REPEAL & REPLACE OBAMACARE vs LYING GOP SENATORS (BROKEN CAMPAIGN PROMISES)

REPEAL & REPLACE OBAMACARE vs LYING GOP SENATORS (BROKEN CAMPAIGN PROMISES):

GOP SENATORS PUSHED "REPEAL OBAMACARE" AGENDA TO WIN CONGRESS & WHITE HOUSE.

NOW THEY DON'T WANT TO KEEP THEIR VOWS.

REPLACING OBAMACARE WITH TRUE UNIVERSAL AFFORDABLE HEALTH CARE IS NOT IMPOSSIBLE.

IT JUST REQUIRES HARD WORK AND WORKING TOGETHER FOR THE AMERICAN PEOPLE WHO ELECTED THEM.


Sources: AP, Fox News, The Hill, Youtube


**** Trump plays hardball on ObamaCare repeal


President Trump on Wednesday admonished Republican senators over their stalled healthcare push and demanded they resume work on a bill to repeal and replace ObamaCare, setting up a last-ditch attempt to avoid an embarrassing defeat.

Trump invited Republican senators to the White House for lunch a day after their healthcare legislation appeared dead, telling lawmakers they should not leave Washington before reaching a solution, even if it means scrapping their already-delayed August recess.

"Frankly, I don't think we should leave town unless we have a health insurance plan," the president said at the start of the lunch in the State Dining Room. "Because we're close; we're very close."

The president's public tongue-lashing appeared to produce results. Senate Majority Leader Mitch McConnell (R-Ky.) said after the luncheon that he would forge ahead with the repeal-and-replace negotiations.

"Next week, we'll be voting on the motion to proceed, and I have every expectation that we'll be able to get on the bill," McConnell told reporters on the White House driveway.

But success is far from guaranteed. Following the meeting, it wasn't immediately clear whether McConnell would move to a straight repeal of ObamaCare - something the White House had urged earlier in the week - or the repeal-and-replace bill. As of Wednesday, both measures lacked the votes necessary to advance.

The initial collapse of the repeal-and-replace plan was a major failure for both Trump and McConnell and sparked mutual recriminations on both ends of Pennsylvania Avenue, including complaints from senators that the president did little to sell the initiative.

Trump on Wednesday appeared hell-bent on making up for lost time. As television cameras rolled, the president personally challenged GOP senators to get on board, reminding them of their campaign promises to overturn President Obama's signature healthcare law.

He seated himself next to Sen. Dean Heller (R-Nev.), a vulnerable incumbent who opposed the legislation, and ticked off what he said were the benefits of the plan, promising it would stabilize individual insurance markets and lower premiums by "60 and 70 percent."

Trump made it clear that he isn't afraid to use strong-arm tactics to persuade the holdouts.

"Look, he wants to remain a senator, doesn't he?" Trump said of Heller. "I think the people of your state, which I know very well, I think they're going to appreciate what you hopefully will do."

The president added, "Any senator who votes against starting debate is really telling America that you're fine with ObamaCare."

Heller appeared to take the ribbing in stride, tilting his head back and chuckling.

"That's just President Trump being President Trump," Heller told reporters at the Capitol following the lunch.
Trump also took a swipe at Sens. Jerry Moran (R-Kan.) and Mike Lee (R-Utah), the two conservatives who announced their opposition to the repeal-and-replace bill Monday night, stopping it dead in its tracks.

"The other night I was surprised when I heard a couple of my friends - my friends, they really were and are. They might not be very much longer, but that's OK," he said.

While the president seemed recommitted to using the bully pulpit to advance the healthcare effort, it's unclear whether it will be enough to get wavering senators behind a bill that is deeply unpopular with the public.

Only 17 percent of Americans approve of the Senate GOP legislation, while 55 percent disapprove, according to a late June NPR/PBS NewsHour/Marist poll. A new NBC News/Wall Street Journal poll showed the measure had only 12 percent support in key counties won by Trump in 2016.

Trump's own approval rating has plummeted - down to only 36 percent in the latest Washington Post/ABC News poll - raising the possibility that vulnerable senators such as Heller will feel emboldened to ignore his pleas.

The president has offered mixed messages on healthcare, and his demand on Wednesday for a repeal-and-replace bill may have added even more confusion to the process.

Just one day earlier, he said that Republicans in Congress should simply abandon their legislative effort and "let Obamacare fail."

That came after a Monday tweet in which Trump appeared to endorse the repeal-without-replace option.

"Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!" he wrote.

White House legislative director Marc Short denied that Trump's message has been inconsistent.

"I think the president has been clear that what he wants is repeal and replace," he said, adding that the president believes that if that doesn't work, "we should at least deliver on the promise to repeal."

Short said that during the lunch, "there was a general enthusiasm for recognizing that this is not something we can walk away from."

But senators acknowledged that they still face a heavy lift.

"It is ... sort of revived," Sen. John Thune (R-S.D.) said of the repeal-and-replace bill.

"I think we don't have any delusions about the fact that this is going to be very hard and we still have members who are not there yet."Three top Trump administration officials - Vice President Pence, Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma - were scheduled to meet Wednesday evening on Capitol Hill with fence-sitting GOP senators to discuss a path forward.

McConnell repeatedly refused to say if he would cancel recess to continue work on healthcare.

WELLPOINT AND CONVERGYS PANDER FOR OBAMACARE DOLLAR$ BUT TREAT INSURANCE AGENTS LIKE DIRT

I concur with the premise that every Human Being should have Health Care Insurance, but unfortunately the AFFORDABLE CARE ACT Law (OBAMACARE) places the Jobs of all Licensed Insurance Agents at risk.

WELLPOINT Insurance company and CONVERGYS Call Center CEOs pander to Politicians for OBAMACARE Funding but they treat their Licensed Insurance Agents like DIRT!

Especially in Right-to-Work states like NORTH CAROLINA where companies such as WELLPOINT and CONVERGYS force Licensed Insurance Agents to illegally Solicit & Sell Health Care Insurance in States where they are NOT Appointed!

Article Sources: Forbes, Fool.com

**ARTICLE: "Insurance Agents Lose Job Security With Obamacare Ruling"**

Much has been discussed in the media about most of the aspects of the Supreme Court ruling on the Affordable Care Act, or “Obamacare.” I have not seen much about the plight of more than 100,000 insurance agents and brokers.

The floodgates are about to open for the mass firing of Healthcare Insurance Agents.

The Patient Protection and Affordable Care Act dictates that health insurers must spend at least $0.80 of every $1.00 in premiums collected on health care in the individual and small group markets, and $0.85 in the large group market.

Insurance agents represented by National Association of Health Underwriters tried hard for the government to define their commissions as part of the medical expense and failed. The argument by insurance agents was a senseless argument.

Obviously, financial constraints are such that health insurance companies are being forced to develop new products that are suitable for the 30 million uninsured Americans who will soon be insured under the law. There will be no room for commissions in the new lower cost products.

The other big development is the advent of healthcare exchanges under the new law. These exchanges are not yet up and running but it is easy to picture them to be akin to Amazon.com (AMZN) by necessity and by law, insurance companies will have to display their products in easy to understand and easy to compare formats. There will be a huge migration of business from traditional healthcare insurance agents and brokers to the exchanges.

In some ways, the migration will be similar to the migration of retail from the likes of Best Buy (BBY), Barnes & Noble (BKS), and Borders to Amazon.com. At least in retail there are numerous good reasons for the masses to go to the brick and mortar stores. With regard to health insurance the argument for procurement through agents is very weak. Some consumers may continue to use agents simply because they are creatures of habits.

Make no mistake: the volume of business underwritten by agents will dramatically drop.

To date, large insurance companies such as WellPoint (WLP), United Health (UNH), Aetna (AET), Humana (HUM), and Cigna (CI) have been reluctant to fire agents but it is all going to change after the Supreme Court’s ruling. Before the ruling, an insurance company would have justifiably been concerned that if it fired agents or cut their commissions deeply, they would simply promote products of their competitors. If the Supreme Court were to have overturned Obamacare, the decision to terminate agents would have backfired.

Now with the clarity of the Supreme Court ruling, the floodgates for the mass firing of healthcare insurance agents are about to open.


**ARTICLE: "What Obamacare May Mean for WellPoint in 2015"**

Few health insurers cozied up more closely to Obamacare than WellPoint (NYSE: WLP ) , the nation's second-largest health insurer.

WellPoint already serves millions of people through its widely known Anthem brand, and the company participated in 14 state health insurance exchanges during the Affordable Care Act's first open enrollment period.

WellPoint's shoot-first approach to the exchanges and the company's good fortune in managing Medicaid plans in multiple states that embraced Medicaid expansion are expected boost the company's membership rolls by as many as 1.65 million people this year.

That would be well above the company's January prediction for 1 million new members.

That membership surge is resulting in better than anticipated sales and profit for the company, so let's takes a closer look.

The Affordable Care Act health insurance exchanges held their first open enrollment from Oct. 1, 2013, to March 31 of this year. Despite a disastrous launch riddled with technical glitches, few would argue that the exchanges failed in their mission to enroll the uninsured. More than 7 million people signed up (and paid) for health insurance through the exchanges during that six-month period.

But Obamacare did not rely solely on the exchanges to boost insurance membership. The ACA also included a state opt-in Medicaid expansion that resulted in membership in that healthcare program growing by more than 8 million people, too.

The combination of spiking health insurance and Medicaid enrollment is mostly offsetting widespread fear leading up to the ACA's implementation that insurers would sag under the weight of new, more costly members.

Instead, insurers such as WellPoint appear to be thriving. In the third quarter, WellPoint's sales advanced 4.3% year over year to $18.4 billion, leading to earnings per share of $2.36.

WellPoint's membership grew by 259,000 people from the second to third quarters of 2014, bringing total membership served to 37.5 million, an increase of about 2 million from the year-ago period.

The company's commercial and individual markets business, which provides insurance plans through employers and directly to individuals both on and off the exchanges, delivered sales that were essentially unchanged from last year. The flatlining top-line results for the segment are due to employers casting off part-time workers, which offset growth in exchange enrollment. Nonetheless, the ACA appears to have delivered for the segment in terms of operating gains. During the third quarter, segment profit jumped 28.7% year over year to $915.7 million thanks to margin growing from 7.2% to 9.3%.

The ACA had a reverse impact on WellPoint's government business. Sales tied to Medicare, Medicaid, and other state plans grew from $7.77 billion a year ago to $8.55 billion this past quarter, but its operating gain dipped by 3.6% to $284 million. Medicaid costs tied to expensive next-generation medicines like the hepatitis C drug Sovaldi, along with falling Medicare enrollment, were behind the unit's sluggish operating profit.

However, the two business units combined to present a broadly healthy -- and growing -- company with middle single-digit sales growth and 19% operating profit growth last quarter.

WellPoint has steadily bumped up its earnings outlook this year as it has become increasingly confident in its post-reform patient mix.

Heading into 2014, the company thought it might deliver full-year EPS of at least $8; however, the company's 2014 forecast in exiting the third quarter now stands at no less than $8.83. WellPoint has also increased its full-year revenue forecast from $73 billion exiting 2013 to between $73.25 and $73.5 billion. While worries persist that enrolling higher-cost members through the exchanges will create a significant expense headwind for WellPoint, the company's guidance for benefits expense of 83.3% this year suggests those concerns remain overblown.

As the second open enrollment period for the healthcare insurance exchanges begins on Nov. 15, and more states will expand Medicaid coverage under the ACA for 2015, WellPoint appears positioned nicely to capture additional growth next year. As many as 14 million Americans might be covered through the exchanges next year and state Medicaid officials expect enrollment growth to accelerate, rather than decelerate, through next June.

According to a Kaiser Family Foundation survey, Medicaid enrollment in fiscal 2015 ending next June will have jumped by 18% in the 28 states participating in expansion of the program; that would be up from 8.3% growth reported for fiscal 2014.

The key for insurer profitability will remain to price plans appropriately to cover medical care costs while maintaining margin. Given that WellPoint has a full year of experience under its belt, it wouldn't surprise me if plan pricing provides more margin support next year. If so, industry watchers might find that their estimate of $9.31 in EPS for WellPoint next year is too low.

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Knowing how valuable such a portfolio might be, our top analysts put together a report on a group of high-yielding stocks that should be in any income investor’s portfolio.

AFFORDABLE CARE ACT: Health Care Insurance Open Enrollment Period Begins Nov 15th

OPEN ENROLLMENT PERIOD: Nov 15, 2014 - Feb 15, 2015

It's time for Open Enrollment again.

It doesn't matter if you hate or love "OBAMACARE", everyone still needs Health Care Insurance!

OBAMACARE UPDATE: Why Are Hospitals Turning Patients Away?? Can't Confirm COVERAGE!

#OBAMACARE

OBAMACARE UPDATE: So why are Patients being turned away at Hospitals??

Hospitals are claiming they can't Confirm proof of Coverage.

BUT WHERE IS THE GOP'S ALTERNATIVE??


ARTICLE: "Obamacare Patients Socked With Huge Cash Bills Flee Hospitals"


Staffers with at least one hospital in Northern Virginia turned away several patients this week due to confusion about Obamacare:

Were the patients covered by insurance or not?

Some patients walked away when they learned that the hospital would be charging them hundreds of dollars for treatment because they couldn’t prove their enrollment in the federal health care system.

“They had no idea if my insurance was active or not,” one woman, Maria Galvez, said to The Daily Mail, outside the Inova Healthplex facility in Springfield, Va. So instead of paying the $500 or more for her needed chest x-ray, she left – untreated, the paper reported.

“The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the x-ray,” she said. “It’s not fair. You know, I signed up last week like I was supposed to.”

Ms. Galvez said she had enrolled in Carefirst Blue Cross three days before Christmas, for $450 per month.

At the same time, she said, in The Daily Mail, “no one has sent me a bill.”

Ms. Galvez’s experience was shared by others.

A woman who asked to be published only by the name Mary said she couldn’t receive emergency services at the Inova Alexandria Hospital down the road, in Alexandria, Va., for the same reason.

“I had chest pains last night,” she said to The Daily Mail, on Thursday. “They took me in the emergency room. They told me they were going to admit me, but when I told them I hadn’t heard from my insurance company since I signed up, they changed their tune.”

She said that a nurse told her that her hospital bill would be at least $3,000 a day if she stayed, due to her inability to prove insurance coverage.

Rather than stay and pay, she left.

“Should I be in the hospital? Probably,” she said, The Daily Mail reported.

“Maybe it’s one of those borderline cases. I have to think that if I were really in danger, they wouldn’t give me the choice. But what if I think I’m covered and I’m really not? The emergency room bill is going to bad enough.”

Source: Daily Mail, Washington Times

OBAMACARE Health Care Insurance Plans Go Into Effect Today (How Will OBAMACARE Fare In 2014?)

"Eight Wonks Share Their 2014 Obamacare Predictions"


Everybody is talking about how Obamacare will look on January 1, 2014.

But how will things look on January 1, 2015?

We put that question to eight smart people who follow health policy.

They represent different political perspectives and come by their expertise in different ways.

There's an economist, three trained physicians, plus a longtime consumer advocate and organizer. Two of them worked for Republican presidents, one served a Democrat.

One frequently criticizes Obamacare from the right, another from the left.

But their predictions have more in common than you might suspect:

1) ****HAROLD POLLACK:

In 2014, the most interesting political and policy stories will shift from Washington to the fifty states. States face a mammoth implementation challenge. They also provide the terrain in which we will see whether bipartisan health policy is actually possible. In some parts of the country, we’ll see some fascinating negotiations as Republican governors and the Obama administration each seek a dignified path to make this thing work.

I hope that we see something else, too: An end to the politics of impunity toward the poor and the uninsured.

It’s sobering to think that the same inequalities that make universal coverage a moral imperative pose the chief political obstacles to universal coverage itself. Those with the most to gain from the Affordable Care Act’s Medicaid expansion are economically marginal, disorganized, alienated from the levers of politics, distrusted or disliked by many other Americans. This reality produces a striking sense of impunity among governors and legislators who deny Medicaid coverage to five million people, even as the federal government stands ready to foot virtually the entire bill.

As Medicaid expansion becomes real, Republican politicians who embrace it will begin to profit. Hospitals, cities and counties, and other interest groups in non-expansion states will ask hard questions about why their states chose a different path. Poor people themselves, in campaigns such as texasleftmeout.org, will increase the pressure, too.

It’s important that these recalcitrant officials pay some price—not just to smooth the way for expanded coverage, but to debunk a particularly toxic assumption in American life. Too many politicians assume that poor people just don’t matter, politically. On many issues from the sequester to unemployment insurance, the practical consequences of this assumption are only too obvious.

This assumption is being put to the test. In 2014, I’m betting that some governors will be surprised.


2) ***GAIL WILENSKY:

As expected, 2014 was a tumultuous year for the Affordable Care Act. It started in January with many people who thought they had enrolled not actually being insured--either because the information hadn't been accurately transmitted back to their insurance companies or because they hadn't paid their premiums by January 10. After a lot of pressure from the Administration to cover people retroactively if necessary, people newly insured began receiving services.

Access to health services was less problematic than many had feared because of the smaller-than-predicted numbers enrolling in private insurance. Only 4.5 million got coverage, even after the March surge in sign-ups. And there were the many "red" states that hadn't expanded their Medicaid coverage. Some states reported challenges getting primary care services provided to the newly insured--California having the most significant problems.

Some of the smaller regional insurance companies participating in 2014 decided not to participate again in 2015. Some larger companies that had only selectively participated in 2014 increased their participation only modestly for 2015, still concerned about the significant adverse selection that had occurred in 2014 and their difficulty to price properly.

The biggest uproar occurred when many smaller/mid-sized employers received notices that their existing policies didn't meet ACA standards and weren't being renewed. As expected, the Administration provided a variety of accommodations to these employers.

The best news is that the majority of states that had not previously expanded Medicaid announced intentions to do so for 2015. The bad news is that the newly elected Congress is even less likely to pass any legislative "fixes" than the previous Congress.

(Gail Wilensky has served as director of Medicare and Medicaid and she has chaired the Medicare Payment Advisory Commission. She is now an economist and senior fellow at Project HOPE.)


3) ***ANTHONY WRIGHT:

By the end of 2014, more than 2 million Californians will be enrolled in new coverage options under the Affordable Care Act. A million will have coverage through our exchange, Covered California, following its second open enrollment period. More will be getting coverage through our Medicaid program. Already 700,000 newly covered people have insurance through an early expansion of Medicaid; by February it will be more than 1 million.

Washington-based media will continue to hyperventilate about Obamacare, mistakenly using every website glitch or early enrollment figure as a binary barometer of the law’s success or failure. But even in a state like California—where the website (mostly) works, premiums came in below expectations, and enrollments are on target—officials aren't putting up a “Mission Accomplished” banner yet. Just as rollout problems were never indications of the ACA’s demise, progress to date is not proof the job is finished.

As elections are about the future, not the past, I predict Obamacare itself won't be a major factor in future contests. The debate will be “What’s Next?”

In states that have been more hostile to the law, at least some officials will change their minds about the Medicaid expansion, allowing it go forward.

In states like California that have embraced the law, officials and supporters of reform will focus on improving the law. Among the questions they will address:

1. How can we ensure a safety-net that survives and thrives—to provide primary and preventative care to the remaining uninsured, including undocumented immigrants that were excluded from the ACA?

2. How can we further regulate the insurance market—beyond basic steps like banning pre-existing condition exclusions—so that insurers compete not on avoiding sick people, but on cost, quality, customer service and prevention? How else can we make the health industry more accountable for improved quality and reduced cost of care? California is likely to debate (through bills, the budget, and the ballot box) more oversight of networks, transparency of health spending, rate regulation, investments in prevention and public health, and more.

While we will concentrate on the unfinished work of implementing the law in 2014, the work to fulfill the full promise of the law will be just beginning.

(Anthony Wright is director of Health Access California, a consumer advocacy organization.)


4) ***SEAN PARNELL:

Although it’s unlikely that 2014 will be as bad for the ACA as the initial rollout was, the law still faces significant challenges in the New Year.

The biggest hurdle will be enrollment, particularly among the young and healthy. Deductibles are high, premium subsidies generally aren’t available except to the poorest, the tax for being uninsured is low, and the young have always been overrepresented among the uninsured. This will continue to be the case in 2014 and beyond.

Late in 2014, insurers will announce premiums for 2015. They will be higher, inflicting a political price on Democrats. Expect more creative interpretations and regulatory flexibility out of the Obama administration in order to smooth over more unintended consequences of the ACA.

There will be more Americans who pay directly for more of their health care. The ACA is projected by the Congressional Budget Office to leave 30 million people uninsured, and tens of millions more will get high-deductible plans through exchanges or their employers. These self-pay patients will demand price transparency and discounts for paying in full at the time of treatment, and innovative entrepreneurs will step up to cater to them while ignoring the traditional third-party payment system.

At the end of 2014, I expect to see many advocates of the ACA look back and conclude that while it’s too early to call the law a failure, the meager results fall far short of what was hoped for.

(Sean Parnell is author of The Self-Pay Patient and a writer at www.theselfpaypatient.com)


5) ***DAVID BLUMENTAL:

The most recent CBO projections for ACA coverage, from May 2013, suggested there would be 7 million new privately insured Americans and 9 million new enrollees in Medicaid/CHIP by the end of 2014.

Through December 30, 1.9 million Americans had enrolled in private coverage through the federal and state marketplaces. As of December 20, 627,000 had enrolled in Medicaid/Chip. Let’s assume that by January 1 the numbers stand at about 2.0 million for private insurance (30 percent of the CBO 2014 target) and 1 million for Medicaid (11 percent).

The real deadline, however, for the first ACA open enrollment period is March 31, 2014, when penalties kick in. It would be reasonable to expect enrollment during February-March, 2014 to equal the 2013 numbers, bringing the total for private enrollees to about 4.0 million or 60 percent of CBO projections

Medicaid/CHIP numbers are harder to predict because enrollment can proceed continuously over the year. Assuming 1.5 million Americans enroll in Medicaid/CHIP during 2014, participation in public plans would come to 2.5 million or about 28 percent of projected.

Including the 3 million young people under 26 who have gained coverage under their parents’ plans in 2013, these projections would mean that a minimum of 10 million Americans would have become newly insured under provisions of the Affordable Care Act by the end of 2014.

As for costs, the ACA is given some credit (deserved or not) for keeping growth in overall health care costs below historical rates. However, times of rising personal wealth have always been times of rising health care spending. If the economy experiences strong GDP growth in 2014, growth in health spending is also likely to increase beyond the 2012 level of 0.8 percent per capita. A reasonable prediction: both GDP and health care will grow in the 2-3 percent range.

As a percent of GDP, health care expenses would remain unchanged at the 18 percent level.

This would have been viewed as a big accomplishment only a few years ago, but that was then.

(David Blumenthal, who has been a professor of medicine at Harvard and the National Coordinator for Health Information Technology, is now president of the Commonwealth Fund.)


6) ***TEVI TROY:

One year from now, the Affordable Care Act will be hobbled but still there. The hangover from the botched rollout will continue to haunt the program, but the website will be in better shape, and an increasing number of people will be getting subsidized insurance via the exchanges. At the same time, sticker shock will continue, especially among those without access to subsidized rates, and take-up rates will continually be lower than the administration predicted.

This will lead to a situation where Democrats are touting the number of covered individuals and calling the ACA a success, while Republicans will highlight the increased costs, lower than expected numbers of covered individuals, and the roll out problems to determine that the plan is a failure. The answer to the question of whether the law is a success or a failure will come from the employer-based market. If employer-based plans continue without significant disruptions, the ACA will weather the storm; but if individuals in the employer-based market lose their insurance or see major changes in their plans, the ACA’s political troubles will worsen.

In addition, one year from now, Republicans will be pleased with their election gains in the House and Senate, but will also realize that, even with their political victory, they cannot repeal the ACA while a lame duck President Obama remains in office.

This will set up the 2016 election as yet another do-or-die test for the ACA.

(Tevi Troy is a former Deputy Secretary of HHS and the author of What Jefferson Read, Ike Watched, and Obama Tweeted: 200 Years of Popular Culture in the White House.)


7) ***JOHN Z. AYANIAN:

The most notable change will be 12 million newly insured Americans. In May, 2013 the Congressional Budget Office (CBO) projected 9 million low-income adults would gain coverage in states opting to expand Medicaid during 2014, and another 7 million Americans would obtain private insurance through new federal and state health insurance exchanges. However, because of incomplete ACA awareness among eligible adults and early technical problems with the exchanges, I expect overall enrollment gains in 2014 will be 12 million instead of 16 million Americans.

A second major change over the next year will be much better functioning insurance exchanges. Major problems faced by HealthCare.gov and many new state exchanges will be essentially resolved through effective technical solutions.

The ACA’s future hinges on the U.S. Senate elections in 2014. If Democrats retain control of the Senate, ACA implementation will continue largely as planned. In contrast, if Republicans control both the Senate and House in 2015, Republicans and moderate Democrats in Congress will agree to change several features of the ACA. Essential benefit requirements for insurers will be loosened, financial penalties for uninsured individuals will be lightened, insurance subsidies will be reduced or eliminated for some currently eligible households (those at 300-400% of the federal poverty level), and the medical device tax will be eliminated. Because President Obama will veto a full ACA repeal, its two core components—Medicaid expansion in 25 or more states and subsidized private coverage for most currently eligible households—will be preserved until the 2016 Presidential election.

(John Z. Ayanian is a professor of internal medicine and director of the Institute for Healthcare Policy and Innovation at the University of Michigan.)


8) ***DON MCANNE:

There is no doubt that, in 2014, we will see enough individuals enrolled in Medicaid, in the exchange plans, and some new enrollment in employer-sponsored plans (to avoid the penalty, though small this year), that the Affordable Care Act will be considered a success. But success is not measured by enrollment in insurance plans but rather by the ability to obtain access to affordable health care.

Not only will tens of millions remain uninsured, those insured that need health care will face financial barriers of high deductibles and other cost sharing, and many will face lack of choice due to narrow provider networks. Unavoidable care provided out of network could result in catastrophic expenses. We will continue to hear stories of people facing excess costs and network problems that will prevent them from accessing care of their choosing.

Already, from both the left and the right, there is much discussion of single payer (improved Medicare for all) as an inevitability once it is realized how poorly functioning will be our fragmented, dysfunctional system of financing health care. We will not see the threshold for action in changing to single payer reached this year, but within a few years, demand for change will occur.

The feeble recommendations from the right would only make things worse, partly by diminishing what little protection we do have, so there isn’t much left other than single payer. Once enough people understand that all of us can have free choice of care that is affordable through equitable public funding, they will demand single payer.

(Don McCanne is a senior health policy fellow with Physicians for a National Health Plan.)

Sources: The New Republic; TIME Magazine