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Do doctors really hate Obamacare?

Do doctors really hate Obamacare? | Healthcare and Technology news |

Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.

A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:

  • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
  • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
  • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
  • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”

When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).

  • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
  • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
  • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
  • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
  • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.

However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:

“Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”

Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).

I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.

But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.

And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

No comment yet.!

Obamacare’s Next 5 Hurdles to Clear

Obamacare’s Next 5 Hurdles to Clear | Healthcare and Technology news |

In its first five years, the Affordable Care Act has survived technical meltdowns, a presidential election, two Supreme Court challenges — including one resolved Thursday — and dozens of repeal efforts in Congress. But its long-term future still isn’t ensured. Here are five of the biggest hurdles remaining:

Medicaid Expansion. About 4 million more Americans would gain coverage if all states expand the state-federal Medicaid programs to cover people with incomes at or slightly above the poverty line. Twenty-one states with Republican governors or GOP-controlled legislatures, including Texas and Florida, have balked, citing ideological objections, their own budget pressures, as well as skepticism about Washington’s long-term commitment to pay for most of the costs.

Anemic Enrollment. Eighteen million Americans who are eligible to buy insurance in federal and state marketplaces haven’t purchased it. Those marketplaces have had particular trouble enrolling Hispanics, young adults and people who object to being told to buy insurance.  Federal funding used by state marketplaces to enroll people and advertise is drying up. Many state marketplaces haven’t figured out how to be self-sustaining. Vermont, Hawaii, Colorado and Rhode Island are among those states searching for more money. The penalty for going without coverage rises next year to $695 per adult or 2.5 percent of family income—whichever is larger.

Market Stability. Nationally, premiums haven’t gone up too much on average in the first two years of the marketplaces, but that could change. The federal government has been protecting insurers from unexpectedly high medical bills, but that cushion disappears after next year. At the same time, insurers finally have enough experience with their initial customers to figure out if their premiums are sufficient to cover medical costs. If they’re not, expect increases.

Affordability. People who get their insurance through their employer have mostly been spared jolts from the health law. But the federal government begins taxing expensive health plans in 2018. The “Cadillac tax,” created by the health law, will pressure employers to offer skimpier health coverage or pass the taxes’ cost on to their employees. Also, individuals buying their insurance on the health law marketplaces continue to risk large out-of-pocket costs if they need lots of care. Their maximum financial obligations for next year are $6,850 for individuals and $13,700 for families. Those who choose to go out of their insurance network may have no ceiling on how much they may have to pay.

Political Resistance. Thursday’s ruling did little to diminish the GOP’s zeal to repeal the health law. Republicans on both sides of the Capitol pledged to continue their efforts to kill the ACA. A lawsuit filed by House Republicans last year alleges the president overstepped his authority when implementing the health law. The topic remains grist for the 2016 presidential campaign, with several Republican presidential candidates – including Sen. Lindsey Graham, R-S.C., and former Florida Gov. Jeb Bush — reiterating their desire to repeal the law. If the Republicans capture both the White House and Congress in 2016, all bets are off over whether the law survives intact.

No comment yet.!

Top Obamacare official looks ahead after Supreme Court ruling

Top Obamacare official looks ahead after Supreme Court ruling | Healthcare and Technology news |

The U.S. official overseeing Obamacare said on Friday she has not seen any indication that states will back away from running their own health insurance marketplaces now that the Supreme Court has validated the federal insurance exchange.

Sylvia Burwell, secretary of Health and Human Services, also said she expected enrollment in both the state and federal health insurance exchanges established under the 2010 Affordable Care Act -- called Obamacare -- to decline from 10.2 million currently to 9.1 million by the end of 2015. That was the number her department had originally set as a goal for 2015.

Speaking with reporters in her office, an upbeat Burwell said now that the Court has upheld the law, she is ready to build on the five-year-old program's progress by continuing to expand Medicaid, which makes benefits available to low-income people.

Obamacare survived a major legal test on Thursday when the Supreme Court upheld the law's tax subsidies, which help millions of Americans pay for health insurance.

The plaintiffs contended the law's authors only intended the subsidies to be paid to consumers on state-based health exchanges. The court rejected that argument, confirming the subsidies were also legal in 34 states now relying on the federal website,

U.S. President Barack Obama holds up a copy of a new National Action Plan for Combating Antibiotic-R …

"We're going to work with states that want to do state-based exchanges. We'll do federal exchanges where there aren't those," Burwell said.

Asked if some states might give up operating their own exchanges and let residents shop for insurance on the federal website, she said: "I don't think we have seen any indication of that, but we'll see."

Thirteen states and the District of Columbia have established their own exchanges where consumers can find insurance. Some state exchanges have had technical and logistical challenges as well as financial difficulties.

Burwell said she expected Obamacare enrollment to decline to 9.1 million by year's end for a combination of reasons. Some people will get insurance through new employment, others will marry and go on their spouses' coverage, and some may not be able to pay their premiums, she said.

She said she learned the administration had won the Court ruling on Thursday as she walked down the hallway of her department and heard a cheer. Then she asked her team: "Are we sure?"

"It was very emotional ... It was just such a moment of, you know, as I said, relief," Burwell said.

No comment yet.!

The Supreme Court's Surprise Ruling Saves Obamacare

The Supreme Court's Surprise Ruling Saves Obamacare | Healthcare and Technology news |

The Affordable Care Act survived its second major challenge at the U.S. Supreme Court on Thursday. In a 6-to-3 decision, the justices ruled that the Internal Revenue Service can continue to provide health-insurance subsidies to middle-class people living in all states.

At issue in the case, King v. Burwell, was whether the subsidies should go to residents of the roughly three dozen states that use the federal health-insurance exchange, in addition to those who live in states that run their own exchanges.

It’s a highly technical difference, but had the decision gone the other way, Obamacare might have unraveled. Individuals who receive these subsidies make less than $48,000 per year, and many would struggle to afford health-insurance plans without the government’s financial help. Health-policy analysts feared that, without the subsidies in place, healthy people would withdraw from the health-insurance exchanges in large numbers. That, in turn, would cause premiums to skyrocket, making insurance unaffordable to almost anyone who does not receive insurance coverage through their jobs.

The Affordable Care Act gave states the option to either set up their own exchanges or to rely on the federal government’s marketplace through The part of the law that describes the subsidies said they should only apply to people in the exchanges “established by the state.” The plaintiffs in the King case said that clause meant the IRS was offering subsidies to residents of federal-exchange states illegally.

In the opinion of the Court, Chief Justice John Roberts dismissed the idea that the fate of the entire Obamacare law should hinge on such a technicality.

“In petitioners’ view, Congress made the viability of the entire Affordable Care Act turn on the ultimate ancillary provision: a sub sub-sub section of the Tax Code,” he wrote. “We doubt that is what Congress meant to do.”

Many patient advocates cheered the decision. “It means that millions of people with serious health conditions such as cancer will continue to have access to essential treatment and care, and millions of others at risk for disease will be able to afford preventive screenings and tests that could save their lives,” said Chris Hansen, president of the American Cancer Society’s advocacy arm, in a statement.

Justices Antonin Scalia, Clarence Thomas, and Samuel Alito dissented, writing, “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’”

Roberts concludes by saying that the Court is attempting to respect what Congress hoped to accomplish in passing the law: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

There are still a few, more minor, legal challenges to Obamacare remaining. But at least for now, the law lives to see another day.

Jannell Alino's curator insight, August 27, 2015 7:43 PM

Congress passed the Affordable Care Act and the Supreme Court ruled that the IRS will be able to continue to administer health insurance to middle class people to all in the United States. If this did not pull through Obamacare would have left thousands of people without insurance and helpless. Many who are on Obamacare make less than 48K a year and need assistance from the government. If this were to happen a large number of healthy people would withdraw from health insurances causing prices to go up and then no one would be able to afford health insurance! The Affordable Care Act gives states the option to set up their own exchanges or rely on the government. With the passing of this act people suffering from serious illness will be able to care and have access to treatment as well as others who are susceptible to illness. Some conclusions that can be drawn from this article are that by the passing of this act thousands of citizens are still able to have health insurance and do not have to pay with an arm and a leg. Yes this argument is logical because it would be irrational to take away a program that has aided so many Americans in getting the health care they need. This relates because if this act was to fail our health insurance prices would go up and going to get a simple checkup would cost a fortune! I think it is great that the congress passed this act because I would want everyone to be able to have the privilege to seek out help if they were ill. No there is no bias, it is objective to all citizens in the united states.!

Despite Obamacare, gap health insurance market explodes

Despite Obamacare, gap health insurance market explodes | Healthcare and Technology news |

Despite the promise of coverage through the U.S. Affordable Care Act (ACA), the number of people applying for non-compliant, short-term health insurance policies was up more than 100 percent in 2014, according to new data available from companies who broker these policies.

This type of health insurance is exactly the kind that the ACA, known commonly as Obamacare, was supposed to upgrade. Short-term plans provide low-cost coverage for major medical events like hospital stays, with high deductibles and out-of-pocket costs, and are subject to denial if applicants have pre-existing conditions. They do not offer the protections of Obamacare for preventive care or maternity coverage, for example.

The government does not count these gap plans as qualifying health insurance, so people who have them are subject to penalties for being uninsured.

Sign-ups at eHealth Inc to the short-term plans it offers through its website were up to 140,000 in 2014 from 60,000 in 2013, an increase of 134 percent, according to the company.

At another short-term carrier, Agile Health Insurance, a subsidiary of Health Insurance Innovations Inc, new policies were up 100 percent last year over the previous year, and are up again so far in 2015, according to Scott Lingle, the company's senior vice president of business development.

Accounting for much of the jump are individuals who somehow missed the open enrollment period for an Obamacare plan. More than 11.7 million consumers signed up for Obamacare coverage through Feb. 22, according to the government.

People missed out mostly because of poor communication between consumers, the government and insurance companies, says Nate Purpura, eHealth's director of PR and Content. Those who missed the opportunity to sign up and did not have a qualifying event now have to wait until the next open enrollment period to try again, so they need an insurance plan to bridge the gap.

Both eHealth and Agile are also seeing new signups from retirees who are looking for a low-cost plan to tide them over until Medicare kicks in at 65. At eHealth, the 55 to 64 age group is now 9 percent of the market.

"If you shop for a 50-year-old on, it is very expensive," says Agile's Lingle. "There are people who have looked at the prices and it makes more sense to buy short term."

The largest constituency is young, healthy people seeking low-cost catastrophic coverage. Those aged 18 to 34 account for 57 percent of eHealth's buyers. A typical policy could cost around $100 a month, depending on the state of residency and the features of the plan.

These customers include 19-year-old college student Kelly Thomas-Cutshaw, who had no insurance through family and her school did not offer group coverage. Thomas-Cutshaw did not qualify for a subsidy under the ACA because she did not have enough income, yet she could not get Medicaid in Oklahoma, where she goes to school, because she made too much and was not a permanent resident there.

Over the winter, Thomas-Cutshaw became ill, and now has a medical bill she says will take her four years to pay off. She decided she needed some plan in place in case she fell ill again.

When her short-term plan runs out in the fall, she is prepared to sign up for an ACA-compliant major medical plan.

"I can mostly afford to live, so that's nice," Thomas-Cutshaw said, thanks to a summer job she just landed. "It been a ridiculous and frustrating experience. I don't wish this on other people."

No comment yet.!

Did Obamacare make it easier for patients to see a doctor?

Did Obamacare make it easier for patients to see a doctor? | Healthcare and Technology news |

One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured.

Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program was a major mechanism for expanding insurance coverage. Medicaid reimbursement has always been low — significantly lower than Medicare pays for the same encounter — so many physicians would not take it. The ACA drafters hoped higher reimbursement would entice these physicians to accept Medicaid. We don’t know if any of these assumptions are correct, but a recent study published in the New England Journal of Medicine suggests a positive impact.

The authors’ method was a bit sneaky, I suppose. They had trained field staff call physicians’ offices posing as potential patients asking for new appointments. They were divided into two groups; one group said they had private insurance, the other said they had Medicaid. The authors compared two time periods — before and after the early implementation of the ACA. A sample of states were compared to see if the rates of acceptance of new Medicaid patients was associated with a particular state increasing physician Medicaid reimbursement.

The results were not striking, but they suggest a significant positive trend. This is what the results showed, in the authors’ words:

The availability of primary care appointments in the Medicaid group increased by 7.7 percentage points, from 58.7% to 66.4%, between the two time periods. The states with the largest increases in availability tended to be those with the largest increases in reimbursements, with an estimated increase of 1.25 percentage points in availability per 10% increase in Medicaid reimbursements (P=0.03). No such association was observed in the private-insurance group.

Again, these are data from the early days of ACA implementation. But they are encouraging. One of the most important components of slowing the seemingly inexorable rise in health care costs is getting people good primary and preventative care. This keeps people with a chronic, manageable condition out of the emergency room and, one hopes, out of the hospital. This is particularly the case with common conditions like diabetes and asthma. For both of those disorders, regular care by a primary care physician can spare patients much suffering and save many thousands of dollars.

I hope this kind of research continues as the ACA matures. It’s a good way to see if the overall goals are being met. Of course, it raises a new challenge: Making sure we have enough primary care physicians. Right now, we don’t.

No comment yet.!

5 Reasons The Affordable Care Act Will Be Good For Americans

5 Reasons The Affordable Care Act Will Be Good For Americans | Healthcare and Technology news |

In October, 2013, at the launch of the Affordable Care Act, I predicted that the health insurance exchanges about to go into effect would grow in popularity and  improve the health insurance marketplace, then so imperfect.

Twenty months later, the exchanges are proving effective in reducing the number of uninsured and are beginning to provide the information people need to make an informed selection about which plan is best for their needs. As a result, I’m even more convinced than I was that they will bring about major improvements – improvements not only in how health coverage is purchased, but also in lowering cost and increasing quality outcomes.

Although concerns still exist, I predict that many of the latest headlines – about the technical challenges faced in the rollout of the law, the pending Supreme Court decision on whether subsidies are being made available consistent with the letter of the law, and the continued bipartisan bickering – will be largely forgotten a decade from now.

Already, with second-year enrollment complete, the results of the exchanges are nothing short of impressive. According to Gallup, the rate of uninsured Americans has dropped from 16% to 12%.  And some 14.1 million Americans already have signed up for the public exchanges.

Here, then, are the top five improvements to American healthcare that will come directly from the exchanges.

1. They Will Transform The Health Insurance Market

The rules of engagement in the marketplace are shifting dramatically. Individuals who sign up for insurance through the exchanges are guaranteed coverage. They also gain advantages from standardized benefit design, cost transparency, and increasingly – at least in some states – data on quality.

With our limited experience on utilization and risk among enrollees, pricing has yet to settle. But in the future, as competition grows, the plans that sell insurance products through both private and public exchanges will be forced, if they want to attract new members, to lower prices and increase the value delivered.

Previously, insurance plans in the individual and small group market competed with each other mainly through product design and risk selection.

The most successful insurance companies figured out how to “slice and dice the risk pool” – selectively trying to enroll the youngest and healthiest in the individual market and thereby minimize the amount they had to pay to physicians and hospitals.

In the individual market, insurers did this by denying coverage to individuals with pre-existing conditions and creating “skinny” plans with limited benefits.

Such tactics are no longer legal under the ACA.

In addition, because competing plans in most communities used essentially the same physicians and hospitals, insurance companies had difficulty differentiating themselves from each other based on quality.

And as a result, they only invested minimally in improving the effectiveness and efficiency of care delivery.

Now we can predict that going forward, individuals will have a broader set of options with added information. And the winners will be those plans that provide high quality medical care at the lowest cost, rather than those who are best able to attract the healthiest patients or design coverage with the narrowest benefits.

2. They Will Enable Companies To Move From a Defined Benefit to a Defined Contribution  

The exchanges extend to employers the opportunity to get out from being a “middle man.” Rather than being responsible for selecting the company’s insurance plan, negotiating the coverage provided and determining the size of the deductibles required, they can provide employees a set amount of money for health insurance – a defined contribution – and increase it in subsequent years at a rate consistent with their ability to fund this benefit.

Employees can then pick among the numerous options on an exchange based on personal preference. If they select a less expensive plan, they can take home the difference. Or they can enroll in a more expensive option and contribute their own money.

Previously, to control costs, some employers forced employees to switch insurance companies and, as a result, change doctors. Others required employees to pay more out of pocket. Both of these means of controlling costs made employees unhappy with their employers.

Now employers can avoid being put in the middle, while ensuring that their company’s cost of healthcare coverage increases at a rate the company can afford.

3. They Will Help Individuals To Comparison Shop Among the Different  Plans  

With costs now transparent, and increasingly quality information being made available, enrollees will be better equipped to make informed choices about the best plan for themselves and their families.

The public exchanges offer standardized benefits and comparable pricing. Each plan, from platinum and gold to silver and bronze, varies in monthly premiums and patient cost-sharing requirements.

Previously, healthcare pricing and benefits constituted nothing less than a “black box.” Plans varied widely in what was covered and how much an individual or family needed to pay out of pocket. It took an actuary to figure out which plan had the most value.

No more.

4. They Will Motivate Changes In Behavior That Drive Down HealthCare Costs

Enrollees through the exchanges will be more active participants in controlling their healthcare costs.

The government-funded subsidies are designed to make the Silver tier the most desirable. By law, this level of coverage requires on an actuarial basis that 30% of the cost be borne by an enrollee. As a result, all include deductibles for which enrollees must pay first dollar out of pocket payments.

Knowing they will be personally responsible each year to pay for a significant amount of their care, they will be more likely to take advantage of the free preventive services offered  and deepen their personal commitment to life style changes that could minimize major medical problems in the future.

And having to pay out of pocket will fuel individuals to be financially motivated to make more cost effective choices — for example, to take time to shop to find the lowest priced CT scan and request generic rather than brand name medications.

But one risk is that higher levels of cost sharing will lead individuals to forgo needed care, and end up with increased medical problems and long-term cost. This bears watching.

5. They Will Increase Health Insurance Options And Competition Over Price

We can expect increased competition to lead to lower pricing.

The number of programs available through most public exchanges today, already quite large, is projected to increase significantly in the future.

And thanks to the pooling of risk and reduced transactional costs, participating plans should be able to further restrain their prices.

Previously, many individuals working for a small business were given only one choice. Offering more options was too expensive.

The Small Business Health Options Program (SHOP) in the ACA is an important step forward, especially the provision that enables employees to choose coverage among competing plans. Unfortunately, SHOP is being implemented slowly.

But with momentum, more businesses will move to exchanges, individuals will have more choice and plans will be forced to provide higher value if they want to attract new enrollees.”

Kiara J Stonestreet's curator insight, April 23, 1:56 AM
The affordable health care act has changed our health care system.!

Will Obamacare Ever Be as Popular as Medicare?

Will Obamacare Ever Be as Popular as Medicare? | Healthcare and Technology news |

With a pen stroke, the president signed into law a health insurance expansion that had previously been deemed "socialized medicine" and had drawn fierce criticism from conservatives.

No, the president wasn't Barack Obama, and the legislation wasn't the Affordable Care Act. Nearly 50 years ago, President Lyndon B. Johnson enacted Medicare and Medicaid amidst passionate opposition to the program that has since become widely ingrained in the fabric of society.

But as liberals celebrate the anniversary of Medicare, it's Obamacare that comes to mind. The hope for liberals: that the shift in perspective on Medicare foreshadows a shift to eventual popularity for Obamacare.

"Before Medicare came into law, one Republican warned that 'one of these days, you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free.' That was Ronald Reagan. And eventually, Ronald Reagan came around to Medicare and thought it was pretty good, and actually helped make it better," Obama said in a 2013 speech in Maryland. "So that's what's going to happen with the Affordable Care Act."

But the differences between the passage and beginning stages of the two laws may be more indicative of Obamacare's future popularity than the similarities, said Jonathan Oberlander, a professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill.

"This is not 1965. American politics are extraordinary polarized by party right now. Congress is more polarized in politics and in ideology than at any point since the 1870s," Oberlander said. "This is a political environment where it's very difficult for a program like the Affordable Care Act that was adopted along partisan lines to gain traction."

Timothy Jost, a Washington and Lee law professor, thinks "there may be some fixes," but believes the law will eventually become entrenched within society.

"I think it already is," he said. "In fact, when people talk about repealing the Affordable Care Act, I think they really don't know what they're talking about."

On that, both agreed: "I think it's past repeal," Oberlander said.

Both the Social Security Amendments—creating Medicare and Medicaid—and the Affordable Care Act created political controversy, and both were passed by large majorities of Democrats in Congress after landslide elections, Jost said. And both took a long time to fully implement—Arizona was the final state to begin its Medicaid program in 1982.

Both were even debated along party lines, although many Republicans ended up voting in favor of the final Medicare bill, viewing it as a lost cause, Oberlander said.

On the other hand, perhaps because they were vastly outnumbered, Republicans never seriously talked about repealing Medicare. The program also had a very identifiable group of beneficiaries, while Obamacare targets diffuse populations, Oberlander said. And there were no significant court cases brought against Medicare, whereas five years after Obamacare's passage it awaits yet another Supreme Court decision on the legality of key aspects of the law.
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Although the gap has narrowed in the past two years, more Americans—43 percent—still viewed Obamacare unfavorably in March than the 41 percent who viewed it favorably, according to a Kaiser Family Foundation poll.

At an event hosted by the Aspen Institute Wednesday to commemorate Medicare and Medicaid's 50th anniversary, several speakers referenced today's partisan gridlock in contrast to the compromises achieved in 1965, although several also brought up the "doc fix" bill—easily passed in the Senate the day before—as a source of hope for increased bipartisanship.

"There are a lot of people who would say this is the most polarized Congress. It doesn't look anything like '64, '65," said former Health and Human Services Secretary Kathleen Sebelius. "I think this is a changed Congress."

Jackie Judd, a special correspondent with the PBS Newshour who served as a moderator at the Aspen Institute event, said the doc fixed served as a reminder that "passions run high around these programs, even today, 50 years later."

But at the end of the day, a bipartisan bill was overwhelmingly passed, a reflection of the way things used to be.

"Medicare and Medicaid were adopted, to some extent, in a bipartisan way, because the parties were much less aligned along the ideological spectrum the way they are now," Jost said.

That meant the programs' flaws could be fixed legislatively. Today, there's little chance of that happening, and solutions instead must come administratively or from the courts, he said.

The question of whether or not subsidies are available on federal exchanges, the largest current threat to the law, "could have easily been fixed by Congress" in 1965, he said.

King v. Burwell, which the Supreme Court is expected to decide this summer, will heavily influence the future of Obamacare. But so will the upcoming presidential election.

"There's a huge difference whether it's Hillary Clinton, Marco Rubio, Scott Walker, or Jeb Bush in the White House," Oberlander said. "The Court case matters greatly here, but I think regardless of what happens in the Court case, the question in 2016 will be: How will the law change?"

No comment yet.!

Seeking Obamacare alternative, Republicans eye tax credits

Seeking Obamacare alternative, Republicans eye tax credits | Healthcare and Technology news |

If the U.S. Supreme Court blows up the tax subsidies at the heart of Obamacare in June, Republicans hope to deliver on their promise to offer an alternative healthcare plan.

But key parts of it may resemble the one President Barack Obama delivered five years ago in the Affordable Care Act, partly reflecting Republican concerns that they could pay a political price if insurance subsidies are yanked from millions of Americans later this year.

Two front-running Republican options at an early stage in Congress include a refundable tax credit that experts say is virtually the same thing as the Obamacare tax subsidy being challenged before the Supreme Court. Republicans deny that their ideas are tantamount to "Obamacare Lite" but acknowledge they will need bipartisan support for their plans to stand any chance of avoiding an Obama veto.

"It's not going to be like Obamacare, in my opinion," said Senate Finance Committee Chairman Orrin Hatch, whose plan includes a refundable tax credit for low-and middle-income Americans.

“It’s not a literal subsidy, it’s a recognition that they should have this credit."

Republicans have been vowing for years to repeal and replace Obamacare, the president's signature policy achievement that Democrats passed in 2010 over united Republican opposition. Democrats say the act is insuring more Americans and helping to slow the growth in healthcare spending.

Conservatives call Obamacare a government overreach that drives up health costs. They object to its mandates -- that everyone have insurance, that employers offer it, and that insurance plans must cover certain items.

But Republicans have never united around a replacement strategy. There is renewed interest in producing one now, however, to be ready if the Court rules for the plaintiffs in the current Obamacare case and disallows tax subsidies through the federal exchange in a ruling expected in June.

Up to 7.5 million people in at least 34 states that use the federal exchange could then lose their tax subsidies, according to the consulting firm Avalere Health, dealing a possibly fatal blow to the program.

Democrats and the White House have said little about what they might do if the Supreme Court rules against the administration. No replacement could go into effect before 2017 unless Obama signs it into law.


Some experts see bipartisan potential in key elements of what Republicans like Hatch, of Utah, and House Ways and Means Committee Chairman Paul Ryan, of Wisconsin, have discussed to date.

The refundable tax credits in both their plans would be available to those who pay little or no tax, similar to the Obamacare subsidies for low-income Americans.

"There is a lot of common ground here," said Stuart Butler, a senior fellow in economic studies at the Brookings Institution, who called the refundable credits "essentially indistinguishable" from the Obamacare subsidies.

One difference is that Republicans would allow the tax credits to be used to buy insurance in the private market, an approach they say will help drive down insurance costs and give consumers more options. Under Obamacare, the credits can be obtained only through the state or federal online exchanges.

In an e-mailed statement to Reuters, Ryan said tax credits would "empower Americans to make their own healthcare decisions rather than government mandates.”

Ryan and Hatch have yet to introduce legislation, but their approaches also diverge from Obamacare in other ways. For example, both lawmakers favor allowing government mandates to be lifted, and letting consumers buy insurance across state lines.

Tax subsidies are popular. A Reuters-Ipsos poll conducted March 6-April 13 said that 79 percent of adults favor providing subsidies on a sliding scale to aid individuals and families who cannot afford health insurance. But Obamacare itself remains divisive. In the poll, 53 percent said they were opposed to it.

More Republican proposals are popping up. If the Court rules against the administration, Wisconsin Senator Ron Johnson wants to make the Obamacare taxpayer subsidies available through August 2017, while repealing the individual and employer mandates.

Louisiana Republican Representative John Fleming favors putting taxpayer money into tax-exempt health savings accounts that individuals can use to pay for healthcare expenses.

"Doing nothing, or not covering more people, was never a goal of Republicans,” Fleming said.

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ACA's Mandate To Buy Coverage May Be GOP-Friendly

ACA's Mandate To Buy Coverage May Be GOP-Friendly | Healthcare and Technology news |

Whether it’s a penalty to pick a drug plan under Medicare or the new Republican proposal to replace the Affordable Care Act or the President’s health law alone, penalties abound for being uninsured.

A new analysis by the Urban Institute said “individual responsibility” requirements akin to the controversial individual mandate included in the Affordable Care Act requiring individuals to buy coverage or face a tax penalty also exist in other health reform proposals and existing health insurance programs.

Some, like the Medicare Part D drug coverage for seniors and Medicare Part B’s physician services for the elderly, have been in place for years. Another, a new Republican proposal to replace the ACA, also has its penalties.

The so-called “Patient Choice, Affordability, Responsibility, and Empowerment Act” or PCARE, proposed by Republican Rep. Fred Upton of Michigan and GOP Sens. Orrin Hatch of Utah and Richard Burr of North Carolina would “impose strong penalties on the uninsured,” Urban Institute health policy researchers Linda Blumberg and John Holahan wrote in their analysis out this week called, “the New Bipartisan Consensus for an Individual Mandate.”

“Specifically, if individuals fail to maintain continuous coverage, they can be medically underwritten or effectively denied insurance in the nongroup market,” the Urban Institute’s authors wrote of the Hatch-Burr-Upton legislation. “Medicare Parts B and D also have provisions that penalize individuals for failing to promptly enroll in coverage for the same reason, yet this approach to an individual mandate has not been controversial.”

All of the proposals share the common thread that health insurance, particularly coverage that involves the private insurance market, need an individual responsibility component to ensure healthy people are in the insurance risk pool. Without healthy people buying coverage and paying premiums, claims submitted largely by sick policyholders would lead to soaring health care costs.

The individual responsibility provision has long been the stance of health care interests like the American Medical Association and the health insurance lobby, America’s Health Insurance Plans, which represents Aetna (AET), Cigna (CI), Humana (HUM), UnitedHealth Group (UNH) and most Blue Cross and Blue Shield plans.

“If you want to keep a private market-centered approach and prevent discrimination in insurance against those with health problems, you have to have a mechanism that brings in and holds in the healthy,” Blumberg, seniors fellow at the Urban Institute’s health policy center told Forbes in an interview. “You have to have an individual mandate to hold the healthy into the insurance risk pools.”

The GOP’s Obamacare replacement requires individuals to have insurance “continuously for 18 months to be guaranteed access to a private nongroup insurance policy,” the Institute said in a statement accompanying their analysis. Meanwhile, the ACA imposes tax penalties for those individuals who go without insurance for more than three months in any given year. And Medicare Parts B and D have penalties that are much steeper than the ACA’s for those who delay enrolling after they become eligible.

“Under both programs, penalties are assessed on those who enroll, disenroll and then enroll again,” the institute fellows wrote.

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Obamacare subsidies likely expanded insurance coverage

Obamacare subsidies likely expanded insurance coverage | Healthcare and Technology news |

Early evidence suggests that the tax credit subsidies at the core of President Barack Obama's healthcare reform law likely helped expand U.S. health insurance coverage last year, Congress's non-partisan research arm said on Monday.

The subsidies - which can be paid by the federal government to insurers in advance to lower monthly insurance premiums - significantly reduced the premium costs, the Government Accountability Office (GAO) said in a report.

"Surveys GAO identified estimated that the uninsured rate declined significantly among households with incomes eligible for the APTC (Advanced Premium Tax Credit)," the GAO said.

For example, one survey, conducted by Washington, D.C.'s Urban Institute, found the uninsured rate declined 5.2 percent between September 2013 and September 2014 among those eligible for the tax credit subsidies, the report said.

The GAO also said its findings on the first year of the Obamacare insurance exchanges could not be generalized to future years because other factors, including health care costs, could affect the affordability of insurance going forward.

The subsidies - aimed at making insurance more affordable for low-income people under Obama's Affordable Care Act - are being challenged in a Supreme Court case, King v. Burwell.

In a ruling expected in June, the high court could bar the federally run insurance marketplace from providing the subsidies in at least 34 states.

The plaintiffs contend the Affordable Care Act allows subsidies to be distributed only through state-based exchanges. Thirteen states and the District of Columbia set up their own exchanges from October 2013.

The subsidies are available to people making between 100 percent and 400 percent of the federal poverty level. They can reduce insurance premiums dramatically - cutting them by 76 percent on average for people who picked an insurance plan on the federal exchange or on one of two state-based plans, the GAO said.

Nearly 11.7 million people have either signed up or re-enrolled for insurance coverage under the U.S. healthcare reform law. The GAO said about 16 percent of non-elderly adults remain uninsured.

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Don't Understand Obamacare Signup Penalty? Get A 'Tax Season' Extension

Don't Understand Obamacare Signup Penalty? Get A 'Tax Season' Extension | Healthcare and Technology news |

The Centers for Medicare & Medicaid Services this morning announced a “a special enrollment period” for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their taxes in states using the federal exchange under the Affordable Care Act.

“For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30,” the Centers for Medicare & Medicaid Services said. ”If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.”

The tax penalties are steeper this year. The fee for not having coverage increases to $325 per adult or 2% of income for 2015. That compares to a fee of $95 per adult or 1 percent of income for those who went without coverage last year.

Before to today’s announcement, open enrollment to purchase coverage for 2015 ended Feb. 15. This window offers a new opportunity. Most major insurers like UnitedHealth Group UNH +0.79% (UNH), Humana HUM +1.56% (HUM), Aetna AET +0.57% (AET) and major Blue Cross and Blue Shield plans have products on the federal exchange depending on the state.

“We recognize that this is the first tax filing season where consumers may have to pay a fee or claim an exemption for not having health insurance coverage,” CMS Administrator Marilyn Tavenner said in a statement.  “Our priority is to make sure consumers understand the new requirement.”

To qualify, CMS says those currently not enrolled must:

  • “Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.”

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U.S. deciding whether to extend Obamacare enrollment

U.S. deciding whether to extend Obamacare enrollment | Healthcare and Technology news |

Americans who have started enrolling for health insurance under the Affordable Care Act can still sign up, and the U.S. government is weighing whether to open a special enrollment period for those who missed Sunday's deadline, the health secretary said on Wednesday.

So far, 11.4 million Americans have enrolled in private health insurance through the health reform law known as Obamacare during the open enrollment period that ended on Sunday, according to the White House.

The Affordable Care Act requires most Americans to have health insurance or face a financial penalty. But some people may not realize they face a penalty for not having coverage until they file their tax returns in coming weeks.


HHS will decide within the next two weeks whether to allow another special enrollment period for consumers, Health and Human Services Secretary Sylvia Burwell told reporters in response to a question about those consumers amid the looming April 15 tax-filing deadline.

“We’re going to analyze it, we’re going to think about it, and we’ll be back. And we will be back quickly on it," she said at a news conference.

Separately, Burwell said fewer than 150,000 people were "in line" as of Sunday to get health insurance coverage through the marketplace set up by the Affordable Care Act. They will have until Feb. 22 to complete their application, she said.

Those applicants were in communication with the telephone call center for the federal exchange marketplace but could not complete their application before Sunday's deadline, according to HHS. They do not include people who had technical issues with the website that prevented them from completing their enrollment, the department said.

Kiara J Stonestreet's curator insight, April 23, 1:59 AM
It's 2020 and I am still not updated about that, but I'm pretty sure it ended.!

Does the Affordable Care Act Guarantee Healthcare as a Right?

Does the Affordable Care Act Guarantee Healthcare as a Right? | Healthcare and Technology news |

In his recent celebratory remarks after the Supreme Court (SCOTUS) upheld the legality of subsidies/tax credits under the Affordable Care Act (ACA), President Obama had this to say: "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate -- we finally declared that in America, healthcare is not a privilege for a few, but a right for all." (1)

It would be good if this were true, but it is not. Healthcare as a right has been debated over many years, but is still not in place for all Americans as this country remains an outlier among advanced industrial countries around the world. Instead, despite the ACA, we continue to have a patchwork of ever-changing programs assuring access to health care for some people some of the time.

Let's look at what we do have in this respect. In the 1960s, Congress established a broad right to health care under statutory law by enacting Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) for the elderly, disabled, people living in poverty, and children. In the 1980s it passed the Emergency Medical Treatment and Active Labor Act (EMTALA) requiring all Medicare-funded hospitals with emergency departments to provide appropriate emergency and labor care. More recently, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2013, which assures a right to equal access to care for patients with medical and mental health problems. SCOTUS has established a right to health care for prisoners and has protected some limited rights for women's reproductive care (2), but has never interpreted the Constitution as guaranteeing a right to health care for all Americans. In fact, the words "health," "health care," "medical care," and "medicine" do not appear in the Constitution. (3) 

It is disingenuous to claim that health care is a right in the U. S. when we consider these inconvenient facts:

  • 35 million uninsured, plus another similar number underinsured.
  • The first question asked of us in seeking care is "what is your insurance?"
  • 21 states have opted out of Medicaid expansion under the ACA.
  • Medicaid eligibility and coverage varies widely from one state to
  • another, in many cases falling far short of necessary care.
  • As the costs of insurance and health care continue to rise and shift
  • more to patients, a growing part of the population cannot afford either and forgo seeking care.
  • More than 40 million Americans now have an account in collection for medical debt. (4)

This situation stands in sharp contrast to elsewhere in advanced societies. Healthcare has been recognized as a right since 1948 when the General Assembly of the United Nations adopted a Universal Declaration of Human Rights including access to health care. (5) The right to health care was also later adopted by the World Health Organization (WHO) in its Declaration on the Rights of Patients. (6) As a result, most of Western Europe, Scandinavia, the United Kingdom, Canada, Taiwan, and many other countries have one or another form of national health insurance assuring access to care for their populations. Here we spend twice as much and still have no universal access to health care.

Can we ever see this country coming around to universal access to health care based on medical need, not ability to pay? The record shows that we never can, or will, as long as we permit corporate stakeholders in our medical-industrial complex to call the shots, and as long as they succeed in perpetuating our exploitive for-profit system. There is a fix -- single-payer national health insurance, as embodied in H. R. 676, Expanded and Improved Medicare for All.

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Obamacare's next 5 hurdles to clear

Obamacare's next 5 hurdles to clear | Healthcare and Technology news |

In its first five years, the Affordable Care Act has survived technical meltdowns, a presidential election, two Supreme Court challenges –including one resolved Thursday – and dozens of repeal efforts in Congress. But its long-term future still isn’t ensured. Here are five of the biggest hurdles left for the law:

  • Medicaid expansion. About 4 million more Americans would gain coverage if all states expand the state-federalMedicaid programs to cover people with incomes at or slightly above the poverty line. Twenty-one states with Republican governors or GOP-controlled legislatures, including Texas and Florida, have balked, citing ideological objections, their own budget pressures, as well as skepticism about Washington’s long-term commitment to pay for most of the costs.
  • Anemic enrollment. Eighteen million Americans who are eligible to buy insurance in federal and state marketplaces haven’t purchased it. Those marketplaces have had particular trouble enrolling Hispanics, young adults and people who object to being told to buy insurance.  Federal funding used by state marketplaces to enroll people and advertise is drying up. Many state marketplaces haven’t figured out how to be self-sustaining. Vermont, Hawaii, Colorado and Rhode Island are among those states searching for more money. The penalty for going without coverage rises next year to $695 per adult or 2.5 percent of family income—whichever is larger.
  • Market stability. Nationally, premiums haven’t gone up too much on average in the first two years of the marketplaces, but that could change. The federal government has been protecting insurers from unexpectedly high medical bills, but that cushion disappears after next year. At the same time, insurers finally have enough experience with their initial customers to figure out if their premiums are sufficient to cover medical costs. If they’re not, expect increases.
  • Affordability. People who get their insurance through their employer have mostly been spared jolts from the health law. But the federal government begins taxing expensive health plans in 2018. The “Cadillac tax,” created by the health law, will pressure employers to offer skimpier health coverage or pass the taxes’ cost on to their employees. Also, individuals buying their insurance on the health law marketplaces continue to risk large out-of-pocket costs if they need lots of care. Their maximum financial obligations for next year are $6,850 for individuals and $13,700 for families. Those who choose to go out of their insurance network may have no ceiling on how much they may have to pay.
  • Political resistance. Thursday’s ruling did little to diminish the GOP’s zeal to repeal the health law. Republicans on both sides of the Capitol pledged to continue their efforts to kill the ACA. A lawsuit filed by House Republicans last year alleges the president overstepped his authority when implementing the health law. The topic remains grist for the 2016 presidential campaign, with several Republican presidential candidates – including Sen. Lindsey Graham, R-S.C., and former Florida Gov. Jeb Bush — reiterating their desire to repeal the law. If the Republicans capture both the White House and Congress in 2016, all bets are off over whether the law survives intact.
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Three years on, U.S. Chief Justice Roberts rescues Obamacare again

Three years on, U.S. Chief Justice Roberts rescues Obamacare again | Healthcare and Technology news |

The healthcare law conceived by President Barack Obama and passed by Congress was by no means perfect, U.S. Chief Justice John Roberts said on Thursday. The law, for instance, had "three separate Section 1563s."

“The Affordable Care Act contains more than a few examples of inartful drafting,” the country's top jurist quipped as he announced the court's ruling from the bench preserving the law.

But the imperfections were not the point, he said.

Simply put, the 60-year-old chief justice said, the law was written to make healthcare insurance widely available, and the disputed tax subsidies at the heart of the case were crucial to keeping the cost of premiums down and enrollment up.

It was the second time in three years that Roberts had authored an opinion rejecting a conservative challenge to the 2010 law known as Obamacare.

If a law was ambiguous, it was the job of justices to provide a fair interpretation, he said, as he read from his majority opinion in the marble-columned chamber before some 300 spectators.

His corporate legal experience before joining the bench might have informed his understanding of insurance markets. But the man who cut his teeth in Washington as a lawyer in the government's executive branch also voiced understanding of the messy compromises that accompany bills taken up by the legislative branch.


He referred to a cartoon described in 1947 by the late Justice Felix Frankfurter, “in which a senator tells his colleagues, ‘I admit this new bill is too complicated to understand. We'll just have to pass it to find out what it means.’"

Curtailing the subsidies, Roberts said, would lead to an economic "death spiral," with premiums rising and the number of people with insurance dropping.

Unlike three years ago, when Roberts was the only conservative joining the four liberal justices on the nine-member bench to uphold the law, fellow conservative Justice Anthony Kennedy, 78, a 1988 appointee of Republican President Ronald Reagan, signed on with Roberts.

The vote three years ago was 5-4; this time it was 6-3.

In 2012, Roberts drew the wrath of Kennedy, Republicans and other conservatives. Some right-wing advocates beyond the court deemed the 2005 appointee of Republican President George W. Bush a traitor.

Three years ago Roberts confronted a multi-faceted constitutional challenge and stitched together various rationales to uphold the law. His approach on Thursday was straightforward interpretation of statute.


In the case decided on Thursday, the challengers, financed by the libertarian Washington-based Competitive Enterprise Institute, had argued that tax-credit subsidies should go only to people who bought insurance on marketplace exchanges "established by the state," as stated in one part of the law.

That reading would dramatically curtail the availability of subsidies because most of the low and moderate income people who qualify live in the nearly three dozen states with exchanges run by the federal government and not the states.

That interpretation also would conflict with the court's usual approach to ambiguous statutes, Roberts said. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," he said.

Spectators laughed along with Roberts when he quoted Frankfurter, but Antonin Scalia, a 79-year-old justice appointed by Reagan in 1986, was not amused.

Given a Roberts majority had now twice preserved Obamacare, the law might as well be called "SCOTUScare," said Scalia, one of the three dissenters, using the six-letter acronym for the Supreme Court of the United States.

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More Patients, Not Fewer, Turn To Health Clinics After Obamacare

More Patients, Not Fewer, Turn To Health Clinics After Obamacare | Healthcare and Technology news |

Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic in North Carolina.

“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.

Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.

“If you need to get more than one box, get more than one box,” Brinsko said. “But you need to check them every morning so that we can adjust things.”

Coble, who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place, relies on the clinic for health care.

“They do a great job with everything,” Coble said. “I couldn’t do without them.”

Nancy Hudson was the clinic’s director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.

“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.

And now they get free or low-cost care at the clinic, which is designated by the government at an FQHC, or federally qualified health center.

The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.

“Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” says Ben Money is president of the association that represents North Carolina’s community health centers.

North Carolina is among the 21 states, including many in the South, that are currently saying no to Medicaid expansion. Louisiana is another.

Dr. Gary Wiltz, the CEO of 10 community health centers in the southwestern part of Louisiana, says demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he says.

Wiltz says other things are at play, too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.

“The need keeps increasing, and I think that’s reflected throughout all the states,” he says.

Wiltz, who also heads the board of directors for the National Association of Community Health Centers, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.

The Charlotte clinic’s Nancy Hudson says there’s another part of the health law helping fuel the growth: additional funding for community health centers.

Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.

“Many of their clients did not have any access to health care,” she says. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and health care is one of them.”

Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to health care.

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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Obamacare’s Big Gamble on Hospital Productivity

Obamacare’s Big Gamble on Hospital Productivity | Healthcare and Technology news |

Can hospitals provide better care for less money? The assumption that they can is baked into the Affordable Care Act.

Historically, hospital productivity has grown much more slowly than the overall economy, if at all. That’s true of health care in general. Productivity — in this case the provision of care per dollar and the improvements in health to which it leads — has never grown as quickly as would be required for hospitals to keep pace with scheduled cuts to reimbursements from Medicare.

But to finance coverage expansion, the Affordable Care Act made a big bet that hospitals could provide better care for less money from Medicare. Hospitals that cannot become more productive quickly enough will be forced to cut back. If the past is any guide, they may do so in ways that harm patients.

The Obamacare gamble that hospitals can become much more productive conflicts with a famous theory of why health care costs rise. William Baumol, a New York University economist, called it the “cost disease.” (He wrote a book about it by that title; I blogged on it as I read it if you’d like to quickly get the gist.)

This theory asserts that productivity growth in health care is inherently low for the same reason it is in education: Productivity-enhancing technologies cannot easily replace human doctors or teachers. In contrast with, say, manufacturing — a sector in which machines have rapidly taken over functions that workers used to do, and have done them better and more cheaply — there are, at least for the time being, far fewer machines that can step in and outperform doctors, nurses or other health sector jobs.

But a new study casts doubt on that theory and suggests Obamacare’s bet may indeed pay off. The study, published in Health Affairs by John Romley, Dana Goldman and Neeraj Sood, found that hospitals’ productivity has grown more rapidly in recent years than in prior ones. Hospitals are providing better care at a faster rate than growth in the payments they receive from Medicare, according to the study.

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How Many People Has Obamacare Really Insured?

How Many People Has Obamacare Really Insured? | Healthcare and Technology news |

One of the key questions surrounding Obamacare is just how many people have been newly insured under the law. The answer is clouded by the fact that the White House and others have changed some rules of math for making these assessments.

For example, several years ago, the Obama administration fiddled with the Census Bureau’s definition of what it means to be “uninsured.” The new parameters, which were looser than the old factors, make it hard to construct comparisons between today’s figures for the total number of uninsured and the historical trends.

The Obama team also abruptly started to exclude uninsured illegal immigrants from the national tally on total number of uninsured Americans. Before Obamacare, these individuals were counted in that reporting, inflating the numbers. After Obamacare, these individuals didn’t get insurance, but suddenly didn’t get counted any more.

Now, a new analysis from the highly regarded managed care analyst at Goldman Sachs, Matthew Borsch, and his team, cast uncertainty on some of the recent data releases from the White House, and its network of academicians. In particular, the Goldman breakdown conflicts in some key ways with a recent analysis from RAND that was published in the journal Health Affairs and widely cited by the media.

Goldman Sachs estimates that total coverage under the ACA increased by 13 to 14 million last year and may have increased by another 4 million during the first five months of 2015, for a total coverage increase of 17 to 18 million combined. At a top line, this coincides with the figure from RAND, which estimated that there were 22.8 million newly insured people since the launch of the ACA. At the same time, 5.9 million people lost coverage. This comes out to a net gain of 16.9 million lives.

But how the two reports arrived at their numbers differ in important ways. The Goldman analysis relied on multiple data streams, including information released by insurers. The RAND study used a survey instrument sent to 1,589 people.

There are two critical questions embedded in all of these analyses. First, how many of the newly insured people would have gotten health coverage anyway, through some other mechanism (like their workplace)? In other words, is the law simply crowding out other forms of private coverage? Second, how many of the newly insured simply ended up on an expanded (and decaying) Medicaid program? The answers to these questions are an important measure of the ACA’s “success.”

On the latter question, according to the Goldman analysis, about two-thirds of the 2014 coverage increase was from the expansion in Medicaid. For 2014, their figures for net new coverage includes 9 million more people obligated to Medicaid, and about 2 million aging into Medicare. Only about 3 million got commercial coverage.

Moreover, Goldman estimates that employer sponsored coverage declined by about 2 million lives last year, which is at odds with other estimates. The widely cited study by RAND, for example, estimated that 9.6 million people who became newly insured since the fall of 2013 gained their coverage by enrolling in employer sponsored insurance. At the same time, the Goldman analysis estimates that total individual, commercial coverage increased by about 5 million. People migrating out of employer-sponsored insurance, and onto the Obamacare exchanges, explain a large measure of the relative change, under the Goldman analysis. The biggest change, according to their data, was for small employers, where the number of covered lives declined by 2.2 million people, a reduction of 13% year-over-year.

This is in sharp contrast to other analyses, and particularly the RAND study published in Health Affairs, which found that an increase in employer-sponsored insurance was the biggest driver of the total rise in coverage. Moreover, RAND estimates that 43% of the people newly insured by workplace coverage had the insurance available to them in 2013, but opted not to take it. This would suggest that the new tax penalty compelled them to seek the coverage. The RAND authors noted that there were possible methodological challenges with their survey; including confusion people might have had about their own source of coverage. This could potentially explain the wide discrepancies between the two analyses.

Obamacare’s supporters have argued that the public exchanges have not crowded out private insurance coverage that was previously offered at work. The Goldman analysis suggests that the law has indeed crowded out some employer coverage.

Unanswered in all this is also the question of how many employers might have offered insurance for the first time, or expanded their coverage, but for Obamacare and the ability to move their workers onto the exchanges. In an expanding economy, the total share of employer-sponsored coverage should have similarly grown, if historical trends are any guide. Yet the number of people insured through work was flat by many other estimates, and according to the Goldman analysis, actually declined. This strongly suggests the ACA is displacing private coverage.

It could be that most of what Obamacare does to address the “uninsured” problem is obligate a whole lot more people to Medicaid, a program that already suffers from severe access problems owing to years of underfunding relative to its expanding mission, and the chronic health needs of its mostly indigent population. Obamacare only adds to the program’s strains. At the same time, on the commercial side, Obamacare may be mostly creating churn — by displacing people from their employer-sponsored coverage and moving them onto the exchanges.

It’s hard to know for certain, since the current figures – at least those released by Washington – can’t be compared to historical trends. The Census Bureau made a significant change in how it estimates the number of people who lack insurance, starting with its assessment for 2013. That means that after 2013, the results can’t be compared to those for prior years. The government’s new method conveniently results in a lower estimate of the total number of people without insurance.

So far, even if you accept the most optimistic math, Obamacare is hardly the unmitigated success that its many apostles proclaim. Whatever minimal gains in the level of commercial coverage that’s been achieved has come at a huge fiscal expense. This is not to mention the massive growth in costly and restrictive regulation.

These numbers will continue to be the subject of fierce scrutiny, dispute, and fiddling. The proclamations of those who worship the ACA as a new religion are carved out of these numerals. Their scripture is open to a lot of interpretation.

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Obamacare Penalty May Not Be High Enough For Middle Incomes

Obamacare Penalty May Not Be High Enough For Middle Incomes | Healthcare and Technology news |

Even though penalties under the Affordable Care Act for not having health insurance jumped significantly this year, they still might be too low to attract Americans to signup for subsidized coverage, a new analysis shows.

Avalere Health, a Washington health policy and consulting firm, said some middle income healthy individuals would rather pay the fine when they weigh it against spending a few hundred dollars more on insurance.

The fee increased to $325 per adult or 2% of income for 2015, according to That compares to a fee of $95 per adult or 1% of income for those who went without coverage last year.

“Individuals earning more than double the poverty level may continue to forgo coverage since paying the fine is still much more affordable than purchasing insurance,” Caroline Pearson, senior vice president at Avalere, told journalists during a panel discussion Friday on exchanges at the Association of Health Care Journalists annual meeting in Santa Clara.

Avalere looked at such a person for its analysis, citing a 27-year-old who makes $23,000 a year. Here’s a link to the analysis and cost comparisons to income.

“If he did not buy insurance, he would pay $230 in penalties – $619 less than if he had purchased coverage,” Avalere said in its report. “However, with mandate penalties rising in 2015, if the same individual chose to stay uninsured in 2015, he would spend only $391 more on insurance than if he had paid the penalty.”

With such scenarios likely common, it’s no wonder just 68,000 Americans took advantage of the recent special open enrollment period for those who didn’t enroll in the regular open enrollment period that ended in February and faced a penalty for not signing up for 2014 coverage.

“That lackluster uptake of the special enrollment period is driven, in part, because for most people individual mandate penalties are much lower than actual costs of coverage,” Avalere said in a statement accompanying its report.

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Health Care Industry Sees Best Obamacare Quarter Yet

Health Care Industry Sees Best Obamacare Quarter Yet | Healthcare and Technology news |

With the second year of subsidized private insurance and expanding state Medicaid coverage adding millions more insured Americans under the Affordable Care Act, health care insurers and medical care providers are already seeing billions of dollars in new revenue.

Two major barometers of health industry profits, insurance giant UnitedHealth Group UNH +0.77% (UNH) and hospital operator HCA Holdings HCA +0.59% (HCA) last week raised their 2015 revenue projections by billions of dollars.

HCA, in its preliminary 2015 first quarter report, said revenue could reach $40 billion, an increase of the hospital chain’s earlier outlook of between $38.5 billion and $39.5 billion. It raised its profit forecast as well. HCA chairman and CEO R. Milton Johnson said the quarter’s performance was “driven by continued favorable volume and payor trends in core operations.”

Meanwhile, UnitedHealth in its first quarter earnings report raised its revenue outlook for 2015 by $2 billion, saying the insurer will now generate $143 billion in revenue.


In UnitedHealth’s case, they entered several new markets and put more products on public exchanges after sitting on the sidelines in all but a few states in 2014. “We knew back in January that the market was responding positively so it’s played out nicely,” UnitedHealth Group CEO Stephen Hemsley.

UnitedHealth said it also saw growth in Medicaid where several states opted to expand coverage under the health law this year after ironing out political issues that kept them from expanding in 2014.

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Tax refunds for many take hit or get bump from health law

Tax refunds for many take hit or get bump from health law | Healthcare and Technology news |

As the April 15 tax deadline nears, people who got help paying for health insurance under President Barack Obama's law are seeing the direct effect on their refunds — hundreds of dollars, for better or worse.

The law offers tax credits so people without access to job-based health insurance can buy private coverage. Because these subsidies are tied to income, consumers must accurately estimate what they will make for the coming year.

That's been a challenge for millions of people.

Guess on the low side, get more help now with premiums, but owe money later at filing time. Overestimate income, expect bucks back from the taxman.

Many consumers may not have understood that is how it works when they signed up. Some experts caution that such complications could discourage uninsured people from getting covered.

Rob Tuck of Dublin, California, said he had anticipated a refund of about $400 on his 2014 taxes. But that almost has been wiped out because he had to repay some of the subsidy. He changed jobs during the year, and his income went up a little.

Tuck, who works for a San Francisco area tech-support company, said he enrolled to avoid tax penalties for being uninsured, but feels penalized anyway now.

"I was expecting to get dinged a little bit, but I was actually kind of surprised when it came down that much," he said.

Kelsey Park started out 2014 in Dallas, earning good commissions by selling wedding gowns. She left for graduate school at the University of Alabama in Tuscaloosa, and signed up for coverage through the law. She ended up overestimating her income because she didn't get another job as anticipated.

Park's tax refund came to $2,500, partly because she had too much income tax withheld and partly because she received a smaller health care subsidy than she was entitled to.

"It was hard to estimate what I would be earning because I was transitioning in life," said Park, who's studying for a master's degree in marketing. "I tend to overestimate because I don't want to have to pay back," she said.

The average refund is large enough to offset any repayment in most cases, according to the Treasury Department. The White House says the Affordable Care Act is working even better than anticipated.

But this is the first year that the complicated connections between the law and the tax system are playing out for consumers.

Initial reports suggest a fairly even split between tax-return winners and losers.

Earlier in the filing season, tax preparation company H&R Block reported that 52 percent of its customers who got health insurance subsidies owed money back. Repayments averaged $530, reducing expected refunds by 17 percent.

On the other hand, roughly one-third of customers with subsidies overestimated their incomes. As a result, their refunds went up by $365 on average.

In a recent study, the nonpartisan Kaiser Family Foundation estimated that half those eligible for a subsidy would owe money, while 45 percent would receive a bigger refund.

The estimated average repayment was $794, and the refund was $773. The estimates were based on an analysis of census data about income changes among people likely eligible for health care subsidies.

Kaiser calculated that overall between 4.5 million and 7.5 million households have to account to the IRS for their subsidies.

This year is "a learning experience" for consumers and the government alike, said Kaiser's Cynthia Cox. "To the extent this makes people unsure of how much financial help they are going to get, it could be a discouragement for some to sign up."

To avoid tax surprises, consumers should contact the health insurance exchange if their income changes during the year.

Tucker Bush, an AmeriCorps VISTA volunteer in Tacoma, Washington, basically broke even. He ended up giving back $19 of his subsidy, but not before he had spent an hour trying to figure out IRS Form 8962, which taxpayers must use to account for their subsidies.

"It caused me a little bit of a headache, and I have a college degree," said Bush, who volunteers at a nonprofit dental clinic for children. "If you are trying to help someone who may not have a college diploma, this is going to be a nightmare."

Bill Preus of St. Petersburg, Florida, was covered under the health care law for three months last year before transitioning to Medicare because of disability. Preus once had his own insurance agency, selling life and health policies. He is used to complexity, but said he never has seen anything like this.

Preus said he faces the prospect of paying back close to $4,000 because of poor coordination between and his insurer, the government's failure to discontinue his health law subsidy after he went on Medicare, and forgiveness of a student loan debt that caused his income to go up.

"There is no one to talk to who can coordinate when extenuating circumstances like this come up, and it's a total mess," he said.

Preus said a tax preparer and an IRS representative both advised him to file an incomplete return so as to trigger an audit, suggesting that may be the best way to straighten things out.

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Obama says he's ready to sign Medicare doctor payment fix

Obama says he's ready to sign Medicare doctor payment fix | Healthcare and Technology news |

President Barack Obama said Wednesday that he's ready to sign good bipartisan legislation to fix Medicare's doctor payment problem, without endorsing any specific legislation.

Without a fix, doctors face a 21 percent cut in Medicare fees, the consequence of a 1990s budget law that Congress has repeatedly waived.

The House is expected to vote Thursday on a bill with rare support from both top leaders in the House that would permanently fix the problem. Obama backed the idea of a fix at a White House event marking this week's five-year anniversary of his signing the Affordable Care Act, while stopping short of backing the House compromise.

"As we speak, Congress is working to fix the Medicare physician payment system. I have my pen ready to sign a good bipartisan bill," he said.

The House bills calls for a period of basically stable reimbursements, followed by gradually shifting a larger share of doctors' pay so that it's keyed to quality, rather than quantity, of service. The Medicare fix is packaged with an extension of children's health insurance, funding for community health centers and dozens of other provisions. The outlook in the Senate is unclear.

Drafted with the unusual support of both top leaders in the House — Speaker John Boehner for the GOP and Democratic leader Nancy Pelosi — the bill is aiming for the political center. That seemed to have collapsed on health care in the battles over President Barack Obama's overhaul.

The legislation is being criticized from the political right and the left. Conservatives don't like that most of the cost will be added to the federal deficit. Liberals object to higher premiums for upper-income beneficiaries, when drug companies are not being asked to share the burden through Medicare rebates.

Obama also announced a cost-cutting effort that the White House calls a Health Care Payment Learning and Action Network. The White House says more than 2,800 health care providers, patients and consumer groups have agreed to take part.

The goal is to tie more payments for health care services to the quality — not quantity — of services rendered. Earlier this year the administration set a goal to tie 30 percent of Medicare payments to quality and value, but Obama wants to go further.

"A central notion in the Affordable Care Act was we had an inefficient system with a lot of waste that didn't also deliver the kind of quality that was needed that often put health care providers in a box where they wanted to do better for their patients, but financial incentives were skewed the other way," Obama said.

"We don't need to reinvent the wheel — you're already figuring out what works to reduce infections in hospitals or help patients with complicated needs," Obama told health care providers gathered in the Eisenhower Executive Office Building next to the West Wing. "What we have to do is to share these best practices, these good ideas, including new ways to pay for care so that we're rewarding quality."

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Obamacare Is Five: The Penalties Begin

Obamacare Is Five: The Penalties Begin | Healthcare and Technology news |

Monday, March 23, 2015, marks the fifth anniversary of the passage of Obamacare. Buried in its hundreds of thousands of pages is a mandate that every American must acquire and maintain qualified health insurance. Taxpayers who fail to comply and do not qualify for an exemption will be penalized. This penalty has been dubbed a “shared responsibility payment.” Whatever moniker you choose, this provision is sure to increase the burden on a number of individuals and families, especially those who are struggling financially. Therefore, it is crucial to learn more about this portion of the law.

In this article, we’ll discuss how the penalty works, who is required to pay it, and provide you with everything you need to know to easily calculate it.

The Penalty: How It Works
The Obamacare penalty, effective January 1, 2014, will soon be an aggravating topic for many Americans. Here’s how it works. When you file your 2014 federal income tax return, you will be required to do one of the following:

One: Prove that you had qualified health insurance each month during 2014; or
Two: Obtain a qualified exemption; or
Three: Pay a penalty.

The Penalty: How Much Is It?
Here are the guidelines for determining the penalty for tax years 2014, 2015, 2016, and beyond. The penalty will be the greater of the following:

Tax Year 2014
1.0% of household income or $95 per uninsured adult and $47.50 per uninsured child, up to a maximum of $285 per family.

Tax Year 2015
2.0% of household income or $325 per uninsured adult and $162.50 per uninsured child.

Tax Year 2016 and Beyond
The amount will increase and will be indexed for inflation.

NOTE: The penalty amount has an overall maximum which is equal to the cost of the national average premium for a bronze-level health plan available through the Marketplace for the specified calendar year. The national average premium for a bronze-level plan in 2014 is $2,448 per individual ($204 per month) or a max of $12,240 ($1,020 per month) for a family with five or more members.

The penalty is affected by the number of months you were uninsured. If you were insured for part of the year, your penalty may be reduced or eliminated. For example, if you were without coverage less than three consecutive months, it is called a “short gap” and you won’t be penalized. However, if you have more than one “short gap” during a calendar year, you will only escape the penalty for the first short gap.

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Obama Cites Health Plan Tally of 11.4 Million

Obama Cites Health Plan Tally of 11.4 Million | Healthcare and Technology news |

President Obama said Tuesday that 11.4 million people had selected private health insuranceplans or renewed their coverage under the Affordable Care Act in the enrollment period that ended Sunday.

“It gives you some sense of how hungry people were out there for affordable, accessible health insurance,” Mr. Obama said in a video released by the White House.

Administration officials said the numbers would grow in the next week as insurance marketplaces, or exchanges, signed up people who had tried to enroll but encountered technical problems on or state insurance websites.

The White House celebrated the latest numbers as evidence of the success of the health law, which was adopted in 2010 without any Republican votes.

“The Affordable Care Act is working,” Mr. Obama said. “It’s working a little bit better than we anticipated — certainly, I think, working a lot better than many of the critics talked about early on.”

More than a million people selected health plans in the last nine days of the latest open enrollment period.

“On the final day,” said Sylvia Mathews Burwell, the secretary of health and human services, “we had more consumers sign up than we’ve every had, last year or this year.”

Many people cited the threat of tax penalties as a reason for obtaining insurance.

Federal health officials emphasized that the latest numbers were preliminary. People are not formally enrolled until they pay the first month’s premium. Some people who gain insurance and pay the initial premium lose the coverage because they do not pay their share of premiums in later months.

Ms. Burwell had set a relatively modest goal for 2015, saying she wanted to have 9.1 million people signed up and paying premiums at the end of the year. The Congressional Budget Office had projected enrollment of 12 million for 2015.

The administration has had difficulty establishing a firm count of people gaining insurance under the health law.

In April 2014, Mr. Obama announced that eight million people had signed up in the initial enrollment period that had ended March 31. By October, that number had declined to 7.1 million because some people failed to pay premiums or were found ineligible because of unresolved questions about their citizenship or immigration status.

The number shrank again in November, to 6.7 million, as congressional investigators discovered that the administration had overstated enrollment by including about 400,000 people with dental insurance.

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