Presumptuous Politics

Thursday, February 13, 2014

Cave In?

Insurance industry raises questions about new ObamaCare enrollment numbers being ‘inflated’

The Obama administration’s latest rosy scenario about 3.3 million consumers signing up for health care plans is facing skepticism from top insurance industry officials, who estimate that somewhere in the range of 10 to 25 percent of those “enrollees” actually have not yet paid their premiums and are not fully enrolled.
“The numbers are not as high as 3.3 million -- it’s lower,” one senior insurance industry source told Fox News. “Those numbers are inflated. The question is how much.”
Industry officials tell Fox that some insurance companies have privately reported up to 30 percent of enrollees have not paid up, while other companies believe a higher percentage of customers have taken care of their premiums. The senior insurance industry source suggested it averages out to roughly 10 to 25 percent of enrollees not yet paying into the system, and thus those individuals do not really have insurance.
Scenarios for not paying include people who went through the struggles of logging on to HealthCare.gov and eventually decided it was not worth it to go through the final steps of payment, and others who may simply not be able to afford the premiums. Industry officials believe others have gone through the process of choosing a plan and simply have not gotten around to writing a check, but eventually may make the payment to complete the process and wind up being a success story.
It’s hard to pinpoint precisely how many people have paid their premiums, since companies like Humana and United have not yet disclosed numbers. Aetna has said that 70 percent of their enrollees paid premiums in January, and of those who signed up before January, 90 percent paid their premiums. WellPoint has reported that a majority of its 500,000 enrollees have paid premiums but not a “vast majority” as of yet.
Insurance industry officials are also raising questions about whether the White House really does not know how many people have paid into the system, as White House Press Secretary Jay Carney has suggested.
Pressed by Fox on Wednesday about how many of the 3.3 million enrollees have paid premiums, Carney said the data rests with the industry. “It is a contract between an individual or – well an individual even representing his or her family – and a private insurance provider,” he said. “So insurance companies obviously have data about when those payments were made, but this would be no different from any other insurance contract that you would – you would purchase.”
A senior insurance industry source said the administration actually does have at least a rough idea of how many people have paid into the system because that determines who gets government subsidies, so the administration has to eventually know who’s paying into the system in order to make sure subsidies are going to the right people.
As a rough example, an industry source said if a consumer has to pay a $100 monthly premium for coverage and the government subsidy is worth $80, the consumer only pays the $20 difference to the insurance company. The $80 subsidy is later paid by the government directly to the insurance company, so the insurance companies have to show the administration who is paying into the system in order to get that reimbursement.
An administration official confirmed that the key federal agency involved does get some payment data, but stressed the administration is more focused on getting the payment system completed over the long term.
“CMS receives aggregate-level enrollment data on a monthly basis from issuers that are owed payments of marketplace financial assistance,” said the official. “However, enrollments on the individual level for all issuers will be measured in the long term” using documents known as 834 forms.
The official added that some health plans have already begun providing those forms, “which will eventually be the mechanism for making payment and reporting enrollment data as part of our automated system.” Once that system is fully operational, the official said, “we will determine the most appropriate way to make detailed payment information available.”

Democrats who oppose Keystone XL pipeline own shares in competing companies

Democrats who oppose the Keystone XL pipeline have thousands of dollars invested in direct competitors to the company looking to build the pipeline, public records show.
A recent environmental assessment by the State Department was seen as a step toward the pipeline’s approval, but Sen. Tim Kaine, D-Va., remains opposed to its construction.
“In my view, there is now enough evidence to conclude that construction of this pipeline is not in America’s long-term interest,” Kaine said in a statement on the review.
The freshman Democrat has between $15,000 and $50,000 invested in Kinder Morgan Energy Partners, according to his most recent financial disclosure. Kinder Morgan is looking to build a pipeline that would directly compete with Keystone.
Kinder Morgan is considering expanding its Canadian pipeline infrastructure with an expansion of the Trans Mountain Pipeline, which carries oil sands crude from Alberta to refineries and export terminals on Canada’s west coast.

Wednesday, February 12, 2014

Missouri Senate endorses bill that would nullify federal gun laws

JEFFERSON CITY, Mo. – Missouri senators endorsed legislation on Tuesday that seeks to nullify U.S. gun restrictions and send federal agents to jail for enforcing such laws, though the measure would likely face a court challenge if it gets approved in the state.
Courts have consistently ruled that states cannot nullify federal laws, but that hasn't stopped Missouri and other states from trying.

Sen. Brian Nieves, the Republican sponsoring the bill, said the legislation would protect law-abiding gun owners from federal encroachments and regulations. Missouri Republicans began pushing for the legislation following President Obama's call last year for increased background checks and a ban on assault weapons.
The legislation would subject federal agents to civil and criminal penalties for knowingly enforcing federal gun laws. Agents could face up to one year in prison and a $1,000 fine.
"This is primarily purposed to protect liberties of Missourians," said Nieves, of Washington.
The measure also would give school districts the option to designate personnel to carry a concealed weapon in school buildings after undergoing training. Opponents argue that provision would increase access to firearms, which could then lead to more instances of gun violence.
"I cannot support this legislation in good conscience," said Sen. Jamilah Nasheed, D-St. Louis. "Kids are killing kids in school."
An amendment was added to require school districts to hold a public meeting before allowing personnel to carry in buildings. That provision's sponsor said he hopes that would cause districts to think twice before letting guns in the classroom.
"I believe my parents would say we don't want our teachers to carry guns and our school board members would then have to look at the consequences of that decision," said Rep. Jason Holsman, D-Kansas City.
Holsman's amendment would also allow designated personal to choose to carry pepper spray instead of a weapon.
Another provision of the bill would let holders of concealed gun permits carry firearms openly, even in municipalities with ordinances banning open carry. It would also lower the minimum age to get a concealed weapons permit to 19, down from 21. Under the bill, health care professionals could not be required to ask or document whether a patient owns a firearm.
The Senate also approved an amendment sponsored by Nasheed that would give gun owners 72 hours to report a stolen firearm to law enforcement.
Democratic Gov. Jay Nixon vetoed a similar measure that the Republican-controlled Legislature passed last year.
Nieves' bill is less specific than last year's version about which federal laws it seeks to nullify. It removes references to the 1934 and 1968 gun control acts, while keeping generic references to fees, registration and tracking policies that are considered "infringements" or "have a chilling effect on the purchase or ownership" of guns and ammunition by law-abiding citizens.
The measure needs one more affirmative vote in the Senate before heading to the House.

House Republicans fighting Treasury Dept. effort to limit political activities of tax-exempt groups

Republican lawmakers are fighting back against what they call an effort by the Obama administration to silence the political speech of tax-exempt groups, including those originally targeted by the IRS.
A House panel passed a bill Tuesday that would delay regulations by the Treasury Department designed to limit the political activities of so-called social welfare groups.
Treasury officials claim the regulations would help clarify vague rules about which groups qualify for tax-exempt status, but congressional Republicans believe the regulations are an attempt to legalize the targeting of conservative groups.
“Make no mistake about it: the Obama administration is doing this as a blatant attempt to silence political speech,” Rep. Tom Price, R-Ga., said in a statement.
The proposed regulations came after IRS officials acknowledged last spring that agents had improperly targeted Tea Party and other conservative groups for extra scrutiny when they applied for tax-exempt status.
The Ways and Means Committee voted 23-13 to pass a bill that would block the regulations for a year. It was a straight party-line vote, with Republicans in favor and Democrats opposed. The full House is expected to take up the bill after the House returns from its Presidents' Day vacation.
Committee Chairman Dave Camp, R-Mich., said delaying the regulations would give Congress and the Justice Department time to finish their investigations.
"The notion that the administration would rush forward with rules intended to remove these groups from the public forum is simply unacceptable," Camp said. "I have long made clear that this committee will fight any and all efforts to restrict the rights of groups to organize, speak out and educate the public."
Senate Republicans have embraced the effort but the bill has little chance of becoming law because Democrats oppose it. Democrats said the bill is little more than an election-year ploy by Republicans to rally the party base. They note that final regulations probably wouldn't be issued for at least a year, anyway.
"Unfortunately, the proposed regulations are being used by Republicans in Congress to renew a tireless campaign to turn the issue into a scandal that would pay political dividends," said Rep. Sander Levin of Michigan, the top Democrat on the Ways and Means Committee.
The regulations would apply to social welfare groups applying for tax-exempt status under section 501(c) 4 of the tax code. Under current regulations, these groups can engage in politics, but their primary mission cannot be to influence the outcome of elections.
"It is about disclosure," said Rep. Bill Pascrell Jr., D-N.J., a senior member of the House Ways and Means Committee. "Nowhere in the Bill of Rights does it say you have the right to say anything you want — and also not pay any taxes."
The current regulations have led IRS agents to ask groups intrusive questions about the amount of time they spend on activities that are potentially political.
The proposed rules would limit certain "candidate-related political activity,” but leave open the question of how much the activity would be restricted.
Limited activities would include voter drives and voter registration efforts, as well as ads that "expressly advocate for a clearly identified political candidate or candidates of a political party." Also included would be ads that mention a politician or a political party within 60 days of a general election or 30 days before a primary.
Republicans have raised myriad concerns in recent weeks about the status of the IRS controversy. The Justice Department has received complaints over the slow pace of the investigation and the discontent grew louder after officials announced last month they aren’t expecting criminal charges will be filed in the case.

Monday, February 10, 2014

The Hillary Papers: Archive of 'closest friend' paints portrait of 'ruthless' first lady

On May 12, 1992, Stan Greenberg and Celinda Lake, top pollsters for Bill Clinton's presidential campaign, issued a confidential memo. The memo's subject was "Research on Hillary Clinton."
Voters admired the strength of the Arkansas first couple, the pollsters wrote. However, "they also fear that only someone too politically ambitious, too strong, and too ruthless could survive such controversy so well."
Their conclusion: "What voters find slick in Bill Clinton, they find ruthless in Hillary."
The full memo is one of many previously unpublished documents contained in the archive of one of Hillary Clinton's best friends and advisers, documents that portray the former first lady, secretary of State, and potential 2016 presidential candidate as a strong, ambitious, and ruthless Democratic operative.
The papers of Diane Blair, a political science professor Hillary Clinton described as her "closest friend" before Blair's death in 2000, record years of candid conversations with the Clintons on issues ranging from single-payer health care to Monica Lewinsky.
The archive includes correspondence, diaries, interviews, strategy memos, and contemporaneous accounts of conversations with the Clintons ranging from the mid-1970s to the turn of the millennium.
Diane Blair's husband, Jim Blair, a former chief counsel at Tyson Foods Inc. who was at the center of "Cattlegate," a 1994 controversy involving the unusually large returns Hillary Clinton made while trading cattle futures contracts in the 1970s, donated his wife's papers to the University of Arkansas Special Collections library in Fayetteville after her death.

Contractor hired to fix Healthcare.gov reportedly has history of problems

Accenture, the contractor fired to fix ongoing problems with the federal health exchange website, has been heavily criticized by some of its largest clients, including federal agencies, according to a published report.
The Washington Post reports that the U.S. Postal Service Inspector General's Office recommended this past June that the agency consider terminating more than $200 million in contracts with Accenture. The recommendation cited an "absence of business ethics" by the firm, including a 2011 settlement with the Justice Department to resolve allegations of "kickbacks" and "bid-rigging" in federal contracts. Accenture, which paid $63 million to resolve the claims, denied the allegations.
The Obama administration announced last month that it had tapped Accenture to become the lead contractor for Healthcare.gov after cutting ties with CGI Federal, which handled the site's troubled launch this past Oct. 1. Technical glitches blocked many prospective customers from initially using the site, and while enrollment has picked up, the numbers have struggled to recover from the early setback and reach the administration's benchmarks.
Accenture's contract to oversee Healthcare.gov is believed to be for one year and worth an estimated $91 million. Experts interviewed by the Post were divided over whether Accenture was the right choice to tackle the ongoing problems of the site, with one IT consulting firm executive saying Accenture was "at the top of the stack" in the industry. However, the same executive also questioned whether Accenture's relative lack of experience in health care would be an issue. Citing the government spending tracker website USASpending.gov, the Post reported that less than $50 million of Accenture's $10 billion in federal contracts has involved the Centers for Medicare and Medicaid Services.
The Post reports that nearly 30 projects undertaken by Accenture over the past 10 years have encountered problems like technical malfunctions and cost overruns. Among the troublesome federal projects spotlighted by the Post include a computer system for the Department of the Interior's Mineral Management Service, which regulates the oil industry. A 2007 report quoted an accounted as telling auditors that the system took longer to use than the one it replaced.
Between 2004 and 2007, the Post reports that the Pentagon and four states canceled Accenture contracts to develop online voting for voter registration systems. And in 2006, a report by the IT firm The Wendell Group blasted a tax office computer system for the District of Columbia developed by Accenture. The report found that the system incorrectly calculated penalties and interest on tax bills and called it "poorly designed" and "mismanaged."
"There is a real concern," Daniel I Gordon, the former head of government procurement policy for the Obama administration, told the Post. "This company has problems in their past performance that are relevant and recent ... The real question is whether the government did its due diligence."

Sunday, February 9, 2014

Vets face crashes, delays on fed's online benefits system like those that plagued ObamaCare site

The glitches and other problems with the ObamaCare website that sparked a national firestorm are similar to those military veterans using the federal government’s online benefits system have routinely faced for about the past 18 months.
Eric Jenkins, a veteran and American Federation of Government Employees representative, recently told Congress that during January, the Veterans Benefits Management System crashed about once a week, with downtimes ranging from one hour to multiple days.
“The constant … technical issues and frequent shutdowns make it difficult for me and others to serve veterans,” Jenkins told a House Veterans Affairs subcommittee.
The $537 million system went online in fall 2012 at a Department of Veteran Affairs office in New England and is now in all 56 regional offices.
The change to a paperless system was a major part of the Veterans Affair’s goal of eliminating a massive backlog of compensation claims by 2015 with 98 percent accuracy.
The number of claims started skyrocketed in 2010, to more than 1 million annually, in large part because of troops returning from Iraq and Afghanistan.
But Jenkins and other critics say the push to slash the backlog has created its own problems, similar to those experienced by insurance shoppers on the ObamaCare website, HealthCare.gov.
Jenkins said the VA computer system had to be rebooted four times during one week, resulting in him losing all the electronic claims on which he was working, with no paper documents as backup.
The problem is “quantity over quality,” he said in testimony Wednesday before the Subcommittee on Disability Assistance and Memorial Affairs.
The federal ObamaCare website and the 14 state-run exchanges went online in October, but their early debut also was spoiled by crashes, as well as slow response times and the dissemination of inaccurate information.
Jenkins, a disabled combat veteran and a VA service representative, also pointed out that the benefits management system has another problems similar to one during the rollout of ObamaCare -- more users compound slow response times.
Subcommittee Chairman John Runyan, R-Pa., said the regular, weekly shutdowns “weren’t the only problems” with Veterans Affairs systems, pointing to a recent security breach of the electronic benefits system that reportedly compromised the personal data of 1,400 users.
“The lack of security is of tremendous concern,” he said.
Nevada Rep. Dina Titus, the subcommittee’s top ranking Democrat, said: “We’re not overly impressed by the systems’ security and consistency.”

Exclusive: AIDS patients in Obamacare limbo as insurers reject checks

By Sharon Begley and Julie Steenhuysen

NEW YORK (Reuters) - Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud.

Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.

The state's largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.

"In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law," Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters.

AIDS FUNDS EXEMPT FROM FRAUD CONCERNS

The dispute goes back to a series of statements from Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency.

In September, CMS informed insurers that Ryan White funds "may be used to cover the cost of private health insurance premiums, deductibles, and co-payments" for Obamacare plans.

In November, however, it warned "hospitals, other healthcare providers, and other commercial entities" that it has "significant concerns" about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud.

The insurers told healthcare advocates that the November guidance requires them to reject payments from the Ryan White program in order to combat fraud, said Robert Greenwald, managing director of the Legal Services Center of Harvard Law School, a position Louisiana Blue still maintains.

"As an anti-fraud measure, Blue Cross and Blue Shield of Louisiana has implemented a policy, across our individual health insurance market, of not accepting premium payments from any third parties who are not related" to the subscriber, Maginnis said.

On Friday, CMS spokeswoman Tasha Bradley told Reuters that, to the contrary, Ryan White grantees "may use funds to pay for premiums on behalf of eligible enrollees in Marketplace plans, when it is cost-effective for the Ryan White program," meaning that having people with HIV/AIDS enroll in insurance under Obamacare could save the government money.

"The third-party payer guidance CMS released (in November) does not apply to" Ryan White programs.

Maginnis did not respond to further requests, sent after business hours, for comment on CMS's Friday statement.

Hundreds of indigent HIV/AIDS patients are dependent on Ryan White payments for Obamacare because they fall into a gap. They are not eligible for Medicaid, the joint federal-state health insurance program for the poor, because Louisiana did not expand the low-income program, and Obamacare federal subsidies don't kick in until people are at 100 percent of the federal poverty level.

Before Obamacare, the 1990 Ryan White Act offered people with HIV/AIDS federal financial help in paying for AIDS drugs and health insurance premiums, especially in state-run, high-risk pools.
Obamacare, which bans insurers from discriminating against people with preexisting conditions, was designed to replace these high-risk pools.
Starting on October 1, AIDS advocates and others in Louisiana "were enrolling anyone and everyone we could" through the Obamacare exchange, said Lucy Cordts of the New Orleans NO/AIDS Task Force.
Last month, her clients and those of other AIDS groups began to hear from Louisiana Blue that their enrollments were in limbo because the company would not accept the Ryan White checks for premium payments.
The only other carrier that is refusing to accept such payments is Blue Cross Blue Shield of North Dakota, according to a CMS official.

North Dakota Blue "restricts premium payment from third parties including employers, providers, and state agencies," said spokeswoman Andrea Dinneen, but "is currently reviewing its eligibility policies with respect to recipients of Ryan White Program funding."

'SURE LOOKS LIKE DISCRIMINATION'

Healthcare advocates are worried that the refusal to accept Ryan White payments is an effort by insurers to keep AIDS patients from enrolling in their plans and last month began pressing the issue, including with the office of Democratic Senator Mary Landrieu.

In an email reviewed by Reuters, a healthcare expert on Landrieu's staff wrote, "BCBS LA told me their decision was not due to the CMS guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns. I have also recently learned North Dakota's BCBS plan has implemented the same policy."

Jessica Stone, the Landrieu staff member, declined to elaborate on the email further or to discuss her interactions with Louisiana Blue.

Adverse selection refers to the situation where an insurer attracts patients with chronic conditions and expensive care. Louisiana Blue's action "sure looks to us like discrimination against sick people," said John Peller, vice president for policy at the AIDS Foundation of Chicago.

Asked if it were engaging in efforts to avoid adverse selection by refusing to accept Ryan White payments for would-be customers with HIV/AIDS, Louisiana Blue said it was not trying to keep such customers out of its plans. "We welcome all Louisiana residents who chose Blue Cross and Blue Shield of Louisiana," said Maginnis.

LA Times: California’s ObamaCare execution has been something of a hot mess

Because getting through the signup process, dear enrollees, was only the beginning. It was only ever going to be the beginning, really.

After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor’s office.
A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.
Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.
Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin’s lymphoma and discovered a suspicious lump near her jaw in early January.
But when she went to her oncologist’s office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.

Conservatives have been warning about the limited networks and fewer healthcare options that insurers were bound to use as a way to help control costs since before the law’s passage; some of the law’s cheerleaders finally caught on just a tad bit later; and now that the law has gone into effect, Americans are living it. And if organizing just the signup process through the website was such a shame spiral of royal bureaucratic incompetence on so many fronts, you know that trying to administer the actual healthcare system through it is going to be just as bad — as California also aptly showcased today. Again via the LA Times:

Admitting it gave some consumers bad information, California’s health insurance exchange pulled its physician directory for having too many errors.
Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.
The exchange yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November. …
The exchange said Thursday that “while the combined provider directory was a useful service for many consumers, some enrollees located physicians thought to be in their plan, and subsequently discovered they were not.”

The state suggested that enrollees “who are unsatisfied with their provider network still have time to cancel their coverage and sign up with a different insurer” before enrollment ends in March — but I doubt that that’s much comfort to the people for whom signing up in the first place was a tortuously drawn-out trial, or for the people who are discovering that they cannot, in fact, keep their doctor. Or, you know, “if you want to, you can pay for it.” It’s a matter of “choice,” or something.