Is Obamacare Fraud or Incompetence?

Grouper

Expert
21
Florida
I emailed this to every Republican United States Senator this morning.
I think the significance of the administration's Obamacare actions in the past week are not getting the attention they should because the ramifications are not obvious.
They are eliminating the supposed funding and maintaining the expense and steering Obamacare towards the goal they want while jettisoning the ameliorating aspects that helped sell it.

We are on the cutting edge of the elimination or implementation of this fraud:


Is “Obamacare” the Biggest Scam of All Time, or is the Administration Incredibly Inept?

The Obama administration announced this past week (at 5 PM on the Friday after July 4th) that they have removed the key funding and anti-fraud measures from “Obamacare” aka The Patient Protection and Affordable Care Act;
-the employer mandate to provide health insurance or pay $2,000/ $3,000 per employee fines has been delayed for a year (and probably forever), and
-individuals in states that run their own health insurance exchanges, like democratic strongholds California and New York (and eventually probably all states), will not be required to show they don’t have affordable employer provided coverage or have their income verified before qualifying for huge premium subsidies.
The employer “fines” were a key part of Obama’s pledge that Obamacare WOULD NOT INCREASE THE FEDERAL DEFICIT when he sold it to congress and the senate. The safeguards that only the truly needy would be able to get the $10,000+ annual premium subsidies would protect the new system from fraud.

Now the administration says they are responding to pleas from the business community that the reporting provisions (benefits and employee cost) are too onerous to comply with and the administration will no longer require employers to report the cost and benefit of their health plans.
The provision that premium subsidies are only available to those that do not have access to “an adequate plan at an affordable cost” at work is gone. The new health insurance exchanges will accept the applicant’s statement that they don’t have affordable employer coverage available to them and won’t be able to verify this because the employer will not be required to report their benefits and costs as Obamacare originally required.
The administration also says they cannot implement the database to verify an individual’s income and resultant qualification for premium subsidies, a key anti-fraud provision of Obamacare.

They will accept the applicant’s “attestation” of their income when determining the level of subsidy and resultant net health insurance premium a participant pays!
A provision buried in the new law when it was passed in 2010 provides that incorrect subsidies that are received due to understated income, that are identified by future tax returns, can only be recovered by withholding from future tax refunds. No tax refund= no subsidy repayment!

It’s all laid out now for billions of dollars in health insurance subsidies, much of it fraudulently obtained, to be provided by deficit spending.
No one, democrat or republican, would have voted in favor of Obamacare in it’s present form.
What’s going to happen in the near future when the administration has to go to the senate and congress and request hundreds of billions of dollars to fund the Obamacare program that was supposed to require no funding?

It all leaves the question of whether:

1-the Obama administration knew all along that Obamacare could not be implemented as they sold it and that they always knew they would strip away the funding and safeguards at the last minute and leave the country with a huge new unfunded
entitlement program that was riddled with fraud, or

2- the Obama administration is incredibly inept and truly did not realize that Obamacare could never work as they proposed and sold it, and that it would become a huge new unfunded entitlement program that was riddled with fraud.
 
My .02 is that they had no clue what they were proposing because they have no clue how the US healthcare/insurance systems work. They thought it would work, and it sounded good in speeches, but they never considered how hard it would be to completely renovate a heavily regulated, centuries old industry that makes up 17% of our GDP.

Now the reality is setting in, and this thing is getting torn apart.

Nothing they proposed was impossible by itself. Accomplishing everything they proposed, in the time frame allotted, with the garbage guidance provided, just plain could never happen.
 
They will accept the applicant’s “attestation” of their income when determining the level of subsidy and resultant net health insurance premium a participant pays!

Don't lose any sleep over this item. I can tell you from working with people on medicaid, medicare subsidies, State Plan Assistance, etc. that they will be verifying income, and in some cases assets, before handing out any of "their money" (not tax payers). The money belongs to the government, we just live here.
 
My .02 is that they had no clue what they were proposing because they have no clue how the US healthcare/insurance systems work. They thought it would work, and it sounded good in speeches, but they never considered how hard it would be to completely renovate a heavily regulated, centuries old industry that makes up 17% of our GDP.

Now the reality is setting in, and this thing is getting torn apart.

Nothing they proposed was impossible by itself. Accomplishing everything they proposed, in the time frame allotted, with the garbage guidance provided, just plain could never happen.

17%?

What a shame. If this country doesn't have another resources to make money, lets bring them from sick people. Many years money was/are changing pockets, but wasn't growing. 17%? from internal barter.
 
I think the people that designed the plan understood most things because insurance companies know what has to be in order to run a block of business. Implementation with all various parties having different interests let negotiations turn good intent into a cluster ****.
 
To me neither. I have Crohn's and in May 2014 in Georgia started a business and did an SEP from small-group Humana POS to exchange POS from 2014-16, then starting this year went off-exchange with BCBS POS. The HIPAA Conversion health insurance I had from Celtic 2010-12 was fraud and incompetence. The individual coverage I've had post ACA has been at least every bit as good and rock solid (if not better) than any group coverage I've ever had in the workplace going back to the 1990s.
 
To me neither. I have Crohn's and in May 2014 in Georgia started a business and did an SEP from small-group Humana POS to exchange POS from 2014-16, then starting this year went off-exchange with BCBS POS. The HIPAA Conversion health insurance I had from Celtic 2010-12 was fraud and incompetence. The individual coverage I've had post ACA has been at least every bit as good and rock solid (if not better) than any group coverage I've ever had in the workplace going back to the 1990s.

Celtic has been problematic in the past. I haven't seen them in TN for years.

ACA problems are not with carrier claims administration. Problems are with the exchange, exchange properly processing enrollments, ACA premiums, premium increases and declining number of carriers etc. Once enrolled with a major carrier, claims are paid as normal. It is everything else that is screwed up. Also, agents are no longer paid and only help with ACA policies as a favor and do not have the normal agent/carrier authority where the agent can call on behalf of a client and fix a issue.

Being able for those that have pre-ex to buy coverage is the only thing that ACA fixed. I suppose the subsidy is helpful for those that qualify but premiums are high enough that even low income people have high deductibles. Statistically, 90% of people have claims under $5,000. This means that 90% of the people will have $0 paid from their HDHP.
 
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