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The latest news on Obamacare from Business Insider

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    Barack Obama

    The Obama administration on Monday projected between 9 million and 9.9 million would be enrolled in private insurance plans by the end of 2015, millions fewer than the Congressional Budget Office has estimated.

    The Department of Health and Human Services released an analysis Monday with the projections, which come in around 3 million to 4 million short of what the nonpartisan budget office estimated in April.

    HHS cited a slower-than-anticipated shift away from employer-sponsored insurance and off-market individually obtained insurance as the reason for the lowered expectations. The federal and state insurance marketplaces, the department said, are not "ramping up" as fast as the CBO had projected.

    "Recent data suggest mixed evidence about the extent to which there is a shift in ESI and off-Marketplace individual coverage into the Marketplace," HHS said in the analysis.

    The department said sign-ups through the exchanges would still be on track to hit 25 million by the end of 2017, a benchmark number that is considered important to the law's success. But it said it would continue to measure accomplishments by the number of people that have become uninsured after the advent of the law.

    "It is also important to view Marketplace enrollment in the broader context. One important goal of the law is reducing the number of uninsured people, and the Marketplace is just one means to that end," the department said.

    "In practice, reducing the uninsured will be achieved through a combination of Marketplace retention, new Marketplace enrollment, increases in Medicaid enrollment, and continued support for a robust system of employer-sponsored insurance. Thus, we will measure our success by whether we are making continued progress in reducing the number of uninsured Americans. We will continue to work to decrease the number of uninsured Americans and expect the number to continue to decline."

    HHS also said 7.1 million people were fully enrolled in insurance plans obtained through the Affordable Care Act as of Oct. 15, down from the 8 million figure it trumpeted in the spring.

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    About 10 million Americans gained insurance coverage in 2014 thanks to the benefits of the Affordable Care Act, dubbed Obamacare.

    The graphic on the right shows how US President Barack Obama's public health reform affected the percentage of non-elderly Americans (18 to 64 years old) with no health insurance: in summer 2013 they peaked at more than 22%, just before steeply declining to just 16% in May this year.

    The number declined by almost 5 percentage points between January and June this year alone.

    The Financial Times quoteda paper from the president of the White House's Council of Economic Advisors, Jason Furman, who describes the decrease as one of the biggest legacies of the Obama administration. 

    The data comes from a special report of the New England Journal of Medicine that calls the Affordable Care Act"the most ambitious attempt to expand health coverage in the US in decades."

    The NEJM found out that since the open-enrolment period began in October 2013, "the number of Americans without health insurance declined significantly."

    Open enrolment is the period in which people can apply for a plan under the new act. The next window to apply opens between Nov. 15 and Feb. 15 and will allocate plans for all of 2015.

    The NEJM report estimates that about 10 million adults gained coverage, mainly among African-Americans and Hispanics. (This number sits within a wider range of seven to 17 millions as a margin of error.)

    A decision from the Supreme Court in June 2012 allowed individual states to opt out of the expansion of Medicaid that was part of Obamacare, bringing huge differences between the parts of the country that expanded their coverage allowance and those that didn't

    In States like California, New York, and Illinois, which adopted the Medicaid expansions under Obamacare, the decline of uninsured people was about 6 percentage points in the first six months of this year, compared with only 3.1 percentage points in states that opted out, like Texas, Florida, and North Carolina.

    The Financial Times concludes that, although new data could change the scene in the future, the decline in uninsured "seems like one of the most under-discussed trends of the year."

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    New York Times columnist and Princeton economist Paul Krugman spoke with our own Henry Blodget about Obamacare. In particular, the Supreme Court's decision to hear arguments in a case that could wipe out insurance subsidies in some states.

    Produced by Alex Kuzoian. Additional camera by Graham Flanagan and Devan Joseph.

    Follow BI Video:On Twitter

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    Sen. Marco Rubio (R., Fla.) and Rep. Paul Ryan (R., Wis.) are working on a health care alternative to Obamacare, the Tampa Bay Times reported.

    With a Republican-controlled House and Senate, the proposal could gain traction. 

    “We want to have every American to be able to buy the kind of health insurance they want at a price that they are willing to buy, and from any company in America that will sell it to you,” Rubio said recently during an interview on a Denver radio station. “And you should be able to buy it with either tax credit or pre-tax dollars, just like your employer pays for it if they decide to give it to you. And that’s a lot better than the disaster we have right now.”

    Without more detail, it’s difficult to assess the scope and implications of the legislation. Rubio’s office indicated Monday that things were still coming together. (He’s broadly talked about other ideas.)

    Republicans don’t have the ability for a full repeal–lacking the votes to override a presidential veto–but are determined to make changes, and the Rubio-Ryan legislation is likely to be joined by other proposals. President Obama said last week that he’s open to hearing ideas but made clear he’s not willing to do anything dramatic, such as removing the individual mandate.

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    dean 1

    Former DNC Chairman Howard Dean gave an excoriating critique of his own party’s key piece of legislation, Obamacare, saying it was “put together by a bunch of elitists” who “don’t fundamentally understand the American people.”

    Speaking to MSNBC’s Mika Brzezinski on Wednesday, Dean was shocked that Obamacare architect Jonathan Gruber said “the stupidity of the American voter” was a “political advantage” in passing Obamacare.

    “The problem is not that he said it. The problem is that he thinks it,” Dean said. “The core problem under the damn law is it was put together by a bunch of elitists two don’t fundamentally understand the American people. That’s what the problem is.”

    Brzezinski cringed after repeating Gruber’s quote.

    “Jesus!” Dean exclaimed after hearing that one of Obama’s key health care advisors would call the lack of transparency “critical” in passing the massively unpopular law.

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    If you are one of the 7.3 million Americans who purchased health insurance through or one of the other health exchanges during Obamacare's inaugural open enrollment period, it will soon be time to decide whether to renew or replace your policy.

    It's an important question.

    "You really do have to pay attention," says Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington, D.C.

    Save on health insurance by comparing quotes from insurers

    Mid-December deadline for making a switch

    This year's open enrollment period runs from November 15, 2014, through February 15, 2015, three months shorter than last time. If you have a plan from the previous enrollment season and want to replace it, you'll need to act by December 15 to avoid a possible lapse in coverage in the new year. and many state-built exchanges will automatically renew your plan for another year (provided the same plan is still offered) or enroll you in a similar one — without any action on your part. If you don't like the updated premium or benefit changes on the renewal form your insurer sends you this fall, you can select a new plan, either through the exchange or on the private market.

    Health experts agree that the work-in-progress nature of exchange-based plans and pricing, combined with network volatility as hospitals and physician groups jockey for limited network slots, make this the wrong year to sit idly by while your policy auto-renews.

    "The policy you're being renewed into may not be exactly what you selected," Chollet says.

    Reasons it may be time for a change

    Here's why your current plan may no longer be right for you.

    1. Subsidy changes: If you're among the vast majority of exchange-based policyholders who qualified for a federal tax credit to make your plan more affordable, that subsidy may change depending on the mix of policies offered on your state exchange this year. If your plan's new premium exceeds your area's second-lowest midlevel, or "silver," plan (the benchmark used for determining subsidies), you may have to pay the difference.

    2. Plan changes: If your plan's monthly premium jumped or your cost-sharing or prescription drug coverage changed for the worse, a better plan may now be available.

    3. Network changes: Doctors and hospitals are on the move these days, consolidating and renegotiating with insurers. If your health care providers disappeared from your plan's network, they now may be in-network on a different plan.

    4. Circumstantial changes: If your family size or annual income changed this year, you need to report that to your exchange to ensure you continue to receive the correct tax subsidy. Failure to stay current could alter or even end the subsidy help you receive for premiums, deductions, copayments and coinsurance.

    5. Your plan is canceled: If your insurer drops your exchange plan, it will offer you another plan available in your area. Or, you could choose a plan from one of your state's other insurers. But if you don't act, the exchange may auto-renew you to the next closest fit.

    obamacare flyer

    Forecast for smooth season, lower costs

    Whatever hand the exchange deals you, time will be of the essence this fall.

    "Those facing a big premium jump because of a change in the marketplace or their policy are going to have to act on it quickly if they want to choose a new plan," Chollet says.

    Fortunately, a recent Kaiser Family Foundation analysis of upcoming premiums in major cities in 15 states and Washington, D.C., forecasts fairly smooth sailing for exchange shoppers this year. Plus, unlike last year, you can now window-shop policies before open enrollment begins.

    "On the benchmark silver plan, we found a slight overall decrease (0.8%) in the average price of premiums," says Cynthia Cox, the senior policy analyst who led the study. "We're also seeing about the same or slightly more plans offered state to state this year."

    While nine markets showed premium increases, six of those were modest 1% to 3% jumps. The cost of a benchmark plan has fallen in the other seven markets.

    "Since we would regularly see double-digit increases in plan costs in the past, even a single-digit increase is an encouraging trend," Cox says.


    More choices for exchange shoppers

    Most areas in the Kaiser survey will have five or more insurers offering exchange plans, with three markets boasting 10 or more.

    Nationally, the Department of Health and Human Services says shoppers can expect 77 more insurers to be represented on the exchange this year, a 25% increase over the first open enrollment.

    Lynn Quincy, associate director of health reform policy for Consumers Union, the policy and action arm of Consumer Reports, says health care reform has made shopping for a plan easier than ever before.

    "The Affordable Care Act did a lot to standardize coverage, which means there are fewer traps and tricks waiting for consumers," she says. "Things like out-of-pocket maximums, which used to be very holey with all these exceptions, have been pretty much addressed."

    Going uninsured or outside the exchanges?

    But beware if you plan to simply drop coverage altogether or shop for an individual plan on the private market, as both can be problematic.

    The penalty for ignoring the Affordable Care Act's individual mandate, which requires most adults to carry health insurance, rises in 2015, from $95 per adult or 1% of household income to the greater of $325 per adult or 2% of household income. Plus, without insurance, you would be solely responsible for all of your medical costs.

    If you opt to shop outside the exchange, you'll need to find a policy that meets the federal definition of "minimum essential coverage" to avoid the individual mandate penalty. Even if you do, you won't be eligible for the premium tax subsidy or the reductions in out-of-pocket costs available only through the exchange.

    Best bet for the befuddled?

    "Shop around," advises Cox. "You may save money, and it would definitely be worth checking to see that your health care providers are still in your network."

    SEE ALSO: Ignoring These Health Issues In Your 40s Could Cost You Thousands

    Join the conversation about this story »

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    President Barack Obama

    Rich Weinstein went to bed on July 24 after posting a comment on a Washington Post blog post from his iPad. 


    For months, he had been trying to bring to light past comments from Jonathan Gruber, the MIT economist who was one of the authors of the Massachusetts health law that served as the model for Obamacare. His comment on the Post story finally did it.

    Mid-morning on July 25, Weinstein, an independent investment analyst, grabbed his iPad, turned it on, and searched for "Jonathan Gruber" on Google. He saw his name next to Gruber's. The story was everywhere.

    "I said, gee, I wonder what's going on with that," Weinstein told Business Insider. "And then it gets to the point, the next day, where Rush Limbaugh is talking about it and the White House was responding to it."

    For more than a year, Weinstein has been digging up past remarks made by Gruber, one of the key architects of the Affordable Care Act. Those comments from Gruber have roiled the debate over the most high-profile ongoing legal challenge to undo the law — and Republicans are planning to use them as ammunition in their messaging against Obamacare.

    The comments Weinstein surfaced in July, where Gruber made comments critics of the healthcare law characterized as making the case for the plaintiffs in the legal challenge, were only the beginning.

    This week, at least three more of Gruber's past comments have surfaced, jut days after the Supreme Court agreed to hear a case that could potentially cripple President Barack Obama's healthcare law. In these remarks, Gruber insulted American voters and painted the architects of the Affordable Care Act and its supporters in Congress as having been intentionally opaque about the law in order to get it passed. 

    Weinstein's first revelation this week was from an October 2013 conference, during which Gruber said the lack of transparency throughout the legislative process was a "huge political advantage" for Democrats trying to pass the bill. He said the law was written in a "tortured way" so the Congressional Budget Office wouldn't score the mandate to buy health insurance as a tax. 

    "Lack of transparency is a huge political advantage," Gruber said in the video. "Call it the stupidity of the American voter, or whatever. But basically, that was really, really critical to get the thing to pass. I wish we could make it all transparent. But I'd rather have this law than not."

    Gruber did not return multiple requests for comment for this story. However, the day after his first comments surfaced this week, he went on MSNBC and apologized. 

    "The comments in the video were made in an academic conference," Gruber said on the network. "I was speaking off the cuff, and I basically spoke inappropriately. And I regret having made those comments."

    Jonathan Gruber

    But in the past two days, the second and third rounds of controversial Gruber comments have come to light. In the second, Gruber made another remark about how Congress was able to pass the law because the American public was "too stupid" to grasp its finer points. 

    And in the third clip (seen around the 29-minute mark of that link), which was first reported on by The Daily Caller, Gruber described how Congress was able to exploit the American public's lack of awareness of economic policy with respect to the healthcare law's tax on so-called "Cadillac" insurance plans. He said it was common knowledge among people debating the law that the cost of the plans would eventually be passed on from the insurance companies to American taxpayers.

    "It's a very clever basic exploitation of the lack of economic understanding of the American voter," Gruber said during an appearance at the University of Rhode Island in 2012.

    The newly minted Republican majority in Congress is planning to use the comments as a messaging tool. One senior Republican congressional aide told Business Insider they were "sure" Republicans will employ the comments broadly in their Obamacare messaging.

    Almost on cue Thursday, the office of House Speaker John Boehner slammed the comment. Boehner also reiterated that he and incoming Senate Majority Leader Mitch McConnell have made a renewed commitment to repeal the law.

    "The American people are anything but ‘stupid,'" Boehner's office said in a statement. "They’re the ones bearing the consequences of the president’s health care law and, unsurprisingly, they continue to oppose it."

    Other Republican congressional aides on Capitol Hill said the comments would likely be leveraged in potential hearings on the law. Now that Republicans control the Senate, they plan to hold more hearings on the Affordable Care Act in general. And controversial statements made by one of the law's key architects serve as potentially prime fodder for arguments against the law.

    Democrats, meanwhile, have moved quickly to distance themselves from Gruber and from the comments in general. 

    "I don't know who he is. He didn't help write our bill," House Minority Leader Nancy Pelosi told reporters Thursday morning — even though, in 2009, her website touted his work.


    Weinstein, for his part, has no opinion on the political or policy implications of the videos. He simply wants the footage out in the open for the public to watch. 

    His interest in the comments is personal, and it stems from the flap over Obama's original pronouncement that if "you like your plan, you can keep it." About a year ago, he and his wife received a notice that their insurance plan did not meet the minimum standards under the Affordable Care Act, so he couldn't keep it. (Obama later revised this provision so that "grandfathered" plans that don't meet basic requirements can still be offered through 2016.)

    Weinstein said his premiums doubled, and on Wednesday afternoon, he got more bad news — his premiums are projected to be about 26.7% higher than the doubling next year. 

    "It's a big nut to crack," Weinstein said. "That kind of got my attention."

    He's a frequent watcher of cable television, and some of the guests who appeared most frequently on cable-news shows described themselves as the "architects" of the law. He started to look into some of them — David Cutler, Ezekiel Emanuel, and Gruber, among others — to get a better understanding of certain provisions of the law and how it came to be.

    "I thought, I’ll bet you these guys might have left a paper trail. Because they’re not part of the administration or talking heads," Weinstein said.

    Nothing about Cutler or Emanuel particularly stood out. But Gruber seemed to have more of a political bent, Weinstein noticed. One comment from a PBS "Frontline" interview made him perk up. In that appearance, Gruber talked about former Republican presidential candidate Mitt Romney — who instituted a similar, state-level reform in Massachusetts — and he said that, as a Democrat, he was impressed with Romney and scared he'd eventually become president.

    Over the next few months, he kept finding more and more appearances. Weinstein spotted Gruber everywhere — on a book tour, on podcasts, on radio interviews, and on conference panels. In January, Weinstein read about the Halbig case — a similar challenge is the one making its way up to the Supreme Court. He knew he had heard the plaintiffs' argument against Obamacare before — from Gruber

    Weinstein remembered Gruber had suggested that states, not the federal government, could only set up exchanges. In the case before the Supreme Court, the plaintiffs are arguing the Affordable Care Act only allows for states to set up the exchanges and any federal subsidies handed out for health insurance are illegal.

    "I couldn't have said it better myself!" Michael Cannon, the director of health policy at the Cato Institute and one of the key architects of the Halbig lawsuit, told Business Insider in an interview after Gruber's comments surfaced.

    But for a while, Weinstein had trouble getting anyone to take the bait on his scoop. He emailed Indiana's attorney general, who is at the forefront of a similar lawsuit to Halbig, but did not hear back. He tried hard to get the clip into a reporter's hands, but not one would budge.

    "The people who are now calling me are the ones who didn’t want anything to do with the video I sent them," Weinstein said.

    Cannon was among the first to notice Weinstein's video when it began circulating after his comment on The Washington Post story. He published a blog post touting the video on Forbes, where he is a contributor. 

    This round was similar. Weinstein found the clips two days before the midterm elections, but no one seemed interested. He eventually pushed the video out on his Twitter feed, which he estimated had about 20-25 followers last week.

    One of his followers who saw it was Phil Kerpen, the president of the conservative group American Commitment. He clipped the video down to about one minute. And, in the words of Weinstein, "it went crazy." 

    The message to Weinstein: A relatively average guy can have a big effect on the conversation.

    "I want people to see what’s out there and to encourage people not to rely on the media," he said. "There’s an expression out there. I don’t know exactly how it goes, but it's something like, 'If you don’t like it, then do it yourself.' So I did!"

    Weinstein stressed many other people could have a similar impact. 

    "I’m just a regular guy like everyone else," he added. "I Googled, and I grabbed the right piece of the thread at the right time."

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    The second sign-up season under President Barack Obama's health overhaul opened Saturday, with hopes that this time consumers will have a positive experience.

    But the fear is that entrenched political opposition and renewed legal challenges may yet collapse the program that's bringing health care to millions of previously uninsured Americans. The administration can't afford another technology meltdown.

    With 7 million paying customers in new insurance markets, the Affordable Care Act has shown it is helping to reduce the number of uninsured. Insurers, not known for altruism, have stuck with the fledgling program despite ongoing technical headaches with the website. More companies are participating for 2015, a sign they see a business opportunity.

    Obama urged consumers, whether they currently buy coverage through the insurance markets or still need to sign up for a plan, to go to the health care website and review their options. He said they could end up saving money or finding a better plan, and urged them to act fast since the enrollment period closes Feb. 15.

    "This window won't stay open forever. You only have three months to shop for plans, so it's worth starting right away. And it might make a big difference for your family's bottom line," Obama said Saturday in his weekly radio and Internet address, which the White House released as the president visited Brisbane, Australia.

    obamacare sign upThe administration said late Friday that some functions would be turned off for several hours in the transition to the start of sign-up season. The website appeared to functioning early Saturday.

    "Obamacare" is still struggling to win hearts and minds. The latest Associated Press-GfK poll finds that, if forced to choose between repealing the law and implementing it as written, 56 percent of Americans would repeal it completely. Only 41 percent would carry it out.

    However, most don't see the law going away. Sixty-one percent said they expect it to be implemented in its current form, or something near that.

    Health and Human Services Secretary Sylvia M. Burwell, a management expert assigned to save what's been a problem child of social programs, says she's confident the sign-up season will be successful, even if it's only half as long as last year's: three months, through Feb. 15.

    Will the law remain on the books after Republicans gain full control of Congress in January?

    "The idea of repeal ... is not something this administration will let happen," said Burwell.

    What about the legal challenge the Supreme Court has just agreed to hear, calling into question the law's tax credits that make premiums affordable for millions?

    "Nothing has changed," Burwell said, adding that the tax credits "will be continuing." At least for the time being. The Supreme Court isn't likely to hear the case until the spring, after 2015 open enrollment is over.

    yellenWebsite outages are not out of the question this year, but a full-scale meltdown seems less likely. has been revamped to handle last season's peak loads and beyond. The federal website will serve as the online portal for coverage in 37 states, while the remaining states run their own insurance exchanges. Consumers can also apply in person or through call centers.

    The pool of potential customers is an estimated 23 million to 27 million people who don't have access to affordable coverage on the job.

    For most newcomers, the online application has been simplified, cut to 16 computer screens from 76. Navigation is easier. Window shopping is available without first having to create an account.

    Premiums for 2015 are a wild card. Nationally, the average increase is expected to be modest. But prices can vary dramatically from state to state, even within regions of a state. Many returning customers could end up facing premium increases if they don't shop around.

    The administration is seeking to lower expectations. Burwell said her target is a total enrollment of 9.1 million people in 2015, a 28 percent increase. The nonpartisan Congressional Budget Office had estimated the number would nearly double, to 13 million people enrolled next year.

    The administration is facing several new tests.

    obamacare sign upThis sign-up period will be the first time that renewal has been tried for current customers, and also overlaps for the first time with tax-filing season.

    For those already signed up, coverage will renew automatically if they do nothing, but that may not produce the best result. The returning customers could miss out on lower-premium options and get stuck with outdated and possibly incorrect subsidies. In most cases, they have until Dec. 15 to update their income information or switch insurance plans, in order to have the changes take effect on Jan. 1.

    The tax issues will emerge during next year's filing season.

    Current customers who got tax credits this year will have to file new tax forms to prove they got the right amount. Too much subsidy and their tax refunds will be reduced. Too little, and the government will pay them.

    People who remained uninsured risk a penalty that will be deducted from their tax refunds. Millions may qualify for waivers, but getting exemptions could involve a paperwork ordeal.

    Community-based counselors helping uninsured people say interest remains strong, but they worry about this year's abbreviated sign-up season.

    Nathalie Milias, who works with Haitian groups in Miami, said she has been feeling the demand since the summer as uninsured people approached her.

    "They see me in the store, they call," said Milias. "The locations I go to are already calling and saying, 'How many appointments do you want for Monday?'"

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    Barack Obama

    WASHINGTON (Reuters) - U.S. President Barack Obama on Sunday defended the transparency of his signature healthcare law, after one of the White House's advisers on the reform said the law passed, in part, because of the "stupidity" of American voters.

    Obama said the law, which extends private health coverage to uninsured Americans, was extensively analyzed and written about before its passage in 2010, and in subsequent debates.

    "The fact that some adviser who never worked on our staff expressed an opinion that I completely disagree with ... is no reflection on the actual process that was run," Obama said during a press conference at the Group of 20 leaders meeting in Brisbane, Australia.

    "I would just advise every press outlet here, go back and pull up every clip, every story ... It was a tough debate."

    Obama was responding to the comments of Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who advised the White House on the Affordable Care Act as well as Massachusetts on the health law enacted by former presidential candidate Mitt Romney when he was governor of that state.

    In several speeches from prior years that came to attention in the past week, Gruber said the law's ultimate passage benefited from the "stupidity" of American voters, who did not fully understand the provisions.

    Gruber's comments were quickly picked up by Republicans in Congress, who are committed to repealing or dismantling parts of the healthcare law.

    But the White House trumpeted some good news about the health reforms this weekend, saying 100,000 people were able to submit new online applications for health coverage during the start of open enrollment on Saturday.

    The website was beset by technical glitches last year that shut down the operation within minutes of its opening and drove Obama's signature domestic policy to the brink of disaster.

    The administration expects 9.1 million people in total to enroll in government-backed federal and state health insurance marketplaces this year, down from an initial target of 13 million.

    "When you give the American people the tools to make the right choices for themselves, they're going to do that," Health Secretary Sylvia Mathews Burwell said of the enrollment figures on NBC's "Meet the Press."

    "And that's what this is about."


    (Reporting by Anna Yukhananov, additional reporting by Alina Selyukh; Editing by Clelia Oziel)

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    travis kalanick"The democratization of those types of benefits allow people to have more flexible ways to make a living. They don’t have to be working for The Man."— "Uber Just Stuck A Knife In The Republican Party's Heart," by Jonathan Chait in New York Magazine

    I had an Uber driver tell me yesterday that the service has completely changed his life for the better. He drove a cab for 24 years and was afraid to ever give it up because of all the security that went with working for the company that held the medallion.

    He’s been wiping vomit out of his backseat for decades and dealing with the worst humanity has to offer — drunks, violent people, pigs who leave trash in his car, ride thieves who jump out at red lights, etc. And working for other people, horrible people who would take advantage of him at any juncture — just because they knew he had no way to stop them.

    Now he deals with customers who actually have a stake in being on their best behavior and he has never been happier. He gets to drive a clean vehicle and interact with conscientious passengers. Best of all, there’s no haggling and tips are included — automatically. The nasty friction of being a cabbie for hire is gone and in its place is a professional work situation.

    In the quote above, Uber founder and CEO Travis Kalanick explains how Obamacare has helped make this all possible.

    For all its flaws (and there are plenty), one thing that single-payer insurance does is it lets people cut the umbilical cord with bad work situations or become more entrepreneurial without the threat of having to drop out of society.

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    During a Brookings Institution panel in April 2006, then-Sen. Barack Obama claimed he had “stolen” ideas from a gang of liberal economists and academics, including the now-infamous Obamacare architect Jonathan Gruber.

    “You have already drawn some of the brightest minds from academia and policy circles, many of them I have stolen ideas from liberally,” Obama said. “People ranging from Robert Gordon to Austan Goolsbee; Jon Gruber; my dear friend, Jim Wallis here, who can inform what are sometimes dry policy debates with a prophetic voice.”

    Despite Obama’s attempt to distance himself and his unpopular signature health care legislation from Gruber, it is clear that 2006 Obama never anticipated videos of his once-trusted adviser calling American voters ‘stupid’ would surface in 2014.

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    AP774846391720The Obama administration said on Thursday it had overcounted a recent Obamacare enrollment number it released by "mistake." The clarification came after a report from Bloomberg that said the administration had included dental-plan enrollees, a change from previous enrollment reports.

    Bloomberg's Alex Wayne reported earlier on Thursday that the administration had included as many as 400,000 dental-plan enrollees in its September enrollment total of 7.3 million. That had in turn pushed total enrollment passed by the 7-million projection originally offered by the Congressional Budget Office.

    The Centers for Medicare and Medicaid Services then said after the report that "a mistake was made." The correct enrollment total is 6.7 million as of Oct. 15.

    “A mistake was made in calculating the number of individuals with effectuated Marketplace enrollments," a CMS spokesperson said in an email. "We have determined that individuals who had both Marketplace medical and dental coverage were erroneously counted in our recent announcements."

    "Moving forward only individuals with medical coverage will be included in our effectuated enrollment numbers," the spokesperson said.

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    Cathey Park of Cambridge, Massachusetts wears a cast for her broken wrist with

    NEW YORK (Reuters) - Leading U.S. CEOs, angered by the Obama administration's challenge to certain "workplace wellness" programs, are threatening to side with anti-Obamacare forces unless the government backs off, according to people familiar with the matter.

    Major U.S. corporations have broadly supported President Barack Obama's healthcare reform despite concerns over several of its elements, largely because it included provisions encouraging the wellness programs.

    The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't.

    But recent lawsuits filed by the administration's Equal Employment Opportunity Commission (EEOC), challenging the programs at Honeywell International and two smaller companies, have thrown the future of that part of Obamacare into doubt.

    The lawsuits infuriated some large employers so much that they are considering aligning themselves with Obama's opponents, according to people familiar with the executives' thinking.

    "The fact that the EEOC sued is shocking to our members," said Maria Ghazal, vice-president and counsel at the Business Roundtable, a group of chief executives of more than 200 large U.S. corporations. "They don't understand why a plan in compliance with the ACA (Affordable Care Act) is the target of a lawsuit," she said. "This is a major issue to our members."

    "There have been conversations at the most senior levels of the administration about this," she added.

    Business Roundtable members are due to meet Obama in a closed-door session on Tuesday, where they may air their concerns.

    It is not clear how many members of the group, whose companies sponsor health insurance for 40 million people, are considering any action. It is also not clear if the White House can stop the EEOC from challenging wellness programs.

    A threat of a corporate backlash comes at a time when Obama faces criticism even from his Democrats' ranks that he had devoted too much political capital to healthcare reform.

    Such action could take the form of radical changes in health benefits that employers offer. It could also mean supporting a potentially game-changing challenge to Obamacare at the Supreme Court next year and expected Republican efforts to eviscerate the law when they take control of Congress in 2015.


    Obamacare allows financial incentives for workers taking part in workplace wellness programs of up to 50 percent of their monthly premiums, deductibles, and other costs. That translates into hundreds and sometimes thousands of dollars in extra annual costs for those who do not participate.

    Typically, participation means filling out detailed health questionnaires, undergoing medical screenings, and in some cases attending weight-loss or smoking-cessation programs.

    One of the arguments presented in the lawsuit against three employers is that requiring medical testing violates the Americans with Disabilities Act.

    That 1990 law, according to employment-law attorney Joseph Lazzarotti of Jackson Lewis P.C. in Morristown, N.J., largely prohibits requiring medical tests as part of employment.

    "You can't make medical inquiries unless it's consistent with job-necessity, or part of a voluntary wellness program," he said.

    The lawsuits are based on the view that it is no longer voluntary if employees face up to $4,000 in penalties for non-participation, loss of insurance or even their jobs.

    Employers, however, see the lawsuits as reneging on the administration's commitment to an important part of the healthcare reform.

    On Nov. 14, Roundtable president John Engler sent a letter to the Labor, Treasury and Health and Human Services cabinet secretaries who oversee Obamacare asking them to "thwart all future inappropriate actions against employers who are complying with" the law's wellness rules, and warning of "a chilling effect across the country."

    Asked for a response to the letter, an administration official told Reuters that it supported workplace health promotion and prevention "while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status."


    In practical terms, large corporations have several ways to undermine Obamacare if they decide to.

    One is to support legal challenges to the subsidies given to low-income individuals who buy health insurance on the federal exchange established under the law. Neither the Business Roundtable nor any of its CEO members have done this so far. The Supreme Court is expected to hear oral arguments in the case in 2015.

    Another option is to make top executives available for hearings on repealing or diluting Obamacare. "We never did this before," said the person familiar with the executives' thinking. "But they could turn up the noise. I don't think the White House would want the CEOs turning on them and supporting these efforts on the Hill."

    The nuclear option would be to radically change employer-sponsored health insurance. Large corporations are highly unlikely to eliminate it, but they might give workers a fixed amount of money to buy coverage on a private insurance exchange. That would allow employers, almost all of which pay workers' medical claims out of their earnings, to cap their healthcare spending.


    (Reporting by Sharon Begley; Editing by Michele Gershberg and Tomasz Janowski)

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    obamacare sign up

    As the cost of health care rises, more and more Americans in nearly every economic class are choosing to delay medical treatment because they can’t afford it. 

    new Gallup poll released Friday found that about one in three Americans say they have put off treatment for themselves or a family member because of cost—the highest rate recorded in Gallup’s history.

    Gallup said that about 38 percent of middle class people with a household income of between $30,000 and $75,000 per year have delayed medical care because of costs, up from 33 percent last year. 

    Meanwhile, about 28 percent of households earning above $75,000 said they delayed care this year, compared to just 17 percent in 2013. 

    “Variation in the pricing for medical treatments, not to mention differences in how much insurance plans cover, could be confusing Americans or making them fear a needed treatment is too expensive,” the Gallup poll noted.

    The poll comes just weeks after the start of Obamacare’s second open enrollment period, which runs into February 15, 2015. Last year, around seven million people got health coverage through the new law’s exchanges and millions more obtained access through Medicaid expansion. 

    Despite expanding access to health insurance to millions of people, the survey suggests that Obamacare hasn’t tackled one of its major goals: making health care more affordable.

    Despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure,” Gallup’s Rebecca Riffkin wrote in a blog post.

    That’s likely because many of the plans sold on the law’s health exchanges tend to be considered high deductible plans, meaning they may have lower premiums but high out of pocket costs. 

    The Internal Revenue Service defines high deductible plans as those with annual deductibles of $1,300 or more for individuals or $2,600 for families.

    A recent study by HealthPocket found that the average deductible for 2015 Bronze-level policies, the lowest tiered plan, is about $5,181 for individuals - up from $5,081 last year and about four times the IRS’s benchmark for high-deductible plans. Families who enroll in these plans have deductibles averaging about $10,500 deductibles.  

    “One of the goals of opening the government exchanges was to enable more Americans to get health insurance to help cover the costs of needed medical treatments,” Riffkin wrote on the Gallup site. “While many Americans have gained insurance, there has been no downturn in the percentage who say they have had to put off needed medical treatment because of cost.”

    It’s not just Obamacare policies that are trending toward higher cost sharing plans. In the last few years, employers have begun shifting their workers into higher deductible plans as the overall cost of health care continues to rise.

    Gallup’s poll found that the cost of health care is only expected to climb. A new report from PricewaterhouseCooper’s Health Research Institute says health care costs are expected to jump 6.8 percent overall next year. Therefore, as costs rise it’s likely that more people will continue to put off care.

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    obamacare health insuranceThis story was co-published with The New York Times' The Upshot.

    At first glance, the 2015 health plans offered by the Ohio nonprofit insurer CareSource look a lot like the ones it sold this year, in the Affordable Care Act's first enrollment season.

    The monthly premiums are nearly identical, and the deductibles are the same.

    But tucked within the plans' jargon are changes that could markedly affect how much consumers pay for health care. Generic drugs will soon be free, but the cost of expensive specialty medications will increase. Co-payments for visits to primary-care doctors will go down, but those for emergency room trips will be higher.

    Millions of people nationwide bought health insurance this year through the federal government's health insurance exchange, often through the website Now, as they pick plans for next year, they face a complex battery of choices and changes.

    They have until Dec. 15 to select a new plan or they'll be re-enrolled automatically in the one they currently have. Or, if that plan no longer exists, they'll be enrolled in another product offered by the same insurer, when available. But even if they get the same plan 2014 of the nearly 2,800 health plans offered in 2014, about 1,700 of them will exist in the same form next year 2014 their benefits may not stay the same.

    "You're getting re-enrolled in the same carrier, but there's basically no guarantees that your product looks anywhere near the same as it did last year," said Caroline Pearson, vice president of Avalere Health, a consulting firm.

    Much attention has focused on changes to plans' monthly premiums, but changes to other kinds of benefits 2014 affecting the cost of things like doctors' visits and prescriptions 2014 can be trickier to understand and make a huge difference in annual health care costs.

    A ProPublica analysis of the 2014 and 2015 plans in 34 states being offered on the exchange shows the adjustments taking place. ProPublica has created a tool that allows users to see, quickly and easily, some significant ways the plans have changed from one year to the next.

    Customers of more than 900 plans will see their out-of-pocket maximum for medical bills increase, usually to $6,600 for individuals, the most allowed by law for next year. Only about 250 plans are lowering their out-of-pocket maximums. About 180 plans are being discontinued for at least some customers, and the rest are keeping the same limits.

    Members of more than 600 plans will see their medical deductibles increase, while those in about 380 will see their deductibles drop. Consumers of one Illinois plan will see their deductible increase by $4,800. Those re-enrolled in plans offered by Florida Blue face deductibles as much as $3,650 higher than those this year, while other customers of the same company will see deductibles decrease by up to $3,000. Florida Blue did not respond to a request for comment.

    More than a quarter of the 2,800 health plans altered the costs of specialty medications for conditions like multiple sclerosis and AIDS, mostly increasing the patients' share.

    Some policy changes appear subtle, just a matter of adding or subtracting a few words, but are actually quite significant. This year, many insurers charged members a set fee of a few hundred dollars for emergency room visits. For next year, some of those plans changed the wording of their benefit, adding "co-pay after deductible."That means the insurers won't pay for any portion of an emergency room visit until consumers meet their deductible, spending thousands of dollars.

    "Everyone has focused on premiums in the press because premiums are at least easy to understand," Pearson said. People have a harder time detecting the effect of changes to what's called a plan's benefit design. "It's just incredibly hard to do, but I think it's really important."

    What ProPublica's analysis suggests is that even those who would be willing to pay higher premiums to keep their current plan may be surprised to learn that substantial details have changed. They should go back to or to ProPublica's news app to make sure their plan is still the best choice.

    obamacare insurance

    Shopping around is essential 2014 and there's little time to delay.

    The open enrollment period continues until Feb. 15, and customers who are automatically renewed in their plans can still make changes until that time, but only changes made by Dec. 15 will take effect on Jan. 1.

    The Health and Human Services secretary, Sylvia Burwell, has been encouraging consumers to take an active role in the renewal process. But in the first two weeks of open enrollment, fewer than 400,000 consumers actively re-enrolled. "The first deadline is just a couple of weeks away," she said in a news release on Wednesday. "We're encouraging everyone who is already covered through the marketplace to come back and shop because there could be savings."

    Everyone's health care needs are different. Some people might do best with a plan that has a higher premium and lower out-of-pocket costs for particular services; others might save money by choosing a plan with a lower premium and higher co-payments.

    Those earning less than four times the federal poverty rate ($62,920 for a couple) qualify for subsidies to pay their premiums, and those earning even less may qualify for additional help to lower their out-of-pocket costs once enrolled.

    Changes to insurance benefits are hardly exclusive to the Affordable Care Act marketplaces. They happen regularly in health plans offered by employers.

    Under the law, insurers are somewhat limited in how they can change their plans. Products are grouped by tiers: Bronze plans cover about 60 percent of their members' overall health services; silver plans 70 percent; gold plans 80 percent. To stay at those levels from year to year, plans can't just increase all of their charges. If they charge more for some things, that often means charging less for others.

    Explore the app »

    That's what happened at CareSource, the Ohio nonprofit. Officials there said they changed their benefits based on comments from members and conversations with others who are uninsured. "Many didn't understand the value of health insurance," said Scott Streator, vice president of Enterprise Strategy at CareSource. "Therefore, we changed our plan design to make it more simple, more understandable and more preventive, focused on everyday types of health care needs."

    That translated into free generic drugs and lower co-pays for physician office visits, Streator said. "If you make these changes, there's trade-offs," he said. "The costs go up somewhere else." In contrast with this year, when members pay $250 for emergency room visits, they will need to meet the plan's deductible next year before their E.R. visits are covered with a co-payment that varies from $250 to $500. And members will now pay 40 percent of the cost of specialty medications, up from 25 percent this year.

    CareSource enrolled more than 30,000 people during the 2014 open enrollment cycle and expects to double that amount this time around, Streator said.

    Another insurer whose products are changing is Coventry Health Care. One Coventry silver plan in the Kansas City, Kan., region is decreasing the costs of primary care visits to $5 from $10, but is increasing its medical deductible to $2,750 from $2,000, increasing its out-of-pocket maximum to $6,600 from $6,350, and increasing the cost of generic drugs to $15 from $10, among other changes. Premiums are also going up.

    A spokesman said the company tries to balance its benefits and costs.

    hospital wheelchair healthcareVantage Health Plan, based in Louisiana, is increasing the medical deductible in its silver plan to $2,900 from $1,800 and is raising its maximum out-of-pocket costs, too. But the company said most of its members won't feel the changes much. That's because about 85 percent of the 8,400 members who enrolled in the last cycle received government subsidies.

    Although those without subsidies "are going to get hit, all that was designed so that all those who are getting the subsidy, their blow would be softened because that's where the majority of our business falls," said Billy Justice, Vantage's director of marketing and sales.

    Vantage hopes to double its enrollment for next year.

    The data analyzed by ProPublica does not include information for states that run their own insurance exchanges, including California and New York. In California, plans are required to offer a standard benefit design, which allows consumers to compare plans more easily. Insurers compete on their brand's reputation, premiums and on the size of their doctor and hospital networks.

    "There can be a big difference in the experience of the consumer in terms of what they pay out of pocket if you don't have standardized benefits," said Anthony Wright, executive director of the consumer advocacy group Health Access in California.

    The government's plan to automatically re-enroll consumers for 2015 has come under criticism, with some warning that consumers who don't make a choice themselves could end up in a plan with higher costs. As a result, the government is considering a different system for 2017 in which consumers who don't pick their own plan could be shifted to the lowest-cost plan in the market.

    Has your insurance company changed your benefits this year? We'd like to hear about it. Email

    ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

    SEE ALSO: One Map Shows Exactly What Obamacare Has Done To The Country

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    U.S. President Barack Obama appears on The Colbert Report with Stephen Colbert at the Lisner Auditorium at George Washington University in Washington December 8, 2014. 

REUTERS/Kevin Lamarque

    President Barack Obama appeared on "The Colbert Report" Monday night and took over a segment on the show.

    He told Colbert: "You’ve taken plenty of shots at my job, I’m going to take a shot at yours."

    Obama read the prompter for Colbert's "The Word" segment (which Obama changed to "The Decree") while jokes appeared on screen next to him.

    He mostly joked about Obamacare, a major point of contention during his two terms as president.

    Check out some of the jokes that popped up on screen while Obama was giving his "Decree":

    When he discussed Obamacare:

    Obama Colbert Report

    He said there are things both parties actually like about Obamacare:

    Obama Colbert Report

    And pointed out that children can stay on their parents' policies until they're 26:

    Obama Colbert Report

    And that 7 million people have signed up for Obamacare in the past year:

    Obama Colbert Report

    Then he asked how you stop something that more and more people are starting to like:

    Obama Colbert Report

    He said that even if Republicans repealed Obamacare, they'd have to replace it with their own healthcare plan:

    Obama Colbert Report

    He also dropped a joke about Mitch-McConnell-Care:

    Obama Colbert Report

    Obama said there's only one surefire way to kill Obamacare:

    Obama Colbert Report

    He said he'd have to make signing up unappealing to young people:

    Obama Colbert Report

    And he acknowledged that Obamacare's website rollout had been "a little bumpy":

    Obama Colbert Report

    But he assured people that the new website works, and wondered how to get the message out to young people since they don't watch "real news shows like this one":

    Obama Colbert Report

    He said going on a comedy show was "beneath his dignity":

    Obama Colbert Report

    This was one of Colbert's last episodes before he takes over David Letterman's job on CBS' "Late Show."

    The final episode of The Colbert Report is scheduled for Dec. 18.

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    Jonathan Gruber

    Massachusetts Institute of Technology professor and healthcare-reform adviser Jonathan Gruber profusely and repeatedly apologized Monday for a series of controversial remarks he made about Obamacare.

    "I behaved badly, and I will have to live with that, but my own inexcusable arrogance is not a flaw in the Affordable Care Act," Gruber said before a congressional committee hearing, according to his prepared remarks.

    Gruber, who is widely regarded as one of the architects of President Barack Obama's signature healthcare reform, added fuel to the already contentious debate over the law earlier this year when videos emerged showing him mocking the American public while discussing the strategy behind the Affordable Care Act.

    "Lack of transparency is a huge political advantage," Gruber said in one clip. "Call it the stupidity of the American voter, or whatever. But basically, that was really, really critical to get the thing to pass. I wish we could make it all transparent. But I'd rather have this law than not." 

    However, speaking Monday before the House Oversight and Government Reform Committee, Gruber backtracked on those claims and said he was "embarrassed."

    "I would like to begin by apologizing sincerely for the offending comments that I made," he said. In some cases I made uninformed and glib comments about the political process behind healthcare reform. I am not an expert on politics and my tone implied that I was, which is wrong. In other cases I simply made insulting and mean comments that are totally uncalled for in any situation. I sincerely apologize both for conjecturing with a tone of expertise and for doing so in such a disparaging fashion. It is never appropriate to try to make oneself seem more important or smarter by demeaning others. I know better."

    Contrary to his claims in the videos, Gruber went on to defend the law and insist it was passed in a transparent fashion. He also downplayed his role in helping construct the legislation and said he was not "the architect" of Obama's healthcare reform. Gruber, who's become a lightning rod for conservative criticism, concluded by urging the country to "move past the distraction" he caused.

    "While I will continue to reflect on the causes of my own insensitivity, I hope that our country can move past the distraction of my misguided comments and focus on the enormous opportunities this law provides," he said.

    View Gruber's full prepared remarks below.

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    The way the risk corridor program works: Insurers estimate in advance how their insurance pools will look and if in the end they're significantly better than estimated, they pay money into the program; if they're significantly worse than estimated, they are paid money by the program.

    The CRomnibus, which funds most of the government through the next year, prohibits the Health and Human Services Department from transferring funds from other sources to fund the program. The practical impact, one policy expert told TPM, is that HHS can therefore only use money brought into the program to make payouts, effectively making it revenue neutral.

    "As far as anyone can tell, that's what's going on," Timothy Jost, a health law professor at Washington and Lee University who is supportive of the law, told TPM. In theory, if the program doesn't bring in enough money to make its payouts, that could mean insurers will have to -- at the very least -- wait a year before getting their money. In turn, that could have a negative impact on 2016 premiums if insurers have to take a loss in the meantime.

    "I think it's important, but I don't think it's the end of the world," Jost said, explaining that major insurers should have the bandwidth to absorb any adverse effects. But smaller insurers might be relying on the risk corridor program, along with the law's reinsurance and risk adjustment programs that are also designed to keep prices stable in the law's early years, to remain solvent.

    But any negative effects on insurance companies -- and then, by extension, Obamacare -- are a policy win for Republicans, who have derided risk corridors as a taxpayer-funded bailouts. Sen. Marco Rubio (R-FL) proposed a bill last year to repeal the program entirely.

    America's Health Insurance Plans, the industry's lobbying group, told TPM that they were aware of the change and had concerns about it. An official statement alluded to the potential negative effects on premiums.

    "American budgets are already strained by health care costs, and this change will lead to higher premiums for consumers and make it more difficult to achieve affordability," Clare Krusing, an AHIP spokesperson, said. "Our focus should be on changes to the law that will lower costs -- like repealing the health insurance tax -- not those that drive premiums higher."

    The Senate is expected to take up the CRomnibus, which is supported by the White House and Senate Democratic leadership, on Friday or Monday. The White House didn't immediately respond to TPM's request for comment about the risk corridor provision.

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    Mitch McConnell Boehner Reid

    Now that Congress is back in Washington with a Republican majority, you can expect another symbolic Obamacare repeal vote that will be quickly quashed by the president’ veto pen. But there are a number of actual fixes to the health law and other health policies that Congress could realistically take up this year—maybe even in bipartisan fashion.

    The issues all include policy tweaks that likely require congressional action. They range in unintended consequences from the way the law was written that are disproportionately affecting poor people, to an expiring insurance program for low-income children (the Children’s Health Insurance Program or CHIP) that needs to be reauthorized by the end of the year. 

    There are other pieces of Obamacare that lawmakers will likely also take up—including potentially repealing the law’s medical device tax, as well as the employer mandate—though that one is less likely. 

    Both of those issues also have bipartisan support in Congress; however, it’s more plausible that lawmakers tweak the law’s language than make actual policy changes. 

    For example, a flaw in the way the Internal Revenue Service wrote regulatory rules under the law created something called the “family glitch” that made health insurance unaffordable for millions of people—many in the low-income bracket. 

    Lawmakers on both sides of the aisle have introduced measures to fix the glitch, but with the combination of usual gridlock and the midterm elections, they’ve been hesitant to make any real attempts to get rid of it. 

    These issues have support from both sides of the aisle, however, it is unclear how productive the 114ths Congress will be. 

    Here are the three health policy fixes lawmakers could reasonably make this year: 

    The Family Glitch  
    The “family glitch” is an unintended consequence of the law’s language. When the Internal Revenue Service wrote the regulatory rules defining who’s eligible to receive federal subsidies, it said people who have access to employer health care can’t qualify for subsidies, nor can their families. Under the law’s employer mandate, midsized to large employers are required to cover individuals and offer affordable coverage—(about 9.5 percent of household income.)

    So, when a person has access to health care through their employer, but the rest of their family isn’t covered—their family members still are deemed ineligible to receive financial help through the exchanges because of the way the law was written. Most policy experts and lawmakers agree that this was not what the law intended, which is why there are a number of proposals to try and remedy it.

    For example, Sen. Al Franken (D-MN) introduced a bill that would amend the law to determine affordability based on the cost of family-based coverage---not just an individual’s. The bill also says the administration has authority to adjust the language so families can receive the subsidies. According to the American Action Forum, if lawmakers do nothing to address the glitch more than 1.93 million Americans will be affected.

    Reauthorizing CHIP 
    The Children’s Health Insurance Program, a federal-state partnership insurance program for poor children, is set to run out of funding in September. Congress has until then to reauthorize funding for the program or millions of kids will lose their health coverage. Right now, about 6 million children receive health care through CHIP.

    In June, the Medicaid and CHIP Payment Access Commission (MACPAC) called on Congress to extend CHIP for two years to allow time to make policy changes that would make the Affordable Care Act better serve children. So far, there are two pieces of legislation, one in the House and one in the Senate, that propose new funding for CHIP. Just last month, a bipartisan group of 39 governors signed a letter of support for a four-year funding extension for CHIP. Still, it’s unclear if we’ll see similar bipartisanship in Washington before September.

    Fixing Pay-for-Performance
    The Affordable Care Act’s pay-for-performance provision was supposed to improve the quality of care and get the U.S. health care system away form the traditional fee-for-service model. But because the program evaluates performance by a hospital’s readmission rates, it’s unfairly penalizing hospitals that serve primarily poor populations

    Here’s how it works: Medicare and private insurance companies pay providers based on their performance and patient outcomes. If a hospital has high readmission rates, it gets penalized. If readmission rates are low, the hospital gets more funding. Though the intention is good—reward good hospitals and doctors, punish the bad ones. 

    But it’s not that simple. Since, low-income patients are less likely to have successful outcomes (they may not be able to afford medication or transportation to get to their treatments) the hospitals primarily serving them may be unfairly labeled as “poor performers” and get hit with penalties. A panel of 26 experts commissioned by the Obama administration earlier this year recommended that the program should take the socioeconomic status of patients into account when evaluating hospitals. And lawmakers have listened. 

    In June, Sens. Joe Manchin (D-WV), Roger Wicker (R-MS), Mark Kirk (R-IL) and Bill Nelson (D-FL), proposed a bipartisan bill that would require Medicare to account for the socioeconomic status of each patient when calculating penalties. The measure received support from lawmakers on both sides of the aisle as well as a handful of health policy experts. 

    Still, like the other fixes, it’s unclear if a new divided government will actually make real progress this year. 

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    A man arrives at an H&R Block tax center in New York April 15, 2014. April 15 is the deadline for Americans to file their taxes with the IRS. REUTERS/Brendan McDermid

    (Reuters) - H&R Block Inc expects a boost from new U.S. tax forms required under President Barack Obama's healthcare law and from new clients seeking the company's help, Chief Executive Officer Bill Cobb told Reuters on Wednesday.

    Cobb said the Kansas City, Missouri, company expected about 25 percent of its clients to file one of two forms newly required on 2014 returns by the 2010 Affordable Care Act.

    While Cobb would not disclose specific pricing figures, he said Wedbush Securities analyst Gil Luria had offered estimates in the right ranges. Luria has suggested H&R Block could charge anywhere from $5 to $30 to fill out each of the new forms.

    Luria estimates about 13.9 million clients will visit H&R Block's retail locations. If 25 percent of them pay $30 to file one of the new forms, that would yield as much as $104.25 million in additional revenue for the company this year.

    Cobb said he expected the new healthcare requirements to attract more new clients as well.

    "Generally tax complexity is a good thing for H&R Block," Cobb said.

    For the year ended April 30, H&R Block said its revenue rose 4 percent to $3.02 billion, including $2.56 billion in the all-important February-April quarter.

    Cobb would not say how much the company will charge per form. He said H&R Block also faced higher costs such as for training its employees to handle the new paperwork.

    H&R Block has charged Massachusetts residents $5 to process the state healthcare form required by a law passed under then-Governor Mitt Romney, but at least one of the so-called Obamacare forms is far more complex.

    As the largest tax preparation service, H&R Block handles about 21 million U.S. returns a year, including roughly 7 million that taxpayers complete with the company's software.

    Under Obamacare, the current tax season will mark the first time people will have to reconcile their actual 2014 income with what they estimated when they signed up for health insurance exchanges.

    Taxpayers who earned more than they estimated will have to repay subsidies they received when they purchased their 2014 insurance. Cobb said 50 percent or more of those who received subsidies may fall into this category.

    People who did not have health insurance during 2014 will have to file a separate form to calculate their penalties.


    (Reporting by Ross Kerber; Editing by Linda Stern and Lisa Von Ahn)

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