PBMs

Most of the time “the three Rs” mean reading, writing, and arithmetic.  But for healthcare, what comes to mind are risk adjustment, reinsurance and risk corridors.  These are risk-sharing mechanisms for insurance companies in the Affordable Care Act (ACA), better known as Obamacare.  Taxpayers need to pay very close attention to the risk corridors because they are not functioning as planned due to the badly designed ACA.  Some politicians want to supplement the risk corridors with taxpayer dollars in order to bail out insurance companies.

While “irreconcilable differences” is a term often used in divorce proceedings, it might also describe the vast policy chasm on legislative proceedings between an extremely liberal President and an increasingly conservative Congress.  In that light, where all but the least controversial policies (think naming of post offices) face a veto threat, it is no wonder that the Republican majorities in both chambers have resigned themselves to getting few of their legislative priorities to the President’s desk, with little hope that he will agree to sing the bills into law.

The great umbrage against government waste, fraud, abuse, and mismanagement expressed by politicians during election cycles give taxpayers hope that something will be done when they get to the nation’s capital.  And there is no shortage of targets once they arrive on Capitol Hill.

In April, 2015 Citizens Against Government Waste examined Consumer Operated and Oriented Plans (CO-OPs), created under the Affordable Care Act (ACA) or Obamacare.  They were established as an alternative or compromise to placate several Democratic Senators who wanted to adopt a government-run, or single payer, option for healthcare reform.  The theory was that the nonprofit and member-owned CO-OPs would provide real competition to big healthcare insurance companies.  But like most provisions of Obamacare, they have not worked as intended.