million uninsured relative to the absence of the Act.

[OAW]

Originally Posted by ebuddy 

Relative to what would have been the case in the absence of the Act and it's fairly large subsidies.

First of all, the CBO report doesn't say anything about "2+ million people opting out of the workforce". It's the typical mischaracterization that all too often comes from the right. Because it gives the erroneous impression that the ACA is going to cause 2+ million people to all of a sudden quit their jobs and live off public assistance. It's the Welfare Queen myth all over again. Let's see what the report actually says shall we?

Originally Posted by CBO Report

The reduction in CBO’s projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024. Although CBO projects that total employment (and compensation) will increase over the coming decade, that increase will be smaller than it would have been in the absence of the ACA.

See that? 2+ million full-time-equivalent workers. NOT 2+ million people. So this could be 4 million people choosing to work part-time for 20 hours a week instead of full-time for 40 hours a week. Or 8 million people choosing to work part-time for 10 hours a week. Etc. For instance, married women with small children. Or older workers looking to cut back on their time spent in the office. Perhaps even retire earlier. But true to form, instead of looking at it as a means of providing flexibility for labor force participation ... the right characterizes it in a manner that implies laziness. But let's continue with what the report actually says and see if I'm just making all this up. Here's what it says about the Effects of the Medicaid Expansion on Labor Supply:

Originally Posted by CBO Report

Incentives to Change Labor Supply and Groups Affected.

For some people, the ACA’s expansion of Medicaid will reduce the incentive to work—but among other people it will increase that incentive. As with exchange subsidies, access to Medicaid confers financial benefits that are phased out with rising income or (more commonly) eliminated when income exceeds a threshold; some people will thus work fewer hours or withdraw from the labor force to become or remain eligible (the substitution effect). Moreover, those financial benefits will lead some people to work less because the increase in their available resources enables them to reduce work without a decline in their standard of living (the income effect).

At the same time, some people who would have been eligible for Medicaid under prior law—in particular, working parents with very low income—will work more as a result of the ACA’s provisions. In 2013, the median income threshold for that group’s Medicaid eligibility was 64 percent of the FPL (albeit with substantial state-to- state variation). The incentives and groups affected depend on whether a state has adopted the Medicaid expansion (and, in both cases, those incentives are inter- twined with the effects of the exchange subsidies):

- In states that have chosen to expand Medicaid, the ACA now allows parents to qualify for Medicaid with income up to 138 percent of the FPL. And if their income rises above that threshold, those parents would generally be eligible for premium tax credits and cost-sharing subsidies for insurance purchased through the exchanges unless they are offered qualified employment-based health insurance. The subsidies will cover a smaller share of enrollees’ medical costs than Medicaid would, but under prior law those participants ultimately would have become ineligible for Medicaid and lost all benefits. As a result, some people who would have curtailed their hours of work in order to maintain access to Medicaid under prior law will now be able to increase their hours and income while remaining eligible for subsidized insurance.

- In states that choose not to expand Medicaid, the availability of exchange subsidies also will lead some people to work more. Specifically, some people who would otherwise have income below the FPL will work more so that they can qualify for the substantial exchange subsidies that become available when income is equal to or just above the FPL.

Responses of Affected Groups

A number of studies examining the impact of changes in Medicaid eligibility for parents and children have shown either no effects or small effects on the labor supply of single mothers; effects on two-parent households appear to be somewhat larger, in part because health insurance has stronger effects on the labor supply of secondary earners.

More recently, several studies have examined changes in state policies that affect childless adults—who constitute the majority of those gaining coverage through the Medicaid expansion—and larger effects have been reported. Some reductions in employment are reported among people who have gained Medicaid eligibility, although the findings differ regarding the magnitude and statistical significance of that effect. Similarly, other research shows a rise in employment rates with the withdrawal of Medicaid coverage from childless adults who had previously been turned down for private insurance. Because those studies examined state-level policy initiatives affecting program eligibility—instead of changes in eligibility attributable to income changes, which could merely reflect changes in employment—the results provide some useful insights into the potential effects of the ACA (even though other aspects of the studies raise questions about their applicability to an analysis of the ACA).

Taking that research into account, CBO estimates that expanded Medicaid eligibility under the ACA will, on balance, reduce incentives to work. That effect has a relatively modest influence on total labor supply, however, because the expansion of eligibility for Medicaid primarily affects a relatively small segment of the total population—both because most people’s income will significantly exceed the cutoff for Medicaid eligibility and because some low-income people live in states that are not expected to expand Medicaid.

So with the Medicaid expansion some have an incentive to work more ... and some have an incentive to work less. Poor single mothers? No impact. Married women with children? Some may work less. And isn't that a good thing for the "family values" crowd? Childless adults? Some may work less. But on balance the overall "disincentive to work" ... much of which has nothing to do with lazy people looking for a handout ... is "relatively modest".

So what does the report have to say about the Effects on Retirement Decisions?

Originally Posted by CBO Report

Changes to the health insurance market under the ACA, including provisions that prohibit insurers from denying coverage to people with preexisting conditions and those that restrict variability in premiums on the basis of age or health status, will lower the cost of health insurance plans offered to older workers outside the workplace. As a result, some will choose to retire earlier than they otherwise would—another channel through which the ACA will reduce the supply of labor.

So an older worker who would rather retire may now be able to retire because affordable health insurance is now available outside the workplace. Thereby potentially freeing up a position for an unemployed college graduate looking for a job. But this is a bad thing to a friends on the right I guess.

Originally Posted by ebuddy

This means it is new, OAW. This is novel. It's an additional 2+ million people opting out of the workforce to qualify for a new, larger entitlement. There's no way around this OAW. It is people paying more for other people who choose to work less to qualify for a handout; another aspect of the law that if made more clearly at the outset would've hindered the law from passage. It's a big deal because it's a big deal and a perfect illustration first-hand of why Republicans complain about entitlements. It just means more coming out of what had become the left's favorite mouthpiece.

Again. What is "new" or "novel" about this? Certainly the ACA is a "new" law in the sense that it previously didn't exist. But there is nothing "novel" about its approach of means-tested subsidies. That already exists in other federal programs as I said earlier. And it is also the preferred GOP approach for another such program ... namely, Social Security. A fundamental point you conveniently failed to address when I mentioned it earlier. But no worries, because I'll just point out YET ANOTHER example of the GOP criticizing things they previously supported as soon as they were utilized in the ACA:

There’s a saying that “nothing is more admirable in politics than a short memory.” But we are amazed by the audacity of the latest attack by Republican leaders on the Affordable Care Act.

The target of Republicans’ new criticism is a sensible mechanism to ensure an even distribution of risks across insurance companies. According to Republican leaders like House Budget Chairman Chairman Paul Ryan of Wisconsin, these risk corridor provisions are “massive insurance company bailouts.” Florida Sen. Marco Rubio has even introduced a bill to strip them from the ACA. Some conservative groups are calling them “nothing more than a built-in, blank check bailout for insurance companies.”

What’s most remarkable about their comments on risk corridors is that Republican leaders are denouncing a model they created to smooth out rate increases in prescription drug coverage under Medicare. When Senate Minority Leader Mitch McConnell voted in 2003 to create Medicare Part D, he called the law “the most important social legislation … in my memory” and said it provided “a genuine opportunity for the private sector to actually compete in offering this new drug benefit.” House Republican Leader John Boehner made similar comments, noting in 2007, “By almost every measure, this drug benefit has exceeded expectations, and it continues to score high marks among seniors for providing big savings on their prescription costs.”

An innovative part of the law McConnell and Boehner voted for was its “risk corridors” program, a new idea back in 2003. The corridors are a mechanism to distribute or balance risks across insurance companies, so that those that sign up healthier enrollees help those that attract sicker enrollees. Under the program, if insurers’ actual costs for medical claims are more than 3 percent below their expected costs, they will transmit a portion of their profits into the federal Treasury. Those funds will then be redistributed to insurers whose actual costs exceed their expected costs by more than 3 percent. The provisions were included in Medicare Part D to give the insurers confidence to enter a new market. And they worked.

....

When congressional Democrats wrote the Affordable Care Act, we included the exact same mechanism, except we made the risk corridors a temporary three-year program to create stability during the startup period. We also made the program less generous, with higher thresholds for risk-sharing than the Republicans included in Part D.

Given this history, and the fact that our risk corridor program is more conservative than the Part D version in both eligibility and duration, the new GOP attacks on the Affordable Care Act ring hollow. Some are blatantly dishonest, while others are completely false. Rubio has warned that we are getting “closer to the reality that billions of dollars in taxpayer money is going to be used to bail out these exchanges.” In fact, this week, the nonpartisan Congressional Budget Office says the program will actually save the federal government $8 billion because collections from insurers will significantly exceed payments. And unlike Medicare Part D, which was not paid for, the Affordable Care Act reduces the deficit by more than $1.5 trillion.

The Latest GOP Lie About Obamacare - Rep. Henry Waxman and Rep. Sander Levin and Rep. George Miller - POLITICO Magazine

Is it just me or does that sound eerily familiar to the GOP criticizing a a means tested subsidy in the ACA when they support it for Social Security? So when the GOP criticizes its own ideas ... AGAIN ... when the Dems adopt it I can't even call that ideology trumping facts. Because clearly the opposition isn't ideological. It's pure partisanship trumping good policy.

OAW

[OAW]

Originally Posted by ebuddy

And about jobs; do you suppose it's entirely coincidental that part-time employment is at an all-time high of more than 8.2 million people as of the latest jobs report?

What I "suppose" is that it would be better to see what the CBO Report actually says about that as well.

In CBO’s judgment, there is no compelling evidence that part-time employment has increased as a result of the ACA. On the one hand, there have been anecdotal reports of firms responding to the employer penalty by limiting workers’ hours, and the share of workers in part- time jobs has declined relatively slowly since the end of the recent recession. On the other hand, the share of workers in part-time jobs generally declines slowly after recessions, so whether that share would have declined more quickly during the past few years in the absence of the ACA is difficult to determine. In any event, because the employer penalty will not take effect until 2015, the current lack of direct evidence may not be very informative about the ultimate effects of the ACA.

So perhaps it would be best to revisit this argument when a CBO report comes out after 2015 when the employer mandate actually goes into effect?

Originally Posted by ebuddy

And the answer to my question, OAW is a third. We've upended the entire health care industry to cover one-third the uninsured when it's all said and done. Worse, for now we're still at a deficit of 4+ million uninsured relative to the absence of the Act.

"Upended the entire health care industry" is without question a textbook example of hyperbole. Implementing a Single-Payer system would've certainly qualified to be described as such. The ACA most definitely does not:

Here's the biggest thing to know about Obamacare: Most people will never notice it. If you get health insurance through your employer or the government -- as 80 percent of Americans do -- it's very unlikely that you'll interact with Obamacare's coverage expansion at all. (There are other provisions in Obamacare, like some of the efforts to improve care quality or cut health-care costs, that could affect you. But that's not the core of the law or the part that's starting Tuesday.)

Obamacare mostly matters most for the 20 percent of Americans who are either uninsured or get insurance on the individual (or "non-group") market. Anyone in those groups can get insurance through Obamacare. Those who make more than the federal poverty line, but less than four times the poverty line ($94,200 for a family of four), can buy subsidized insurance on the marketplaces. Those making less than 133 percent of the poverty line, and living in a state that has accepted the Medicaid expansion, can get Medicaid.

The Congressional Budget Office expects that the Affordable Care Act will cover about 14 million of the uninsured in 2014 and 25 million by the end of the decade. That still leaves about 30 million people uninsured.

Everything you need to know about life under Obamacare |WashingtonPost.com

Medicare: Untouched.

Medicaid: An EXISTING program had its eligibility expanded to 138% of the Federal Poverty Line and childless adults.

Other Government Programs: Untouched.

Non-Group and Uninsured: Eligible for the Healthcare Exchanges.

Employer: Essentially untouched. The Shared Responsibility Fee (aka the "employer mandate") will have a modest impact as described below:

The Affordable Care Act does not include an employer mandate. In 2014, as a matter of fairness, the Affordable Care Act requires large employers to pay a shared responsibility fee only if they don’t provide affordable coverage and taxpayers are supporting the cost of health insurance for their workers through premium tax credits for middle to low income families.

The law specifically exempts all firms that have fewer than 50 employees – 96 percent of all firms in the United States or 5.8 million out of 6 million total firms – from any employer responsibility requirements. These 5.8 million firms employ nearly 34 million workers. More than 96 percent of firms with 50 or more employees already offer health insurance to their workers. Less than 0.2 percent of all firms (about 10,000 out of 6 million) may face employer responsibility requirements. Many firms that do not currently offer coverage will be more likely to do so because of lower premiums and wider choices in the Exchange.

...

Under the Affordable Care Act, an estimated 4 million small businesses nationwide could qualify for a small business tax credit this year, which will provide a total of $40 billion in relief for small firms over the next 10 years.

Health Reform For Small Businesses | WhiteHouse.gov

So now that we've dispelled with all the exaggerations and overstated rhetoric about the "entire health care industry" ... which BTW includes providers, pharmaceutical companies, medical device and supply companies, etc. which aren't impacted at all by the ACA ... let's move on to your comment about "to cover one-third [of] the uninsured when it's all said and done.".

From an earlier CBO Report ...

The graph atop this post shows the predicted insurance situation (numbers come from this CBO report) for non-elderly Americans if health-care reform didn't pass. It's not a pretty graph, but it'll do the trick. You're seeing 162 million people in the employer market, 54 million uninsured, 35 million people on Medicaid or the Children's Health Insurance Program, and 30 million people in the non-group/other market (this contains not just the individual market but small public plans). To put that slightly differently: No insurance is predicted to be the second-most common arrangement. Compare that to the post-reform prediction:



Here you're seeing 159 million Americans on the employer market, 44 million on Medicaid or the Children's Health Insurance Program, 25 million on the non-group/other market, 24 million in the exchanges, and 22 million left uninsured. The uninsured category has gone from the second largest to the absolute smallest. And though there's no public option, there are a lot more people eligible for public programs. But all in all, only 40 million Americans are in a different insurance situation than would otherwise have been the case. Three-quarters of them would've been otherwise uninsured, and a few more would've been on the individual markets or getting insurance through a small business who's now using the exchange.

But some of you have asked why there's an uninsured category at all. There are a couple of reasons. About a third of the remaining uninsured are illegal immigrants, who are ineligible for coverage through the program. Then there are some folks who have incomes below the individual mandate threshold. Under the terms of the individual mandate, if coverage would cost more than 8 percent of their monthly income, they can skip it. Other people will decide to pay the individual mandate's $750 penalty rather than purchase insurance. Still others will be eligible for public programs such as Medicaid but won't sign up.

So the population of the uninsured will be far reduced, and primarily composed of illegal immigrants, the few people who can't afford their insurance and aren't getting subsidies to help them purchase it, and people who have decided to pay the penalty rather than purchase insurance.

Ezra Klein - Who is left uninsured by the health-care reform bill? | WashingtonPost.com

So that's 32 out of 54 million which means the ACA is projected to cover two-thirds of the uninsured by 2019 ... not one-third. Granted, this analysis was from 2010 before the conservative majority on the SCOTUS struck down the Medicaid Expansion requirement on the states. So now given the refusal by the vast majority of GOP governors to do so that number is undoubtedly lower. But let's be fair ... the responsibility for that is on them.

In any event, those left uninsured are ...

- Illegal immigrants. (who the GOP would have had a hissy fit about if they received subsidies)

- The indigent whose incomes are below 133% of the FPL (i.e. in 2012, $9,750 for a single person and $27,100 for a married couple with two children). (who the GOP has never given two shits about other than to offer a tax credit on the pittance they make that's already not taxable)

- Those with access to unaffordable coverage (i.e. > 8% of monthly income). (Typical GOP view: Why should I pay for your health insurance?)

- Those who'd rather pay the individual mandate penalty. (Typical GOP view during the Clinton Admin: FREELOADER! ... typical GOP view during the Obama Admin: FREEDOM!)

- Those who are eligible but choose to forego public assistance. (Typical GOP View: BOOTSTRAPS!)

The bottom line here is that by and large the GOP could care less about expanding healthcare coverage to the uninsured. Most won't just come out and say that. Instead they'll rail against "big government" and all that jazz but it really just comes down to their anathema towards their tax dollars being used to help the less well-off afford healthcare coverage. And for those in that fold who do care? Well that's all fine and good as long as the DEMS aren't the ones making it happen.

There is an old adage .... "Don't let the perfect be the enemy of the good." Perhaps one day our good friends on the right will take heed to that wisdom with respect to the ACA.

OAW

[Snow-i]

Originally Posted by OAW 

There is an old adage .... "Don't let the perfect be the enemy of the good." Perhaps one day our good friends on the right will take heed to that wisdom with respect to the ACA.

OAW

Can you name one good thing the ACA has done so far? I mean for christ's sakes man they haven't even built the damn backend to the website yet!

[OAW]

Originally Posted by Snow-i 

Can you name one good thing the ACA has done so far? I mean for christ's sakes man they haven't even built the damn backend to the website yet!

How about this?

2010
NEW CONSUMER PROTECTIONS

• Putting Information for Consumers Online. The law provides for where consumers can compare health insurance coverage options and pick the coverage that works for them. Effective July 1, 2010.
  
• Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions. The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans.
  
• Prohibiting Insurance Companies from Rescinding Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The health care law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.
  
• Eliminating Lifetime Limits on Insurance Coverage. Under the law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010.
• Regulating Annual Limits on Insurance Coverage. Under the law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010.
• Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Effective for new plans beginning on or after September 23, 2010.
• Establishing Consumer Assistance Programs in the States. Under the law, states that apply receive federal grants to help set up or expand independent offices to help consumers navigate the private health insurance system. These programs help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. The programs will also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that need further oversight. Grants Awarded October 2010.

IMPROVING QUALITY AND LOWERING COSTS

• Providing Small Business Health Insurance Tax Credits. Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit. Effective now.
  
• Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole.” An estimated four million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each eligible senior will receive a one-time, tax free $250 rebate check. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap.
• Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010.
• Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity. Funding begins in 2010.
• Cracking Down on Health Care Fraud. Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP. Many provisions effective now.

INCREASING ACCESS TO AFFORDABLE CARE

• Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions. The Pre-Existing Condition Insurance Plan provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. National program effective July 1, 2010.
• Extending Coverage for Young Adults. Under the law, young adults will be allowed to stay on their parents’ plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work). Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23.
• Expanding Coverage for Early Retirees. Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. Applications for employers to participate in the program available June 1, 2010.
• Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .
  
• Holding Insurance Companies Accountable for Unreasonable Rate Hikes. The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases will be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014. Grants awarded beginning in 2010.
• Allowing States to Cover More People on Medicaid. States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. Effective April 1, 2010.
• Increasing Payments for Rural Health Care Providers. Today, 68% of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010.
• Strengthening Community Health Centers. The law includes new funding to support the construction of and expand services at community health centers, allowing these centers to serve some 20 million new patients across the country. Effective 2010.

2011
IMPROVING QUALITY AND LOWERING COSTS

• Offering Prescription Drug Discounts. Seniors who reach the coverage gap will receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Effective January 1, 2011.
  
• Providing Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare. Effective January 1, 2011.
• Improving Health Care Quality and Efficiency. The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These methods are expected to improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including by these programs. Effective no later than January 1, 2011.
• Improving Care for Seniors After They Leave the Hospital. The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. Effective January 1, 2011.
• Introducing New Innovations to Bring Down Costs. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care. Administrative funding becomes available October 1, 2011.

INCREASING ACCESS TO AFFORDABLE CARE

• Increasing Access to Services at Home and in the Community. The Community First Choice Option allows states to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes. Effective beginning October 1, 2011.

HOLDING INSURANCE COMPANIES ACCOUNTABLE

• Bringing Down Health Care Premiums. To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers. Effective January 1, 2011.
• Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care. Effective January 1, 2011.

2012
IMPROVING QUALITY AND LOWERING COSTS

• Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. Effective for payments for discharges occurring on or after October 1, 2012.
• Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012.
• Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012.
• Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities. Effective March 2012.

INCREASING ACCESS TO AFFORDABLE CARE

• Providing New, Voluntary Options for Long-Term Care Insurance. The law creates a voluntary long-term care insurance program – called CLASS -- to provide cash benefits to adults who become disabled. Note: On October 14, 2011, Secretary Sebelius transmitted a report and letter to Congress stating that the Department does not see a viable path forward for CLASS implementation at this time.

::::::to be continued:::::::

OAW

[OAW]

2013
IMPROVING QUALITY AND LOWERING COSTS

• Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.
• Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.

INCREASING ACCESS TO AFFORDABLE CARE

• Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.
  
• Open Enrollment in the Health Insurance Marketplace Begins. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. Effective October 1, 2013.

2014
NEW CONSUMER PROTECTIONS

• Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.
• Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014.
• Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.

IMPROVING QUALITY AND LOWERING COSTS

• Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014.
• Establishing the Health Insurance Marketplace. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too.
• Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations. Effective January 1, 2014.

INCREASING ACCESS TO AFFORDABLE CARE

• Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014.
• Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014.

About the Law | HHS.gov/healthcare

Those are ALL the provisions of the ACA already in effect. I've highlighted some of the KEY provisions in blue. Of them all, the only one that had botched rollout ... largely resolved at this point .... is the following:

Open Enrollment in the Health Insurance Marketplace Begins. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. Effective October 1, 2013.

So the question then becomes ... which ones do YOU prefer rescinding and why?

OAW

[turtle777]

WTF, OAW ?

-t

[ebuddy]

Originally Posted by OAW 

So perhaps it would be best to revisit this argument when a CBO report comes out after 2015 when the employer mandate actually goes into effect? :roll eyes:

We have to wait for the law to find out what's in it. Sounds familiar.

The bad news is we already have information on what this will look like. It'll be another one of those "I told you so" moments that will become increasingly popular among the cigar-chomping, evil Republicans who will assuredly pick up a wealth of seats this year.

Small Businesses and ObamaCare - WSJ;

Public Opinion Strategies survey of more than 400 business owners with between 40 and 500 employees conducted in September and October for the U.S. Chamber of Commerce and International Franchise Association. Some 64% of small business franchise owners (such as owners of fast food and retail stores) believe the law will have a "negative impact" on their business, while only 5% expect a "positive impact." For non-franchise businesses the ratio was 53% negative and 12% positive. Only one in 12 agree with the President that the health-care law will "help" their business.

Even more problematic is how businesses are already responding to the new law. The White House continues to deny any relationship between hiring and ObamaCare. The poll finds 27% of franchise businesses and 12% of non-franchises have already replaced full-time with part-time employees in anticipation of the law's employer mandate. ObamaCare defines a full-time employee as someone who works 30 hours or more a week.

The survey also reveals that the "49er" effect is very real. These are businesses that will cap their full-time payroll workforce at 49 employees to avoid ObamaCare's insurance mandate for companies with more than 50 full-time equivalent workers. Of firms with between 40 and 70 employees, a little over half say they are likely to "make personnel decisions to keep" their "workforce below the threshold of 50 full-time employees and avoid the requirements and penalties associated with the new health care law."

Originally Posted by OAW

"Upended the entire health care industry" is without question a textbook example of hyperbole. Implementing a Single-Payer system would've certainly qualified to be described as such. The ACA most definitely does not:

CBS News;

"Every employer plan since the passage of the health care law has been working to make sure their health care cost trends keep their plans under the 'Cadillac tax,'" Steve Wojcik of the National Business Group on Health, a nonprofit that represents large employers, told CBSNews.com.

The impact of the tax is concerning to labor groups that have fought with employers for good benefits.

So... it's jacking with the individual market, it's jacking with Employer-sponsored health care, Unions, and it's going to result in cutting hours, cutting people, cutting benefits... yeah -- it is upending the entire insurance industry.

NPR.org;

A number of employers have been overhauling the health benefits they offer employees, citing rising costs.

There are two themes to what they are doing. In trying to control their own spending, employers often are shifting health costs to employees. So the average annual deductible for an individual — what consumers pay before insurance kicks in — nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.

Some employers that have offered part-time workers minimal coverage, such as Trader Joe's and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges.

How will the excise tax impact employer-based plans?

• Insurers will be taxed at 40percent of the aggregate value of plans above a high-cost threshold beginning in 2018. In the case of self-insured plans, the tax will be paid by plan administrators.
• The cost of this tax will likely be passed on to employers and enrollees through higher premiums. To avoid the tax, some employers and unions will want to make changes to their plans, such as changes in benefits, cost sharing or provider networks.
• The aggregate value of a plan includes the combined worker and employer contributions to premiums, in addition to employer contributions to a Health Savings Account, Health Reimbursement Account, Medical Savings Account or a Flexible Spending Arrangement. The value will be calculat- ed excluding dental and vision benefits. Employers are responsible to pay any tax on the HSA or MSA amounts and to notify the insurer of the full cost of coverage.
• In 2018, the high-cost thresholds will be $10,200 for individual coverage and $27,500 for family coverage. The thresholds will be adjusted firm-specific age and gender and increased by $1,650/$3,450 for retirees aged 55 and over who are not Medicare-eligible, electrical and telecommunications installation/repair workers and individuals in high-risk jobs (including longshore work, emergency response, firefighting, law enforcement, construction, mining, agriculture, forestry and fishing). The thresholds may be adjusted upwards initially to the degree that Federal Employee Health Benefits Program premiums rise more than expected between 2010 and 2018 and will be indexed by inflation in 2020 and subsequent years (inflation plus 1 percent in 2019).

Does the law make other tax changes related to health insurance?

Stand-alone Health Reimbursement Accounts (HRAs) will no longer be allowed in 2014, except for retiree-only HRAs.
Contributions to a Flexible Spending Arrangement (FSA) for medical expenses are limited to $2,500 beginning in 2013.
Funds from a HRA, FSA, Health Savings Account (HSA) or Medical Savings Account (MSA) cannot be used as reimbursement for over-the-counter medications not prescribed by a doctor beginning in 2011.
Distributions from a HSA or a MSA that are not used for qualified medical expenses will be taxed at an increased rate of 20 percent beginning in 2011.
The law eliminates the tax deduction for employers who subsidize Medicare Part D retiree drug payments effective in 2013.

Medicare: Untouched.

Right off the bat, I'd say gutting it by $716 Billion cannot be deemed "untouched". Nice try.
Impact on Seniors: An Update

the Medicare Trustees project that the lower Medicare payment rates would cause 15 percent of hospitals, skilled nursing facilities, and home health agencies to become unprofitable by 2019, and this percentage would reach roughly 25 percent in 2030 and 40 percent by 2050.
This means that seniors would have an increasingly difficult time accessing care. As the Trustees explain:
Medicare’s payments for health services would fall increasingly below providers’ costs. Providers could not sustain continuing negative margins and would have to withdraw from serving Medicare beneficiaries or (if total facility margins remained positive) shift substantial portions of Medicare costs to their non-Medicare, non-Medicaid payers.

In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.[4] About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage.
When Obamacare was enacted in 2010, the Medicare Actuary projected that the impact of Obamacare’s cuts would be significant: “We estimate that in 2017, when the MA provisions will be fully phased in, enrollment in MA plans will be lower by about 50 percent (from its projected level of 14.8 million under the prior law to 7.4 million under the new law).”[5] This means that these enrollees would have to enroll in the less generous traditional Medicare program, causing them to lose their current health plan and likely face increased out-of-pocket costs.

Obamacare gradually reduces seniors’ out-of-pocket costs in the Medicare Part D drug coverage gap, commonly referred to as the “donut hole,” until the gap is completely phased out in 2020. While this will help a small number of seniors who face the gap, it will increase the cost of the Part D benefit, a portion of which will be passed on to the beneficiaries.
According to the CBO, “enacting those changes would lead to an average increase in premiums for Part D beneficiaries of about 4 percent in 2011, rising to about 9 percent in 2019.”[9] This average premium increase means a lot considering how few seniors actually fall into the gap. While the average premiums of all Part D beneficiaries will increase, of the 48.6 million Medicare enrollees in 2011, only 3.6 million actually fell into the donut hole.[10]

Higher Taxes
Obamacare will also cause seniors to pay higher taxes. The higher taxes on prescription drugs (effective in 2011) and medical devices (effective in 2013) will affect seniors especially, as they are more heavily dependent on those very products. Older people, of course, have higher health costs than younger people, but the existing tax deduction for medical expenses will be raised from 7.5 percent to 10 percent of adjusted gross income in 2013. The reduced tax deductibility of medical expenses is waived for seniors only from 2013 to 2016. Likewise, older people have larger investments than younger people, so high-income seniors will be more heavily affected by the new 3.8 percent Medicare tax imposed on unearned or investment income (effective in 2013).[11]
New federal health insurance taxes, both premium taxes and excise taxes, will also affect older workers and retirees. The federal premium tax (effective in 2014) will be applicable to Medicare Advantage plans and health plans offered to federal retirees in the Federal Employees Health Benefits Program (FEHBP). Oliver Wyman, a leading benefits consulting firm, has estimated that “[in] the Medicare market, the premium tax would increase the expected cost of MA coverage per enrollee by $3,604 over the ten-year period.”[12]

Originally Posted by OAW

Medicaid: An EXISTING program had its eligibility expanded to 138% of the Federal Poverty Line and childless adults.

Let's expand an already woefully insolvent program. Only an ideological progressive could come up with something so dubious.

Other Government Programs: Untouched.

Irrelevant.

Non-Group and Uninsured: Eligible for the Healthcare Exchanges.

Heavily subsidized on the backs of the young and healthy. An element of the law the President had to outright lie about for passage.

Employer: Essentially untouched. The Shared Responsibility Fee (aka the "employer mandate") will have a modest impact as described below:

Given that this has been called the Affordable Care Act, I'm not interested in the .gov's actual name for the fee. Employers aren't untouched. Trust me. It'll be yet another "I told you so" moment that you and MSNBC will be trying to spin again later this year and next.

Health Reform For Small Businesses | WhiteHouse.gov

Let's see here, should I take the words of OAW, the Obama Administration, and MSNBC or should I take the words of the overwhelming majority of small businesses and the SBA representing them in ardently opposing the ACA? I'm sorry. It is going to be yet another "I told you so" moment for Republicans and blue-dog Dems now running from it and this Administration.

So now that we've dispelled with all the exaggerations and overstated rhetoric about the "entire health care industry" ... which BTW includes providers, pharmaceutical companies, medical device and supply companies, etc. which aren't impacted at all by the ACA ... let's move on to your comment about "to cover one-third [of] the uninsured when it's all said and done.".

Let's see, in my above citations I've already illustrated the impacts on providers, pharmaceuticals, the medical device taxes and other taxes, small businesses, larger businesses, the individual market, the employer market, Unions, the young, and the old... I don't think the case of how large in scope this whole thing is can be overstated quite frankly. We've only touched the surface. Here's an idea of the pages of new regulations under Obamacare for perspective;

So that's 32 out of 54 million which means the ACA is projected to cover two-thirds of the uninsured by 2019 ... not one-third. Granted, this analysis was from 2010 before the conservative majority on the SCOTUS struck down the Medicaid Expansion requirement on the states. So now given the refusal by the vast majority of GOP governors to do so that number is undoubtedly lower. But let's be fair ... the responsibility for that is on them.

In any event, those left uninsured are ...

- Illegal immigrants. (who the GOP would have had a hissy fit about if they received subsidies)

- The indigent whose incomes are below 133% of the FPL (i.e. in 2012, $9,750 for a single person and $27,100 for a married couple with two children). (who the GOP has never given two shits about other than to offer a tax credit on the pittance they make that's already not taxable)

- Those with access to unaffordable coverage (i.e. > 8% of monthly income). (Typical GOP view: Why should I pay for your health insurance?)

- Those who'd rather pay the individual mandate penalty. (Typical GOP view during the Clinton Admin: FREELOADER! ... typical GOP view during the Obama Admin: FREEDOM!)

- Those who are eligible but choose to forego public assistance. (Typical GOP View: BOOTSTRAPS!)

I like how you immediately start by bloating the number of uninsured. That's rich. Is that the number of uninsureds since Obamacare was implemented?

Washington Post.com - Obamacare leaves millions uninsured

Per Journal Health Affairs; When we talk about the Affordable Care Act, we mostly focus on the millions of Americans who will gain health insurance coverage. We talk less about the millions who will remain uninsured.
And there are a lot of them: 30 million Americans will not have coverage under Obamacare, according to a new analysis in the journal Health Affairs.
"Even if the law were fully implemented, there would have been 26 million uninsured people," co-author Steffie Woolhandler said in an interview Thursday. "This isn't just about the Medicaid expansion. This is the system as originally designed."

Thirty million is a lot smaller than the 48.6 million Americans who lack insurance coverage right now. It's also, as Woolhandler points out, not exactly breaking news: The Congressional Budget Office estimated over a year ago that between 26 million and 27 million Americans would not have insurance under the expansion.

I stand corrected. The proper statement would've been; little more than a third. But that's splitting hairs of course.

The bottom line here is that by and large the GOP could care less about expanding healthcare coverage to the uninsured. Most won't just come out and say that. Instead they'll rail against "big government" and all that jazz but it really just comes down to their anathema towards their tax dollars being used to help the less well-off afford healthcare coverage. And for those in that fold who do care? Well that's all fine and good as long as the DEMS aren't the ones making it happen.

With all due respect, this is among the most ignorant things I've read in this forum in a very long time and so illustrative of the problem in politics today. There is absolutely no possible meat on the bone for reason here. Zero. The ACA dropped a bunker-buster on an anthill. By design. Period. End of story. Please spare me your lecture on what you believe the GOP does or does not care about. They are a party of folks that dollar-for-dollar, give more. Substantially more.

- Nicholas D. Kristof, NYT
“When I started doing research on charity,” Mr. Brooks; author of a book on donors to charity, “Who Really Cares” wrote, “I expected to find that political liberals — who, I believed, genuinely cared more about others than conservatives did — would turn out to be the most privately charitable people. So when my early findings led me to the opposite conclusion, I assumed I had made some sort of technical error. I re-ran analyses. I got new data. Nothing worked. In the end, I had no option but to change my views.”

It's a much more fundamental difference in views that has nothing to do with one lacking in compassion for another.

There is an old adage .... "Don't let the perfect be the enemy of the good." Perhaps one day our good friends on the right will take heed to that wisdom with respect to the ACA.

OAW

I think the more apt adage here is; "The road to hell is paved with good intentions." There are those expecting perfection, you won't find them on the right. They already know better.