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Author Topic: Is anyone troubled by the number of waivers given?
flydye
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quote:
A week after Republicans announced plans to investigate waivers granted to organizations for healthcare reform provisions, President Obama’s health department made public new waivers for more than more than 500 groups.

The Department of Health and Human Services (HHS) is granting temporary waivers to organizations that would not be able to meet the reform law’s new requirement for annual coverage limits.

As of last week, HHS had granted waivers to 222 organizations covering 1.5 million individuals. Though the number of groups receiving waivers has now more than tripled, the number of individuals covered by the waivers increased just 600,000 to 2.1 million.

The law gives HHS Secretary Kathleen Sebelius the flexibility to grant waivers to avoid disruption in the insurance market, but Republicans say the waivers are either gifts to Democratic allies or proof that the reform law isn’t working. However, a large number of businesses, in addition to unions, have received waivers.


The waivers have been granted to hundreds of so-called "mini-med" plans that offer limited health coverage to employees. The waivers are designed to preserve stability in the insurance market until new state-run insurance exchanges open in 2014.


Politically powerful businesses and unions get a pass. Never been too impressed with this law but damn! These optics suck.
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TomDavidson
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I'm not troubled by waivers at this stage of the game, especially since the law is still so much in flux; changing horses mid-stream doesn't make it any easier on businesses to comply. As I said the last time this issue came up, if we're continuing to issue a bunch of waivers three or four years after the law's stabilized, then we have a problem.
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G2
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Troubled? Sure. Surprised? Not in the least. It's called payback. This is SOP for socialist regimes, all part of the business model.

How about the fact that the SEIU will be dropping healthcare coverage for children, while also having been granted healthcare waivers. Anyone troubled by that? It's what nearly $30 million in campaign donation gets you.

Do you know how many waivers have been denied? No. They're not telling you who or why.

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G2
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quote:
Originally posted by TomDavidson:
I'm not troubled by waivers at this stage of the game, especially since the law is still so much in flux;

especially since the law is still so much in flux

Read that a few times kids. Think it through. What does it mean to have a law that takes over a large swath of the national economy, affects every single person, and that law is "in flux"?

I'll go ahead and tell you - this law means whatever they tell you it means. This law is simply made up as it goes. There is no real law here as any rational person traditionally understands law. This is a Humpty Dumpty law:

“When we create a law,” Democrats said, in a rather a scornful tone, “it means just what we choose it to mean—neither more nor less.”

“The question is,” said the people, “whether you can make laws mean so many different things.”

“The question is,” said Democrats, “which is to be master that’s all.”

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JWatts
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I think it's a little too early to judge the success of the current health care reform law by this metric. These are essentially minimal health insurance plans to start with.

However there is a very high proportion of local government and union groups in this list. Perhaps just an aspect of the kind of coverage these groups offer, but still troubling. It certainly looks like an attempt at political favorism to reliable Democratic voters.

List

And this entry is just completely ironic:
Kaiser Foundation Health Plan of Ohio

The Kaiser Foundation is a left wing pro-health care, pro-nationalized health care group, but they are apparently too cheap to offer their own employees full medical coverage. [Roll Eyes]

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TomDavidson
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quote:
What does it mean to have a law that takes over a large swath of the national economy, affects every single person, and that law is "in flux"?
Well, for one thing, it means that portions of the current Congress are actively trying to undo parts of it. If you're a business, and you're having to allocate resources to comply with the law, it is easier to apply for a waiver than bring yourself into compliance just before the law changes again due to a change of political leadership.
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Pyrtolin
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Representing less than 1% of the population, yeah, i'm a bit surprised at how few have been required so far.

500 companies might be significant if you were talking about one city or county, maybe even a very small state, but the whole country? That's barely more than statistical noise.

quote:
This law is simply made up as it goes
No, it means that things are changing because the law is in the process of being implemented and some support is required the see the process through since there's no magic wand that gets waved for a transition.

The only uncertainty here is whether the House will refuse to authorize the funds that were allocated to help see the process through and whether some states will completely drop the ball as far as setting up effective exchange or submitting innovation proposals to get their own waivers on complying with the general system.

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Pyrtolin
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quote:
Kaiser Foundation Health Plan of Ohio
You are confusing the Kaiser Family Foundation (a health advocacy group) with Kaiser Permanente (a health insurance system)
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G2
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quote:
Originally posted by Pyrtolin:
No, it means that things are changing because the law is in the process of being implemented and some support is required the see the process through since there's no magic wand that gets waved for a transition.

What law is being implemented with these waivers? Point out the section or paragraph that details the criteria for the waivers. Go ahead, give it a shot genius.
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JWatts
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quote:
Originally posted by Pyrtolin:
quote:
Kaiser Foundation Health Plan of Ohio
You are confusing the Kaiser Family Foundation (a health advocacy group) with Kaiser Permanente (a health insurance system)
No, not really, they are all interconnected groups.
quote:
Kaiser Foundation Health Plan of Ohio is a subsidiary of the Kaiser Foundation Health Plan

However, the Foundation is no longer affiliated with Kaiser Permanente or Kaiser Industries. So yes they are not one and the same group, but none-the-less, the situation is notable.
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Pyrtolin
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http://www.hhs.gov/ociio/regulations/patient/ociio_2010-1_20100903_508.pdf

That cites the relevant sections, lists the criteria, and details the waiver application process.

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Pyrtolin
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quote:
Originally posted by JWatts:
quote:
Originally posted by Pyrtolin:
quote:
Kaiser Foundation Health Plan of Ohio
You are confusing the Kaiser Family Foundation (a health advocacy group) with Kaiser Permanente (a health insurance system)
No, not really, they are all interconnected groups.
quote:
Kaiser Foundation Health Plan of Ohio is a subsidiary of the Kaiser Foundation Health Plan

However, the Foundation is no longer affiliated with Kaiser Permanente or Kaiser Industries. So yes they are not one and the same group, but none-the-less, the situation is notable.

They split apart in 1977 when Kaiser Industries was split up ten years after the founder had died. By 1985, the KFF had divested itself of all interest in Kaiser Permanente and Kaiser Industries. The KFF did not reorganize itself as an advocacy group until 1990.

So the fact that the Kaiser Foundation Health Plan (notice the lack of "Family" in there as well), which is part of Kaiser Permanente, got a waiver- (not surprising given that the KP health system is a top-to-bottom care system that falls somewhat outside of the norm so more information on the waiver would be needed to see if it amounts to anything more than "our book keeping doesn't work that way") has absolutely no bearing on the Kaiser Family Foundation, which makes grants and acts as a Health Care advocacy group, but doesn't sell insurance to anyone.

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G2
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quote:
Originally posted by Pyrtolin:
http://www.hhs.gov/ociio/regulations/patient/ociio_2010-1_20100903_508.pdf

That cites the relevant sections, lists the criteria, and details the waiver application process.

That's a memo saying how they're gonna do it as of 9/2010, they can change that anytime they want.

So you're thinking memos are laws now? Ol' Steve at HHS just fires off a memo, and creates the laws. Yep, just like I said.

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flydye
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quote:
Originally posted by TomDavidson:
quote:
What does it mean to have a law that takes over a large swath of the national economy, affects every single person, and that law is "in flux"?
Well, for one thing, it means that portions of the current Congress are actively trying to undo parts of it. If you're a business, and you're having to allocate resources to comply with the law, it is easier to apply for a waiver than bring yourself into compliance just before the law changes again due to a change of political leadership.
And for all the many waivers given out BEFORE the last November elections?
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TomDavidson
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I was, of course, addressing the question of why the handing out of waivers has apparently accelerated. You can track down the initial thread on this topic for my explanation of why a few hundred waivers in a situation like this are perfectly understandable and do not constitute a problem.
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Pyrtolin
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quote:
Originally posted by G2:
quote:
Originally posted by Pyrtolin:
http://www.hhs.gov/ociio/regulations/patient/ociio_2010-1_20100903_508.pdf

That cites the relevant sections, lists the criteria, and details the waiver application process.

That's a memo saying how they're gonna do it as of 9/2010, they can change that anytime they want.

So you're thinking memos are laws now? Ol' Steve at HHS just fires off a memo, and creates the laws. Yep, just like I said.

The memo does not create the regulation, it explains the details of the regulation as established by HHS, the regulatory authority that the law empowered with setting the particulars

Imagine that- a regulator agency that actually has the authority to properly regulate things within its scope. And not only that, it can do so on an intelligent basis so that individual needs can be taken into account rather than trying to shoehorn everyone into an arbitrary, one-size-fits-all mold that can't possibly account for all situations. Total madness there.

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G2
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quote:
Originally posted by Pyrtolin:
The memo does not create the regulation, it explains the details of the regulation as established by HHS, the regulatory authority that the law empowered with setting the particulars

Nice doublespeak. It doesn't create the regulations, it just creates the regulation details. Those details are now "law". Those details can change any time HHS wants them to.

quote:
Originally posted by Pyrtolin:
Imagine that- a regulator agency that actually has the authority to properly regulate things within its scope. And not only that, it can do so on an intelligent basis so that individual needs can be taken into account rather than trying to shoehorn everyone into an arbitrary, one-size-fits-all mold that can't possibly account for all situations. Total madness there.

This is what I'm saying, welcome to the reality. However, you're just not able to see the big picture are you? You have no idea why this would be bad? None? Are you on drugs?
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Funean
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Is there any reason you can't get through a post without some kind of obnoxious ad hominem, G2?

I'm glad for the other conservatives on this board who can mount a coherent argument or even just make a point without resorting to calling those with opposing viewpoints some variation of moron, traitor, or loon.

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Pyrtolin
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quote:
It doesn't create the regulations, it just creates the regulation details. Those details are now "law".
Law and regulation are not the same thing. The law grants the regulator the authority to regulate here, rather than trying to guess what the needed regulations would be and then making them counterproductive by inflexibly setting them in stone.

quote:
Those details can change any time HHS wants them to.
I can take my pants of any time I want to as well. Doesn't mean I'm going to do it on the bus. A traffic cop who is manually running a light can change it however he wants to, that doesn't mean that he's likely to start flashing it randomly. Your vague FUD based argument there is meaningless. And really, it's not accurate to imply that they can change at the drop of the hat; they can change any time HHS goes through its established procedures for updating regulations.
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JWatts
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In a further update to health care waivers:

quote:
Of the 204 new Obamacare waivers President Barack Obama’s administration approved in April, 38 are for fancy eateries, hip nightclubs and decadent hotels in House Minority Leader Nancy Pelosi’s Northern California district.

Regardless of who obtains the waivers, such a high number (19%) going to 1 congressional district is absurd. That district represents about 0.25% of the countries population, so it is obtaining a very large political win fall.

Furthermore, the businesses getting the waivers aren't businesses that can't afford to actually provide decent insurance to their staff.

This whole waiver process is nothing more than a political pay-off scam with Democratic districts and Union backed shops getting a disproportional share of the goods.


quote:
But Pelosi’s district’s waivers are the first major examples of luxurious, gourmet restaurants and hotels getting a year-long pass from Obamacare.

For instance, Boboquivari’s restaurant in Pelosi’s district in San Francisco got a waiver from Obamacare. Boboquivari’s advertises $59 porterhouse steaks, $39 filet mignons and $35 crab dinners.

Then, there’s Café des Amis, which describes its eating experience as “a timeless Parisian style brasserie” which is “located on one of San Francisco’s premier shopping and strolling boulevards, Union Street,” according to the restaurant’s Web site.

“Bacchus Management Group, in partnership with Perry Butler, is bringing you that same warm, inviting feeling, with a distinctive San Francisco spin,” the Web site reads. Somehow, though, the San Francisco upper class eatery earned itself a waiver from Obamacare because it apparently cost them too much to meet the law’s first year requirements.

Link

I can just imagine the outcry if John Boehner's district had obtained waivers in this number.

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Pyrtolin
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If you want to complain about allocation, can you at least provide as a baseline the application and denial statistics? Is the rate at which they were granted out of proportion to the rate at which they were applied for?

Also what actual evidence to you have to back up your speculations about the financial states of those companies? What are the details of their current plans, for that matter? The issue could be something as simple as being in the middle of a contract term that prevents them from making unilateral changes, and thus needing a waiver until they can renegotiate the current contract or let it run out and put more conforming terms in the next one.

It doesn't seem very surprising, for example, that a batch of applications from one business type in a given area would come in at about the same time, given that they likely have a trade association of some sort that would have presented resources for making the applications to all of them at the same time.

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G2
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quote:
Originally posted by Pyrtolin:
If you want to complain about allocation, can you at least provide as a baseline the application and denial statistics? Is the rate at which they were granted out of proportion to the rate at which they were applied for?

Those statistics, like the criteria for getting a waiver, are not published.
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Pyrtolin
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quote:
Originally posted by G2:
quote:
Originally posted by Pyrtolin:
If you want to complain about allocation, can you at least provide as a baseline the application and denial statistics? Is the rate at which they were granted out of proportion to the rate at which they were applied for?

Those statistics, like the criteria for getting a waiver, are not published.
I've linked at least once to the fully detailed criteria and application forms. HHS has it all up and easily accessible for anyone who bothers to look.
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JWatts
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Ok Pyr, can you give me a list of the companies that have been denied waivers or who have "pending" waivers.

A Republican group requested information regarding the waiver process with an FOIA request.

quote:
Re: Freedom of Information Act Request
January 7, 2011

Dear Mr. Eckert: Pursuant to the Freedom of Information Act ("FOIA"), 5 U.S.c. § 552, et. seq., as amended, we respectfully request the following documents from files maintained by the United States Department of Health and Human Services ("HHS"), including but not limited to files maintained by HHS's Office of Consumer Information and Insurance Oversight:

Any and all memoranda, guidance, directives, instructions and other documents -whether electronic or written and whether distributed internally or externally - relating to the criteria to be applied by HHS in deciding whether to grant or deny applications for waiver of the annual limit requirements of the Public Health Services Act (the "PHS Act") Section 2711.
Any and all memoranda, notes, letters and other documents - whether electronic or written and whether distributed internally or externally - relating to the approval, denial or consideration of applications for waiver of the annual limit requirements of PHS Act Section 2711 by an applicant with 1,000 or more enrollees, including but not limited to any letters submitted to HHS in support of or against waiver, such as any letters submitted by members of the United States Congress, state officials or local officials.

As required by FOIA, please provide redacted copies of documents if the document contains some information which is subject to a FOIA exemption. If any documents are fully withheld based on a FOIA exemption, please explain the basis of such full withholding.

We will assume financial responsibility for all necessary charges incurred, including costs of the search and duplication of files. Please contact me in advance at (202) 739-5617 if the cost will exceed $300.

Your prompt attention to this matter is appreciated. Please contact me as soon as possible at (202) 739-5617 if you are unable to fully process and respond to this request within the twenty (20) day response period provided for by the FOIA or if you have any questions related to this request. Although we believe our response is very narrowly targeted so that a full response can be provided in the 20-day response period, if some but not all of the requested documents cannot be provided in the 20-day response period, please provide a partial response with those documents that are available. Thank you in advance for your assistance.

Link

The Administration has failed to comply. Now the group is suing.

quote:
Crossroads GPS is suing the Obama Administration to for failure to comply with a Freedom of Information Act request. This request asked for materials relating to the approval and denial of waivers from Obamacare.

Link

The process is not transparent and your claims that it is are ridiculous. Posting the requirements on a web site doesn't tell us anything about which groups are being granted waivers and which groups are being delayed and/or denied.

If the process is as transparent as you say why has the Administration failed to grant the FOIA request.

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G2
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by G2:
quote:
Originally posted by Pyrtolin:
If you want to complain about allocation, can you at least provide as a baseline the application and denial statistics? Is the rate at which they were granted out of proportion to the rate at which they were applied for?

Those statistics, like the criteria for getting a waiver, are not published.
I've linked at least once to the fully detailed criteria and application forms. HHS has it all up and easily accessible for anyone who bothers to look.
No, you linked to a internal memo (only 3 pages long?!?) with what amounts to a very high level description that they will do waivers - not the criteria for them.

[ May 18, 2011, 12:36 PM: Message edited by: G2 ]

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Pyrtolin
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No, I linked to this page as well:

http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html

Which is trivially easy to find and has all of the information needed to apply and lays out what the companies need to demonstrate to be eligible.

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G2
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quote:
Originally posted by Pyrtolin:
No, I linked to this page as well:

http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html

Which is trivially easy to find and has all of the information needed to apply and lays out what the companies need to demonstrate to be eligible.

Hmm, that one is out of date and no longer updated. Since it is so "trivially easy" as you say, I did a little looking. There are now at least six separate lists with separate totals and that are updated, at most, bi-monthly as far as I can tell and are mostly out of synch with each other (updated at different times,). I quit looking after six separate sites but can only assume there are more or soon will be.

Since this is so "trivially easy", as you say, perhaps you can trivially quickly point us to the place(s) where we can with similar trivial ease determine who gets waivers and who doesn’t? What are the prerequisites for waivers? Which conditions would require approval, and which would require rejection? Who has been rejected and on what grounds?

It is not "trivially easy" to find this out and that's probably no accident.

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Pyrtolin
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http://cciio.hhs.gov/resources/regulations/index.html#alw

Has the documents it was the top link in a search for "waivers" on the new main site, and that's on my first visit there without any of the experience and resources that a health plan manager would have for getting such information. They list very clearly and concisely what needs to be submitted in an application for a waiver.

quote:
1. The terms of the plan or policy form(s) for which a waiver is sought;

2. The number of individuals covered by the plan or policy form(s) submitted;

3. The annual limit(s) and rates applicable to the plan or policy form(s) submitted;

4. A brief description of why compliance with the interim final regulations would result in a
significant decrease in access to benefits for those currently covered by such plans or
policies, or significant increase in premiums paid by those covered by such plans or
policies, along with any supporting documentation;

and
5. An attestation, signed by the plan administrator or Chief Executive Officer of the issuer
of the coverage, certifying 1) that the plan was in force prior to September 23, 2010; and
2) that the application of restricted annual limits to such plans or policies would result in
a significant decrease in access to benefits for those currently covered by such plans or
policies, or a significant increase in premiums paid by those covered by such plans or
policies.

As to the evidence needed to support the accusations of bias that you're making, that's your job to

[ May 18, 2011, 07:58 PM: Message edited by: Pyrtolin ]

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JWatts
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So basically, you can't give us a list of which companies waivers haven't been approved and for how long they've been waiting. [Wink]

Nor apparently can an FOIA request obtain the information either. Just blithely pointing to the submittal process doesn't tell us anything about what is actually happening.

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Pyrtolin
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Can't? It's more like I'm not going to bather spending the time to do your research for you. You're the one who wants to assert that there's something unfair about the process, so you're the one that needs to come up with evidence in the first place. Heck, even a bit of anecdotal evidence from a handful of companies that claim that they were unfairly denied a waiver wold be a good place to start.

Right now is seems that approved waivers are over 1300, while denied waivers are somewhere between 50-100 (one report that notes that 50 were denied, and a direct statement that the total is less than 100) so the overall approval rate is over 90%. That doesn't suggest much difficulty in getting the waivers or any overt partisan bias, unless conservative businesses only represent about 10% of the applicant pool.

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Wayward Son
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PoliFactCheck has weighed in on this, responding to an ad making an accusation that unions don't have to comply with Obamacare, while everyone else does.

A pertinent statement from the article:

quote:
We contacted the HHS and asked for the number of waivers they’ve granted so far. A spokeswoman told us that they have approved 1,372 applications and denied 92. Of the approved applications, 27 represent unions and another 315 represent plans jointly managed by unions and employers. Even if you took the broadest definition possible, counting all the joint plans as union plans, only 25 percent of the waivers have gone to unions. The rest have gone to plans offered by employers, insurance companies and other non-union groups.

To be clear, though, the waivers do not exempt these groups from the health care law. They only allow them to continue offering their current health plans with annual limits until 2014.


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JWatts
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Once again PolitiFact seems to be make a very flawed analysis. Hmmm, it almost seems intentional.

This statement in particular:

quote:
Even if you took the broadest definition possible, counting all the joint plans as union plans, only 25 percent of the waivers have gone to unions. The rest have gone to plans offered by employers, insurance companies and other non-union groups.
While technically true it seems deliberately misleading. It uses a count of the number of waivers vs the far more relevant number of enrollees. The plans under the union categories cover far more people on average.

Here is a better look at the enrollee numbers:
Self-Insured Employers (528) 446K
Health Reimbursement Arrangements (457) 116K
Multi-Employer Plans (315) [union] 970K
Non-Taft Hartley Union Plans (27) [union] 583K
Health Insurance Issuers (39) 873K
State-Mandated Policies (4) 96K
Association Plans (2) 12K

Total = 3,096K
Union total = 1,553K

Union percentage: 50%
Percentage of Americans in Unions: 11.9%

I have a hard time believing the experts at Politifact missed the fact that the union waivers covered on average far more people. To state the figures accurately, Union workers are over 4 times than non-union workers.

[ May 24, 2011, 10:57 AM: Message edited by: JWatts ]

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TomDavidson
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Why would the number of people covered be more relevant than the number of waivers granted?
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Pyrtolin
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Waivers are applied for at the plan level, not the individual level- the exact number of people wasn't missed, it's completely irrelevant, even if your clime is that those 97 rejected applications represented about 12 million non-union workers.

So far, all we've got here is that unions are a bit more likely, in proportion to other employers, to have mini-med plans and apply for exemptions for them, while over 95% of the workforce doesn't require any kind of waiver. There is certainly some natural application bias, but nothing to suggest procedural bias.

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JWatts
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Union workers are 421% more likely to be covered than non-union workers.

[ May 24, 2011, 11:37 AM: Message edited by: JWatts ]

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Pyrtolin
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quote:
Originally posted by JWatts:
Union workers are 421% more likely to be covered than non-union workers.

People who live on the beach are more likely to have sand in their shoes than people who live in a forest.

How much more likely is a union worker than a non union worker to have a mini-med plan that would need transitional coverage?

You're wandering off into complete irrelevance to the stated claims, which are that there are a large number of waivers being granted and that they're being granted based on political support.

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JWatts
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quote:
Originally posted by Pyrtolin:
You're wandering off into complete irrelevance to the stated claims, which are that there are a large number of waivers being granted and that they're being granted based on political support.

And a rate 421% greater than base line is evidence that the waivers are indeed granted on a political basis. Not conclusive evidence, but none the less a serious anomaly. Or evidence that the Unions helped craft the legislation and ensured that the results would favor their members.

It is emphatically not an irrelevant fact.

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Wayward Son
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quote:
It is emphatically not an irrelevant fact.
Once the reason for this fact is established.

For instance, it could be that these unionized workers typically have low-paying jobs, ones that would not qualify for health care in non-union situations. It could be that the only reason they have health insurance is because the unions demanded it. And, because they are low-paying jobs, the health insurance is the cheapest that could be found--the mininal kind.

So, these large unions have an unnatural number of members with minimal health insurance, precisely the type that the waivers are given for.

So while it may appear that there is favoritism toward the unions, it may simply be the nature of the situation.

Now, I don't know any of this for sure. But neither do we know that it is the result of favoritism. Until more facts are known, it cannot be inferred that these percentages mean one or the other.

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TomDavidson
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I think the takeaway is this: if you are a low-income employee, you are four times more likely to have some sort of health benefit if you are a member of a union.
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JWatts
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quote:
Originally posted by TomDavidson:
I think the takeaway is this: if you are a low-income employee, you are four times more likely to have some sort of health benefit if you are a member of a union.

Would you care to actually show some evidence of this? Or are you just going to throw out a completely unsupported assumption?
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