Obamacare

Insurers face pressure for limiting doctor choice for ObamaCare enrollees

Bailey Comment: " I'm thinking this is one of the reasons that the Canadians come over here for medical. Now that ours is just as crappy, where are they gonna go?"

Federal and state regulators and lawmakers are stepping up pressure on the insurance industry for offering plans under ObamaCare that limit access to doctors and hospitals -- a strategy insurers say is necessary to keep coverage prices low in the health law's marketplaces. 
The Wall Street Journal reports that some state legislatures are weighing bills that could force insurers to add more hospitals and doctors to plans, while federal regulators have proposed a tougher review process for plans to be sold next year through HealthCare.gov.
The access problem is a byproduct of the effort to drive down costs of subsidized coverage, prompting insurance companies to offer limited choices of doctors and hospitals.
Under a federal proposal announced this week, insurance companies selling plans in the federally-run marketplace would be required to submit to the government a full list of providers in a network before the plans are approved for the exchanges, The Wall Street Journal reported.
A spokesman for the Centers for Medicare and Medicaid Services told the newspaper it is "working to strengthen the network adequacy requirements that took effect for this year."
In Washington state, Seattle Children's Hospital has sued over the state insurance department's decision to approve networks that didn't include the facility. The hospital is excluded from five of seven plans on Washington’s state insurance exchange, according to Bloomberg News.
The hospital says is struggling to get paid for care given to about 125 children it has treated since Jan. 1, when ObamaCare coverage took effect. The facility will be required to pick up costs beyond the standard deductible if insurers refuse to cover their services.
"We made the decision to see all the children," Sandy Melzer, the facility's strategy officer, told Bloomberg News. "Maybe we’ll be paid, maybe we won’t. It’s completely done on faith." 
The family of 5-month-old Gabriella Blankers visited Seattle Children’s last month for a CT scan that found a rare birth defect. They said they were initially rejected by their insurer because the hospital wasn't in their network, though the insurer later made a temporary exception, according to the report.
"There’s nowhere else I could go," to get the care Gabriella needed, Rebekah Blankers, the girl’s mother, told Bloomberg News. "Unless I went out of state, out of network, or out of pocket."
Lawmakers in a Washington state Senate committee heard a proposal this week that would reportedly allow health insurance companies to keep offering insurance plans that don't meet the new federal and state requirements. But they would only be offered to people who were enrolled in such plans as of Oct. 1, 2013.
Senate Bill 6464 also would let insurers from other states sell plans to Washingtonians without requiring the carriers to meet Washington state insurance regulations.
When President Obama announced he would leave it up to the states to decide whether to continue to offer some old plans for a while, Washington's Insurance Commissioner Mike Kreidler said he would not allow it.
Meanwhile, in Mississippi, proposed legislation would bar insurers from cutting off most doctors and hospitals that agree to prices set by insurers. The bill also would prohibit insurers from charging higher copayments at certain doctors' offices or hospitals, according to The Wall Street Journal. 

The Obamacare Security Nightmare: It Gets Worse

 
Michelle Malkin | Feb 05, 2014

 Fraudsters on the inside, hackers on the outside. Here we are, stuck in the middle with the security nightmare called Obamacare. Can it get any worse? Yes, it can.
After the spectacular website crashes during last fall's federal health insurance exchange rollout, enrollees will soon wish the entire system had stayed down and dead. "404 Error" messages and convicted felon Obamacare navigators may be the least of our health care tech problems now. The latest? U.S. intelligence agencies notified the Department of Health and Human Services last week that the Healthcare.gov infrastructure could be infected with malicious code.
Who's responsible? Washington Free Beacon national security reporter Bill Gertz writes that U.S. officials have "warned that programmers in Belarus, a former Soviet republic closely allied with Russia, were suspected" of possible sabotage. A government tech bureaucrat in the Belarusian regime bragged last summer on Russian radio that HHS is "one of our clients" and that "we are helping Obama complete his insurance reform."
Gulp. When an authoritarian minion from the country known as "Europe's last dictatorship" boasts about "helping" the Obama White House, be afraid. One of our intel people spelled it out for Gertz: "The U.S. Affordable Care Act software was written in part in Belarus by software developers under state control, and that makes the software a potential target for cyber attacks."
No kidding. The friends of Vladimir Putin are not our friends. If you've been paying attention, you know that Belarus and other Eastern European hacking gangs have been at the center of several recent international cybercrimes. These aren't merely schemes to steal credit card numbers or vandalize websites with annoying graffiti. They're acts of espionage and sabotage -- like using malware in a phishing scheme aimed at White House employees to gather military intelligence and pilfer sensitive government documents.
It's not just the federal health care system's problem. Former Obamacare website contractor CGI still holds dozens of contracts with other federal agencies and state governments worth billions of dollars -- and wide access to health and financial data. In my state of Colorado, for example, CGI has a $78 million contract to "modernize, host and manage" the state's financial system. Have they checked to see whether Belarus hackers are standing by?
For their part, Obamacare officials are making their usual "don't worry about it, the problem's under control" noises. But we already know the problem is far out of control. Last month, GOP oversight hearings exposed persistent failures by Obamacare overseers to fix security lapses.

Administrators reverse ban on American celebration at high school

The sun was just beginning to rise over the Rocky Mountains, but Sheriff Justin Smith was already awake. He was standing outside Fort Collins High School – shivering in the frigid cold.
It was 12 degrees. Snow was falling. But Mr. Smith, wearing his dress blues, stood resolute, waving an American flag.
The sheriff of Larimer County, Colorado had come to school Tuesday to send a message to those responsible for educating the county’s children. The sheriff was not in a good mood.

Whoever would have thought that American teenagers would be treated as second-class citizens in their own country?

He was standing in the winter snow to protest the school’s decision to ban a celebration of American patriotism.
The student council had wanted to designate a day during Spirit Week to celebrate the red, white & blue. The young people called it “’Merica Monday.” But the school turned down their request.
“They said they didn’t want to offend anyone from other countries or immigrants,” a 16-year-old member of the student council told me. “They just really did not want to make anyone feel uncomfortable.”
But after a day of righteous Rocky Mountain outrage, the principal at Fort Collins High School reversed course and apologized. 
Principal Mark Eversole sent a letter to parents announcing that next Monday would in fact be America Day.
Following is the entire letter that was obtained by Fox News Radio affiliate KCOL:

“We apologize for our recent decision regarding My Country Monday and that it was seen as not patriotic. This could not be further from the truth. The original intent of Spread the Love week at Fort Collins High School was to unify the student body. When students first proposed "Merica Monday," we felt that it was against this unifying theme and disrespectful to our country. Merica is a slang term that is often used in a negative stereotypical way to describe life in the United States. This is what led us to discuss alternatives with students. We were surprised that our community interpreted our actions as anti-American. We are a proud public school in America and support many activities to celebrate our great nation. Due to this outpouring of sentiment and misinterpretation of our intentions, we have decided to rename the first day of Spread the Love week to "America Day" as opposed to "Merica Day." We look forward to enjoying the creativity and energy of our students as they celebrate their patriotism next week."

That’s not exactly how parents or students recall the events. They said they suggested “America Monday” but administrators rejected that idea. And members of the student council were adamant that the only reason the event was barred was to prevent non-Americans from being offended.
It seems to me that a public school administrator got caught with his hand in the multicultural cookie jar.
While  the school should be commended for doing the right thing and allowing students to celebrate America, whoever would have thought that American teenagers would be treated as second-class citizens in their own country?
And that’s why Sheriff Smith was standing in the bitter cold, waving his American flag – the one that normally flew outside his home.
“We can’t and we won’t stand for that kind of attitude in our schools,” Sheriff Smith told me in a telephone interview. “It’s our country. They’re our community schools. We will take them back and restore the values – the ones that made America the great nation it is today.”
“I realized I could not just sit on the sidelines,” he said. “I had to stand up and do something.”
Within minutes, he was joined by a dozen others – an uprising of patriots sick and tired of the anti-American venom spewing from public school administrators.
“This is really a sign of root problems we have,” he said. “A lot of us understand -- this anti-American sentiment has poisoned our schools – the ideas and beliefs that are preached to them.”
A sort of grassroots protest movement unfolded early Tuesday on KCOL, the local news radio station that carries my daily commentary. Callers unleashed their fury over the airwaves. Students from the high school emailed passionate messages.
Among them, was a young man – a tenth grader who asked not to be identified.
“I'm personally outraged at the school that we can celebrate every other culture but our own,” this young American teenager wrote. “We have activities that go on during Cinco de Mayo but we can't celebrate and honor our own country [where] we live I'm very angry.”
As Sheriff Smith and his frozen band of patriots waved their flags, drivers honked their horns, bus drivers waved and students stopped to watch.
“It was important to send a message to students,” the sheriff said. “They needed to know they are not alone and that they did the right thing by standing up. I hope when they and their parents saw their sheriff standing out in front of the school – they knew they weren’t alone.”
The sheriff is correct. These brave young men and women are not alone.
We are compelled to stand alongside our fellow countrymen at Fort Collins High School.
Patriotism must never be sacrificed on the altar of political correctness.
“This is a wake up call,” Sheriff Smith said. “We’ve been given the blessing of a wake up call as to what is going on (in our school). Now the question is -- what do we do about it?”

Hillary’s ‘inevitability’: Is it her fault, or the media echo chamber?

The media drumbeat began the day after the 2012 election: Hillary’s inevitable.
It grew louder when Barack Obama and Hillary Clinton sat for a joint “60 Minutes” interview: Hillary’s inevitable.
It grew louder still as she was plastered on one magazine cover after another: Time, the New York Times Magazine, and on and on.
It grew deafening when media polls showed her 60 points ahead of any potential Democratic challenger. And really, goes the journalistic refrain, what Republican is going to beat her?
She’s a juggernaut. She’s unstoppable. She’s the next president of the United States.
And now comes the carping: How dare Hillary project an aura of inevitability? Where does she get off? This is a huge mistake!
That’s right: the media, which have wrapped Hillary in the cloak of inevitability, are now echoing complaints that she hasn’t taken to the rooftops to shout: No I’m not!
This debate is crystallized by a story in Buzzfeed, which is a good piece of reporting in that it gets some Obama aides and strategists on the record in warning about Hillary’s strategy. But the underlying assumption is that the former secretary of State is mounting this huge campaign-like effort, when she insists she hasn’t made up her mind about running.
“Top advisers and former aides to Barack Obama say Hillary Clinton is repeating the mistakes she made in 2008, building a machine in lieu of a message and lumbering toward the Democratic nomination with the same deep vulnerabilities that cost her the nomination eight years earlier,” says Buzzfeed.
White House pollster Joel Benenson is quoted as saying: “I just don’t see any strategic value in stories positioning her as inevitable or the pre-emptive nominee, and I don’t think people who are out there talking about this help her, and I think she should make that clear.”
And 2012 Obama campaign spokesman Ben LaBolt says: “Even if it is a well-known candidate — sometimes more so — activists, donors, and voters like to see candidates fighting for every vote.”
They have a point. Hillary’s top-heavy operation proved the media wrong in 2007 and 2008 as she blew an election in which she was overwhelmingly favored—and was upset by an upstart named Obama.
It’s also true that despite her occasional speeches, she doesn’t have a message. But that’s essentially because she’s not a candidate. And if she starts acting more like a candidate, she will be subjecting us to a three-year campaign and taking lots of incoming Republican fire.
Lots of other front-runners have laid low until they had to announce. But there’s never been anyone like Hillary: potentially the first female president, wife of a controversial ex-president, and a political persona that overshadows all possible rivals, even an incumbent vice president.
To underscore that point, a CNN poll showing her with a 55-39 lead over Chris Christie, after he had been leading her by 2 points in December. Of course, that has more to do with the governor’s bridge troubles, but it adds to the Hillary aura. She leads every other major GOP contender by at least 15 points. (Standard warning: such early polls are largely meaningless.)
Clinton is acquiescing as groups such as Ready for Hillary raise money on her behalf, but I doubt that’s the root of her problem since she can’t be legally involved.
She also has to retool for the Twitter age. One mistake that Clinton made in her last campaign was barely showing her warmer side. So she tries a joke--a Super Bowl tweet that tweaked Fox--and everyone goes bananas and overanalyzes it.
The biggest problem she will face, in my view, is that by 2016 many people will be sick of her. She will seem like a status quo incumbent, running for a third Obama term, while the Republicans are promising change. That’s why a lower-profile 2014 makes sense for her.
 In the meantime, the press will keep on saying Hillary is inevitable. And I can’t see how she muffles that.

Senator rebukes IRS over decision to reinstate 2013 employee bonuses

The IRS' announcement Monday that it will pay cancelled 2013 bonuses has infuriated Utah Republican Sen. Orrin Hatch, who wants to know why an agency with employees who “inappropriately” targeted conservative political groups would reinstate the rewards.
“The IRS is accused of targeting conservative groups, with many of its employees having conducted themselves in a manner inappropriate for government officials, and the agency decides to reinstate employee bonuses?” asked Hatch, the top Republican on the Senate Finance Committee. “This is outrageous.”
The announcement was made by new IRS Commissioner John Koskinen, who said the performance bonuses were reinstated after agency employees repeatedly asked him about them during his first weeks on the job and after reaching a deal with the Union for Federal Employees.
The targeting scandal broke in spring 2013 when the agency revealed it had targeted for closer scrutiny Tea Party groups and other politically conservative organizations that were applying for tax-exempt status.
The revelations resulted in an inspector general report as well as FBI and congressional investigations. Though agency officials said originally the targeting was limited to a Cincinnati, Ohio field office, the probes revealed that higher-ranking officials at the agency’s Washington headquarters knew about the situation and that liberal groups also were targeted but to a lesser extent.
President Obama in May 2013 asked for the resignation of acting Commissioner Steven Miller. And Louis Lerner, the agency’s director of Exempt Organizations, resigned in Sept. 2013 after refusing to testify before Congress several months earlier.
“It’s hard to think of a group of people less deserving of bonuses than IRS employees,” Hatch said. “I understand that not every IRS worker was responsible, but this just is the wrong signal to send the American people who were rightly outraged by how this agency treated people for their political views.”
Koskinen said last year was an “extremely challenging budget year” because of sequestration so “a tough decision had to be made last summer to eliminate the bonuses.”
He also said that in light of the agency’s “continuing dire budget situation” the award payouts will be about 1 percent, less than the 1.75 percent provided in previous years.

‘Not even a smidgen of corruption’: Obama downplays IRS, other scandals

President Obama, in an interview with Fox News’ Bill O’Reilly, tried to put behind him the scandals that have hung over his second term, suggesting his administration did not mislead the public on the Benghazi attack and going so far as to say the IRS targeting scandal had “not even a smidgen of corruption.”
Obama addressed concerns over Benghazi, the launch of HealthCare.gov and the IRS, during the interview Sunday before the Super Bowl. He adamantly rejected the suggestion that the IRS was used for political purposes by singling out Tea Party groups seeking tax exemption.
“That’s not what happened,” he said. Rather, he said, IRS officials were confused about how to implement the law governing those kinds of tax-exempt groups.
“There were some bone-headed decisions,” Obama conceded.
But when asked whether corruption, or mass corruption, was at play, he responded: “Not even mass corruption -- not even a smidgen of corruption.”
He acknowledged that then-IRS Commissioner Doug Shulman had been to the White House more than 100 times but said he couldn’t recall speaking to him on any of those occasions.
Obama also downplayed the controversy over how the Sept. 11, 2012, Benghazi attacks were described by the administration.
He said he considers any such strike an act of terror and that he was told by then-Defense Secretary Leon Panetta at the time only that it was an “attack” -- and that the more important issue is whether security lapses have now been fixed.
“All of the security precautions that needed to be taken didn’t happen,” the president said. “The key is that we’ve implemented the reforms that have been recommended.”
He also said his administration didn't try to “hide the ball” regarding the attacks, in which four Americans were killed including Ambassador Chris Stevens.
“We revealed to the American people exactly what we understood at the time,” the president said.
Obama also claimed that the attackers were made up of a mix of people, some affiliated with terror organizations and others who were just “troublemakers.” A recent report from the Senate Intelligence Committee, though, definitively declared that individuals tied to Al Qaeda groups were involved.
On the rocky launch of the health care exchange system, Obama said he anticipated problems with the rollout of ObamaCare in October, particularly with the HealthCare.gov website because computer programs have glitches.
“But neither I nor anybody else anticipated the degree of problems with HealthCare.gov,” he said.
The president argued that total enrollment is now just about a month behind schedule and that young people, key to making ObamaCare work, are enrolling at a good rate.
He would not answer when asked repeatedly why he kept Health and Human Services Secretary Kathleen Sebelius on the job.
“I try to focus not on the fumbles but on the next play,” he said.

Thousands of ObamaCare site error appeals reportedly going unfixed

Thousands of people who tried to sign up for a health plan via the federal healthcare exchange website, Healthcare.gov, have seen their appeals to fix site issues go unanswered.
The Washington Post, citing internal government data, reports that approximately 22,000 Americans have filed appeals to try and get site errors corrected. The complaints range from being denied coverage altogether to being overcharged for coverage to being steered into the wrong program. 
So far, months after the site launched October 1, the appeals have been untouched. What's more, the Post reports, people who have tried to call the marketplace directly for assistance, have been told that the Healthcare.gov computer system is not yet allowing workers to correct enrollment records. 
In theory, error appeals can be filed through the site itself, by phone, or by mail. However, only the mail appeal is currently available. But according to the Post, the appeal by mail process only goes as far as scanning the seven-page forms and transferring them to a computer system, where they currently sit unread and uncorrected. 
A CMS spokesman told the Post "We are working to fully implement the appeals system." In the meantime, the paper reported, applicants are being told to go back to Healthcare.gov and start over, thought it is not clear how many of the 22,000 who complained of errors have done so. 
However, the lack of action on appeals means that some who signed up for plans taking effect January 1 have been stuck with health plans costing them too much. One of those, 27-year-old West Virginian Addie Wilson, told the Post she was paying $100 more per month than necessary for her insurance, with a deductible that's $4,000 too high.