Editorial: Nevada should impose work requirement for Medicaid enrollees

Even though Congress could not find a way to repeal the budget-busting, economy-distorting Affordable Care Act, affectionately known as ObamaCare, there are still a few things the states can do to ameliorate its impact.

Chief among these, according to a report prepared for the Nevada Policy Research Institute and the Washington Policy Center by Dr. Roger Stark, is to implement work requirements for able-bodied Medicaid enrollees. The Trump administration announced recently that it is willing to accept waiver requests — known as 1115A waivers — from states that wish to impose a work requirement.

“Applying for a waiver to implement work requirements is a common-sense reform, and it’s one that’s already supported by the administration,” says NPRI policy analyst Daniel Honchariw. “Medicaid should help its able-bodied members who are willing to work, rather than encouraging an unsustainable and demoralizing cycle of dependency.”

Honchariw notes that 60 percent of the Nevadans who gained free Medicaid coverage under ObamaCare’s expansion of the program — approved by Republican Gov. Brian Sandoval, by the way — did not earn a penny of income in all of 2015. Expanded Medicaid now covers 600,000 Nevadans at annual cost of about $5,700 each.

“Such costs are unsustainable over the long-run without dramatic tax increases,” Honchariw states.

According to Dr. Stark, ObamaCare has resulted in only 20 million of the 50 million uninsured people before the law was passed — without a single Republican vote, by the way — to gain health insurance coverage. A large portion of those were handed Medicaid. In Washington state, 80 percent of the newly insured were placed on Medicaid.

“Obamacare has raised insurance premiums for virtually everyone in the country outside of the free Medicaid entitlement. Health care spending was 17 percent of the economy when the ACA became law,” Stark writes. “By 2021, with the ACA in place, estimates show that the country will spend 21 percent of the annual economy on health care.”

He said this past year the cost of Medicaid was $545 billion nationally and is projected to grow to $700 billion by 2020.

Studies have found that the health outcomes for people covered by Medicaid are no better than the uninsured.

We encourage Nevada’s lawmakers to take advantage of the work-requirement waiver and other options to curb the cost to taxpayers and break the cycle of dependency such entitlements foster. —TM

 A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.
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Taking the ‘affordable’ out of ObamaCare

Affordable Care Act? Only if someone else is paying the premiums.

According to an AP news account, middle-class Americans who get no subsidies under ObamaCare are going to get hammered again in 2018 with double-digit health insurance premium increases.

The report quotes one woman from Delaware whose monthly premiums are expected to increase from $740 to $1,000, and that’s for insurance with a $6,000 deductible.

 

The average 2018 premium hike is 25 percent for a midlevel plan on HealthCare.gov.

In Nevada, Health Plan of Nevada has proposed a 27.24 percent average rate increase for 2018, ranging from 19 percent to 36 percent, depending on the plan. Anthem had proposed increasing rates by 62 percent before it dropped out of coverage in the state altogether.

Silver Summit is to fill the void left by Anthem, but since the company was not previously in Nevada there is rate increase information.

In 2017 the average premium in the Nevada health insurance exchange was $379 a month, but 83 percent of those are getting subsidies that reduce their out-of-pocket premiums to $142 a month. But someone is paying the $237 difference every month and will pickup some portion of the 2018 premium increase.

We wonder who that will be?

 

 

Editorial: Congress needs to delay or repeal health insurance tax

You might not have said anything when they announced that ObamaCare-compliant health insurance premiums are going up nearly 40 percent next year, because you get your insurance elsewhere.

You might not have said anything when they announced there will be no ObamaCare-compliant health insurance policies available in 14 Nevada counties, because you get your insurance elsewhere.

You may have just shrugged about the tax on so-called Cadillac health insurance, because that is not your insurance.

You may not have spoken out when Congress failed to pass the “skinny repeal” that would have dropped the penalties for those who don’t buy health insurance, including 90,000 Nevadans, because you have health insurance.

Now they are coming for you.

If Congress fails to act soon, everyone who pays for health insurance will get hammered with a new tax in 2018. In 2015 Congress declared a one-year moratorium on the ObamaCare provision that imposes a health insurance tax of almost 3 percent — dubbed appropriately enough with the acronym HIT — in 2017, but that expires at the end of the year.

In 2016 the HIT tax cost insured Americans $11.3 billion, but that is to increase by 26 percent if reimposed in 2018.

If not delayed or repealed, HIT is expected to tap American wallets for $14.3 billion next year, and the hardest hit will be average Americans. One analysis of the tax estimates that fully half the tax will be paid by those earning between $10,000 and $50,000 a year.

A study by Oliver Wyman broke down the cost by state and found that in Nevada those with small group family insurance would pay $453 in HIT tax. Those with large group family policies would pay $519. Even Medicare Advantage users would have to pony up an additional $271, and Medicaid users would also be hit with $120 in taxes.

Grover Norquist, president of Americans for Tax Reform, has noted, “The health insurance tax directly impacts as many as 1.7 million small businesses, 11 million households that purchase through the individual insurance market, and 23 million households covered through their jobs. The National Federation of Independent Business estimates the tax could cost up to 286,000 in new jobs and cost small businesses $33 billion in lost sales by 2023.”

This is in addition to a tax on employer provided care, a tax on innovative medicines and treatments, a tax for failing to buy insurance, a tax on medical devices and taxes on health savings accounts, Norquist says.

“The trillion dollars in higher taxes have restricted health care choice, increased costs, made saving more difficult, and granted government more control over care at the expense of individual control,” the tax reform guru argues. “The passage of these taxes also broke President Obama’s promise not to increase any form of tax on any middle class family.”

Additionally, the higher cost is expected to result in people dropping their health insurance, resulting in an increase in the uninsured.

President Obama promised that his healthcare law would decrease premiums by $2,500 a year. Instead, it increased premiums by nearly $5,000. Still Congress has not been able to repeal it.

So, the very least Congress can do is repeal or delay the costly tax on health insurance premiums. And we do mean the least.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

Thanks for your lack of support, here take some money

This is what happens when the right hand doesn’t care what the left hand is doing after being stabbed in the back — to mangle a metaphor.

This past month Anthem Inc. announced it would stop selling ObamaCare-compliant health insurance plans in all but three Nevada counties. The decision left no company willing to sell ObamaCare policies in any counties except Clark, Nye and Washoe.

Gov. Brian Sandoval called the action devastating and unfortunate. His statement at the time read: “My administration is working diligently to identify solutions to ensure there is, at the very least, a safety net available to rural Nevada residents who will be left without any options for coverage in the wake of these devastating and unfortunate decisions. The reduced footprint of carriers on the exchange will leave more than 8,000 Nevadans with no coverage, and that is unacceptable.”

Heather Korbulic, the state’s health exchange director, called the situation a “health care crisis for rural Nevada.”

In pulling out of those 14 counties Anthem stated the “individual market remains volatile” and “planning and pricing for ACA (Affordable Care Act)-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market …”

This week the state repaid Anthem’s decision with a huge tax abatement package.

According to a press release from Las Vegas Global Economic Alliance, the Governor’s Office of Economic Development has decided to hand Anthem $831,000 in tax abatements in exchange for leasing a customer service office in Las Vegas and hiring as many as 400 workers — at an average wage of $21.52 an hour or 1 percent more than the minimum requirement — over the next two years. That’s more than $2,000 per job.

Did anyone consider trying to use a little leverage for the rural counties? Or are they better off without ObamaCare policies, since the price is climbing by double digits.

In 2016 Anthem paid its top executive more than $16 million. The company’s gross profits in 2016 exceeded $18 billion.

 

 

 

No ObamaCare premium increases in 14 Nevada counties due to central plannig

The bad news for those who live in Clark, Carson City and Nye counties is that companies offering ObamaCare-compliant health insurance policies have requested 38 percent premium increases. The good news for those in the rest of Nevada is that their ObamaCare premiums will not be going up because there are no companies offering such policies.

In pulling out of those counties Anthem stated the “individual market remains volatile.” The company said that “planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies.”

As F.A. Hayek warned:

This is, perhaps, also the point where I should briefly mention the fact that the sort of knowledge with which I have been concerned is knowledge of the kind which by its nature cannot enter into statistics and therefore cannot be conveyed to any central authority in statistical form. The statistics which such a central authority would have to use would have to be arrived at precisely by abstracting from minor differences between the things, by lumping together, as resources of one kind, items which differ as regards location, quality, and other particulars, in a way which may be very significant for the specific decision. It follows from this that central planning based on statistical information by its nature cannot take direct account of these circumstances of time and place and that the central planner will have to find some way or other in which the decisions depending on them can be left to the “man on the spot.”

Congress should slow the slide down ObamaCare’s slippery slope

Darn you, Charles Krauthammer. Why do you have to write what I was going to write just before I write and say it so much better than I ever would?

Take the lede on today’s column in the local newspaper, which is actually his Friday column in the Washington Post:

The Lord giveth and the Lord taketh away, but for governments it’s not that easy. Once something is given — say, health insurance coverage to 20 million Americans — you take it away at your peril. This is true for any government benefit, but especially for health care. There’s a reason not one Western democracy with some system of national health care has ever abolished it.

I’ve already protested that RyanCare contains too many of the market manipulating machinations of ObamaCare, lamented the efforts to make sure no one ever has any handout taken away.

But I’m getting hoarse from screaming at the TV and printed page over the reporting that millions will “lose” health insurance cover, when in reality many of those millions will be gladly “throwing” away that pathetic and nearly useless coverage due to sky high deductibles. (Never mind that the CBO estimates of the uninsured under RyanCare are probably just as inflated as its estimate of the newly insured under ObamaCare.) And just what were those able-bodied millions added to Medicaid doing before the Democrats charity?

But, as the astute Krauthammer notes:

There is no free lunch. GOP hard-liners must accept that Americans have become accustomed to some new health-care benefits, just as moderates have to brace themselves for stories about the inevitable losers in any reform. That’s the political price for fulfilling the seven-year promise of repealing and replacing Obamacare.

Retrenching is better than leaving ObamaCare in place and letting it evolve in the single payer system Obama and Harry Reid wanted to begin with.

Reid, asked on public radio a couple of years ago if the country will eventually work beyond private health insurance, Reid enthusiastically replied, “Yes. Absolutely, yes.”

He was later quoted by the Las Vegas Sun insert in a rare local article: “What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever. We had a real good run at the public option … don’t think we didn’t have a tremendous number of people who wanted a single-payer system,” but he could not get enough votes back then.

As Krauthammer points out, once that happens there will be no going back: “There’s a reason not one Western democracy with some system of national health care has ever abolished it.”

Nate Beeler, The Washington Examiner

When haggling over details, it is easy to forget what the rules are

When you are down in the scrum, butting heads and scrambling for the ball it is easy to forget the rules of the game or even what game you are playing.

Now, if it is wrong for Congress to mandate under pain of tax penalties that everyone buy insurance from privately owned and operated health insurance companies or through state or federally operated exchanges, isn’t it just as wrong for Congress to order those health insurers to charge a 30 percent premium penalty to those who let their insurance lapse?

The Commerce Clause has been stretched beyond any semblance of rationality when a person can be fined for growing grain to feed his own cattle because that disrupts interstate commerce, but health insurance is not commonly available across state lines.

Where does Congress derive the enumerated power to micromanage health insurance — whether via ObamaCare or RyanCare?

And why pray tell can you be given Medicaid — basically government insurance that dictates what allegedly private doctors and hospitals may charge for care no matter what it really costs — if your income is 138 percent of the poverty level, but you are on your own if you earn 139 percent of the poverty level?

Overturn the actuarial tables and whole concept of insurance when Congress dictates that those with pre-existing conditions and “children” to the age of 26 must be covered at the same rate as others. What is the difference between only allowing insurers to charge three times as much for older people than healthier younger people than only allowing them to charge five times as much.

Despite what you may have read in the morning paper, RyanCare does not repeal the tax on so-called Cadillac insurance plans. It merely delays it a couple of years.

When you are up to your arse in alligators it is hard to remember your objective was to drain the swamp.