Thursday, July 24, 2014

10 Million Newly Insured Because Of Health Law, Study Says

Preface: From time to time, I reprint ,with their permission, material from Kaiser Health News. Their lead story is today is that the Affordable Care Act reduced the rate of uninsured by 5.2% from October 13, 2013, the date of launch to June 2014. The full text of the article is available in July 24,

The study, done by Harvard researchers and published by the New England Journal of Medicine, was based on Gallup polling and data from the Department of Health and Human Services. It also estimated that the uninsured rate declined by 5.2 percentage points in the second quarter of 2014.

In their conclusion to their NEJM piece, its six authors carefully hedge their bet on the future of ObamaCare and the significance of their data: “These observations are merely observational. We can only identify suggestive associations between the ACA, the declining insurance rate, and access to care.”

The Associated Press: Study: 10M Have Gained Coverage Through Health Law

A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama’s law took hold in much of the country. The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points

Politico: New England Journal Of Medicine Report: 10 Million Newly Insured

The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans — this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage — although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation (Winfield Cunningham, 7/23).

Modern Healthcare: 10.3 Million Gained Insurance Under Obamacare

About 10.3 million Americans have gained insurance coverage since the full implementation of Obamacare last year, according to an analysis published Wednesday in the New England Journal of Medicine. The uninsured rated dropped to 16.3% at the end of April from 21% before the initial open enrollment period for plans on the new insurance exchanges. The decreases were most pronounced among low-to-middle income households in states that expanded Medicaid eligibility to residents with incomes up to 138% of the federal poverty level .

The Hill: Study Finds 10.3M Gained Insurance Through Health Law

The study conducted by researchers from the Department of Health and Human Services and Harvard University found the the number of uninsured has fallen from 21 percent in September 2013 to 16.3 percent in April 2014. In particular, it found jumps in the insurance rates for Hispanics, blacks and young adults.

: Over 10 Million U.S. Adults Gain Coverage Under Obamacare

The study, which appeared in the New England Journal of Medicine, also found evidence that more Americans had a personal doctor and fewer difficulties paying for medical care within the first six months of gaining insurance (Morgan, 7/23).
Ouch! Government Accounting Office (GAO) Sting Reveals Applications for Subsidies Can Be Faked

Nothing stings more sharply than the loss of money.

Livy (58 BC to 17 AD), History XXX

Something is rotten in the state of Denmark.

Shakespeare (1564-1616), Hamlet

Government subsidies are what make ObamaCare work. Subsidies are what make the individual and employer mandates possible. Without subsidies, ObamaCare collapses into an unworkable, unsustainble heap.

Subsidies take the sting out of ObamaCare premiums. Without subsidies, premiums become unaffordable, subsidized people exit from the market, and ObamaCare enters a death spiral.

According to Betsy McCaughey “A Ruling That Could Doom ObamaCare,” New York Post, July 22, 2014), without ObamaCare, subsidized people would have to pay four times the subsidized price. That would be too much financial pain to bear, and they would withdraw from the ObamaCare market.

McCaughey is referring to the possible effect of the Halbig-Burwell ruling on July 22. The ruling barred the federal government from handing out subsidies in 35 states with federal health exchanges.

In those states, five million people enrolled in health exchange plans. Eighty five % qualified for subsidies because of individual incomes below $46, ooo or family incomes of $194,000 or less.

If the Halbig- Burwell ruling were to stick (it probably won’t, and it may be up for the Supreme Court to decide), a mass exodus from ObamaCare plans would occur, an insurer death spiral would ensue, and ObamaCare would die.

This theoretical sequence of events is unlikely but was predictable. The accuracy of the verification system has always been suspect, along with prospects for massive fraud. The “back-end” of, it has been repeatedly pointed out, could not sort out those eligible to qualify for government subsidies. Now we learn you can fake eligibility.

To ObamaCare backers, prospects for compassionate “free” government handouts to help the poor and uninsured was irresistible. Obama’s IRS ruled that intent to subsidize the politically disenfranchised overrode the specific wording of the Accountable Care Act, which plainly said only the states could hand out subsidies. ObamaCare supporters had three years to find textual evidence in the law supporting their theory of congressional intent, but they could not or did not.

On July 22, the D.C. court of appeals stepping in with the Halbig-Burwell ruling. Two hours later, the less prestigious court of appeals in Richmond ruled otherwise, saying subsidies were legal because of congressional intent.

Then, in a bewildering turn of events, to compound the confusion, the GAO (Government Accounting Office) simultaneously announced results of s sting operation. The GAO said it had faked online and telephone applications for 12 people, and 11 of the 12 qualified for subsidies. The GAO did this by creating false identities by inventing Social Security numbers, income, and citizenship information and counterfeiting documents.

And so it went. To critics, the GAO sting confirms their worst suspicions – that there is something rotten about and ObamaCare itself. It opens the government and taxpayers to massive hacker fraud. This may not prove to be the case, the possibility exists.

In the words of Muhammed Ali (aka Cassius Clay), born 1942, ObamaCare and “Float like a butterfly, sting like a bee.”

Wednesday, July 23, 2014

Obama and His Health Law

Show me the man, and I’ll show you the law.

David Ferguson: Scottish Proverbs (1641)

Obama seems to think he is above the law.

Even as lower appeal courts fight to a draw.

He feels he can make or break any statute,

The President, you see, is a national statue.

His intentions, not the law, are what counts.

That is to what his attitude amounts.

The health law does not reflect his intent.

Its language does not say what he meant.

Critics say law is clear and unambiguous,

But with its words he is noncontiguous.

Mere words of the health law are meaningless,

To those uninsured in such distress.

Next legal step is full court of appeals.

His knowledge reveals how its majority feels.

He appointed four of its eleven judges.

Against him they harbor no real grudges.

Seven of the eleven voted Democratic.

Their decision will be for him automatic.

So says he, let the Supreme Court decide.

It cannot and will not my law override.

Tuesday, July 22, 2014

Kindle book Direct Pay Independent Practice: Medicine and Surgery, is now available on amazon Book makes point that ObamaCare, which raises premiums and deductibles to unaffordable levels for many, is a potent incentive sales program for direct pay concierge and direct pay ambulatory care practices as alternative to ObamaCare.
Appeals Courts Conflict on Health Law Subsidies

It is emphatically the province and duty of the judicial department to say what the law is.. If two laws conflict with one another, the court must decide.

John Marshall (1755- 1835), First Supreme Court Chief Justice

It is starting to look like the Supreme Court will again have to decide if ObamaCare meets the letter of laws governing the President and his executive actions.

Today, Tuesday, July 22, 2014, two appeals courts issued two conflicting rulings of ObamaCare within hours of each other.

• The D.C. circuit court rules 2:1 that subsidies could only be available in state exchanges, not in the 36 federal exchanges, thereby ruling invalid subsidies given in the recent health exchange launch, which ended on April 1 and in subsequent two weeks.

• The U.S. Appeals Court for the Fourth Circuit in Richmond , unananimousliy struck down this challenge to ObamaCare subsidies, which effectively the entire intent of the ACA.

These conflicting decisions come in the wake of the Hobby Lobby decision to invalidate part of the Contraceptive Mandate, a setback for ObamaCare.

If subsidies are blocked, an estimated 7.3 million people – about 62% of those expected to enroll in federal exchanges by 2016 – will lose out on $36.1 billion in subsidies. As matters now stand, people qualify for subsidies with incomes under $45,960 for individuals and $94, 210 for families of four.

On the other hand, if subsidies continue, health care premiums may rise to unacceptable levels for many of the middle class.

A negative rulings by either the full court of appeals, expected soon, or the Supreme Court latter, should it accept the case, would effectively kill the Employer and Individual mandates and ObamaCare itself.

If the subsidies case goes before the Supreme Court, ObamaCare success is not a given court rulings so far on Hobby Lobby and the 13 to 0 record of recent negative Court rulings against Obama.


1. Paige Winfield Cunningham, “Wild Day for ObamaCare: Appeals Court Rulings Conflict, Politico, July 22. 2014.

2. Robert Pear, “Courts Issue Conflicting Rulings on Health Care Law,” New York Times, July 22, 2014.

Looking at Health Reform Anew

Our obligation is about generating new ways to reconceptulize the world and new ways to participate in it, new ways to imagine, to shape, and make it.

Mariko Silver, “Show the World Anew,” President of Bennington College, 2014 inaugural address to alumni, students, faculty, and friends of Bennington College

I am not an alumnus of Bennington College. But one son, Carter, went there. The other son, Spencer, presented his poems there.
And it was at Bennington that my society mentor, Peter Drucker (1909-2005), taught and learned what he needed to know to develop the theories that inspired and informed modern management.

There Drucker learned about makes America tick – its history, government, philosophy, and religion. Drucker believed in limited government but also in business management that created and led institutions with larger social purposes.

I am writing this because I am engaged in writing an ObamaCare triology spanning the period from ACA passage, March 23, 2010 to November 4, 2014. I believe the midterms will determine the fate and shape of health reform.

What am I learning from this writing engagement, this process, of writing about ObamaCare?

Much of what I am learning was expressed eloquently in Mariko Silver’s inaugural address as President of Bennington College.

One, “Life has never been lockstep or linear.” Neither has the process of implementing ObamaCare. ObamaCare is a new way of reconceptualizing health reform, a sometimes bizarre combination of government and the private sector, as a means of reshaping and remaking health care delivery.

Two, “Humans are ever seeking to capture the complexity of the world and to bind it into little boxes.” I have tried to capture the essence of ObamaCare by binding them into 600 little boxes called blogs and then to rebox them into bigger boxes called categories and then into even bigger boxes called books.

Three, “But if we want change, if we want progress, if we want fundamental shifts and improvements in the human experience – and the state of the planet as well – then we need to require our institutions to advance and even to break course and take on new, as yet never realized or even yet imagined, directions – new boxes, or maybe no boxes.” ObamaCare does not fall neatly into little boxes, like blogs, or even into big boxes – like liberalism or conservatism, or single-payer, government- driven care. or competition, and market-driven care.

Instead ObamaCare advocates and distractors and the alternatively-minded opponents should seek “liberate and nurture the individuality, the creative intelligence, and the ethical and aesthetic sensibility” of students and perpetrators of health reform for “constructive social purposes” , rather than for raw political power.

The quest for the right health reform is an ongoing, perpetual , creative – and chaotic – process. It has no definite endpoint. There will always be room and gloom for improvement.

But we as a resilient nation can do it because of our endowment of individual, natural, and freedom-loving resources. We can do it by defying conventional wisdom that there is just one right way of doing things. Let us do it the American way by embracing complexity and diversity and by thinking of our creative restlessness as an asset, rather as an exercise in political partisanship.