From The Heritage Foundation:
Pretty soon, under Obamacare, the interests of patients are going to be subordinated to the interests of the state, explains Jeffrey Singer (Reason, March 15):
[H]ospitals, clinics, and health care providers have been given incentives to organize into teams that will get assigned groups of 5,000 or more Medicare patients. They will be expected to follow practice guidelines and protocols approved by Medicare. If they achieve certain goals established by Medicare with respect to cost, length of hospital stay, re-admissions, or other “core measures,” they will get to share a portion of Medicare’s savings. If the reverse happens, they will face economic penalties.Private insurance companies are currently setting up the non-Medicare version of the ACO. These will be sold in the federally subsidized exchanges mandated by the Affordable Care Act. In this model, there are no fee-for-service payments to providers. Instead, an ACO is given a lump sum, or “bundled” payment for the entire care for a large group of insurance beneficiaries. The ACOs are expected to follow the same Medicare-approved practice protocols, but all of the financial risks are assumed by the ACOs. If the ACOs keep costs down, the team of providers and hospitals reap the financial reward: a surplus from the lump sum payment. If they lose money, the providers and hospitals eat the loss.In both the Medicare and non-Medicare varieties of the ACO, cost control and compliance with centrally-planned practice guidelines are the primary goal. The hospital and provider networks will live or die by these objectives. […]In a few years, almost all doctors will be employees of hospitals and will be ordered to practice medicine according to federally prescribed guidelines—guidelines that put the best interests of the state ahead of the interests of individual patients.
In Indiana, health insurance premiums are going to go up drastically after Obamacare’s rules on private insurance markets kick in, according to an analysis produced for the state by Milliman. Under the new rules, insurers can no longer set premiums according to individual health risk. That means the healthy, who are typically younger, will have to pay more. Also driving up premiums is the government’s mandate that everyone buy insurance, a mandate that entails a benefits package larger than most insureds would buy on their own, per HHS diktat. Some of the results of Milliman’s analysis, as summarized by Grace-Marie Turner (National Review Online’s Condition Critical blog, March 21, 2012):
• By eliminating rating on health status, the ACA brings the highest risk to the general marketplace resulting in premium increases of 35 percent to 45 percent.• The essential-health-benefit requirements will represent a benefit expansion for the individual market, forcing Hoosiers to buy coverage they may not want or need. This will increase premium rates by 20 percent to 30 percent.• The increases in premiums are not equally distributed. On average, individual-market premiums will increase by 75 percent to 95 percent. However, these increases will be greatest for young healthy males due to the fact that the ACA eliminates premium rating based on gender and health status, and restricts premium rating based on age.• Young healthy males at 250 percent of the federal poverty level (FPL), or $28,000 a year, can expect to experience almost a 100 percent premium increase even after the application of the premium tax credit. Young healthy males at higher income levels — 400 percent of the FPL and above, or about $45,000 a year — can expect to realize premium increases over 250 percent in 2014.