Florida Blue, the state’s largest health insurer, is increasing premiums by an average of 17.6 percent for its Affordable Care Act exchange plans next year, company officials say.

The nonprofit Blue Cross and Blue Shield affiliate blames higher health costs that are a result of attracting older adults this year who previously lacked coverage and are using more services than expected.

Florida insurance regulators plan to release rate information for all companies next week. The exchange plans cover individuals who are not covered by employer-based policies.

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Dr. Bob Russo is sure of it. He’s a radiologist and he’s also the president-elect of the Connecticut State Medical Society. He says that the low rates and administrative burdens that come along with the ACA could make it a financial loser.

“You get what you pay for,” he says. “If you can’t convince [doctors] that they’re not losing money doing their job, it’s a problem. And they haven’t been able to convince people of that.”

He, like Counihan, worries about creating a tiered health care system. Think about Medicaid, he says. Before a recent rise in rates, it paid doctors even less than Medicare, so many stopped accepting Medicaid patients.

“There’s no question that Medicaid, under its old rates, wasn’t working,” he says. “So, have we just invented a new Medicaid that kind of slid the scale up a little more to make access a little more?”

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“As many as 1 in 5 of the people in the top half of the tax credit range might actually end up having income that puts them out of the tax credit range, which means whopping bills at tax time,” Brandes said. “We’re talking about millions of people here.”

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With five months to go until the Affordable Care Act’s 2015 open enrollment season, states that had troubled exchanges during the inaugural sign-up period are scrambling to either upgrade their sites or transition to the federal exchange””all on the taxpayer’s dime.

A new analysis from the Wall Street Journal finds that the cost for Maryland, Massachusetts, Minnesota, Nevada and Oregon to overhaul their exchanges or transition to healthcare.gov will be as high as $240 million in total.

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Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums, but the Obama administration has squelched the idea in a new ruling. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day ”” or $36,500 a year ”” for each employee who goes into the individual marketplace.

The ruling this month, by the Internal Revenue Service, blocks any wholesale move by employers to dump employees into the exchanges.

Under a central provision of the health care law, larger employers are required to offer health coverage to full-time workers, or else the employers may be subject to penalties.

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The Obama administration has quietly adjusted key provisions of its signature healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money.

The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall’s congressional elections.

Administration officials for months have denied charges by opponents that they plan a “bailout” for insurance companies providing coverage under the healthcare law.

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I will take comments on this submitted by email only to KSHarmon[at]mindspring[dot]com.

Previous studies suggest that many people will use the new coverage to obtain medical care for conditions that went untreated while they were uninsured.

The new health law reduces special payments to hospitals serving large numbers of low-income patients, on the assumption that many of the uninsured will gain coverage through Medicaid.

But hospital executives are unsure that the savings will materialize. Dr. Campbell said the cuts could create serious financial problems for hospitals treating large numbers of Medicaid patients.

Recent research in other states has raised similar questions.

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If realized, the larger move to marketplace coverage would shift more of the cost and responsibility for employee health insurance to workers themselves.

“Once a few notable companies start to depart form their traditional approach to health care benefits, it’s likely that a substantial number of firms could quickly follow suit,” the report noted. “The result would be a dramatic departure from the legacy employer/employee payroll deduction benefit provision relationship, and could quickly be the modern day equivalent of companies moving from defined benefit pension plans to defined contribution programs.”

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Seemingly divided, the Supreme Court struggled Tuesday with the question of whether companies have religious rights, a case challenging President Barack Obama’s health overhaul and its guarantee of birth control in employees’ preventive care plans.

Peppering attorneys with questions in a 90-minute argument, the justices weighed the rights of for-profit companies against the rights of female employees. The discussion ranged to abortion, too, and even whether a female worker could be forced to wear an all-covering burka.

The outcome could turn on the views of Justice Anthony Kennedy, often the decisive vote, as his colleagues appeared otherwise to divide along liberal and conservative lines.

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A divided Supreme Court seemed inclined to agree Tuesday that the religious beliefs of business owners may trump a requirement in President Obama’s Affordable Care Act that they provide their employees with insurance coverage for all types of contraceptives.

With both snow and demonstrators gathering on the sidewalk outside, it was difficult to predict a precise outcome from the spirited 90-minute argument.

But a majority of the justices seemed to agree that the family-owned businesses that objected to the requirement were covered by a federal statute that gives great protection to the exercise of religion. That would mean the government must show the requirement is not a substantial burden on their religious expression, and that there was no less intrusive way to provide contraceptive coverage to female workers.

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A challenge to part of President Obama’s healthcare law that hits the Supreme Court on Tuesday could lead to one of the most significant religious freedom rulings in the high court’s history.

Four years ago, in their controversial Citizens United decision, the justices ruled that corporations had full free-speech rights in election campaigns. Now, they’re being asked to decide whether for-profit companies are entitled to religious liberties.

At issue in Tuesday’s oral argument before the court is a regulation under the Affordable Care Act that requires employers to provide workers a health plan that covers the full range of contraceptives, including morning-after pills and intrauterine devices, or IUDs.

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….with less than 10 days left in the 2014 window to apply for coverage with policies through the federal marketplace, lots of people still don’t understand the penalties. Who pays? Who doesn’t? How do you pay? How do you avoid paying?

Toni McKinnon of Columbia stopped by Richland Library’s main branch on Assembly Street last week to find out about the health insurance marketplace because she was worried about having to pay a penalty.

“When you’re living paycheck to paycheck, you can’t afford insurance,” McKinnon said, “and you sure can’t afford to pay some kind of penalty.”

She left the library slightly confused and very disappointed.

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Health industry officials say ObamaCare-related premiums will double in some parts of the country, countering claims recently made by the administration.

The expected rate hikes will be announced in the coming months amid an intense election year, when control of the Senate is up for grabs. The sticker shock would likely bolster the GOP’s prospects in November and hamper ObamaCare insurance enrollment efforts in 2015.

The industry complaints come less than a week after Health and Human Services (HHS) Secretary Kathleen Sebelius sought to downplay concerns about rising premiums in the healthcare sector. She told lawmakers rates would increase in 2015 but grow more slowly than in the past.

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About 4.2 million people have signed up for health plans on Obamacare exchanges through the end of February, making it unlikely that the Obama administration will hit lowered enrollment estimates in the program’s first year.

Whatever momentum was building in January appeared to drop off in February, as the number of sign ups fell below the administration’s expectations. The numbers — which were released a day before Health and Human Services Secretary Kathleen Sebelius testifies on the Hill — also show young people aren’t enrolling at rates officials had predicted. That group is key because they are generally presumed to be healthier and less costly.

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For healthcare reform to mature unimpeded, the debates surrounding the Affordable Care Act require concentrated, nonpartisan attention. And for reform to succeed, we also need hospitals to flourish, especially in places with few options.

Every hospital has a story to tell. Lower Oconee Community Hospital will not keep the nation’s attention for long, but its absence and that of other hospitals that close will certainly leave profound voids throughout their communities. Rather than ignore these continuing cracks in the foundation of our evolving healthcare system, there is much to be learned from these now-defunct facilities. We would do well to address the underlying problems behind the closures.

As any medical practitioner will tell you, it is wiser to treat the cause today than alleviate the symptoms tomorrow.

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The repeated and prolonged phone waits were Sisyphean, the competence and customer service abysmal. When finally she found a plan that looked like it would cover her Sandostatin and other cancer treatments, she called the insurer, Humana…to confirm that it would do so. The enrollment agent said that after she met her deductible, all treatments and medications””including those for her cancer””would be covered at 100%. Because, however, the enrollment agents did not””unbelievable though this may seem””have access to the “coverage formularies” for the plans they were selling, they said the only way to find out in detail what was in the plan was to buy the plan.

[My mother].. is a woman who had an affordable health plan that covered her condition. Our lawmakers weren’t happy with that because . . . they wanted plans that were affordable and covered her condition. So they gave her a new one. It doesn’t cover her condition and it’s completely unaffordable.

Though I’m no expert on ObamaCare (at 10,000 pages, who could be?), I understand that the intention””or at least the rhetorical justification””of this legislation was to provide coverage for those who didn’t have it. But there is something deeply and incontestably perverse about a law that so distorts and undermines the free activity of individuals that they can no longer buy and sell the goods and services that keep them alive. ObamaCare made my mother’s old plan illegal, and it forced her to buy a new plan that would accelerate her disease and death. She awaits an appeal with her insurer.

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President Obama gave a lovely speech at the recent National Prayer Breakfast – and one is reluctant to criticize….

[but]…many in the audience were reaching for their own jaws when Obama got to the liberty section of his speech, according to several people who attended the breakfast. Michael Cromartie, vice president of the Ethics and Public Policy Center, summed up the general reaction of many with whom he spoke: “Stunned.”

“Several people said afterward how encouraged they would have been by President Obama’s remarks if only his acts reflected what he said,” Cromartie told me.

One table was applauding only out of politeness, according to Jerry Pattengale, who was sitting with Steve Green – president of the Hobby Lobby stores that have challenged Obamacare’s contraceptive mandate. Pattengale described the experience as “surrealistic.”

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I will take comments on this submitted by email only to KSHarmon[at]mindspring[dot]com.

The budget office analysis found that the law, in effect, nudges workers to work less. The insurance expansion reduces the need for a person to take a full-time job just to get coverage. The premium subsidies effectively bolster household income. Higher taxes for richer households also reduce the incentive to work.

But it will also have an effect on businesses, the report said, including by encouraging them to reduce employee hours to avoid the “employer mandate.” The overall demand for labor would not change, in other words, but businesses might arrange their workers’ schedules differently to avoid having to provide them with health care.

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As 2014 dawns, ObamaCare’s most disruptive changes to the health care system are just now getting under way. For American businesses, that means a raft of new taxes that will pose devastating consequences for their employees and the broader economy.

Paramount among them is a new tax on health insurers (HIT) that’s projected to “hit” them for more than $100 billion over the next decade. ObamaCare’s architects intended to eat into the margins of insurers with this levy ”” and even set it proportional to each company’s market share, so that bigger insurers pay more.

But the truth is that firms in every sector will pay it, as insurers will simply pass the tax along to employers in the form of higher premiums.

Indeed, premiums are expected to jump 2% to 3% over the course of this year thanks to this tax. By 2023, they could be about 4% higher.

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The 41 employees of Extreme Dodge in Jackson, Mich., are very familiar with trade-ins, but this year they’re learning about trade-offs as they come face to face with the new realities of health care. A few workers say they’re getting a great deal, but most have a severe case of sticker shock.

“I feel like I’ve been taken to the cleaners,” said Neal Campbell, a salesman.

Read it all or watch the video report from NBC.

The Chapmans acknowledge that they are better off than many people, but they represent a little-understood reality of the Affordable Care Act. While the act clearly benefits those at the low end of the income scale ”” and rich people can continue to afford even the most generous plans ”” people like the Chapmans are caught in the uncomfortable middle: not poor enough for help, but not rich enough to be indifferent to cost.

“We are just right over that line,” said Ms. Chapman, who is 54 and does administrative work for a small wealth management firm. Because their plan is being canceled, she is looking for new coverage for her family, which includes Mr. Chapman, 55, a retired fireman who works on a friend’s farm, and her two sons. “That’s an insane amount of money,” she said of their new premium. “How are you supposed to pay that?”

An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person’s income.

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Healthcare.gov seems to be working better for consumers, relatively, but it is not clear that it works for insurers (in which case it doesn’t work for consumers either, as they are trying to buy insurance). Insurers have long said that they are receiving botched enrolment forms, or 834s, if they receive them at all. On December 2nd health officials said they had fixed a problem that accounted for 80% of the glitches with 834s. But they would not confirm what share of 834s were being bungled, so it is hard to know the fix’s importance.

If the site is working better for consumers, as it seems to be, shoppers may rush to sign up for insurance before Mr Obama’s deadline of December 23rd. They will expect coverage to kick in just a few days later, on January 1st. That gives insurers little time to process 834s, even if they are sent without problems, let alone deal with garbled forms. Mr Obama’s goals for health reform have always been laudable. But the gruelling, technical job of enrolment will be the big story for some time yet.

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I will take comments on this submitted by email only to KSHarmon[at]mindspring[dot]com.

Companies are bracing for an influx of participants in their insurance plans due to the health-care overhaul, adding to pressure to shift more of the cost of coverage to employees.

Many employers are betting that the Affordable Care Act’s requirement that all Americans have health insurance starting in 2014 will bring more people into their plans who have previously opted out. That, along with other rising expenses, is prompting companies to raise workers’ premium contributions, steer them toward high-deductible plans and charge them more to cover family members.

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While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.

Lawmakers and the employees who work in their “official offices” will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.

“D.C. Health Link set up shop right here in Congress,” said Eleanor Holmes Norton, the delegate to the House from the nation’s capital.

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Americans’ views of the 2010 healthcare law have worsened in recent weeks, with 40% approving and 55% disapproving of it. For most of the past year, Americans have been divided on the law, usually tilting slightly toward disapproval. The now 15-percentage-point gap between disapproval and approval is the largest Gallup has measured in the past year.

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A Catholic family in Madison that owns a vehicle lighting manufacturing company won an important religious liberty victory in a Nov. 8 ruling handed down by a three-judge panel of the 7th U.S. Circuit Court of Appeals in Chicago.

Judge Diane Sykes, writing the majority opinion in the 2-1 decision, said that members of the Grote family and Grote Industries, which they own, cannot be compelled to provide abortion-inducing drugs, sterilizations and contraceptives to their employees in their company health plan as required under the Affordable Care Act.

The suit challenged the U.S. Department of Health and Human Services mandate in the health care law that requires most employers to provide such coverage even if they have moral objections to it.

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Insurers say the early buyers of health coverage on the nation’s troubled new websites are older than expected so far, raising early concerns about the economics of the insurance marketplaces.

If the trend continues, an older, more expensive set of customers could drive up prices for everyone, the insurers say, by forcing them to spread their costs around. “We need a broad range of people to make this work, and we’re not seeing that right now,” said Heather Thiltgen of Medical Mutual of Ohio, the state’s largest insurer by individual customers. “We’re seeing the population skewing older.”

The early numbers, described to The Wall Street Journal by insurance executives, agents, state officials and actuaries, are still small””partly a consequence of the continuing technical problems plaguing the federally run exchanges, experts say. HealthCare.gov, the federally run marketplace serving 36 states, is suffering serious technical problems that have prevented many people from signing up.

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The D.C. Circuit Court of Appeals ”” the second most influential bench in the land behind the Supreme Court ”” ruled 2-1 in favor of business owners who are fighting the requirement that they provide their employees with health insurance that covers birth control.

Requiring companies to cover their employees’ contraception, the court ruled, is unduly burdensome for business owners who oppose birth control on religious grounds, even if they are not purchasing the contraception directly.

“The burden on religious exercise does not occur at the point of contraceptive purchase; instead, it occurs when a company’s owners fill the basket of goods and services that constitute a healthcare plan,” Judge Janice Rogers Brown wrote on behalf of the court.

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Palmetto Primary Care Physicians will launch a new in-house health insurance plan next month for its employees because BlueCross BlueShield of South Carolina’s rates have become too expensive, the group’s CEO said Tuesday.

The in-house plan will reduce health insurance costs for the practice’s 600 employees by as much as 85 percent per pay period, said spokeswoman Vivian Barajas.

“The savings on my end is over 50 percent,” she said. “It’s kind of like getting a mini-raise for us.”

Read it all (from the front page above the fold of the print edition of the local paper).

1–A constant battle is underway between insurance companies that do not want to pay any claims, even legitimate ones, and doctors and hospitals incentivised to rip off patients, insurers, and taxpayers with unnecessary surgeries and Medicare fraud.

2–Insurance companies demand massive amounts of paperwork out of rational fear of fraud and unnecessary treatments. Doctors perform for-profit (as opposed to for-patient) procedures that guarantee more explanations and more paperwork.

3–Doctors and hospitals have direct personal contact with patients, but insurance companies don’t. In cases where doctors put patients at huge risk with needless procedures and surgeries, it’s easy for hospitals and doctors to point their finger at insurance companies. On the other hand, many sincere, honest doctors have difficulty getting patients the care they should have because insurers believe they are getting ripped off by unnecessary procedures, even when they aren’t….

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