Over 214,000 Doctors Opt Out of Obamacare Exchanges

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By Barbara Boland

Over 214,000 doctors won’t participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows. That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It’s also about a quarter of the total number of 893,851 active professional physicians reported by the Kaiser Family Foundation.

In January, an estimated 70% of California’s physicians were not participating in Covered California plans.

Here are some of the reasons why:

1. Reimbursements under Obamacare are at bottom-dollar – they are even lower than Medicare reimbursements, which are already significantly below market rates. “It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60,” a study by the think-tank American Action Forum finds. “For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California’s Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent.”

2. Doctors are expected to take on more patients to make up for the lost revenue, but that’s not happening, because primary care doctors already have more patients than they can handle. “Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the PCPs time at lower pay,” says the study.

The study also points to two reasons that doctors might not get paid at all:

3. An MGMA study indicates that 75% of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they will get stuck with the bill.

4. HHS requires that insurers cover customers for an additional 90 days after they have stopped paying their premiums: the insurer covers the first 30 – but, it’s up to the doctor to recoup payment for the last 60 days. This is the number one reason providers are opting to not participate in the exchange plans. Currently, about a million people have failed to pay their premiums and had their plans canceled.

So, Obamacare is asking doctors to take on sicker patients for less money, with the risk of not getting paid at all? No wonder doctors are running from these plans!

Here’s How Obamacare ‘So Far Is an Expansion of Medicaid’

71% of Obamacare Signups Traced to Government’s Expansion of Medicaid

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The vast majority of Americans gaining health coverage under Obamacare actually qualified for Medicaid because of loosened eligibility —and that’s what boosted enrollment among those previously uninsured, according to a new report from The Heritage Foundation.

The Obama administration has boasted that the Affordable Care Act, popularly known as Obamacare, would allow those previously uninsured to purchase quality, affordable health care.

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“The inescapable conclusion is that, when it comes to covering the uninsured, Obamacare so far is an expansion of Medicaid,” Heritage Foundation health policy experts Edmund F. Haislmaier and Drew Gonshorowski write in a research paper scheduled for release today.

Officials announced in May that more than 8 million Americans had picked a health plan on the Obamacare website, HealthCare.gov.

Haislmaier and Gonshorowski conclude that 8.5 million Americans gained coverage through Obamacare from January to July.

Commentary: The Real Story on How Much Obamacare Increased Coverage

However, their paper says, more than 70 percent of those signups can be traced to the expansion of Medicaid eligibility in 24 states:

Of the 8.5 million total individuals who gained health insurance coverage, 71 percent of that net coverage gain was attributable to Obamacare’s expansion of Medicaid to able-bodied, working-age adults.

In the states that adopted and implemented Medicaid expansion under Obamacare, enrollment skyrocketed as an additional 5.7 million Americans signed up for coverage.

In 21 states opting out of Medicaid expansion, however, enrollment was strikingly lower. The Heritage report finds that 355,674 Americans signed up for Medicaid in those states.

In all, Medicaid enrollment increased by 6 million individuals for the first half of 2014.

The Daily Signal is the multimedia news organization of The Heritage Foundation.

The Affordable Care Act, popularly known as Obamacare, loosened eligibility requirements for Medicaid, traditionally the government’s health program for the poor. The changes made it easier for individuals with an income of up to 138 percent of the federal poverty line (roughly $16,000) to qualify for the taxpayer-funded health coverage.

>>> Report: Obamacare Will Add $131 Billion to Federal Deficits in Next Decade

As the Heritage experts note, many Medicaid-eligible Americans under the new requirements also don’t have dependent children.

States got an incentive–federal dollars–to adopt the requirements.

Twenty-seven states and the District of Columbia opted to expand Medicaid. By July, however, 24 states had implemented the program.

The Affordable Care Act went into effect in October. Its implementation included the rollout of HealthCare.gov, the online marketplace where consumers can peruse and purchase insurance plans.

HealthCare.gov’s advent was accompanied by well-publicized malfunctions, glitches and failures. White House officials scrambled to fix the website as consumers experienced long delays. As a result, the Obama administration extended the close of open enrollment from March 30 until April 15.

>>> California Politician Claims Obamacare Contracts Went to Agency Director’s Cronies

Despite the rocky rollout of HealthCare.gov, President Obama and then-Health and Human Services Secretary Kathleen Sebelius touted that enrollment in Obamacare insurance plans topped the original goal of 7 million.

According to reports from the Department of Health and Human Services, enrollment likely hovered around 7.3 million, as original estimates took into account those who selected a plan, but did not pay their first month’s premiums.

Sylvia Mathews Burwell, who in June replaced Sebelius as HHS secretary, said in a speech last month at the Brookings Institute:

Four years after President Obama signed the law, middle class families have more security, and many who already had insurance have better coverage. Fewer Americans are uninsured, and at the same time, we’re spending our health care dollars more wisely, and we’re starting to receive higher quality care.

Tax refunds will be cut for ACA recipients

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Susan Tompor, Detroit Free Press 9:10 a.m.

A significant benefit of the Affordable Care Act is the opportunity to receive money-saving tax credits up front to cut the overall cost of health insurance, but now hundreds of thousands of consumers could owe back some of that money next April.

Those affected took advance payments of the premium tax credit for health insurance. Some married couples could owe $600 or $1,500 or $2,500 or even more. It might feel like a raw deal for some who are already suffocating under the escalating costs of health insurance.

“Health insurance is confusing enough, and now they’re adding the complexities of the Tax Code,” said Lorena Bencsik, a member of the Michigan Association of CPAs and owner of Prime Numbers in Ferndale.

When you file that 2014 tax return next year, the Internal Revenue Service will compare your actual income for the year with the amount you estimated when applying for exchange-based health insurance under the health insurance law.

The next open enrollment period begins Nov. 15. But notices were sent this week to some consumers whose incomes don’t match up to such things as 2012 tax return information.

On Monday, the Centers for Medicare and Medicaid Services said at least 279,000 households reported incomes that still don’t match what the government has on record. Supporting documents are needed by Sept. 30.

What can you do to avoid tax-time problems?

Experts say people need to realize early on that they should report changes in income and other changes in one’s life, such as a marriage, throughout the year. See HealthCare.gov to report “income and life changes.”

Of course, many people may have no idea that they’d need to report changes.

The IRS put out some more details on the issue mid-month.

What should you report? A move, an increase or decrease in income, a marriage or divorce, the birth or adoption of a child, whether you started a job that offers health insurance and whether you gained or lost eligibility for other health care coverage.

Best spots for information: HealthCare.gov and IRS.gov/aca.

Karen Pollitz, senior fellow with the Kaiser Family Foundation, said many people who qualify for these tax credits aren’t working 9-to-5 jobs with regular salaries. So guesstimating one’s income for the coming year can be very tough.

“It’s people in transition. Maybe they’re in and out of work,” she said. Or maybe they’re self-employed.

People who lose a job would want to report that change during the year, as well, because that change can lead to a higher advance payment for the credit.

“Life changes can drive tax changes,” said Mark Steber, chief tax officer for Jackson Hewitt Tax Service.

Steber stressed that people need to make sure to update information via HealthCare.gov or their state insurance exchanges.

The Kaiser Family Foundation site has a calculator to help figure out potential tax credits, based on one’s situation.

Premium tax credits are available to individuals and families with incomes between 100% of the federal poverty line ($23,550 for a family of four this year) and 400% of the federal poverty line ($94,200 for a family of four) who purchase coverage in the health insurance marketplace in their state.

The tax credits are paid directly to the insurer, if taken in advance. People are not required to take the entire credit in advance. Realistically, if you cannot afford insurance, you’d need some credit in advance.

To be sure, there are some caps on the amount filers must pay back and the cap is based on household income. The cap ranges from $300 to $1,250 for some single taxpayers and $600 to $2,500 for married taxpayers, again based on income.

But if the income is 400% or more above the poverty line, there is no cap and the taxpayer must pay back the full amount.

Rules exist for qualifying for the premium tax credit: You must buy health insurance through the marketplace; you’re not eligible for coverage through an employer or government plan; your income must be within certain limits; you do not file a married-filing-separately federal tax return (unless you meet certain exceptions, such as victims of domestic abuse and spousal abandonment) and you cannot be claimed as a dependent by another person.

The actual credit would vary based on how close your are to the federal poverty level, your age, the size of your family and where you live.

Sadly, it’s fair to say some people will see some unexpected, unpleasant surprises on their tax returns next year.

THE OBAMA ADMINISTRATION POLICIES THAT JIHADISTS ARE USING TO LEGALLY IMMIGRATE TO AMERICA

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Did you know that one of the Americans that was recently killed fighting for ISIS once cleaned planes at Minneapolis-St. Paul International Airport?

by MICHAEL SNYDER | END OF THE AMERICAN DREAM | SEPTEMBER 4, 2014

Did you know that one of the Americans that was recently killed fighting for ISIS once cleaned planes at Minneapolis-St. Paul International Airport? His name was Abdirahmaan Muhumed, and he was a Somali refugee. Since 1975, more than 3 million refugees have been resettled in cities in the United States, and thanks to the Obama administration an increasing percentage of those refugees are Muslim. As you will read about below, Obama has even made it possible for refugees that have given only “limited material support” to terrorists to come to America. The Obama administration says that it is still trying to keep full-blown terrorists from entering the country, but it has become exceedingly clear that administration officials aren’t exactly into that whole “border security” thing. And once refugees arrive in the United States, they are fully eligible for food stamps, Medicaid, housing assistance and a whole host of other welfare programs. So if you are a jihadist and you want to move to the United States legally, all you have to do is claim to be a “refugee” and you might just find that the red carpet gets rolled out for you.

According to a survey conducted by Pew Research, “the estimated share of legal Muslim immigrants entering the U.S. each year has roughly doubled, from about 5 percent of legal immigrants in 1992 to about 10 percent in 2012.” And this rise in Islamic immigration has been accelerated by a series of moves by Barack Obama.

For example, earlier this year the Wall Street Journal reported on a decision by the Obama administration to bring thousands of additional Syrian refugees into the country by the end of this year…

U.S. plans to resettle thousands of Syrians displaced by their country’s civil war could hinge on those refugees receiving exemptions from laws aimed at preventing terrorists from entering the country.

A U.S. official stated publicly for the first time this week that some of the 30,000 especially vulnerable Syrians the United Nations hopes to resettle by the end of 2014 will be referred to the U.S. for resettlement.
Will “refugees” with ties to ISIS or other jihadist organizations be weeded out?

Hopefully at least some of them will be. But at this point the Obama administration has set the bar pretty low. In fact, the Obama administration has decided that it is even okay for those that have provided “limited material support” to terrorists to be allowed into the country…

The Obama administration has issued new exemptions to a law that bars certain asylum-seekers and refugees who provided “limited material support” to terrorists who are believed to pose no threat from the U.S.

The Department of Homeland Security and the State Department published the new exemptions Wednesday in the Federal Register to narrow a ban in the Immigration and Nationality Act excluding refugees and asylum seekers who had provided limited material support, no matter how minor, to terrorists.

“These exemptions cover five kinds of limited material support that have adversely and unfairly affected refugees and asylum seekers with no tangible connection to terrorism: material support that was insignificant in amount or provided incidentally in the course of everyday social, commercial, family or humanitarian interactions, or under significant pressure,” a DHS official explained to The Daily Caller.
When they arrive in the United States, many Muslim refugees are resettled in cities in the heartland of America. For instance, the city of Minneapolis, Minnesota has had such an influx of Somali refugees that it has become known as “Little Mogadishu”…

Minneapolis, Minnesota, sits at the heart of the controversial program. Known as “Little Mogadishu” to some critics, the city has since 1983 welcomed thousands of Somali refugees, most of whom are practicing Muslims and attend a local mosque or Islamic center.

While the Minneapolis-St. Paul area plays host to the largest Somali refugee population, it’s not the only American city that is taking in refugees from the war-torn African nation. Columbus, Ohio, and San Diego, California, have also served as refugee resettlement hot spots.
Of course most of the refugees are law-abiding people that are not causing problems.

But there are an alarming number of exceptions.

It is not just a coincidence that the two Americans that were fighting for ISIS that were recently killed were both from Minnesota…

The trend was underscored again last week when it was reported that two Americans, both from Minneapolis, had linked up with the ISIS terrorist organization in Syria and were killed on the battlefield in that country’s civil war. One was a Somali refugee and the other reportedly was an African-American with ties to the Somali community in Minnesota.

And many more have been tried and convicted of providing money or material support to overseas Muslim terrorist organizations. Among them was one Somali woman from Minnesota who refused to rise when called upon by the judge, citing a verse in the Quran.

“I’ll not stand for anyone except for Allah,” Amina Farah Ali told the federal judge.
And guess what?

If they had not been killed on the battlefield, they would have been welcomed back into the United States with open arms.

Just check out what Congresswoman Michele Bachmann learned when she asked the FBI about this…

Minnesota Congresswoman Michele Bachmann (R) was stunned when she questioned the FBI about what would happen to American citizens who have gone overseas to fight with the Islamic State, and then try to return to the United States.

“Two from my state were the first Americans who were fighting for ISIS,” she began on The Glenn Beck Program Tuesday. “I had gone earlier this year and asked the FBI, ‘Are there any Minnesotans that are over fighting with ISIS?’ It was classified information at the time, I couldn’t reveal it. Now everyone knows.”

“At that time, these two hadn’t been killed yet,” Bachmann continued. “So what I asked is, ‘OK, once they’re done fighting with ISIS, what’s going to happen if they try to return?’ And they said, ‘Well, they’ll come into the country.’”
Wow.

Fighting for ISIS won’t even keep people out the country?

Are we insane?

And while jihadists are staying inside our country, they are eligible for a free ride that the rest of us are paying for.

The following information comes from Refugee Resettlement Watch…

Refugee access to welfare on the same basis as a U.S. citizen has made the program a global magnet.

The federal programs available to them include:

∙ Temporary Assistance for Needy Families (TANF) formerly known as AFDC
∙ Medicaid
∙ Food Stamps
∙ Public Housing
∙ Supplemental Security Income (SSI)
∙ Social Security Disability Insurance
∙ Administration on Developmental Disabilities (ADD) (direct services only)
∙ Child Care and Development Fund
∙ Independent Living Program
∙ Job Opportunities for Low Income Individuals (JOLI)
∙ Low-Income Home Energy Assistance Program (LIHEAP)
∙ Postsecondary Education Loans and Grants
∙ Refugee Assistance Programs
∙ Title IV Foster Care and Adoption Assistance Payments (if parents are qualified immigrants – refugees, asylees, etc)
∙ Title XX Social Services Block Grant Funds
Of course most refugees are more than happy to take advantage of all of these “services”. Here is more from Refugee Resettlement Watch…

Public Assistance Utilization Among refugees who arrived during the 5 years previous to the survey 57.7% are on government medical assistance such as Medicaid, about 25% have no health insurance at all, 70.2% are receiving food stamps, 31.6% are in public housing (an additional percentage is on a public housing waiting list), and 38.3 % are getting cash assistance such as TANF or SSI.

The figure of 57.7% dependent upon government medical assistance is actually an undercount since it excludes children under 16.
Yes, our southern border is wide open for any jihadists that want to come into our country illegally.

But if you are a jihadist that wants to immigrate to America, there is a much easier way.

Just tell the Obama administration that you are a “refugee”, and you might just find that you are soon living in one of our major cities at U.S. taxpayer expense.

OBAMA OFFICIAL DELETED OBAMACARE EMAILS SOUGHT BY CONGRESS

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Administrator of Centers for Medicare and Medicaid Services deleted some of her emails

Patrick Howley
Political Reporter

The administrator of the Centers for Medicare and Medicaid Services (CMS) deleted some of her emails and may not be able to cooperate with a congressional investigation into the flawed Obamacare rollout, CMS has warned Congress.

Marilyn Tavenner, who was appointed by President Obama to take over CMS within the Department of Health and human Services in 2013 — prior to the Obamacare rollout — deleted some of her emails and did not save hard copies as the Federal Records Act requires her to do, MSNBC reported Thursday.

Though Tavenner’s computer did not crash like ex-IRS official Lois Lerner’s computer allegedly did, Tavenner may be unable to cooperate with House Oversight and Government Reform Committee subpoenas.

“During her entire tenure at CMS, Ms. Tavenner’s CMS email address, which is accessible to both colleagues and the public, has been subject to write-in campaigns involving thousands of emails from the public,” according to a letter CMS sent Wednesday to the National Archives and Records Administration. “Therefore, she receives an extremely high volume of emails that she manages daily. To keep an orderly email box and to stay within the agency’s email system capacity limits, the Administrator generally copied or forwarded emails to immediate staff for retention and retrieval, and did not maintain her own copies.”

CMS noted that this practice of not keeping emails “continued until November 2013,” just one month after the Obamacare website launched.

“It is possible that some emails may not be available to HHS,” the letter stated.

Read more: http://dailycaller.com/2014/08/07/obama-official-deleted-obamacare-emails-sought-by-congress/#ixzz3A8BGXosj

Obama Official Deleted Obamacare Emails Sought By Congress

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Patrick Howley

The administrator of the Centers for Medicare and Medicaid Services (CMS) deleted some of her emails and may not be able to cooperate with a congressional investigation into the flawed Obamacare rollout, CMS has warned Congress.

Marilyn Tavenner, who was appointed by President Obama to take over CMS within the Department of Health and human Services in 2013 — prior to the Obamacare rollout — deleted some of her emails and did not save hard copies as the Federal Records Act requires her to do, MSNBC reported Thursday.

Though Tavenner’s computer did not crash like ex-IRS official Lois Lerner’s computer allegedly did, Tavenner may be unable to cooperate with House Oversight and Government Reform Committee subpoenas.

“During her entire tenure at CMS, Ms. Tavenner’s CMS email address, which is accessible to both colleagues and the public, has been subject to write-in campaigns involving thousands of emails from the public,” according to a letter CMS sent Wednesday to the National Archives and Records Administration. “Therefore, she receives an extremely high volume of emails that she manages daily. To keep an orderly email box and to stay within the agency’s email system capacity limits, the Administrator generally copied or forwarded emails to immediate staff for retention and retrieval, and did not maintain her own copies.”

CMS noted that this practice of not keeping emails “continued until November 2013,” just one month after the Obamacare website launched.

“It is possible that some emails may not be available to HHS,” the letter stated.

Read more: http://dailycaller.com/2014/08/07/obama-official-deleted-obamacare-emails-sought-by-congress/#ixzz39jyOTeVF

Doctors Begin To Refuse Obamacare Patients

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Sarah Hurtubise

Obamacare plans have shrunk payments to physicians so much that some doctors say they won’t be able to afford to accept Obamacare coverage, NPR reports.

Many of the eight million sign-ups in Obamacare exchanges nationwide already face more limited choices for physicians and hospitals than those in the private insurance market. But with low physician reimbursement rates, the problem could get even worse.

For a typical quick patient visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer would pay $100 while Medicare would pay around $80. But Obamacare plans are more likely to pay closer to $80, which Gerard says is unsustainable for his practice.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Dr. Gerard told NPR. ”You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Narrow networks have become a hallmark of many Obamacare exchange plans, as one of few options left to insurance companies that allows them to save money by lowering reimbursement rates and covering fewer providers. In the health-care law’s first year, 70 percent of all Obamacare plan networks were either narrow or ultra-narrow, according to an analysis from consulting firm McKinsey.

But doctors are feeling even more financial pressure due to the changes and many believe there’s a risk that Obamacare insurance will go the way of Medicaid, where patients still struggle to find a doctor after low reimbursement rates led many physicians to stop accepting it.

“I don’t think most physicians know what they’re being reimbursed,” Gerard said. “Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

If Obamacare coverage continues on its current track, exchange customers could face a lower level of care than those who buy coverage in the private market.

“I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care,” Connecticut Obamacare chief Kevin Counihan told NPR. ”That’s been something, at least in our state, that we’re trying to work against. And the carriers are, as well.”

The problem is especially bad for private practices like Gerard’s, where physicians’ income is directly tied to reimbursements. But hospitals — especially top-tier ones that treat the most difficult diseases — are also increasingly rejecting the low reimbursement rates. The nation’s best cancer treatment centers are often covered by very few exchange plans in their states; if Obamacare customers end up with a difficult-to-treat cancer, they’re likely to face a lower quality of care right off the bat.

“You get what you pay for,” said Connecticut State Medical Society president-elect Bob Russo. “If you can’t convince [doctors] that they’re not losing money doing their job, then it’s a problem. And they haven’t been able to convince people of that.”

Read more: http://dailycaller.com/2014/08/04/doctors-begin-to-refuse-obamacare-patients/#ixzz39TNjuopb