Cutting through the fog of Obamacare signups.

President Obama is declaring Obamacare a success.  As Michael Tanner notes, the President did not take questions. 

But while the president basked in his success and predictably castigated his critics, he took no questions. Perhaps that’s because some of them would have been hard to answer. For instance:

How many new enrollees have paid their premiums? The numbers above include everyone who has “picked” a health plan, even if they haven’t yet paid for it, sort of like Amazon counting every item a shopper puts in their “cart” as a sale. Even Health Secretary Kathleen Sibelius concedes that only 80 percent of those who’ve picked a plan have actually paid the first month’s premium. Insurance executives also report that another 3 percent to 5 percent paid once, but then stopped.

If these numbers hold, it would mean that just 5.6 million Americans (and 312,000 New Yorkers) really bought insurance through the exchanges.

How many were previously uninsured? Seven million insurance sign-ups doesn’t mean 7 million more Americans with insurance. For starters, as many as 6 million Americans had to change their health plans because ObamaCare banned the policy they’d had before. Many of those whose plans got canceled bought new insurance through the exchanges, and are among the 7 million.

How many? Estimates vary, but Rand Corp. data suggest that barely a third of enrollees were previously uninsured. If so, that means fewer than 2 million Americans have actually gained insurance nationwide because of ObamaCare.

While data from New York’s Department of Insurance suggest that the state has done a better job of enrolling the actually uninsured, still, 41 percent of those signing up on the state’s exchange already had insurance. That means just 230,000 newly insured New Yorkers.

How many Americans lost their insurance? In addition to the newly insured, we also need to look at the newly uninsured. That includes some of the millions whose policies got canceled because they didn’t comply with ObamaCare. Most found new plans, though maybe more expensive or that no longer included their current doctor, but the Rand Corp. estimates that slightly less than 1 million Americans couldn’t find an affordable replacement plan, so are now uninsured. Somehow those Americans didn’t make it into the president’s remarks yesterday.

Who signed up? Far more important than the raw number of enrollees is the mix of people signing up. ObamaCare depends on young and healthy people overpaying for insurance in order to subsidize coverage for older and sicker individuals. In order to make that work, 38 percent to 40 percent of those enrolling need to be young and healthy.

In fact, estimates suggest that less than 30 percent of enrollees are under the age of 35. This will mean hefty premium hikes next year, and could eventually lead to a meltdown of the entire insurance market.

And we get all of this for the low, low price of just $2 trillion in taxpayer spending over the next 10 years.

More evidence that Obamacare isn't working.

Here's more evidence that Obamacare isn't working out as planned, e.g. attracting uninsured to the health care exchanges.

The new health insurance marketplaces appear to be making little headway so far in signing up Americans who lack health insurance, the Affordable Care Act’s central goal.

A pair of surveys released on Thursday suggest that just one in 10 uninsured people who qualify for private health plans through the new marketplace have signed up for one — and that about half of uninsured adults has looked for information on the online exchanges or plans to look.

Taken together, the snapshots shown by the surveys provide preliminary answers to what has been one of the biggest mysteries since HealthCare.gov and separate state marketplaces opened last fall: Are they attracting their prime audience?

One of the surveys, by the consulting firm McKinsey & Co., shows that, of people who had signed up for coverage through the marketplaces by last month, just one-fourth described themselves as having been without insurance for most of the past year.

A critique of Obamacare and Obama by a liberal columnist. Not very favorable.

Here's a devastating, even sarcastic critique of Obamacare and President Obama by Margaret Carlson with Bloomberg and formerly Time magazine.

Two statements explain the huge failure of Obamacare. One is by President Barack Obama, the other is about him. 

The first was made in St. Paul, Minnesota, at the end of the 2008 primary campaign, when candidate Obama predicted that generations would look back and see his nomination as “the moment when the rise of the oceans began to slow and our planet began to heal.”

Couple this with the assessment of his closest aide, Valerie Jarrett, about his exceptionalism. “He knows exactly how smart he is,” she told Obama biographer David Remnick. “And he knows that he has the ability -- the extraordinary, uncanny ability -- to take a thousand different perspectives, digest them and make sense out of them.”

Obama “has never really been challenged intellectually,” she went on. “He’s been bored to death his whole life. He’s just too talented to do what ordinary people do.”  

Or what an ordinary president does, for that matter. A chief executive less bored than Obama would have stayed on top of his signature legislation. Those upset that he didn’t are bedwetters, the White House says, nervous Nellies who can’t comprehend the larger picture of health-care reform that will, in due time, emerge. White House spokesman Jay Carney intones the mantra that the president “is focused on delivering the access to quality and affordable health insurance” and isn’t concerned “about the politics of that.”

What's interesting is Carlson is not a conservative.  I think she sees that arrogance may destroy a singular goal of the liberal establishment: government run, single payer health care system.  For that she's not happy.

Whether to with ObamaCare. A "death spiral"?

There's already talk about whether ObamaCare can be saved. Delaying it a year? Dropping penalty? Will those actions save it or end it? 

Here are some comments by Harvard Professor David Cutler who's viewed as one of the architect's of ObamaCare. He was interviewed on Fox. 

"So when you were on last week I asked you, if they don't get enough people in the exchanges, then what happens?" said host Megyn Kelly. "And you said then the premiums go up very, very high. Now, was that ball put in motion today?"

"We don't know yet," said Cutler. "So what the president is trying to do is to say the website is not working, the exchanges are not working. Let's try and slow the process down and delay it by a year. And if it turns out to be a delay of a year, then we can work through that. It would be uncomfortable as it has been for the past month, but it will turn out okay. If it becomes a permanent situation that people who are healthier stay away and people who are sicker go into the exchanges, that becomes a very big problem."

"Is that the beginning of the so-called death spiral?"

"That could be the beginning of a death spiral," said Cutler. "That is, you could have a situation where the only people in the exchanges are very unhealthy people with very high premiums."

ObamaCare is another example of how the world does not work.  Government wasn't designed to make people's health care decisions.  Any more it can run an economy or the food industry.  It's an example of ideology run amok.

Kudlow hits the name on the head about Obamacare - costs, consequences, and untruths.

The costs, consequences, and untruths (Being told one could keep their health insurance when it was known that wasn't the case.) of Obamacare are being exposed daily.  It's not a pretty picture. Larry Kudlow hits the nail on the head in this column.  It comes down to one of freedom and the ability of people to flourish and care for themselves and their families.

May I ask this question? Why is it that Americans don't have the freedom to choose their own health insurance? I just don't get it. Why must the liberal nanny state make decisions for us? We can make them ourselves, thank you very much. It's like choosing a car, buying a home or investing in a stock. We can handle it.
So why must the government tell me and everyone else what we can and cannot buy?

...Here's what else I don't want: As a 60-something, relatively healthy person, I don't want lactation and maternity services, abortion services, speech therapy, mammograms, fertility treatments or Viagra. I don't want it. So why should I have to tear up my existing health-care plan, and then buy a plan with far more expensive premiums and deductibles, and with services I don't need or want?

On top of all of the above, Obamacare attempts to defy reality.  It's unsustainable.

Of course, there are other structural problems to Obamacare that are both unfair and unaffordable. Mainly, younger healthy people are not going to subsidize older sicker folks. We should take care of the latter with transparent government subsidies, and not by trying to redistribute resources (again) from the young to the old.

Or then there's the Medicaid entitlement. It's already out of control and close to bankruptcy. But in the early days of Obamacare, Medicaid sign-ups are exploding, all while sign-ups for private plans on the new exchanges are minuscule.

Between the president's broken promises, the millions of policy cancellations, the continued website breakdowns and the unaffordable, unfair con game between the healthy young and the sicker old, this Obamacare monster is well on its way to collapsing of its own weight.

"Outrage [over Obamacare] Arrives"

The American people are running into the reality of Obamacare.  Despite statements by President Obama that people could keep their current health care insurance, that's not true.

The White House has issued a clarification. When the president said if you like your insurance plan you can keep it, what he meant was you can keep it if he likes it.

Hundreds of thousands of Americans who are getting policy cancellation notices this month can't be as surprised as they pretend to be. President Obama made it clear at his 2010 health care summit what he thought of their taste in insurance. 

 And,

Not only was it deliberate ObamaCare policy to make sure plans millions of Americans like would no longer be available, forcing them to buy more coverage than they want or need. NBC reports that the White House—as Mr. Obama was promising Americans they could keep their current plans—was estimating at least seven million people would not be allowed to keep their current plans.

In drafting rules to put ObamaCare into effect, the Health and Human Services department under Kathleen Sebelius tightened the grandfathering eligibility to make sure even more people would be forced to switch to the excessively costly policies that Mr. Obama wants them to buy. Mr. Obama says he cares about your incentive to get preventive care or tests that you may not get if they don't appear to involve a free lunch.

But the truth is, he wants you to pay for coverage you'll never use (mental-health services, cancer wigs, fertility treatments, Viagra) so the money can be spent on somebody else.

Socialism doesn't work.  Eventually the truth comes out.  Of course they will press on and seek to make it work.

Obamacare not doing too well in North Dakota and the Obama Administration doesn't want people to know it.

The Obamacare health care exchange is having a tough go of it in North Dakota.  Blue Cross the largest health care provider in the state has a grand total of 14 people signed up.  In this article it's noted hat the Obama Administration told Blue Cross not to publicize this fact.

The Obama administration asked North Dakota’s largest health insurer not to publicize how many people have signed up for health insurance through a new online exchange, a company official says.

During a Monday forum in Fargo for people interested in signing up for coverage via the exchange, James Nichol of Blue Cross Blue Shield of North Dakota told the crowd his company received the request from the federal government earlier Monday. Nichol is a consumer sales manager for the company.

Still, a spokeswoman from Blue Cross Blue Shield says about 14 North Dakotans have signed up for coverage since the federal exchange went live Oct. 1. That brings total statewide enrollment to 20 – less than one a day.

Spokeswoman Andrea Dinneen said Tuesday that while Blue Cross generally does not release its internal sales numbers, it has in this case because the problematic rollout of the federal health care exchange is a “unique situation.”

An official from the Centers for Medicare and Medicaid Services, one of the main the federal agencies handling the federal marketplace, would not directly address questions about the request made of Blue Cross Blue Shield, including whether other insurers were also asked to keep quiet about enrollment.

Representatives from the two other North Dakota companies offering coverage on the federal exchange – Medica and Sanford Health – said they had not received similar directions.

Obamacare will lead to more taxpayer funded abortions according to report.

It looks like Obamacare, among it's many problems and bad policy side effects, will result in taxpayers subsidizing between 71,000 to 111,500 abortions each year.  Another example of the fox guarding the chicken coop.

An analysis by the Charlotte Lozier Institute published this week suggests that the number of abortions that will be heavily subsidized via federal premium tax credits and Medicaid expansion is likely to be between 71,000 and 111,500 per year. This approaches one in ten abortions performed in the United States. The number is split roughly 50-50 between abortions subsidized by the ASPs in states that have not barred them from their exchanges and abortions newly reimbursable under Medicaid expansion in states that use their own taxpayer funds to underwrite them.

Obamacare fiasco continues. Delaying employer mandate will now cost government $10 billion.

The decision of the Obama Administration to delay implementation of the employer mandate will cost the government $10 billion in lost penalties.  Certainly this is good for businesses but it shows the costs and perverse incentives Obamacare brings to our health care system.

The government was counting on businesses to shirk the Affordable Care Act (ACA) to help decrease the deficit. But President Barack Obama decided not to enforce the employer insurance mandate until 2015. Now the government is out $10 billion.

The Congressional Budget Office (CBO) released the estimate July 30 in response to the Obama administration’s recent rule changes for the employer mandate and applicant verification bottlenecks. Revising its May report, the new document says Obamacare will generate $12 billion in new costs. Most of the cost—$10 billion—comes because the IRS can’t collect penalties from businesses that don’t provide “affordable” insurance until 2015. CBO Director Douglas Elmendorf, a 2009 appointee of then-House Speaker and Obamacare champion Nancy Pelosi, signed the report.

The $10 billion in lost penalties comes as White House pundits claim the employer mandate only affects 0.2 percent of American businesses. Those are the 10,000 business with more than 50 employees that don’t currently provide health insurance to full-time employees, they say.

In reality, every business that provides insurance faces penalties, even if they offer insurance. 

Businesses must subsidize employees’ insurance so it costs no more than 9.5 percent of their salaries. If not, that business pays a $3,000 penalty for each employee who buys insurance from a federal- or state-run exchange. But employees may choose to move to an exchange because it’s cheaper. When a family of four making $88,200 could get Medicaid to subsidize 70 percent of its costs, an exchange plan is a financial no-brainer that leaves employers holding the bag on penalties.

And the exchanges are where the rest of the $12 billion comes in. As part of massive verification bottlenecks, state exchanges will have the option not to verify a person’s self-reported income and “accept the attestation as final.” Essentially, the CBO expects fraud, saying the “verification process will have significant effects on people’s behavior.” Enough failsafes exist, they say, that the impact will only be about $3 billion over 10 years. After subtracting an additional $1 billion for  an increase in taxable income, the CBO arrived at the $12 billion in new costs costs.

Looming mandates continue to create headaches for businesses and already low-income employees. Many businesses, especially restaurants, have reported plans to cut employee hours below the 30-hour threshold. There’s also the contraceptive mandate: Not providing abortion-inducing contraceptives carries a much higher fine than not providing insurance at all.

The CBO now says 1 million people will lose their employee-provided insurance next year, thanks to Obamacare requirements. That decreases the number of the newly insured under the Affordable Care Act to 13 million.

 Obamacare will deepen our health care system crisis.  I wonder if that's not the goal of some of its proponents.  Create enough chaos, people will clamor for a single payer system.  On the other hand, the crisis could open the door to true reform involving a market based system.  We shall see.

People don't want health insurance?

Here's an interesting article on what's happening regarding Obamacare and Medicaid.  It turns out millions of people who could get health either free or inexpensively aren't doing it.  Of course this has significant implications for Obamacare where they need people to enroll in the exchanges to make it work.

Actors. Actresses. NFL football players. Baseball players. Librarians. Mayors. City councilmen. Members of AARP.

The Obama administration is looking far and wide, leaving no stone unturned in a relentless search for…well…for help.

Help with what? Help with getting people to enroll in health insurance plans this fall.

And why is that? Because the administration is facing the very real possibility that its signature piece of legislation may fall flat on its face.

Last week’s announcement that the employer mandate will be delayed for a year and that income verification for people getting subsidies will also be delayed are the latest signs of trouble. The next shoe to drop may be the failure for people to obtain (ObamaCare) insurance — even if it’s free or highly subsidized.

Consider this:

· About one in every four individuals who are eligible for Medicaid in this country has not bothered to enroll.

· About one in five employees who are offered employer-provided health insurance turns it down; among workers under 30 years of age, the refusal rate is almost one in three.

Think about that for a moment. Millions of people are turning down (Medicaid) health insurance, even though it’s free! Millions of others are turning down their employers’ offers. Since employees pay about 27% of the cost of their health insurance, on the average, millions of workers are passing up the opportunity to buy health insurance for 27 cents on the dollar.

You almost never read statistics like these in the mainstream media. Why? Because they completely undermine health policy orthodoxy: the belief that health insurance (even Medicaid) is economically very valuable, that it improves health and saves lives, and that the main reason why people don’t have it is that they can’t afford it.

Welcome to the huge disconnect in health reform. On the one hand there are the people who are supposed to benefit from health reform. On the other hand there are the people who talk about it and write about it. I think it’s fair to say these two groups almost never meet.

Study after study has purported to have found that health insurance improves health, saves lives, makes people happier, etc., etc. But these studies almost always ignore two cardinal facts:

· We have made it increasingly easy in this country for the uninsured to obtain health care after they get sick.

· We have also made it increasingly easy for people to get health insurance after they get sick.

Both developments reduce the incentive to spend time and money enrolling in a health plan.

I have described before the experience of emergency room care in Dallas:

“At Parkland Memorial Hospital both uninsured and Medicaid patients enter the same emergency room door and see the same doctors. The hospital rooms are the same, the beds are the same and the care is the same. As a result, patients have no reason to fill out the lengthy forms and answer the intrusive questions that Medicaid enrollment so often requires. At Children’s Medical Center, next door to Parkland, a similar exercise takes place. Medicaid, CHIP and uninsured children all enter the same emergency room door; they all see the same doctors and receive the same care.

Interestingly, at both institutions, paid staffers make a heroic effort to enroll people in public programs ― working patient by patient, family by family right there in the emergency room. Yet they apparently fail more than half the time! After patients are admitted, staffers go from room to room, continuing with this bureaucratic exercise. But even among those in hospital beds, the failure-to-enroll rate is significant.

Health Insurance prices set to shoot up under Obamacare.

The reality of Obama's vision for life with big government will be evident when Obamacare starts to kick in.  According to this Wall Street Journal article, insurance rates could double and triple in cost.

Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year, while the premiums paid by sicker people are set to become more affordable, according to a Wall Street Journal analysis of coverage to be sold on the law's new exchanges.

 

Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year, while the premiums paid by sicker people are set to become more affordable. Louise Radnofsky reports.

The exchanges, the centerpiece of President Barack Obama's health-care law, look likely to offer few if any of the cut-rate policies that healthy people can now buy, according to the Journal's analysis. At the same time, the top prices look to be within reach for many people who previously faced sky-high premiums because of chronic illnesses or who couldn't buy insurance at all.

Several big provisions in the law taking effect in six months affect rates for the estimated 20% of Americans who don't have coverage through an employer, Medicare or Medicaid. Plans must be available to consumers regardless of their health and must cover certain items such as hospitalization, maternity care and prescription drugs. The exchanges are set to open Oct. 1 selling plans effective Jan. 1.

A review of rates proposed by carriers in eight states shows the likely boundaries for the least-expensive and most costly plans on the exchanges. The lower boundary is particularly important because the government wants to attract healthy people to the exchanges, and they may choose to pay a penalty and take the risk of going without coverage if they believe they can't get an acceptable deal.

For a 40-year-old single nonsmoker—in the middle of the age range eligible for exchanges—a "bronze" plan covering about 60% of medical costs will be available for about $200 a month in most places, the proposals show.

Though less generous than "silver" and "gold" plans on the exchanges, a bronze plan would still include fuller benefits than many policies available on the individual market today.

The challenge for the law is that healthy 40-year-olds can typically get coverage for less today, especially if they are willing to accept fewer benefits or take on more costs themselves. Supporters of the law say tighter regulation on insurance practices gives consumers more protection and is worth the extra cost, but they have to persuade people who don't have an immediate need for health care of that. If only sick people buy into the new insurance pools, prices could shoot up.

Bob Laszewski, a Virginia health-care consultant and former insurance executive, said the new offerings were likely to anger people who had preferred lower-cost products that were no longer available.

"If a person in 2013 has a choice of buying a Chevrolet or a Cadillac health plan, and in 2014, they can only buy a Cadillac…are they going to be upset? I think the answer is, yes," he said.

Should we be surprised?  Not at all.  When government starts making decisions instead of the millions of individuals operating in a market system this is what we can expect.  Socialism results in equality, e.g. everybody is poorer, worse off together.  Now Obamacare isn't full blown government run health care but it's a huge step in that direction so the results will be similar.

Obamacare in California: Make people feel like their getting more when in fact they're paying more for less.

Here is a good analysis of the games being played with Obamacare in California.  Proponents argue it's going to cost people buying health care less.  In reality it will cost society more but on the micro level pick winners and losers.

One of the most serious flaws with Obamacare is that its blizzard of regulations and mandates drives up the cost of insurance for people who buy it on their own. This problem will be especially acute when the law’s main provisions kick in on January 1, 2014, leading many to worry about health insurance “rate shock.”

Last week, the state of California claimed that its version of Obamacare’s health insurance exchange would actually reduce premiums. “These rates are way below the worst-case gloom-and-doom scenarios we have heard,” boasted Peter Lee, executive director of the California exchange.

But the data that Lee released tells a different story: Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.

Lee’s claims that there won’t be rate shock in California were repeated uncritically in some quarters. “Despite the political naysayers,” writes my Forbes colleague Rick Ungar, “the healthcare exchange concept appears to be working very well indeed in states like California.” A bit more analysis would have prevented Rick from falling for California’s sleight-of-hand.

Here’s what happened. Last week, Covered California—the name for the state’s Obamacare-compatible insurance exchange—released the rates that Californians will have to pay to enroll in the exchange.

“The rates submitted to Covered California for the 2014 individual market,” the state said in a press release, “ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions.”

That’s the sentence that led to all of the triumphant commentary from the left. “This is a home run for consumers in every region of California,” exulted Peter Lee.

Except that Lee was making a misleading comparison. He was comparing apples—the plans that Californians buy today for themselves in a robust individual market—and oranges—the highly regulated plans that small employers purchase for their workers as a group. The difference is critical.

Obamacare to double individual-market premiums

If you’re a 25 year old male non-smoker, buying insurance for yourself, the cheapest plan on Obamacare’s exchanges is the catastrophic plan, which costs an average of $184 a month. (That’s the median monthly premium across California’s 19 insurance rating regions.)

The next cheapest plan, the “bronze” comprehensive plan, costs $205 a month. But in 2013, on eHealthInsurance.com (NASDAQ:EHTH), the average cost of the five cheapest plans was only $92. In other words, for the average 25-year-old male non-smoking Californian, Obamacare will drive premiums up by between 100 and 123 percent.

Under Obamacare, only people under the age of 30 can participate in the slightly cheaper catastrophic plan. So if you’re 40, your cheapest option is the bronze plan. In California, the median price of a bronze plan for a 40-year-old male non-smoker will be $261. But on eHealthInsurance, the average cost of the five cheapest plans was $121. That is, Obamacare will increase individual-market premiums by an average of 116 percent.

 Then there's an interesting exchange between the author and critics of his analysis.

UPDATE 1: On Twitter, Jonathan Cohn of The New Republic argues that I’m being unkind to California (1) by not describing the mandates that Obamacare imposes on insurers in the individual market, and (2) not explaining that low-income people will be eligible for subsidies that protect them from much of the rate shock.

For an extensive discussion of Obamacare’s costly insurance mandates, such as its requirement that plans cover you whether you’re healthy or sick, read this post. For a discussion of how Obamacare’s insurance mandates dramatically increase the cost of insurance for younger workers, go here.

Jon is right that low-income individuals will be protected from these rate increases because of Obamacare’s subsidies, but if you’re not low-income, you face a double-whammy: higher taxes to pay for those subsidies, and higher indvidual-market insurance costs for yourself. A better approach would be to offer everyone access to low-cost consumer-driven health coverage.

UPDATE 2: A number of writers did call out California for the apples-to-oranges comparison last week, including David Freddoso, Philip Klein, and Lanhee Chen.

Lanhee, writing in Bloomberg View, does the useful exercise of showing that even for plans with the same generous benefit package that Obamacare requires, eHealthInsurance is significantly cheaper:

To put it simply: Covered California is trying to make consumers think they’re getting more for less when, in fact, they’re just getting the same while paying more.

Yet there are many plans on the individual market in California today that offer a structure and benefits that are almost identical to those that will be available on the state’s health insurance exchange next year. So, let’s make an actual apples-to-apples comparison for the hypothetical 25-year-old male living in San Francisco and making more than $46,000 a year. Today, he can buy a PPO plan from a major insurer with a $5,000 deductible, 30 percent coinsurance, a $10 co-pay for generic prescription drugs, and a $7,000 out-of-pocket maximum for $177 a month.

According to Covered California, a “Bronze” plan from the exchange with nearly the same benefits, including a slightly lower out-of-pocket maximum of $6,350, will cost him between $245 and $270 a month. That’s anywhere from 38 percent to 53 percent more than he’ll have to pay this year for comparable coverage! Sounds a lot different than the possible 29 percent “decrease” touted by Covered California in their faulty comparison.

While Covered California acknowledges that it’s tough to compare premiums pre- and post-Obamacare, at the very least, it could have made a legitimate comparison so consumers could fairly evaluate the impacts of Obamacare.

 I think the last comment summaries it best.  

"To put it simply: Covered California is trying to make consumers think they’re getting more for less when, in fact, they’re just getting the same while paying more."

Obamacare advocates are fine with driving up the cost of individual premium policies because it will force people into the one size fits all approach.

What his analysis leaves out is those who believe the state can best allocate health care resources have the emotional satisfaction of imposing their ideological worldview on the rest of society.

Fox in charge of chicken coop? IRS agent in charge of tax exempt audits now in charge of Obamacare enforcement in IRS.

Sarah Hall Ingram, the person responsible for over seeing tax exempt organizations during 2009 to 20012 the time when Tea Party, evangelical and Jewish groups were being targeted for audits, is currently in charge of enforcement of Obamacare in the IRS.  She also received significant work bonuses during this time.

Sarah Hall Ingram, the IRS executive in charge of the tax exempt division in 2010 when it began targeting conservative Tea Party, evangelical and pro-Israel groups for harrassment, got more than $100,000 in bonuses between 2009 and 2012.

More recently, Ingram was promoted to serve as director of the tax agency's Obamacare program office, a position that put her in charge of the vast expansion of the IRS' regulatory power and staffing in connection with federal health care, ABC reported earlier today.

Ingram received a $7,000 bonus in 2009, according to data obtained by The Washington Examiner from the IRS, then a $34,440 bonus in 2010, $35,400 in 2011 and $26,550 last year, for a total of $103,390. Her annual salary went from $172,500 to $177,000 during the same period.

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The 2010, 2011 and 2012 bonuses were awarded during the period when IRS harrassment of the conservative groups was most intense. The newspaper obtained the data via a Freedom of Information Act request.

Senate Minority Leader Mitch McConnell, R-Ky., described the Ingram awards as "stunning, just stunning."

Ingram has some history as a government lawyer receiving controversial bonuses. According to The Washington Post, she received a $47,900 bonus for distinguished service in 2004 from President George W. Bush.

Earlier Thursday, The Washington Examiner reported that the IRS paid out more than $92 million in bonuses during the four-year period of Ingram's awards to her and nearly 17,000 other agency employees. Those bonuses averaged more than $5,500 per employee.

Go here for a spreadsheet of the salary and bonus data for IRS employees getting bonuses between 2009 and 2012.

Talk about putting the fox in charge of the chicken coop.

Is Obamacare a waste of money? Will more health insurance significantly improve people's health? Study suggests not.

The assumption behind the push for Obamacare and making sure millions of Americans had health insurance was the assumption it would improve health care and the ultimately the health of the uninsured.  A study out of Oregon suggests that's not the case.

Robert Samuelson reports on study of Medicaid patients who started getting health insurance versus those who didn't.  While they got more health care, though not dramatically (Uninsured people already receive health care.), they health didn't necessarily improve.

He writes:

Oregon's expansion of Medicaid -- the federal-state insurance for the poor -- unwittingly solved this problem. In 2008, the state decided to increase enrollment by 10,000. But there were 90,000 people on the waiting list, so the state adopted a lottery to decide who would receive coverage. The result was two similar groups of poor, one with insurance (Medicaid) and one without, that could be compared. The New England Journal of Medicine recently published the study.

The most overlooked finding is that the uninsured already receive considerable health care. On average, the uninsured had 5.5 office visits annually, used 1.8 prescription drugs and visited the emergency room once. Almost half (46 percent) said they "had a usual place of care" and 61 percent said they "received all needed care" in the past year. About three-quarters (78 percent) who received care judged it "of high quality." Health spending for them averaged $3,257.

True, when people were covered by Medicaid, many of these figures rose. The number of office visits went to 8.2; the number of drugs, 2.5; the share of patients with a usual place of care, 70 percent; the proportion receiving all needed care, 72 percent. Preventive care also increased. The share of patients receiving screening for cholesterol moved from 27 percent for the uninsured to 42 percent; the share of women over 50 having mammograms jumped from 29 percent to 59 percent; the share of men over 50 getting PSA tests for prostate cancer doubled from 21 percent to 41 percent. Spending rose to $4,429.

Unfortunately, the added care and cost didn't much improve people's physical health. The study screened for high blood pressure, high cholesterol, diabetes and the risk of a future heart attack or stroke. There were no major detected differences between the uninsured and Medicaid recipients. There was more treatment for diabetes, though no difference between the two groups on a key indicator of the disease.

 This is supported by a previous 2007 study of Medicare.

The Congressional Budget Office reported that the uninsured typically received 50 percent to 70 percent of the care of the insured. A study in 2007 of the 1965 creation of Medicare -- insurance for the elderly -- concluded that it had "no discernible impact on elderly mortality" in the first 10 years but improved recipients' financial security by limiting out-of-pocket expenses.

Samuelson takes Obamacare advocates to task:  "They were too busy flaunting their own moral superiority. Universal health insurance is a legitimate goal, but 2009 -- in the midst of a major economic crisis -- was the wrong time to pursue it. Predictably, it polarized public opinion and subverted confidence for what seem, based on the available evidence, modest likely public health improvements. The crusade for universal coverage has been as much about advocates' sense of self-worth as about benefits for the uninsured."

And the end result is likely wasting billions upon billions of dollars to implement another big government boondoggle.

Sticker shock with Obamacare - rising health care costs, lost insurance coverage, and cutting workers' hours.

Daniel Kessler in the Wall Street Journal is sounding a reoccurring refrain -- Obamacare will increasingly cause untold problems with our nation's health care and financial systems.

In recent weeks, there have been increasing expressions of concern from surprising quarters about the implementation of ObamaCare. Montana Sen. Max Baucus, a Democrat, called it a "train wreck." A Democratic colleague, West Virginia's Sen. Jay Rockefeller, described the massive Affordable Care Act as "beyond comprehension." Henry Chao, the government's chief technical officer in charge of putting in place the insurance exchanges mandated by the law, was quoted in the Congressional Quarterly as saying "I'm pretty nervous . . . Let's just make sure it's not a third-world experience."
These individuals are worried for good reason. The unpopular health-care law's rollout is going to be rough. It will also administer several price (and other) shocks to tens of millions of Americans.

Start with people who have individual and small-group health insurance. These policies are most affected by ObamaCare's community-rating regulations, which require insurers to accept everyone but limit or ban them from varying premiums based on age or health. The law also mandates "essential" benefits that are far more generous than those currently offered. 

 People are going to pay more.

According to consultants from Oliver Wyman (who wrote on the issue in the January issue of Contingencies, the magazine of the American Academy of Actuaries), around six million of the 19 million people with individual health policies are going to have to pay more—and this even after accounting for the government subsidies offered under the law. For example, single adults age 21-29 earning 300% to 400% of the federal poverty level will be hit with an increase of 46% even after premium assistance from tax credits...

Higher premiums are just the beginning, because virtually all existing policies in the individual market and the vast majority in the small-group market do not cover all of the "essential" benefits mandated by the law. Policies without premium increases will have to change, probably by shifting to more restrictive networks of doctors and hospitals. Even if only one third of these policies are affected, this amounts to more than five million people. 

 More people will lose their insurance.

In addition, according to Congressional Budget Office projections in July and September 2012, three million people will lose their insurance altogether in 2014 due to the law, and six million will have to pay the individual-mandate tax penalty in 2016 because they don't want or won't be able to afford coverage, even with the subsidies.

 And people will lose their jobs and see their hours cut.

None of this counts the people whose employment opportunities will suffer because of disincentives under ObamaCare. Some, whose employers have to pay a tax penalty because their policies do not carry sufficiently generous insurance, will see their wages fall. Others will lose their jobs or see their hours reduced.

Anecdotal evidence already suggests that these disincentives will really matter in the job market, as full-time jobs are converted to part time. Why would employers do this? Because they aren't subject to a tax penalty for employees who work less than 30 hours per week.

There is some debate over how large these effects will be, and how long they will take to manifest. However, the Bureau of Labor Statistics reports on a category of workers who will almost surely be involuntarily underemployed as a result of health reform: the 10 million part-timers who now work 30-34 hours per week.

These workers are particularly vulnerable. Reducing their hours to 29 avoids the employer tax penalty, with relatively little disruption to the workplace. Fewer than one million of them, according to calculations based on the Medical Expenditure Panel Survey, get covered by ObamaCare-compliant insurance from their employer.

 Should we be surprised?  Not at all.  Government wasn't created to provide health insurance.  That's the domain of families and individuals, not government bureaucrats.

President Obama and arm twisting or lack thereof.

I thought this article in the New York Times has an interesting take on President Obama.  He's not usually willing to resort to arm twisting to achieve his political goals.  I suspect those around him are at times but it strikes me his temperament isn't there.  Reason, logic are what he gravitates towards.  The result?  A less effective presidency.  I think that will be the order of the day through the rest of his presidency unless Democrats regain control of the House.

On the other hand, he could position himself to make substantial changes if he's willing to work with Republicans to get control of our deficits, debt and entitlements.  But that would mean crossing his base and his own inclinations.  However, presidents also want a legacy and that will only be achieved by significant accomplishments.  I doubt that Obamacare will stand the test of time.  It looks to be unworkable and will have to be significantly changed or discarded.

...After more than four years in the Oval Office, the president has rarely demonstrated an appetite for ruthless politics that instills fear in lawmakers. That raises a broader question: If he cannot translate the support of 90 percent of the public for background checks into a victory on Capitol Hill, what can he expect to accomplish legislatively for his remaining three and a half years in office?

Robert Dallek, a historian and biographer of President Lyndon B. Johnson, said Mr. Obama seems “inclined to believe that sweet reason is what you need to use with people in high office.” That contrasts with Johnson’s belief that “what you need to do is to back people up against a wall,” Mr. Dallek said.

“Obama has this more reasoned temperament,” he said. “It may well be that it’s not the prescription for making gains. It raises questions about his powers of persuasion.”

Some supporters said the imperative of the moment requires more force from Mr. Obama. “He needs to turn up the heat every way he can and every chance he gets because it’s not political points or poll numbers that are at stake but lives,” said Representative Carolyn B. Maloney, a New York Democrat who has sponsored a gun control bill in the House.

The White House on Monday defended the president’s efforts on the gun legislation, saying he had made a vigorous effort to lobby wavering senators. “He made numerous phone calls and had numerous meetings,” said Jay Carney, the White House press secretary. “And his entire team here engaged in this process completely and thoroughly.”

But the president has long struggled to master his relationship with Congress. During his first two and a half years in office, he favored what aides called an inside approach, working quietly in back rooms to convince lawmakers of the logic of his positions. That worked better when Democrats controlled both the House and the Senate, and he passed legislation to expand health care, regulate Wall Street and spend hundreds of billions of dollars to stimulate the economy.

Obamacare, rising health care costs and possible political fallout in Minnesota.

I had an interesting conversation with a lobbyist at the Minnesota legislature.  He's been around a long time.  He thinks we're heading for a health care crisis with skyrocketing health care costs brought on to a significant degree by Obamacare which is now hitting the states through the mandated establishment of health care exchanges.  I then came across this news clip on the nervousness of democrats on the national level.

The lobbyist said it was a big mistake for democrats in Minnesota to drive Minnesota's health care exchange through the legislature without a single republican vote.  If health costs start going up and up and they invariably will, (What massive intervention in the economy by the government doesn't drive up costs.), then the electorate will be looking for someone to blame.  The prime target for voter frustration will be those in power and most directly responsible for major changes in our health care system.  In Minnesota that involves the health care exchanges.

Many states are refusing to bail out Obamacare by creating their own state exchanges.

Here's an article in the Wall Street Journal pointing out the refusal of 18 states to create their own health care exchanges. Thus the responsibility falls to the federal government which doesn't have the bandwidth or expertise to set up health care exchanges.

It points out part of the mess Obamacare created.

ObamaCare is due to land in a mere 10 months—about 300 days—and the Administration is not even close to ready, so naturally the political and media classes are attacking the Governors and state legislators who decline to help out. Mostly Republicans, they’re facing a torrent of abuse in Washington and pressure from health lobbies at home.

But the real story is that Democrats are reaping the GOP buy-in they earned. Liberals wanted government to re-engineer the entire health-care system and rammed the Affordable Care Act through on a party-line vote, not stopping to wonder whether it would work. Now that implementation is proving to be harder than advertised, they’re blaming the states for not making their jobs easier.

Editorial board member Joe Rago on HHS's extended deadline for states to implement health exchanges under ObamaCare and why many Republicans governors are refusing to.

The current rumpus is over ObamaCare’s “exchanges,” the bureaucracies that will regulate the design and sale of insurance and where 30 million people (and likely far more) will sign up for subsidized coverage. States were supposed to tell the Health and Human Services Department if they were going to set up and run an exchange by October, but HHS delayed the deadline to November, and then again at the 11th hour to December.

Sixteen states have already said they won’t participate. Another 11 are undecided, while only 17 have committed to doing the work on their own. Six have opted for a “hybrid” federal-state model. That means HHS will probably be responsible for fallback federal exchanges in full or in part in as many as 25 or 30 states.

The opposition isn’t so much political as practical. Or rather, the vast logistical and technical undertaking to build an exchange helps explain why so many Governors resisted ObamaCare in the first place.

States have regulated the small business and individual insurance markets for decades (some well, others less so). Now they’re supposed to toss everything out for a complex Washington rewrite, which is still being rewritten. The exchanges will also help enforce the individual mandate and premium increases. They’ll also have to spend a ton of money. Ohio estimates it will cost $63 million to set up an exchange and $43 million to run annually, based on a KPMG study.

Another consequence of government controlled health care? Doctors' shortage.

With the debate over Obamacare at least temporarily settled,  the problems with government run health care will only grow and worsen.  This story "Doc Shortage Could Crash Health Care" caught my eye as another example of a consequence - shortage of doctors.

Why would government run health care mean fewer doctors?  Simple.  Less attractive wages.

In a 2008 census by the AAMC and the American Medical Association, researchers found that the number of medical graduates choosing a career in family medicine dropped from 5,746 in 2002 to 4,210 in 2007 -- a drop of nearly 27 percent.

"It's pretty tough to convince medical students to go into primary care," said Dr. Lee Green, chair of Family Medicine at the University of Alberta, who was not involved with the study.

Green added that he believes this is because currently primary care specialties are not well paid, well treated or respected as compared to subspecialists.

"They have to think about their debt," he said. "There are also issues of how physicians are respected and how we portray primary care to medical students."

These problems loom even larger considering the aim of the Affordable Care Act to provide all Americans with health insurance -- and with it, more regular contact with a primary care doctor.

Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians.

Dr. Randy Wexler of The John Glenn Institute of Public Service and Policy said he has concerns that this trend could be reflected nationwide.

"Who is going to care for these people?" he said. "We are going to have problems just like Massachusetts. [They] are struggling with access problems; it takes one year to get into a primary care physician. Coverage does not equal access."

Some have already proposed solutions to this looming problem. One suggestion is that non-physician medical professionals, such as nurse practitioners and physician assistants, can pick up the slack. Doctors, however, said his may not be enough to fill the gap. 

What will be the response?  Higher taxes to pay these primary care doctors more?  Again wrong headed.  The answer?  Restore a basic free market system rather than command and control from the top via government regulations and mandates.  There are only two ways to control health care costs - consumers responding to market prices or rationing.  Obamacare will mean more rationing.

Obama re-election is a wake up call to Catholics but also Evangelicals.

Here's a sobering article on the impact of the Obama Administration on the Catholic Church. George Weigel, author of authoritative biography on Pope John Paul II, points out the direct attacks posed by Obamacare and gay "marriage".

The immediate threat, of course, is the HHS (Health and Human Services) mandate requiring Catholic institutions and Catholic employers to include coverage of contraceptives, sterilizations, and abortifacient drugs in the health insurance offered to their employees. The legal challenges mounted against this obvious violation of the first freedom, religious freedom, may well be vindicated. But with Obamacare now seemingly set in concrete, the Church will face a host of such implementing “mandates” and it will be imperative to contest those that are morally unacceptable, time and time again. Authentically Catholic health care in America is now in mortal danger, and it is going to take a concerted effort to save it for future generations.

A further threat comes from the gay insurgency, which will press the administration to find some way to federalize the marriage issue and to compel acceptance of the chimera of “gay marriage.” Thus it seems important to accelerate a serious debate within American Catholicism on whether the Church ought not pre-emptively withdraw from the civil marriage business, its clergy declining to act as agents of government in witnessing marriages for purposes of state law.

If the Church were to take this dramatic step now, it would be acting prophetically: it would be challenging the state (and the culture) by underscoring that what the state means by “marriage” and what Catholics mean by “marriage” are radically different, and that what the state means by “marriage” is wrong. If, however, the Church is forced to take this step after “gay marriage” is the law of the land, Catholics will be pilloried as bad losers who’ve picked up their marbles and fled the game—and any witness-value to the Church’s withdrawal from the civil marriage business will be lost. Many thoughtful young priests are discussing this dramatic option among themselves; it’s time for the rest of the Church to join the conversation.

I would add his concerns confront not just Catholics but Evangelical Protestants and Orthodox believers as well.

He does point out one of the consequences of this looming crisis. It will force people who identify with the Gospel of Christ and the Scriptures, to get serious about their faith. That's what persecution always does and I suspect why it is often allowed to come.

As for the opportunity embedded in this crisis, it is nothing less than to be the Church of the New Evangelization, full-throttle. Shallow, tribal, institutional-maintenance Catholicism is utterly incapable of meeting the challenges that will now come at the Catholic Church from the most aggressively secular administration in American history. Only a robustly, unapologetically evangelical Catholicism, winsomely proposing and nobly living the truths about the human condition the Church teaches, will see us through the next four years. Radically converted Christian disciples, not one-hour-a-week Catholics whipsawed by an ever more toxic culture, are what this hour of crisis, in both senses of the term, demands.