Quote: ” ..the Obama administration has implemented rules that even it concedes infringe on the traditional rights of religious employers.”

This article, written by James C. Capretta, details the Administrations’ way of speaking out of both sides of its mouth: “Here, it’s worth repeating some of the basic facts… on the same day that the administration announced it wanted to craft the so-called accommodation [to the mandatory contraceptives rule], it finalized the rule that had been previously issued with no change.” The rule, as I recall, was also published in the Federal Register. So much for “accommodation”.

The dominant elite media is doing it’s best to characterize this problem as no problem at all, as evidenced by this story, which inaccurately states that insurance companies, rather than employers, will be required to pay for these services (obviously, they must think that insurers are able to provide this at no cost to anyone, which boggles the mind, since nothing is ever provided “free” – it must be purchased first, and the cost is inevitably passed on to policyholders, as Mr. Capretta accurately states). In the case of the Catholic Church and its various entities, they are self-insured, for the most part, which means they pay, regardless of what President Obama wants you to think.

As I’ve noted elsewhere, the single largest problem with Obamacare (besides the deliberate destruction of private capital via the “death spiral” for health insurers casually mention by Secretary Sebelius) is the massive expansion of government health care, especially with Medicaid, via taxpayer-funded subsidies, creating a permanent “dependency class” that will accelerate wealth redistribution and move us (nudge us?) forever closer to the Democrat goal of “equality of outcome”. By creating a permanent group of citizens that are entirely dependent on government largesse, Democrats hope to ensure a fifty year lock on Washington to permanently destroy our freedoms and protections under the Constitution. I shudder to think what new entitlements masquerading as “positive rights” might flow from such a situation.

While I wouldn’t stop at 10, here is a list of “10 Terrible Provisions of Obamacare” that anyone concerned about the massive expansion of government into each of our lives should be aware of.

In spite of The White Houses’ best attempts at muddying the waters and shifting the contraceptive controversy to one of “women’s health” from “religious freedom” (and, frankly, some success with this, albeit in cahoots with their progressive brethren in the press, not to mention Democrats in Congress, who excel at press conferences masquerading as committee hearings) in order to get the public on board with his free birth control mandate, Mr. Obama is signaling that, like most anything else he decides he wants, he’ll say whatever he knows the press will echo loudly while doing exactly the opposite – namely, mollifying the religious community with worthless platitudes while giving them absolutely no real reason to think that anything has changed.

Not so fast, say Catholics.

Frankly, to this observer it almost appears as if… is it possible?.. the Prez really wants the Catholic Church and any other religious organization that provides health care of any kind, and objects to unconstitutional mandates that impact their religious freedom, to get out of the business of health care, completely and forever. And, close the door on your way out. To those who scoff at such a notion: the reason given for cutting the guts out of Tricare, the military health care system for active duty and retired military, is to move more people into the (Medicaid-style) Obamacare. So, I think it’s entirely plausible that the Prez isn’t interested in what the Catholic Church or any other religious organization that provides health care thinks: he just wants them out of the way.

As an aside, let me say to the Church: hey, I know exactly how you feel: I’m a health insurance agent.

Let’s recap: The Obama Administration announces the most restrictive definition of religious exemption possible, thereby guaranteeing him a collision course with anyone with a religious objection to mandatory contraceptive coverage. After a day or so of Catholic weeping, wailing, and gnashing of teeth, the President decides that, rather than the Church, insurance companies can pay for it. Problem solved, The One has spoken.

Problem is, Mr. Obama apparently either doesn’t know, doesn’t care, or doesn’t think the press will report on the most important fact of all: the Catholic Church is, for the most part, self-insured. There is no “insurance company” to pay for it, as they provide and pay for their own care for their employees, a fact pointed out by Cardinal Timothy Dolan, president of the U.S. Conference of Catholic Bishops, in a letter to his fellow bishops.

The rest of the letter is illuminating, most of all because the good Cardinal accurately points out that, as we have now seen demonstrated over the last week in excruciating detail, Democrats are busy painting the entire issue as one of “women’s health care” and abortion-inducing drugs rather than one of religious freedom, as evidenced by the vote on the Blunt Amendment. And obviously, there is little evidence in the “mainstream” media that the religion issue is even an issue, or even important. Why, the temerity of those Catholics, to attempt to discuss religious freedom when we all know that women need free contraception, if only to keep the nations’ birth rate down and help hold those health care expenses in check.

The fact that this Administration is doubling down on their position, by publishing the decision in the Federal Register, etc., points out that, on matters of ideology (as in, progressive action), there is no room for any accommodation that deviates from long-held and cherished policy goals of the left, no matter who they have to skewer. And Catholic Bishops, who stood by and actively supported Obamacare, have now learned that very important lesson. They have been used, and others should heed this warning. Republicans in the Senate, take note.

As if we didn’t already know this: The infamous HHS Secretary tells us what she really thinks in Congressional testimony.

Read the comments on that page, too – very interesting.

Another story on this topic references the infamous McKinsey study released last year. “At least 30 percent of employers are likely to stop offering health insurance once provisions of the U.S. health care reform law kick in in 2014, according to a study by consultant McKinsey,” Reuters reported. “McKinsey, which based its projection on a survey of more than 1,300 employers of various sizes and industries and other proprietary research, found that 30 percent of employers will ‘definitely’ or ‘probably’ stop offering coverage in the years after 2014, when new medical insurance exchanges are supposed to be up and running.”

The Obama Administration went to a full-court press in an attempt to deflect and discredit this story as being a put-up job by a) the insurance industry, b) Republican operatives, and c) all of the above, even going so far as to label it an “outlier” (whatever that means!). In fact, Democrats used these and other arguments in a kitchen sink attempt to discredit a study that was, by the way, funded entirely by McKinsey. Their efforts were less than successful, and I can assure you that the survey’s results are, anecdotally, true: I’ve been told the same thing by many clients.

Surprisingly, even Howard Dean says that the McKinsey study is one that “the Democrats don’t like but I do and I think it’s true.” Dean likes it because it will remove a burden from small businesses. Note that Dean, always a proponent of single-payor, pulls no punches as he advocates for a government system, whereas the Obama folks are trying to camouflage their real intent: destroying private insurance companies by crashing their reserves and limiting their ability to offset health care costs with appropriate premiums, which will lead to the same thing.

Quote: 

“When I say ‘If you have your plan and you like it,… or you have a doctor and you like your doctor, that you don’t have to change plans..”

“What I’m saying is the government is not going to make you change plans under health reform.”

(Editors note: unless you have an HSA!)

These are well-known comments from POTUS Obama in the time leading up to the passage of The Affordable Care Act, and afterwards as he flew around ginning up support for an incredibly bad piece of legislation. We now know that these comments aren’t accurate, or even, strictly, truthful. And they directly impact so-called Bronze plans, of which HSAs should be a component. Only, they won’t be.

It should come as no surprise that Democrats despise Health Savings Accounts (HSA for short). Their leading left-wing think tanks routinely lambast them. It’s been somewhat hard to understand why the Administration hasn’t been dissing them openly since the passage of Obamacare; now we know why. They are simply going to eliminate them without a shot being fired, due to a complex series of rules and regs that could only be interpreted as willful, and involve the actuarial percentage of benefits paid in each Gold, Silver, and Bronze plan, and the confusing effects from a price control enacted for political purposes.

The Medical Loss Ratio (MLR) Rule is the culprit. HSAs, under this regulation, cannot qualify.

The MLR Rule requires insurers to spend no more that 20% of premium on administration in the small group and individual markets and 15% in the large-employer market. This spells trouble for high-deductible health plans in exchanges, since only 5% of those with an HSA qualified health plan in a year have any claims paid by their insurance.

HSAs, in summary, are high deductible plans that allow cash to be set aside in a fully tax-deductible savings plan to be used to pay for out-of-pocket expenses before the deductible is met. HSA-qualified health insurance policies are usually lower cost than many fully-featured health plans, and are especially well suited for many small business sole proprietors, or others who believe saving money to pay for their own out-of-pocket costs is better than giving it to an insurer, who is in essence subsidizing other health insurance claims with their dollars.

Here’s part of the problem: payments made by an insurer for health care expenses count towards meeting the MLR Rule; payments by individuals out of their health savings accounts do not. Taking into account the complex rules for “credibility adjustment” and “cost-sharing adjustment” for companies that sell high-deductible plans, HSA-qualified or not, it appears that, given the lower claims-paying of HSA  or other high deductible plans, it is mathematically impossible for any plan to meet the MLR of 80%. This would mean no Bronze plans in the Exchanges, since they cannot meet the complex and required Minimum Loss Ratio Rules.

Obviously, plans with higher deductibles are being intentionally disadvantaged by this arcane formula because they cannot count claims incurred below the deductible. Since Bronze plans under the PPACA cover 60% of the benefit costs of the plan, it seems unlikely that HSA plans will be eligible under this scenario, even though the original guidance showed HSA plans as being eligible based on their deductible range (See here). Further, the carrier must still process claims below the deductible to track deductible expenses, but no cost of that processing can be applied to the MLR’s.

I draw my final conclusions from this study prepared by the HSA Coalition:

“Clearly, the MLR adjustment factors for cost-sharing and credibility help companies offering high deductible plans but only if they have low enrollment. Most [insurance] companies will likely see little benefit because the adjustments end up being minimal and ultimately disappear because of the way the MLR formula is constructed. In the short-term, this could limit future growth of HSAs in the fully-insured markets (individual, small group, large group) and put extra pressure on premium pricing to minimize potential rebates. Insurance companies (especially the current market leaders) may be encouraged to sell more expensive plan designs with more first-dollar coverage (e.g., HMOs and traditional PPOs)because it will be easier to meet the MLR requirements. The result could be a future market dominated by more expensive plans, dramatically reducing affordability of coverage and adding significantly to the costs of income-based subsidies provided under the law, since the subsidies are based on the weighted average premiums for Silver plans in the “market area.”

The end result will be that the exchanges will likely be dominated by high-cost health plans with few lower cost options available, leaving people out of the market – until they desperately require health insurance coverage. This will quickly drive up the cost of coverage, expanding the subsidies needed to pay for it.

A summary of the problem is here. And, here is a detailed article on MLR’s Potential Effect of HRAs and HSAs.

UPDATE on 2/26/12 – Quote: “The obstacles Obamacare creates for consumer-driven health plans could lead to their extinction, even though they are an affordable form of coverage that is gaining in popularity.” See this link.

A recent study shows that Canadians are facing the longest waiting times for medically necessary care in almost two decades.

With all the talk about how bad Obamacare will be, with its standardized benefit structures, centralized command and control, and over-arching subsidy program that will drive as many as 80 million Americans into Medicaid (yes, you read that right, it’s in the bill!) one should remember why so many Canadians have come south of the border to access care: they can’t get any, which is something we are going to be facing in the not-too-distant future, as anyone who’s ever studied socialized, government run or controlled, capitated health care delivery systems knows all too well. Remember: in the Orwellian future of American health care, you are no longer the customer – you are a unit.

ITEM: In a report from late last year, the Fraser Institute, Canada’s leading public policy think-tank, said this:

• “Canadians are being forced to wait almost four-and-a-half months, on average, to receive surgical care, prolonging the pain and suffering patients and their families are forced to endure.”

And this:

• “Despite significant increases in government health spending, Canadians are still waiting too long to access medically necessary treatment.”

Amazingly, Canadians put with waiting times between referral by a general practitioner or PCP and consultation with a specialist of between 7 1/2 weeks to almost 10 weeks, depending on where they live. Obviously, Canucks are way more patient than anyone in my family.

It gets worse:

-I pity the poor fool who needs orthopedic surgery: average wait is more than 39 weeks (more than 9 months).

-And, this is a stunner: if you need neurosurgery, like, on your brain (!) be prepared to pray a lot: you’ll wait 38.3 weeks.

No wonder Canada has introduced “market reforms” that finally allow some people to buy private health insurance. Too bad we’ve taken the wrong path and will have to learn the hard way what Canada and Britain have already learned.