WyBlog

Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama's health care overhaul, sources in both parties said.

The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.

A senior Democratic senator who helped write President Obama's health care law stunned administration officials Wednesday, saying openly he thinks it's headed for a "train wreck."

"I just see a huge train wreck coming down," Senate Finance Committee Chairman Max Baucus, D-Mont., told Obama's health care chief during a routine budget hearing that suddenly turned tense.

Normally low-key and supportive, Baucus challenged Health and Human Services Secretary Kathleen Sebelius at Wednesday's hearing.

He said he's "very concerned" that new health insurance marketplaces for consumers and small businesses will not open on time in every state, and that if they do, they might just flop because residents don't have the information they need to make choices.

"The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade," he told Sebelius.

While there is no vaccine for RSV, there is an FDA-approved treatment available. When it became available in 1997, the American Academy of Pediatrics issued evidence-based guidelines for its use, recommending that the treatment be administered once per month during outbreak season (an average of five months total).

But in 2009, with no clear medical evidence for doing so, the AAP both shrunk the pool of eligible infants and reduced the number of RSV treatments that would be made available — for some babies down to 3 doses, while for others as low as 1 dose. The only clear reason given was cost.

Unfortunately, the AAP s guidelines are widely implemented by Medicaid and insurance providers, who in turn followed suit and greatly reduced coverage.

Health insurance premiums more than doubled over the last decade, driving employers to drop coverage and discouraging employees from signing up, according to a Robert Wood Johnson Foundation study released today.

Nearly 60 percent of private employers in New Jersey provided health coverage to their workforce in 2011 - a 4 percent decline from 2001, the study found.

Business owners who offered insurance required employees to shoulder a larger share of the cost. In 2011, workers paid $1,154 in premiums for an individual policy and $3,714 for a family - more than 2-1/2 and three times, respectively, than they paid a decade earlier.

Tens of thousands of health care professionals, union workers and community activists hired as "navigators" to help Americans choose Obamacare options starting Oct. 1 will be paid up to $48 an hour, more than six times the federal minimum wage of $7.25, according to new regulations issued Wednesday.

The 63-page rule covering navigators, drawn up by the Centers for Medicare & Medicaid Services, also said the government will provide free translators for those not fluent in English - no matter what their native language is. [...]

The Federal Reserve on Wednesday released an edition of its so-called "beige book," that said the 2010 healthcare law is being cited as a reason for layoffs and a slowdown in hiring.

"Employers in several Districts cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff," said the March 6 beige book, which examines economic conditions across various Federal Reserve districts across the country.

Gov. Chris Christie will expand the state's Medicaid program to cover 300,000 uninsured New Jersey residents, The Star-Ledger learned today.

The governor's new budget, which he plans to unveil at joint session of the Legislature this afternoon, also relies on state revenue growth of 4.9 percent and delays some property tax rebates for local taxpayers, according to three sources with knowledge of the budget plan who spoke on the condition of anonymity.

As for his decision to expand Medicaid, the Republican governor, a critic of President Obama's Affordable Care Act, could reap up to $300 million by expanding the state program in the coming budget year.

Before passage of the Affordable Care Act, known as Obamacare, people without children were not eligible unless they applied for welfare and earned no more than $140 a month. Allowing the expansion would reduce the burden on hospitals to treat uninsured patients, and the state, which partly reimburses those costs.

The revised Medicaid program would shift 100 percent of the costs to the federal government for these new enrollees for the first three years, then gradually taper it to 90 percent. The state could expect $1.7 billion a year to cover the costs.

New Jersey next Friday will suspend enrollment in an insurance program for people with preexisting medical conditions mandated by the new federal health care law, officials said.

The state was directed to do so by the federal Department of Health and Human Services, which received limited funding from Congress to provide coverage in each of the 50 states. Without the suspension, the Pre-Existing Condition Insurance Plan would be in danger of running out of money to cover those currently enrolled, according to a message posted on the program's website.

Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama's health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

The Affordable Care Act — "Obamacare" to its detractors — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

First, the law allows insurers to charge older adults up to three times as much as their youngest customers.

Second, the law allows insurers to levy the full 50 percent penalty on older smokers while charging less to younger ones.

And finally, government tax credits that will be available to help pay premiums cannot be used to offset the cost of penalties for smokers.

What's more important? Affordable higher education or health care coverage?

That's the question lawmakers are weighing as they consider controversial legislation that would eliminate New Jersey's requirement that all college students have health insurance in order to attend class.

College officials are pushing lawmakers to kill the law because the implementation of Obamacare is driving up the cost of the basic health insurance plans offered to uninsured students by their schools. The jump in premiums — from a few hundred dollars this school year to more than $1,700 next year in some cases — could force some students to drop out.

Most students use their their parents' plans, which cover children up to age 26. But a large number, especially low-income students and older county college students, purchase low-cost health care plans through their colleges to comply with the state law.

Those minimal-coverage plans, which currently cost $100 to $600 for bare-bones coverage at some schools, are being phased out as the country prepares to switch over to the new federal healthcare regulations championed by President Obama.

Raising the price of a basic health care insurance plan by $1,000 to $1,500 more a year will be enough to keep some students from attending college, school officials testified at the assembly hearing.

The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.

"RAND got a lot of attention and a lot of buzz with the original analysis," said Dr. Kellermann, who was not involved in the 2005 study. "The industry quickly embraced it."

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm's acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The Commonwealth Fund, a privately funded, New York-based health research clearinghouse, looked at premiums across the conutry and found the average cost of a family health insurance plan is just above $15,000 — up 62 percent since 2003.

Median family income rose only 11 percent during the same time period, the report said.

In New Jersey, average premiums for a single payer have risen to $5,673 — up from $3,814 in 2003. For a family, the price has gone up to $15,589 — up from $10,168. All while incomes in the Garden State have basically stagnated in the last decade.

And it's not just premiums that increase. Because employers must pay more for healthcare, there is less money to be doled out in raises to employees.

The study's author's believe that the Affordable Care Act makes small steps toward reduce the rate with which costs increase, but predicts they will still rise far faster than median income.

Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health care overhaul.

The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.

Employee benefits lawyer Chantel Sheaks calls it a "sleeper issue" with significant financial consequences, particularly for large employers.

"Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it," said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

Most of the money will go into a fund administered by the Health and Human Services Department. It will be used to cushion health insurance companies from the initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014.

Governor Christie has vetoed legislation that would have set up a state-run health exchange needed to implement the federal Affordable Care Act in New Jersey.

Though the Democratic-controlled Legislature passed a bill to have the state run its own exchange, New Jersey under Christie, a Republican, had been one of several states delaying a final decision.

Christie said in a statement released Thursday afternoon that the federal government hadn't provided "all the necessary information" he needed to make decision.

"Any other action than this would be fiscally irresponsible," Christie said in a statement.

"Thus far, we lack such critical information from the federal government," he said. "I will not ask New Jerseyans to commit today to a state-based exchange when the federal government cannot tell us what it will cost, how that cost compares to other options, and how much control they will give the states over this option that comes at the cost of our state's taxpayers."

Will the feds be ready to provide an insurance exchange in all of the states that don't have one on October 1, 2013?

I have no idea. And neither does anyone else I talk to inside the Beltway. We only hear vague reports that parts of the new federal exchange information systems are in testing.

The former CIA director couldn't get away with an affair in this town but the Obama administration has a complete lid on just where they are on health insurance exchanges and haven't shown any willingness to want to talk about their progress toward launching on time — except to tell us all not to worry.

We are all worried. I would not want to be responsible for the work that remains and only have ten months to do it…

Millions of senior citizens enrolled in some of the most popular Medicare prescription drug plans face double-digit premium hikes next year according to a private firm that analyzes the highly competitive market.

Seven of the top 10 prescription plans are raising their premiums by 11 percent to 23 percent, according to a report this week by Avalere Health.

The Patient Protection and Affordable Care Act has been blamed for a lot of things—higher taxes, potential insurance rate hikes, and now, higher pizza prices. According to Papa John's Founder, Chairman and CEO John H. Schnatter, health-care reform will cost the company an additional 11 cents to 14 cents per pizza.

Schnatter added that on a corporate basis, the reform would increase Papa John's price per pizza by 15 to 20 cents.

"If Obamacare is in fact not repealed, we will find tactics to shallow out any Obamacare costs. And of course strategies to pass that cost onto consumers in order to protect our shareholder's best interest."

In the Inland Empire, an economically depressed region in Southern California, President Obama's health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area's needs. There are not enough now.

"We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists," said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region's doctor shortage. "We'll have a 5,000-physician shortage in 10 years, no matter what anybody does."

Experts describe a doctor shortage as an "invisible problem." Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

The Catholic family that owns a Colorado-based company won a court victory in their battle to stop the Obama administration from requiring them to provide insurance coverage for abortion-inducing drugs, sterilization and contraception, a mandate they say violates their religious beliefs and First Amendment rights.

Hercules Industries, a Denver-based heating ventilation and air conditioning manufacturer that employs nearly 300 full-time workers, got an injunction in federal court which stops enforcement of the controversial ObamaCare mandate. The company's lawyers said they needed the injunction immediately because if the mandate is enforced, it must begin immediately making changes to its health plan, which renews on Nov. 1.

The case is similar to ones brought by Catholic-based colleges that have refused to provide employee insurance with such coverage, except this time, it is a secular corporation.

In his order, Colorado District Judge John Kane said that the government's arguments "are countered, and indeed outweighed, by the public interest in the free exercise of religion."

The Obama administration argued in a 76-page response that the Newlands' challenge "rests largely on the theory" that a for-profit, secular corporation can claim to exercise a religion and avoid laws regulating commercial activity.

"This cannot be," the motion reads, citing the 1982 case of United States v. Lee, in which the court held that self-employed Amish workers could be exempt from Social Security taxes, but did not extend the exemption to Amish employers. "Indeed, the Supreme Supreme Court has recognized that, '[w]hen followers of a particular sect enter into commercial activity as a matter of choice, the limits they accept on their own conduct as a matter of conscience and faith are not to be superimposed on the statutory schemes which are binding on others in that activity.'"

"Hercules Industries has made no showing of a religious belief which requires that [it] engage in the [HVAC] business," the Justice Department said in a formal filing in the U.S. District Court for the District of Colorado.

In response to the Justice Department's argument that the Newlands can either give up practicing their religion or give up owning their business, the Alliance Defending Freedom, which is representing the family, said in a reply brief: "[T]o the extent the government is arguing that its mandate does not really burden the Newlands because they are free to abandon their jobs, their livelihoods, and their property so that others can take over Hercules and comply, this expulsion from business would be an extreme form of government burden."