Short Summary of Obamacare and Proposed 'Repeal and Replace'

1) Congress passes law to give lots of people free stuff.
2) Congress considers repealing law.
3) Headlines: People will lose free stuff.

Maryland's Obamacare Website: Female Doctor, Male Patient Examination is... Funny?

    Via Maryland's Obamacare site: Watch this clip and imagine if a male doctor and a female patient were portrayed:

        Funny? Outrage? I honestly don't know currently in our society.


UPDATE: If the video above doesn't work for you, try this link.

Obamacare Website Drops Section on 'How to Keep Your Doctor'

    "If you like your doctor, you can keep your doctor" was President Obama's primary catchphrase he used to sell the Affordable Care Act (Obamacare) to the American people. Now Obamacare's flagship website, Healthcare.gov, no longer even addresses the issue.
    Ironically, the section in question was the first public (if indirect) admission by the Obama administration that the president's promise was less than a "guarantee." As THE WEEKLY STANDARD first reported in July 2013, the website told consumers that they "may be able to keep your current doctor," in contrast to the president's unequivocal statement: "Here is a guarantee that I've made.If you have insurance that you like, then you will be able to keep that insurance. If you've got a doctor that you like, you will be able to keep your doctor."
    The original website contained a section entitled "Can I keep my own doctor", later revised to "How to keep your doctor." A version of the website as of last October can be seen here:

    Just before open enrollment began last year, however, this section was dropped. Now the same link takes users to a section entitled "How to pick a health insurance plan". (The internet address that contains the words "keep-your-doctor" redirects to an address ending with "plan-types".)

    The closest the website comes to mentioning the president's "keep your doctor" commitment is, "To be certain your doctor is included in your plan’s network, contact the plan or provider for the most up-to-date information."
    Earlier this year, the White House also removed the "Reality Check" from its own website where "Linda Douglass of the White House Office of Health Reform debunks the myth that reform will force you out of your current insurance plan or force you to change doctors."

    The Reality Check link now directs visitors to a more generic "Health Reform" page that includes no mention of the promise regarding keeping your doctor. An August 2009 blog post called "Facts are stubborn things" can still be found on the website, but is not linked from the new Health Reform page. In that post, the White House asserted, "For the record, the President has consistently said that if you like your insurance plan, your doctor, or both, you will be able to keep them."
    Open enrollment for the 2017 coverage year under the Affordable Care Act begins on November 1, 2016. New enrollees with questions keeping their doctors will face their own reality check with little in the way of answers.

Note: A version of this post first appeared at The Weekly Standard.

27.49 Percent of Everyone's Tax Bill Is Spent on Health Care

    Every year since 2011, the White House has used tax time to post a "Federal Taxpayer Receipt" showing taxpayers how their federal tax dollars are being spent. President Obama introduced the concept in his 2011 State of the Union address, and Wednesday the White House posted the fifth installment so taxpayers can see how "tax dollars are being spent on priorities like education, veterans benefits, and health care."
    While users can punch in their own tax liability and see dollar amounts assigned to each category, the figures are based on percentages from the prior fiscal year budget. Comparing those percentages from year to year, taxpayers can see that from 2012 to 2014, the percentage of their taxes going towards federal healthcare expenses has jumped 22 percent.
    In 2010, the year the Obamacare passed and was signed into law, the healthcare percentage was 24.10. The following year, 2011, it dropped to 23.7 percent, and in 2012 dropped still further to 22.45 percent. After this, however, the trend sharply reversed. In 2013 the healthcare share jumped to 25.19 percent, and the latest numbers posted this week for 2014 show the highest proportion yet at 27.49 percent, a full 22 percent increase over 2012. This means that for every dollar a taxpayer pays in 2014, an additional nickel is going to pay for healthcare that had been spent elsewhere in 2012. Presently, over 27 cents on every dollar is spent by the federal government on healthcare, primarily Medicaid and Medicare.
     One area impacted is national defense. For the five years of the National Taxpayer Receipt, the share for national defense was highest in 2010 at 26.3 percent. By 2014, this figure had fallen to 23.91 percent, a decrease of nine percent. Other budget areas have changed to varying degrees, such as veterans benefits which increased from 4.1 percent in 2010  to 5.93 percent in 2014, a 45 percent increase.
    Although the White House characterizes the Federal Taxpayer Receipts as a promise kept by President Obama to let taxpayers easily know where their tax dollars are going, the administration also used the opportunity to take a dig at Republicans, providing a link to "See how two starkly different tax plans would impact you" where viewers can read about the president's "tax cuts for the middle class" and the Republicans' "giveaways for the wealthy few." In the end, the White House doesn't just want taxpayers to know where their money is going, but where everyone else's is going, too.

Note: A version of this post first appeared at The Weekly Standard.

HHS Terminates Obamacare Coverage for 90,000 for Lack of Citizenship, Immigration Documents

    The Obama administration in recent weeks has been trumpeting the number of signups for health insurance through the Obamacare marketplaces for 2015, but at least 90,000 consumers who had coverage last year are losing it. In this week's Affordable Care Act open enrollment report, the Department of Health and Human Services (HHS) announced that processing has been completed for most accounts with "citizenship and immigration data matching issues," and those unable to provide appropriate documentation have had their coverage terminated. A relevant portion of the item posted on the HHS blog is below [emphasis added]:

We have now completed processing the information submitted by most of those with citizenship and immigration data matching issues described in last week’s snapshot.  As a result, approximately 90,000 consumers who had 2014 coverage were not able to continue their Marketplace coverage in 2015 because they did not provide the necessary documentation of their citizenship or immigration status (the previous estimate was 200,000). Their coverage has been terminated and these individuals are no longer included in the cumulative total.  As such, the change in the weekly and cumulative total reflects both the increased number of sign-ups due to the special enrollment period and the reduced number of re-enrollees due to this action. 

    As noted, HHS had previously estimated the number who lacked documentation to be as high as 200,000. HHS noted that "these individuals are still included in the cumulative total reported ... [8,797,577 plan selections], but they will be removed in future reports after their coverage ends on February 28." Total plan selections, however, still increased as of this week's report to 8,838,291 despite the removal of the 90,000 due to the special enrollment period granted to others who experienced trouble signing up as the February 15 deadline approached.
    It is not clear from the reports if the 90,000 consumers terminated should never have been covered in the first place, or if they were simply unable to provide updated documentation of citizenship or immigration status to continue coverage in 2015. A response has not yet been received to an email inquiry to HHS regarding recovery of subsidies potentially paid incorrectly on behalf of these 90,000 consumers in 2014.

Note: A version of this post first appeared at The Weekly Standard.

Feds Looking for Company to Run 'National Data Warehouse' for Obamacare, Medicare

    The Department of Health and Human Services (HHS) is looking for vendors to run its "National Data Warehouse", a database for "capturing, aggregating, and analyzing information" related to beneficiary and customer experiences with Medicare and the federal health insurance Marketplaces. Although the database primarily consists of quality control metrics related to individuals' interactions with customer service, potential contractors are to "[d]emonstrate ... experience with scalability and security in protecting data and information with customer, person-sensitive information including Personal Health Information and Personally Identifiable information (personal health records, etc.)." Vendors are also instructed that one of the requirements of a possible future contract would be "[e]nsuring that all products developed and delivered adhere to Health Insurance Portability and Accountability Act (HIPAA) compliance standards[.]"
    For a number of years, the Centers for Medicare and Medicaid Services (CMS), the division of HHS responsible for Medicare and now Obamacare also, has maintained a "national data warehouse" (NDW) related to the 1-800-MEDICARE helpline. The passage of the Affordable Care Act and subsequent establishment of the Marketplaces has expanded the scope of the NDW. The CMS notice explains the NDW as follows:

The NDW performs a significant role with oversight and monitoring functions under the Virtual Call Center Strategy (VCS) initiative and Medicare Reform legislation. The NDW acts as the central repository for capturing, aggregating, and analyzing information related to the beneficiary experience with Medicare and the consumer experience with Marketplaces. The NDW also serves as a foundation for operational and management reporting to support improved decision-making, business practices, and services to callers. 

    The type of data included in the NDW "includes information for CMS’ Virtual Contact Center operations including, but not necessarily limited to" items such as "Workforce management data", "Quality monitoring", "Medicare disenrollments", "Beneficiary satisfaction surveys", and "Web Chat metrics." The NDW is part of CMS's larger $15 billion "Virtual Data Center" program awarded to multiple vendors in 2012. The eventual vendor for the NDW must be able to integrate and share data with the other Virtual Data Center vendors.
    The description for the "NDW Functional Requirements" included thirty-six items, several with multiple subpoints, and even this list is not meant to be "all inclusive" according to CMS. In addition to these functions, the "contractor shall implement a security program that adheres to CMS security standards." Interested vendors have until January 19, 2015, to respond.

Note: A version of this post first appeared at The Weekly Standard.

Cost of Healthcare.gov Exceeds $2.2B After Latest Contract Award

    With the announcement Monday of a five-year, $563 million contract award to Accenture, the Healthcare.gov contractor that rescued the Obamacare marketplace after 2013's disastrous launch, the total cost of the site will well exceed $2.2 billion. The new award is on top of the $1.7 billion in contracts reported by the inspector general (OIG) of the Department of Health and Human Services (HHS) in August.
    Accenture was first hired in January after HHS replaced CGI Federal, the original contractor. Accenture reported the new award on its website, noting that not only will the company maintain current services, but is expanding its work to include the small business health plans marketplace (SHOP), and will also assist those state-based exchanges that have decided to transition to the federal site:

As the 2014 enrollment period closed successfully with Accenture’s support, work began to prepare for the 2015 enrollment. Accenture focused on simplifying the process for issuers to update plans, and implemented tools and processes to expedite the resolution of citizen inquiries.  At the same time, Accenture worked with CMS to find new ways to streamline and improve the customer experience. CMS later expanded Accenture’s scope of work to include enhancements and additional functionality of the FFM, the SHOP and state-based exchange transitions.  All of these efforts helped create a successful launch of the 2015 Open Enrollment season that continues through February 15, 2015.

     Although the transition from CGI Federal to Accenture appears to have been successful, the government is still struggling with other aspects of the marketplace. Although Hewlett-Packard was selected to replace Verizon (Terremark) in June 2013 as the host for Healthcare.gov, Verizon was awarded an emergency contract just four weeks before the current open enrollment period began, extending its contract into 2015. The new Hewlett-Packard system is acting only as backup system and a "development environment" for the current open enrollment period.


Note: A version of this post first appeared at The Weekly Standard.

Documents: Healthcare.gov Narrowly Avoided Repeat of Last Year's Debacle

    Less than four weeks before the launch of 2015 open enrollment for Obamacare, the government agency that runs Healthcare.gov suddenly realized the Marketplace site was heading for a repeat of last year's debacle. Documents show that on October 19, the Centers for Medicare and Medicaid Services (CMS), a division of Health and Human Services (HHS), learned that a shortage of computer storage would "cause long outages and slow response times" leading to "a poor user experience." An emergency, no-bid contract for $1.8 million was quickly awarded to Terremark (a subsidiary of Verizon) for 100 terabytes of additional storage plus various computer licenses.
    Since the order was needed in such a hurry, the government decided to skip the usual bidding process mandated for such a contract, a practice that has not been uncommon in the development of Healthcare.gov to date. The Limited Source Justification that was required and subsequently approved internally at CMS spelled out the consequences of delay in stark terms:

    The documents do not disclose how long installation and configuration of the new equipment would take. However, shortly after the problem was discovered on October 19, Healthcare.gov was shutdown for "weekend maintenance" on a Wednesday, October 22. It remains unclear if this shutdown was related to the inadequacies CMS discovered, and CMS did not return an email at the time requesting comment.
    Terremark/Verizon is actually the outgoing contractor for Healthcare.gov. The government announced in June 2013 that Hewlett-Packard would be replacing Terremark/Verizon. However, launch problems and other delays led to numerous extensions on the Terremark/Verizon contract. Most recently, as THE WEEKLY STANDARD reported in September, CMS disclosed that the Terremark/Verizon system would continue to host Healthcare.gov through 2015 open enrollment with the new Hewlett-Packard system acting only as backup and as a "development environment".
    By most accounts, the current open enrollment period is proceeding with few of the problems experienced in the fall of 2013. CMS has undergone some reorganization in the past year, but at least some of the steps spelled out by former HHS director Kathleen Sebelius are still unfulfilled. In a December 2013 press appearance, Sebelius announced her intention to create a Chief Risk Officer position at CMS to, in part, oversee future IT (information technology) planning and purchases such as the one described above and prevent unpleasant surprises. However, the position is still vacant and both CMS and HHS have disregarded numerous inquiries about the status of Sebelius's commitment.


Note: A version of this post first appeared at The Weekly Standard.

Missing From New and Improved Healthcare.gov: Online Customer Service

    New and returning customers to Healthcare.gov this year will have one less option if they run into difficulties. In the run-up to the initial launch in 2013, the Obamacare website promoted a "live chat" feature in addition to the toll-free phone number to be available 24/7 to answer questions:

    This year, however, the "contact us" page on the site includes only a phone number, and the "blue box" mentioned in the excerpt above is nowhere to be seen.
    The online chat feature actually disappeared without fanfare back in the spring of 2014 before the first open enrollment period even ended. In February, the change was alluded to in a blog post by Julie Bataille, director of communications for the Centers for Medicare and Medicaid Services (CMS), noting that "we will transition 1500 service representatives from web chat to direct telephone assistance." There was no mention that the chat feature was being discontinued altogether, and CMS did not respond to a request for comment.
    In spite of the fact that the online help feature was dropped more than eight months ago and the site has undergone extensive revamping and reprogramming in the meantime, one artifact of the chat service remains on the site even today (archived here):

    While the notice is technically correct that the "Live Chat feature is unavailable right now", a more accurate message would inform customers that Healthcare.gov Live Chat is in fact dead.

Note: A version of this post first appeared at The Weekly Standard.

Test Version of Healthcare.gov Inadvertently Exposes New Website Features Early [Updated]

    As 2015 open enrollment for Obamacare nears, Healthcare.gov has been telling consumers that "plans and estimated prices for 2015 coverage will be available in early November." Although signup is not possible until November 15, the website promises this "window shopping" experience will come sooner:

    However, Jayne O'Donnell of USA Today is reporting that this "window shopping" feature, which some were expecting to debut today, maybe still not be available even by Sunday, less than a week before open enrollment begins:

Healthcare.gov won't go live today for window shopping as some expected; no word yet on whether browsing can start Sunday either.
— Jayne O'Donnell (@JayneODonnell) November 7, 2014

    However, THE WEEKLY STANDARD has discovered that a test version of Healthcare.gov is exposed online with some of the new "window shopping" pages. We reported in September that akatest.healthcare.gov has been accessible for months even though it is only a test version of the live site. Most web browsers only display the pages in html code, but the Firefox browser actually displays the content not yet ready for primetime on the live site. Here are two examples:

    Clicking on the SEE HEALTH INSURANCE PLANS & PRICES button, however, does not deliver; rather, it takes users to the "Full-time Equivalent (FTE) Employee Calculator".
    The Department of Health and Human Services (HHS) has not responded to multiple requests for comment about the exposed test site, despite the fact that such test sites have been an issue since at least December 2013, as we reported at the time.


UPDATE: Shortly after this article was posted, the test site, akatest.healthcare.gov, disappeared. A few archives of the site were captured on the Internet Archive here.  However, HHS has still not responded to emailed requests for comment or explanation.

Note: A version of this post (before the update) first appeared at The Weekly Standard.

Healthcare.gov Down For 'Weekend' Scheduled Maintenance... On a Wednesday

    Healthcare.gov continues to prepare for open enrollment beginning on November 15, hoping to avoid a repeat of the disastrous launch in 2013. Apparently the preparations include extra "scheduled" maintenance. Wednesday morning, the site displays a message reading "The system isn’t available right now. We’re performing scheduled maintenance. Learn more." The message was posted on the site some time Tuesday evening:

    The notice links to a September 25 blog entry that explains, "We’re doing maintenance and upgrades to improve the site during certain time periods over the next few weekends."

    Attempts to log in are met with this screen:

    There was no reason given as to why the "scheduled maintenance" was taking place during the week rather than on weekends as planned. An email to the Department of Health and Human Services seeking an explanation has not been returned.


Note: A version of this post first appeared at The Weekly Standard.

Healthcare.gov to Returning Obamacare Customers: 'We’ll TRY To Enroll You Automatically'

    People who signed up for health insurance through Healthcare.gov in 2013 might have deja vu this November. New information posted on the website indicates that everyone, new or returning customers, choosing a new plan or sticking with the current one, must complete five steps to get or maintain coverage for 2015. A new blog post on the site says:

To stay covered through the Marketplace for 2015, you’ll need to follow 5 Steps during Open Enrollment...You’ll need to complete all 5 Steps to staying covered in the Health Insurance Marketplace (PDF) to finish enrolling in a health plan, even if you want to stay in the same plan.

Returning customers will have one month (November 15 to December 15) to continue coverage beginning January 1, 2015. The five steps are:

1. Review your current plan’s 2015 health coverage and costs.
2. Update your Marketplace application, starting November 15.
3. Compare the health plans available to you in 2015.
4. Choose the plan that best meets your needs.
5. Enroll in the health plan you want for 2015 coverage, by December 15, 2014.

What happens if a customer does not finished all five steps by December? A flyer produced by Healthcare.gov says, " If you don’t finish all of the steps by December 15, we’ll try to enroll you automatically so you stay covered.  But this coverage might not be your best option for 2015 and you could miss out on cost savings."

    The flyer does not explain exactly what will happen if Healthcare.gov "tries" and fails, or which steps, if left incomplete, will prevent the automatic enrollment from succeeding.

Feds: Cost of Healthcare.gov Estimated $1.7 Billion

    The federal government issued sixty contracts from 2009 to 2014 in efforts to build the federal insurance marketplace. According to a report issued today by the inspector general (OIG) of the Department of Health and Human Services (HHS), the government had already paid out just under half a billion dollars by February 2014, five months after the beginning of open enrollment. The government is already under obligation for another $300 million, and the estimated value of the sixty contracts totals $1.7 billion. The OIG provided a summary of its findings:

The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.

    A few familiar names appear on the list of contracts, such as Northrop Grumman and Lockheed Martin. Also appearing are CGI Federal, widely blamed for the botched roll out of the site last October, and Accenture Federal Services, which has taken over for CGI in hopes this year's open enrollment will go better than 2013.
    The inspector general presented the report on the contracts largely with commentary, instead noting that "[i]n the coming months, OIG will be issuing additional, indepth audits and evaluations that look more closely at contracting for the Federal Marketplace and will include, when appropriate, recommendations to resolve vulnerabilities we identify and/or build on promising approaches."


Note: A version of this post first appeared at The Weekly Standard.

The Latest From Healthcare.gov: Nonsense -- Literally

    Healthcare.gov has had its share of problems over the ten months since its launch, but those looking for information about appealing a Marketplace decision are facing a brand new one: nonsense -- literally. The inquiry How to Appeal a Marketplace Decision is answered with, "Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec egestas rhoncus orci, at lobortis justo tempor a." The full page appears as follows:

    The page can be seen by selecting the "Get Answers" menu from the home page of Healthcare.gov and choosing "How to appeal a Marketplace decision." Selection of the submenu items on the left return the same result.
    Appeal information is not the only page with the nonsense text. Why Health Coverage is Important brings up an identical result, as does Immigrants.
    Other problems exist on the site as well. A search for "appeal" reveals the following:

    According to the website lipsum.com, the nonsense text is "simply dummy text of the printing and typesetting industry." In other words, the text is simply a placeholder until the permanent information is entered.

    An email to CMS requesting comment was not immediately returned.

Note: A version of this post first appeared at The Weekly Standard.

"You Can Ignore the Facts; You Can’t Deny the Facts"

    Facts, White House Style:

FACTS - 2014

FACTS - 2009

    One can't help but wonder if the climate change "facts" as as stubborn as the health care "facts."

White House: Obamacare Made This Mother's Day "Particularly Special"

    Rahm Emanuel famously declared early in the Obama administration that "you never want a serious crisis to go to waste." Apparently the White House feels the same about holidays.  On Sunday, a blog post appeared on the official White House website entitled "Happy Mother's Day, from the ACA":

This Mother's Day is particularly special for millions of families this year. 

More than 8 million Americans have signed up for coverage through HealthCare.gov. And for families across America, that's making a difference – providing peace of mind for parents and kids alike.

    After several examples of children and mothers who benefited from coverage under the Affordable Care Act, readers are invited to click on a link to answer the question, "What has getting covered meant for your family this Mother's Day?"


Note: A version of this post first appeared at The Weekly Standard.

HHS Spokesperson: "No One Likes to Watch the Daily Show Make Fun of HHS"

    In October 2013, as the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS), was launching Healthcare.gov, CMS also launched a quieter initiative. As part of Ignite, an internal HHS program designed to spur innovation, a team within CMS's press office designed a system to help CMS communicate more quickly and efficiently with the press. The team envisioned that such a system, if functioning well, could also improve CMS's portrayal in the media.  As project leader Emma Sandoe, CMS's Medicaid spokesperson, put it in her presentation of the team's report to other CMS employees, "no one likes to watch the Daily Show make fun of HHS and our job here in the press office is to make sure that doesn't happen as often as it sometimes does[.]"
    The CMS team called their project the Coordinated Press Response Strategy.  In her presentation, Sandoe noted the irony of the project's launch coinciding with that of Healthcare.gov: "We launched this tool in the month of October, which - you may have heard [laughter] we also launched a little website, Healthcare.gov..."
    Ms. Sandoe further said that her team hoped to "develop a coordinated press response strategy in order to get better media and diffuse more media bombs."  "Media bombs" referred back to the beginning of Sandoe's presentation when she likened the atmosphere in a government press office to an episode of the TV terrorism drama "24."  The "ticking time bombs" are reporters' deadlines that the press office is hoping to defuse, but whereas Jack Bauer only had one bomb at a time to worry about, a press office may have dozens.  Sandoe's audience seemed to appreciate the anaolgy.
    The system Sandoe and her team developed was intended to be a "memory vault" to remind press officers what statements they had already made and what cleared information had already been released.  The system was designed not only for official press statements, but a variety of off the record and background information, as well. According to Sandoe, the ease of access to information allowed the CMS press office to cut its average response time on press inquiries from 49 hours to 22.5 hours while the project was in operation.  Sandoe expressed the desire to expand the tool beyond CMS to the press offices of all departments of HHS.
    In addition to improving the response time for inquiries, Sandoe also hoped the project would improve relations with the press and perhaps result in more favorable coverage for her agency.  In Sandoe's words, "if a reporter likes you and the reporter likes working with you, they will write better stories about you; so we're working to improve the stories that are written about HHS."  She later added, "[T]he worst words that you can see in the newspaper as a press officer is 'CMS did not comment.'"
    The Project Summary for the Coordinated Press Response Strategy presented the results in terms of "Time (hours) spent between report inquiry and official response to the inquiry" and "Attitudes of the press officers (via survey)":

The team saw a 52% decrease in the response time for reporter inquiries and a generally positive view from staff of the design. In order to continue the testing and implementation, CMS would like to see increased utilization throughout the department achieved through greater exploration of this workflow model with communications specialists across HHS that are working directly with media.

    To seek clarification and further explanation of the details of the project, THE WEEKLY STANDARD contacted the CMS press office, the Media Relations Group, via email and inquired about what percentage of inquiries CMS responds to and what percentage go unanswered, does CMS prioritize which news outlets will be responded to first, and does CMS usually only respond to 'mainstream' news outlets, or also to less traditional outlets, such as bloggers.  About nine hours later, CMS responded, but with just a single line: "This was an internal project initiated by staff to test a way to improve our operating procedures and increase efficiency within the office."
    A follow up email was sent to CMS: "I assume from your reply that CMS is not prepared to share any further details about the project or whether the system is still being used within CMS’s press office?"
    Shortly thereafter, CMS replied again, this time with but a single word: "Correct."


Note: A version of this post first appeared at The Weekly Standard.

Under Obamacare, HHS Begins Fingerprinting "High Risk" Medicare Providers and Suppliers

    Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks.  Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as "high risk" will be subject to the requirement.  The provision is part of the Medicare, Medicaid, and CHIP Program Integrity Provisions (Title E) of the Affordable Care Act, and gives the HHS secretary broad discretion in applying the background check requirements depending on the potential for abuse, fraud and/or waste.

    The new requirements are spelled out in a document posted online on the website of the Centers for Medicare and Medicaid Services (CMS) last Friday.  The new rules will apply to both current and future enrollees who are classified as "high risk," the stated purpose being to weed out "bad actors" in the Medicare program and prevent any more from enrolling.

    This particular document is a "News Flash" from CMS's Medicare Learning Network and is addressed to suppliers and providers who submit claims for "Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Home Health and Hospice (HH&H) MACs for services provided to Medicare beneficiaries."  There is no effective date or implementation date listed on the document; rather, the document states that "fingerprint-based background check implementation will be phased in beginning in 2014," and that those affected will receive letters after which the individuals will have thirty days to comply with the finger-printing requirement.  The fingerprints will be submitted to the FBI for a background check and will be stored by the government in accordance with federal requirements and FBI guidelines.

    Although initially the new regulations will only be applied to providers and suppliers of "Durable Medicare Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers or Home Health Agencies (HHA)," the "high risk" category is defined at the discretion of the HHS secretary and may be expanded in the future.


Note: A version of this post first appeared at The Weekly Standard.

White House Retweet: 'Kathleen Sebelius Is Resigning Because Obamacare Has Won'

    The first official word from the Obama administration on Kathleen Sebelius's resignation as secretary of health and human services is a retweet by the official White House Twitter account of a tweet by Vox.com's Ezra Klein:

    After news broke yesterday of Sebelius's imminent departure, Klein quickly posted an article entitled "Kathleen Sebelius is resigning because Obamacare has won."  The article was largely met with derision on the right, and even mainstream news reporting called into question the victorious characterization of Sebelius's exit.
    The president is set to speak at eleven o'clock Friday morning and is expected to announce that Sylvia Mathews Burwell, currently director of the Office of Management and Budget, will take Sebelius's place.


Note: A version of this post first appeared at The Weekly Standard.  Some nice coverage at Memeorandum, too.

HHS Spending $800K on Studies to Help Family Planning Clinics Survive Obamacare

    Despite the Obama administration's insistence that everyone -- the government, insurance companies, doctors, medical providers, and consumers -- will reap benefits from Obamacare, a recent grant proposal by the Department of Health and Human Services (HHS) suggests that the agency does have concerns about the ongoing financial viability of one player in the health care market: so-called family planning centers.
    HHS intends to spend up to $800,000 to fund studies to "conduct data analysis and related research and evaluation on the impact of the Affordable Care Act (ACA) on Title X funded family planning centers." At least part of the concern centers on the ACA's provision that allows those 26 and under to stay on their parents' insurance, and how confidentiality considerations may impact the ability of Title X centers to cover their costs.
    The Title X program, which began in 1970 as part of the Public Service Health Act, is "the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services."  Included are contraceptives, breast and cervical cancer screening, pregnancy testing, screening/treatment for sexually transmitted infections (STIs), and HIV testing. Although Title X funds may not be used for abortion, many Title X centers provide abortions using funds from other sources. For instance, Planned Parenthood clinics perform over 300,000 abortions each year, and that organization is the only Title X provider actually listed by name on HHS's Title X website home page:

Services are provided through state, county, and local health departments; community health centers; Planned Parenthood centers; and hospital-based, school-based, faith-based, other private nonprofits.

     The studies that HHS's Orwellian-sounding Office of Population Affairs is soliciting fall into two categories.  The first seeks to assess the national impact, primarily financial, of Obamacare on Title X centers.  The second seeks a qualitative analysis on the impact of the Title X centers providing confidential services. Preserving confidentiality for Title X clients can hurt the centers' ability to be reimbursed for services due to the reporting requirements of state laws and regulations, as well as insurance company rules.  HHS is hoping to acquire case studies on how various Title X centers have managed to overcome this obstacle in order to share those techniques and strategies with other Title X providers.
    The financial concerns of family planning centers center on two areas.  First, HHS has been fielding complaints from family planning centers about "significant challenges" they are facing "negotiating adequate payment terms" with Marketplace private health plans.  On top of this are "continuing challenges" with Medicaid's "varying reimbursement policies around onsite dispensing of contraceptives and education and counseling[.]"  Mandated free contraceptives has been one of the highest profile and most controversial parts of Obamacare, but ironically that increased availability may end up financially harming the very family planning centers that are a significant provider of those contraceptives -- particularly to low income clients.
    The second category of studies looks for ways to mitigate the impacts of confidentiality requirements on family planning centers that can hamstring efforts to secure reimbursements, a problem that Obamacare will only exacerbate.  Since Obamacare aims to increase use of private insurance through the marketplaces, family planning centers will likely see an increase in difficulties obtaining reimbursements without the Explanations of Benefits (EOB) required by insurers.  Since claims details are available to the policy holders, clinics are often not able to file claims for family members wishing to keep their treatment at a family planning clinic private from a spouse or a parent.
    HHS says that "[f]ifty percent of family planning clients are under the age of 25," and under Obamacare, millions of young adults ages 19-25 are now able to remain on their parents' policies.  But along with that coverage comes a lack of privacy for those young adults who may not want their parents to know of their contraceptive use, HIV testing, or treatment for STIs.  HHS says that in "the long term, this practice [of not billing to maintain confidentiality] may result in unsustainable revenue losses for Title X centers."
    To help family planning centers, HHS would like these studies to find ways the clinics can deliver "services confidentially while being able to bill insurance for the visit," which would likely require suppression of EOBs and claims history:

Title X centers regularly forego billing for clients that request confidential services. They are generally unable to negotiate EOB and claims history suppression with issuers because of State laws and regulations. OPA [Office of Population Affairs] is requesting case studies and other qualitative data to identify mechanisms where Title X providers have successfully provided services confidentially while being able to bill insurance for the visit. The specific regulatory issues are not well understood and potential solutions have not been identified.

    HHS is also looking for these studies to provide the following:

• An analysis of statutes, regulations, or other policies (such as issuer or provider policies) across the U.S. that affect the ability of Title X providers to bill insurance when services are requested confidentially. Such an analysis should discuss both challenges as well as potential policies that could serve as best practices. 
• An analysis of successful business practices (such as contract negotiations) or issuer policies, business practices or other mechanisms that have resulted in the ability of centers to successfully bill insurance while maintaining client confidentiality. 
• If “best practices” are located as part of the study, provide an evaluation of the impact to the Title X center’s revenue as a result of the practice. 
• Based on the findings of the initial case studies, an intervention to test whether solutions (or “best practices”) can be implemented at other centers and an evaluation of such implementation in terms of the impact to revenue. Applicants should propose a methodology for an intervention.

    Grant applications from public or non-profit private entities interested in doing the studies are due by April 24, 2014.  Awards will be from $250,000 to $400,000 per year, and may be approved for a project extending up to three years, depending on the availability of grant funds in future years.


Note: A version of this article first appeared at The Weekly Standard.