Voice For Liberty

Tag: Government health care

  • ‘Love Gov’ humorous and revealing of government’s nature

    ‘Love Gov’ humorous and revealing of government’s nature

    A series of short videos from the Independent Institute entertains and teaches lessons at the same time.

    Lov Gov trailer exampleThe Independent Institute has produced a series of humorous and satirical videos to present lessons about the nature of government. The Institute describes the series here:

    Love Gov depicts an overbearing boyfriend — Scott “Gov” Govinsky — who foists his good intentions on a hapless, idealistic college student, Alexis. Each episode follows Alexis’s relationship with Gov as his intrusions wreak (comic) havoc on her life, professionally, financially, and socially. Alexis’s loyal friend Libby tries to help her see Gov for what he really is — a menace. But will Alexis come to her senses in time?

    There are five episode (plus a trailer). Each episode is around five minutes long and presents a lesson on a topic like jobs, healthcare, and privacy. The episodes are satirical and funny. They’d be really funny if the topic wasn’t so serious. I recommend you spend a half-hour or so to view the series.

    The link to view the video series is here.

  • Medicaid found to increase, not decrease, emergency room usage

    Those who continue to call for the expansion of Medicaid in Kansas should be aware of this astonishing finding, which contrary to what the conventional wisdom has told us about health care.

    For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. “Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,” said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured.

    Continue reading at New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare

  • Krugman on solutions to health care

    Following are excerpts from New York Times columns by economist and Nobel Laureate Paul Krugman. You may tweet your reaction to him at @NYTimeskrugman.

    Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system — it runs the hospitals and clinics.

    No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate. (Health Care Confidential, January 27, 2006)

    “You see, we actually have a real live case of impressive cost control in health care: the VA system.” (Medicare and the VA, May 27, 2009)

    What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform.

    Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.

    What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years. (Vouchers for Veterans, November 13, 2011)

  • Medicaid expansion: The impact on the federal budget and deficit

    From Kansas Policy Institute.

    Medicaid Expansion: The Impact on the Federal Budget and Deficit

    By Steve Anderson

    Medicaid.gov Keeping America HealthyThe problem with the uninsured is not going to be solved by expanding Medicaid. Even amongst Medicaid’s staunchest proponents you’ll be hard pressed to find any who will claim it to be the equivalent of high quality private health insurance coverage. The number of federal senators and representatives that choose to exclude their staffers from Obamacare shows that many Washington politicians understand the quality of government insurance plans Medicaid and Obamacare represent. The simple fact is, that health insurance is not to be confused with health care.

    Medicaid’s proponents can only claim anecdotal claims of improving health outcomes of recipients. Even in pre-ObamaCare Medicaid, beneficiaries largely do not access available preventable care services. In fact, a Harvard University study shows that emergency room visits actually increased by 40 percent for Medicaid recipients in Oregon after their expansion. Citizens would do well to remember, a “decrease in ER visits” was a key selling point of ObamaCare generally and Medicaid expansion specifically. ER visits are the most expensive form of care. When these increased visits are paid for by Medicaid, the taxpayers are picking up BOTH the state and federal portion of the high cost of emergency room visits. This flies in the face of the Obama Administration’s claim that Medicaid expansion would actually save money by limiting this sort of behavior.

    It doesn’t stop there and this is the part that hardly anyone has mentioned, and what the Obama Administration would rather you not know — a staggering number of those enrolling in ObamaCare will actually be sent to Medicaid and not be in the private market. And by “private market” we mean one established and controlled by government.

    The following charts are the pre-Medicaid expansion projection of revenues versus expenditures from the Congressional Budget Office. They were completed before the decision by 25 states and the District of Columbia to expand eligibility.i

    The three lines with the steepest slopes and therefore the fastest growing expenditures are Medicaid, Unemployment payments (called Income Security) and Other Programs. The U.S. House of Representatives has addressed the unemployment expense growth by bringing the program back to its original intent – to provide a safety net between jobs. Other Programs will be largely controlled if current trends hold and extension of the various “stimulus” programs are curtailed. However, the one that is going to accelerate with expansion and is larger than the other two combined in total state and federal expenditures is Medicaid. At least 3.9 million of Obamacare participants are expected to be enrolled in Medicaid and 19 million nationwide overall will be added to Medicaid in the next year. A 35 percent increase in Medicaid participants.ii Picture these two charts with 35 percent greater additional costs for the Medicaid entitlement and you have an idea how problematic this is for the federal budget and deficit. Is it any wonder that President Obama has started to back track from the claim that the federal government—which let’s not forget, is funded by you the taxpayer — will pay all the costs for 3 years and 90 percent thereafter. Instead, his administration and he himself talk about blended rates that will transfer a sizeable portion of the cost to state budgets.iii Despite his promises to the contrary.

    The Impact on the Kansas State Budget

    Even the leftist Center on Budget and Policy Priorities, which typically finds spending citizens’ tax dollars an event to celebrate, is cautioning that the “blended rate” shift by the President will “likely prompt states to cut payments to health care providers and to scale back the health services that Medicaid covers for low-income children, parents, people with disabilities, and/or senior citizens (including those in nursing homes). Reductions in provider payments would likely exacerbate the problem that Medicaid beneficiaries already face regarding access to physician care, particularly from specialists.”iv This analysis actually left out the administrative cost of expansion that is largely being absorbed by the states. If anything, this suggests that reality will be more dire than CBPP’s predictions.

    KPI’s own cost study of Medicaid expansion, conducted by a sitting member of the Social Security Advisory Board and former chief economist at the Federal Reserve in Cleveland, shows that Kansas taxpayers can expect to pick a $600 million tab if Medicaid is expanded. Hardly the “free money” that the Kansas Hospital Association has tried to foist on your family. They’ve even hired a former George W. Bush cabinet secretary to aggressively lobby for this “free money.” They’ve also yet to explain what services they recommend the state cut to fund the expansion and if their members are willing to pick up the additional costs when “blended rates” almost certainly take effect.

    As a taxpayer you are going to pay for this on both the federal and state level and you deserve answers when any special interest groups come asking for more of your money.

    i http://directorblue.blogspot.com/2011/01/liberals-democrat-party-will-split-if.html
    ii http://www.bloomberg.com/news/2014-01-02/obamacare-s-medicaid-expansion-may-create-oregon-like-er-strain.htm
    iii http://www.cbpp.org/cms/index.cfm?fa=view&id=3521
    iv Ibid

  • Medicaid found to increase, not decrease, emergency room usage

    This is an astonishing finding, and contrary to what the conventional wisdom has told us about health care.

    For years, it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. “Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,” said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion. In Oregon, people who gained coverage through Medicaid used the emergency room 40 percent more than those who were uninsured.

    Continue reading at New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare

  • Exchange data security breaches don’t require notification

    The breach of consumer data at Target has brought the issue of data security in focus. Yesterday a senator called for more protection and accountability for consumers and retailers. The following story from Watchdog.org tells us that government does not want to hold itself to the standards it wants the private sector to observe. There has been legislation proposed. Rep. Diane Black [R-TN6] has introduced H.R. 3731: Federal Exchange Data Breach Notification Act of 2013, whose title is “To require an Exchange established under the Patient Protection and Affordable Care Act to notify individuals in the case that personal information of such individuals is known to have been acquired or accessed as a result of a breach of the security of any system maintained by the Exchange.”

    Feds not required to report security breaches of Obamacare exchange website

    By 

    HACKED OFF: Hackers or careless bureaucrats could cause private information to be spilled across the Internet. But the federal government, unlike most states, don't have to tell users when they have been compromised.

    HACKED OFF: Hackers or careless bureaucrats could cause private information to be spilled across the Internet. But the federal government, unlike most states, don’t have to tell users when they have been compromised.

    By Eric Boehm | Watchdog.org

    Americans who buy health insurance through the federal Obamacare exchange website could have their personal information stolen by hackers and never even know it.

    Most of the state-run health exchange websites will be covered by state laws that require notification when government databases are breached by hackers. But there is no law requiring notification when databases run by the federal government are breached, and even though the Department of Health and Human Services was asked to include a notification provision in the rules being drawn up for the new federal exchange, it declined to do so.

    Other protections for individuals’ privacy, like the Health Insurance Portability and Accountability Act, or HIPAA, do not apply to the government-run exchange, only to health providers and insurance companies operating within the exchange.

    Privacy advocates and cyber-security experts have had concerns about the lack of a federal notification law for years and hope the scrutiny of the Obamacare exchange will finally bringchange.

    “The notification requirement is a very important part of overall security,” saidDeven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology. “People should be told when their information is at-risk.”

    The lack of a notification requirement is particularly bad for the health insurance exchange website because of all the questions surrounding the site’s security. Poor security, coupled with the website’s high-profile problems, could make it a target for hackers either seeking to steal identities or embarrass the government.

    Unfortunately, security is often an afterthought for the government, said David Kennedy, CEO of TrustedSEC, an Ohio-based cyber-security firm. Kennedy has testified before Congress about security threats in the Obamacare exchange and the need for notification laws.

    “All we need is something that says if the federal government is breached, all we have to do is alert the public,” he told Watchdog.org. “Healthcare.gov is just one website of hundreds that have had these issues going back through the years.”

    Together it creates a possible nightmare scenario. Without strong security on the front end, the hastily built and not fully operational website could become a treasure trove for hackers looking to steal identities. But without any laws requiring that those victims be notified by the federal government users of the Federal health exchange will be in the dark about any potential security breaches of their private data.

    When the federal Obamacare exchange was being developed by HHS prior to its troubled launch on Oct. 1, experts told the department that it should include a data-breach provision in its policies for the website even though one was not required under federal law.

    The department flatly declined to do so.

    The final rules for the exchanges were approved on March 27, 2012, meeting of HHS officials, according to the Federal Register.

    At that meeting, two commenters asked HHS to ensure the exchanges would promptly notify affected enrollees in the event of a data breach or unauthorized access to the exchange’s databases. One suggested that a full investigation be launched each time such a breach occurred, with the goal of holding hackers legally and financially accountable for breaking into the website.

    The department’s response: “We do not plan to include the specific notification procedures in the final rule. Consistent with this approach, we do not include specific policies for investigation of data breaches in this final rule.”

    Since there is no federal notification requirement, breaches of any and all federal databases can occur without the public ever being informed.

    The only way to find out a hack has occurred is when the government decides to disclose it — as several federal law enforcement agencies did last month in response to attacks from Anonymous, a group of super-hackers who threatened to take down the FBI website and others.

    But hacks that happen behind the scenes —potentially stealing everything from Social Security numbers to Department of Homeland Security watch lists — never have to be reported.

    “That’s alarming because there could be a number of federal databases that are compromised already and we don’t know about it,” Kennedy said. “The exchange is part of a bigger problem.”

    Federal privacy protections contained in HIPAA also do not apply to the databases created by the federal exchange website, McGraw said, even though health insurers doing business through the exchange must be HIPAA compliant.

    In other words, the health plan itself is covered by HIPAA and any breaches of security that affect a consumer who has purchased a specific plan would have to be reported. But the process of choosing and purchasing a plan through the federal exchange — along with any information entered into the federal exchange as part of that process — is not subject to HIPAA protections.

    “The problem with the exchanges is that they are such new entities, and they are so unique that existing laws don’t really cover them,” McGraw said.

    But 48 states have laws on the books requiring that they give notification to individuals who may have had personal information stolen or leaked from a government database. Many states require that government agencies and departments alert the state attorney general so investigations can be launched.

    In states that opted to run their own health insurance exchanges, those laws generally cover security breaches of the exchanges, McGraw said, though it depends on the specific wording of each state law.

    Those state laws are how data breaches of several state-level health insurance exchange websites have come to light.

    In September, Watchdog.org reported on a data breech of the Minnesota health exchange — known as “MNsure” — that potentially affected as many as 2,400 people.

    In Florida, concerns about data breaches of the state-run exchange website prompted Gov. Rick Scott to send a letter to Congress saying Floridians would not exchange privacy for insurance.

    On the federal exchange, such breaches are possible, maybe even likely, since the site was launched without comprehensive testing of the security controls for the system.

    A Sept. 27 memo to Medicare chief Marylin Tavernner said insufficient testing of the website before the Oct. 1 launch “exposed a level of uncertainty that can be deemed a high risk,” the Associated Press reported in October.

    Even though the federal government does not have to report any breaches of security, at least a few already have occurred.

    The most high-profile case so far is that of Thomas Dougall, a South Carolina lawyer who had his personal information accidentally leaked to another person after using the Obamacare exchange last month.

    “We logged on and compared some prices,” Dougall later told Fox News’ Greta Van Susteren. “We came home last Friday night to have a young man from a completely different state calling to tell me that when he logged on … he got all my personal information in exchange.”

    Dougall only found out about that breach of security because the recipient was kind enough to give him a call.  Without a requirement that the exchanges report such problems — whether the result of nefarious hackers or glitches in the programming — it is impossible to tell how many other Americans have had their private information released by the federal exchange.

    Kennedy said he would not recommend that anyone use the federal exchange until it is more secure and until breaches of security are reported.

    “I would say think twice about it, at least until we get more details,” he said.

    Kennedy says he supports universal health care and his criticisms of the website are not rooted in political motivations. But the former U.S. Marine whose firm provides computer security to several Fortune 100 companies says there have been “zero changes” to the security of the health insurance exchange website in the run-up to the much-touted Dec. 1 re-launch.

    Congress has debated a federal notification law in each of the past three years, but one has never been passed.

    In July, during a hearing of the House Committee on Energy and Commerce, lawmakers heard testimony from a variety of experts who explained the need for a federal breach notification requirement.

    David Thaw, a law professor at the University of Connecticut who specializes in cyber-security and the legal framework around it, said data breach notification laws, combined with comprehensive data security, are an essential part of protecting consumers and businesses.

    “I analogize the effects of breach notification alone to locking the bank or vault door while leaving a back window wide open,” he said.

    With the federal health insurance exchange, there are questions about whether the vault door has been adequately locked.

    But there is no doubt that the back window is still wide open.

    Boehm is a reporter for Watchdog.org and can be reached at EBoehm@Watchdog.org. Follow him on Twitter @EricBoehm87

  • Study: Kansas premiums to spike following Obamacare rollout

    From Kansas Watchdog.

    Study: Kansas premiums to spike following Obamacare rollout

    By 

    ON THE RISE: A new report from the Heritage Foundation says Obamacare premiums are significantly higher in Kansas compared to average rates before the rollout of the new health care law.

    By Travis Perry, Kansas Watchdog

    OSAWATOMIE — Good news: Kansas landed in the top 10 in a recent study conducted by the conservative Heritage Foundation! Bad news: It’s for massive insurance premium hikes because ofObamacare.

    Kinda puts a damper on things, huh?

    As I said, before dashing your optimism with harsh reality, Kansas is among the top 10 states to possibly see the largest premium increases following the rollout of the federal health care exchange, according to a recent report from Heritage’s Center for Data Analysis. In a nutshell, the report states Obamacare health premiums available to Kansans will be higher than existing policies.

    According to the Heritage report, the average premium for a 27-year-old Sunflower State resident will rise from $87.40 to $200.14, a massive 129 percent bump. This gives Kansas the unfortunate privilege of boasting the sixth-highest increase for young people nationwide.

    The news gets slightly better for other groups, but not by much. Average premiums for a 50-year-old adult could increase from $198 to $341.08 (72.3 percent increase), while a family of four may see an increase from $553.92 to $676.05 (22 percent increase).

    “Many families and individuals will face this reality as they apply for coverage, and the implications of experiencing sticker shock are important to consider if enough people choose not to sign up for coverage for various reasons,” policy analyst Drew Gonshorowski wrote in the Oct. 16 report.

    The massive increase in premiums for young people should be especially concerning, as they’re the one group Obamacare can’t afford to do without. The successful implementation of the Affordable Care Act depends heavily on the young and healthy signing up to help pay for the elderly and infirm.

    It’s important to note the Heritage study compares premium prices straight-up, not including government subsidies designed to decrease the cost to low-income individuals and families.

    “This analysis represents the change in unsubsidized rate levels,” Gonshorowski wrote. “The purpose of this research is to provide further details on the changing premium levels across the country.”

    Source Report: How Will You Fare in the Obamacare Exchanges?

    Contact Travis Perry at travis@kansaswatchdog.org, or follow him on Twitter at@muckraker62.

  • A letter to the U.S. Senate regarding the federal government shutdown

    From KochFacts.com.

    Dear Senator,

    A great deal of what you read and hear about Koch Industries is erroneous or misleading. Indeed, there was false information presented about Koch on the Senate floor by Senate Majority Leader Reid, who claimed yesterday that Koch was behind the shutdown of the federal government in an effort to defund the Affordable Care Act or “Obamacare.” Because several of you have asked what our position is on this issue, we want to set the record straight and correct this misinformation.

    Koch believes that Obamacare will increase deficits, lead to an overall lowering of standards of health care in America, and raise taxes. However, Koch has not taken a position on the legislative tactic of tying the continuing resolution to defunding Obamacare nor have we lobbied on legislative provisions defunding Obamacare.

    Instead, Koch has focused on educating the public about reducing our nation’s debt and controlling runaway government spending. We believe that Congress should, at a minimum, keep to sequester-level spending guidelines, and develop a plan for more significant and widespread spending reductions in the future. We also believe that Congress should work to rein-in rampant government spending so that it becomes no longer necessary to continually raise the debt ceiling.

    Congress should focus on these efforts: balancing the budget, tightening and cutting government spending, curbing cronyism, and eliminating market-distorting subsidies and mandates.

    We are hopeful this sets the record straight and that in the future Senator Reid and other politicians will stop misrepresenting and distorting Koch’s positions.

    Sincerely,
    Philip Ellender
    President, Government & Public Affairs
    Koch Companies Public Sector, LLC

  • ObamaCare employer mandate delayed, start of train wreck?

    aspirin-bottleScheduled to take effect on January 1, the employer mandate portion of the Affordable Care Act (ObamaCare) has been delayed for one year.

    Curiously, this announcement was made on an obscure Treasury Department blog, along with articles titled “Meeting, and Exceeding, Our Small Business Procurement Goals in FY 2012” and “In Case You Missed It: Top Executives Say U.S. Is #1 for Foreign Direct Investment.”

    The employer mandate requires those who employ more than 50 full time-equivalent employees to provide insurance or pay a penalty. Cato Institute’s Michael D. Tanner notes the general problem, and a specific problem based on the decision to delay the employer mandate:

    In postponing the implementation of the Affordable Care Act’s employer mandate until after the 2014 mid-term elections, the Obama administration has tacitly admitted what critics of the law have long contended: that Obamacare is unworkable and would be a significant burden for American business and the economy at large. Stay tuned for further dominoes falling.

    Actually, the Administration’s decision to postpone the employer mandate may make a bad situation worse. Because the individual mandate remains in place, workers may now face a situation where they must purchase their own insurance or pay a penalty because their employers don’t provide coverage. In effect, the administration’s decision shifts the cost from employers to workers. This hardly seems fair, and may force the administration to rethink the individual mandate as well. (And So the Obamacare Train Wreck Begins … )

    Will the implementation of other parts of ObamaCare be delayed? I think it seems likely. But: Section 1513 AVC states, regarding the employer mandate: “The amendments made by this section shall apply to months beginning after December 31, 2013.” So does the administration have the legal authority to make changes like this?

    uninsured-estimates-2013-05

    Also: For all the wrenching debate and changes, there will still be many uninsured people. Here’s a chart based on the Congressional Budget Office May 2013 estimate of the effects of the Affordable Care Act on health insurance coverage.

    This is just the start of discovery of pathologies built into ObamaCare. Here’s Avik Roy explaining an incentive contained within the employer mandate:

    The strong penalty vs. the weak penalty

    The employer mandate actually consists of two different penalties, based on two different categories of employer behavior. These originate from Section 4980H of the Affordable Care Act. Subsection (a) requires steep penalties for employers who offer no coverage at all. Subection (b) requires modest penalties for employers who offer “minimum essential coverage under an eligible employer-sponsored plan.” This difference — between the strong penalty in 4980H(a) and the weak penalty in 4980H(b) — is crucial to understanding how things will play out in the future.

    Under the strong penalty, in which an employer “fails to offer to its full-time employees…the opportunity to enroll in minimum essential coverage,” and “at least one full-time employee” enrolls in an exchange, the employer has to pay a fine of $2,000 times the total number of full-time-equivalent employees at the firm, minus 30. (The employer mandate only applies to firms with 50 or more full-time-equivalent workers.) So if you employ 50 workers, that’s a fine of 20 * $2,000 = $40,000. And the fine isn’t tax-deductible, adding to the pain.

    Under the weak penalty, in which an employer does offer “the opportunity to enroll in minimum essential coverage,” but that coverage doesn’t meet Obamacare’s requirements for affordability or actuarial value, and at least one worker enrolls on an exchange instead, the fine is $3,000 times the number of workers who enroll on the exchanges. So, if you employ 50 workers, and three of them get coverage on the exchange instead, the fine is a much lower 3 * $3,000, or $9,000. (Technically, in subsection (b), employers pay the lesser of the weak penalty or the strong penalty, but this in most cases should be the weak penalty.)

    So: Employers avoid the strong penalty and gain eligibility for the weak penalty by offering “minimum essential coverage.”

    Roy goes on to explain that “minimum essential coverage” means coverage my any insurance plan that can legally be sod in a state, including plans that provide limited coverage or services. Roy writes that companies may offer these bare-bones plans to their employees and escape the penalties.

    This behavior, which federal officials have confirmed is allowed, evidently wasn’t considered by officials, writes Roy: “Nonetheless, Obamacare’s designers expressed surprise that employers would do such a thing. ‘Our expectation was that employers would offer high quality insurance,’ said Robert Kocher, a former Obama health care adviser. It wouldn’t be the first time that the law’s authors didn’t recognize how economic incentives actually work.”

    Economic incentives are what makes the world work. They’re based on human behavior, and that isn’t easily changed, even to suit Barack Obama’s desires.