Author Archive | John Barrett

California insurance chief criticizes exchange for cancellations

California Insurance Commissioner Dave Jones says the state health exchange “made a bad decision” by requiring its participating insurers to cancel coverage by Dec. 31 for hundreds of thousands of consumers. “I don’t think it was necessary,” Jones said in an interview. “I think people should be given the opportunity to stay in their current plans for another year.”

  • Tuesday, Jones discussed a settlement with Blue Shield of California that will buy some more time for about 80,000 policyholders whose policies are being terminated. The San Francisco insurer agreed to let those policyholders extend their current coverage until March 31 to resolve regulators’ claims it didn’t give customers ample warning about the changes.
  • “This is important because it will allow people with current plans more time to shop and it resolves a defect we discovered,” Jones said. But Blue Shield said the changing deadlines may confuse customers and lead some people to pay a deductible twice in one year after they enroll in a new plan for 2014.
  • The issue of cancellations for about 900,000 individual policyholders in California and several million nationwide has sparked intense criticism of President Obama’s healthcare law. In recent weeks, insurance companies across the country have notified policyholders that their existing coverage will expire because it doesn’t meet all the standards of the Affordable Care Act.
  • In previous interviews, Peter Lee, executive director of Covered California, has defended the exchange’s requirement for health plans to end current policies by Dec. 31. He says consumers will benefit in the long run from having more people in the larger risk pool, which will influence future rates.
  • Lee and others had worried about insurers cherry-picking their healthier customers and renewing them for another year through most of 2014, as permitted under the healthcare law.
  • Jones said he isn’t sure those fears were warranted. “I’m not convinced it would have been fatal to the risk pool,” said Jones, a Democrat who has strongly backed the implementation of the healthcare law. “The Dec. 31 cutoff for individual policies in California didn’t have to happen.”

*Modified from a LA Times article

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Anthem will be second Golden State insurer to delay Obamacare cancellations

Anthem Blue Cross is the second major health insurer to delay cancellations of individual coverage in the wake of controversy over Obamacare-related deadlines, Anthem officials confirmed to the San Francisco Business Times late Monday afternoon. But the delay will involve 104,000 people, not the 92,000 mentioned Monday afternoon by the California Department of Insurance in a media advisory of a press conference Tuesday morning.

  • The affected Anthem policyholders will now have until the end of February, rather than year-end, to switch to new policies that are consistent with — or, as the phrase du jour has it, “compliant with” — the requirements of the Affordable Care Act.
  • Overall, Anthem reportedly has 760,000 individual or family plan members in California, but many of them are not subject to regulation by the Department of Insurance. That includes so-called grandfathered plans — which can continue if they were in effect before the ACA became law — and non-grandfathered plans, which are the ones that are being required to change.
  • The Department of Insurance was able to step in and require the delay because Anthem inadvertently missed the Oct. 1 deadline to inform some policyholders of the need to move into different policies, due to what an Anthem spokesman said was a “mailing glitch.” The glitch caused a delay in notifying some policyholders before the deadline, 90 days before the changes took effect Jan. 1.
  • The move follows in the footsteps of a Blue Shield of California unit last week to delay the termination of coverage for 80,000 policyholders and 113,000 individuals, which led to a wave of controversy. Up to 1 million of the 1.8 million Golden State residents covered by individual or family plans may have to change health plans at year-end (or shortly thereafter, due to these delays).

 

  • As of January, all of Anthem’s exchange policies will be under the jurisdiction of the Department of Managed Health Care, not the Department of Insurance, which is taking advantage of a short window of opportunity to force Blue Shield and now Anthem to delay the policy cancellations, which some prefer to call “transitions,” since they involve moving from one type of coverage to another one that meets Obamacare requirements.

*Modified from a San Francisco Business Times article

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Blue Shield forced by state to delay its Obamacare cancellations

California Insurance Commissioner Dave Jones will announce Tuesday an agreement with a “major health insurance company” in California to delay by three months cancellation of more than 115,000 individual policies due to Affordable Care Act rules. UPDATE: On Tuesday morning, Blue Shield of California clarified that the 80,000 policies in question cover 113,000 people.

  • Blue Shield officials said Monday evening that the Department of Insurance had required them to take this step, on threat of a lawsuit compelling the insurer to delay the cancellations. The department declined official comment ahead of the insurance commissioner’s press conference.
  • The deal has the look and feel of a political retreat by Democratic officeholders worried about the recent outcry about cancelled individual policies. Technically, insurance regulators reached a deal with Blue Shield of California Life & Health Insurance Co., a subsidiary under DOI’s regulatory umbrella. The deal only affects non-grandfathered policyholders, and includes what Blue Shield described as “significant risks to policyholders,” including potentially facing two deductible limits in a single year.
  • The extensions can’t last more than three months, and must end March 31, Blue Shield said. Consumers need to be aware that taking advantage of the delay could come with downsides, including the possibility of being liable for two sets of deductibles and possibly missing out on tax credits and cost-sharing subsidies available only through the Covered California exchange.

Blue Shield noted in a statement to the Business Times that the three-month extension is likely to be most appealing to “healthy individuals who use few health care services,” and as a result could damage Covered California’s efforts to recruit as many healthy policyholders as possible to counteract the expected interest by older, sicker Californians in signing on. Without an influx of young, healthy policyholders, “average medical costs for people in the Exchange will be higher, which could result in premium increases in 2015 for everyone,” Blue Shield’s statement said.

Blue Shield has about 119,000 individual policyholders whose policies are being cancelled at year-end, although many of them have the option of moving into other Blue Shield plans, some of which are considerably more expensive.

Jones’ late Monday media advisory said that 115,000 policyholders “may keep lower priced, wider network policies through first quarter of 2014,” potentially the first hole in the dike, given many consumers’ unhappiness about the cancellation of individual plans they thought President Barack Obama had promised not to take from them.

As many as 1 million individual and family plan enrollees in California may face cancellation of existing coverage at year-end due to Obamacare and contracts signed with Covered California, as the Business Times reported late last week.

*Modified from a Bizjournals.com article

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More healthcare sticker shock as 1 million Californians face policy cancellations

As a national debate rages over individual health policy cancellations because their coverage doesn’t meet the Affordable Care Act’s requirements, another shoe is likely to drop very soon in California. That’s because, so far, there’s been no word on how the changes will affect enrollees in individual and family plans at Anthem Blue Cross, which rivals say is by far the biggest player in the Golden State’s individual market, with about 760,000 enrollees.

[Note: Letters are currently being sent to Anthem Blue Cross members]

  • If Woodland Hills-based Anthem’s enrollment is affected at about the same rate as other insurers’ individual plans in California, about half of those members — or approximately 380,000 — may have received letters in recent weeks telling them their current plans are being cancelled, and advising them on alternate options. Anthem officials haven’t yet chimed in, and have not responded so far to multiple requests for comment and enrollment data by the San Francisco Business Times. 
  • But close to 1 million Californians are likely to be forced to switch health plans due to national health reform’s requirements. Peter Lee, executive director of the Covered California exchange, told an editorial board meeting at the San Francisco Chronicle this week that 900,000 individual policyholders would be in that position, according to an Oct. 29 blog post by Chronicle columnist Debra Saunders.
  • Patrick Johnston, president of the California Association of Health Plans, described the controversy as “the delayed effect of the law that was passed in 2010,” the ACA. “The attention is caused by the notices that people are receiving, but the (ACA) set up the transition,” Johnston told the Business Times. “The health plans implement the law, they didn’t create it.”
  • No one can be denied insurance because of pre-existing conditions under the Affordable Care Act, which is a popular provision, he said, but because of the changes some people “will pay more,” including people who chose less comprehensive, and consequently less expensive coverage that is no longer one of the options. “They were probably probably health and relatively young,” for the most part, and the ACA is now moving them, as planned, into a pool that includes many older and sicker individuals. That’s why in many cases their costs are going up steeply.
  • A number of national stories have mentioned that San Francisco-based Blue Shield of California is cancelling current individual coverage for 119,000 enrollees, and that Kaiser Permanente is taking a similar step with 160,000 members. The Business Times reported yesterday that 76,000 Health Net of California enrollees also received letters informing them of the need to switch to a so-called “compliant plan.”
  • Some enrollees in individual plans in California are allowed to stay put, having been “grandfathered in” because they signed up for coverage before passage of the Affordable Care Act, aka Obamacare, in March 2010. But the Golden State has about 2 million members of such plans, according to a Los Angeles Times story late last week, and roughly half of them may be forced to move into other coverage by Jan. 1 that meets the ACA’s strictures, including offering more comprehensive coverage than many bare-bones individual plans have provided.
  • Although much of policyholders’ ire has been directed at the health plans that sent the letters, executives at a major California health insurer point to language in contracts they and other plans signed with the Covered California exchange that require them to “terminate or arrange for the termination of all of its non-grandfathered individual health insurance plan contracts or policies which are not compliant with the applicable provisions of the Affordable Care Act.”

So far, Covered California hasn’t released updated information on completed applications since a week after the site went live Oct. 1, and haven’t provided any information about how many — if any — Californians have successfully enrolled. Twelve Golden State health plans signed contracts with Covered California in August to participate in the exchange, but a small subset of those plans — including Anthem, Blue Shield, Health Net and Kaiser Permanente — provide the bulk of individual coverage in the state.

Participating health plans spent much of the summer finalizing details of the Covered California contracts, many of which “had a material effect on the actual plans we would offer in 2014,” said a participant at one of the major players. Not until late August did one major player, for example, have health plan details and pricing nailed down. Then it had to compare those details against existing coverage provided to tens of thousands of individual plan members whose coverage wasn’t deemed to be ACA-compliant (many other policyholders were grandfathered in, according to federal guidelines).

The health plans with individual policyholders were legally required to advise policyholders of any “material changes” to their coverage at least 90 days in advance, the health plan executive said, which meant letters had to reach enrollees by Oct. 1.

*Modified from a bizjournals.com article

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Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare

Obama administration knew that Obamacare would disrupt private plans. Disruption of the existing health insurance market—a disruption codified in law, and known to the administration—is only just beginning. It turns out that in an obscure report buried in a June 2010 edition of the Federal Register, administration officials predicted massive disruption of the private insurance market

  • “The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” wrote the administration on page 34,552 of the Register.
  • All in all, more than half of employer-sponsored plans will lose their “grandfather status” and get canceled. According to the Congressional Budget Office, 156 million Americans—more than half the population—was covered by employer-sponsored insurance in 2013.

On Tuesday, White House spokesman Jay Carney attempted to minimize the disruption issue, arguing that it only affected people who buy insurance on their own. “That’s the universe we’re talking about, 5 percent of the population,” said Carney. “In some of the coverage of this issue in the last several days, you would think that you were talking about 75 percent or 80 percent or 60 percent of the American population.”

By “coverage of this issue,” Carney was referring to two articles. The first, by Chad Terhune of the Los Angeles Times, described a number of Californians who are seeing their existing plans terminated and replaced with much more expensive ones. “I was all for Obamacare until I found out I was paying for it,” said one.

The second article, by Lisa Myers and Hanna Rappleye of NBC News, unearthed the aforementioned commentary in the Federal Register, and cited “four sources deeply involved in the Affordable Care Act” as saying that “50 to 75 percent” of people who buy coverage on their own are likely to receive cancellation notices due to Obamacare.

But Carney’s dismissal of the media’s concerns was wrong, on several fronts. Contrary to the reporting of NBC, the administration’s commentary in the Federal Register did not only refer to the individual market, but also the market for employer-sponsored health insurance.

  • Section 1251 of the Affordable Care Act contains what’s called a “grandfather” provision that, in theory, allows people to keep their existing plans if they like them. But subsequent regulations from the Obama administration interpreted that provision so narrowly as to prevent most plans from gaining this protection.
  • How many people are exposed to these problems? 60 percent of Americans have private-sector health insurance—precisely the number that Jay Carney dismissed. As to the number of people facing cancellations, 51 percent of the employer-based market plus 53.5 percent of the non-group market (the middle of the administration’s range) amounts to 93 million Americans.
  • Another 25 million people, according to the CBO, have “nongroup and other” forms of insurance; that is to say, they participate in the market for individually-purchased insurance. In this market, the administration projected that “40 to 67 percent” of individually-purchased plans would lose their Obamacare-sanctioned “grandfather status” and get canceled, solely due to the fact that there is a high turnover of participants and insurance arrangements in this market. (Plans purchased after March 23, 2010 do not benefit from the “grandfather” clause.) The real turnover rate would be higher, because plans can lose their grandfather status for a number of other reasons.

Will these canceled plans be replaced with better coverage?

  • President Obama’s famous promise that “you could keep your plan” was not some naïve error or accident. He, and his allies, knew that previous Democratic attempts at health reform had failed because Americans were happy with the coverage they had, and opposed efforts to change the existing system.
  • Now, supporters of the law are offering a different argument. “We didn’t really mean it when we said you could keep your plan,” they say, “but it doesn’t matter, because the coverage you’re going to get under Obamacare will be better than the coverage you had before.”

Senator Ron Johnson (R., Wisc.) and Rep. Fred Upton (R., Mich.) have proposed the “If You Like Your Health Care Plan You Can Keep It Act,” with dozens of co-sponsors. The two-page bill simply states that “nothing in [the Affordable Care Act] shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled during any part of the period beginning on the date of enactment of this Act and ending on December 31, 2013.”

*Modified from an article by Avik Roy on Forbes.com

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Report: Obama administration knew millions would be forced to change insurance

Before the Affordable Care Act became law in 2010, President Barack Obama promised Americans they could keep their health care plans if they liked them. But already hundreds of thousands of citizens are receiving notification that their plans are being canceled because they don’t comply with the new law, and, according to NBC News, the Obama administration has known for at least three years the cancellations were coming.

  • While campaigning for health care reform in 2009, Obama went out of his way to make one thing perfectly clear: If you like your current health care plan, you will be able to keep it. On June 15, 2009, Obama said this: “We will keep this promise to the American people. If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period.”
  • In 2012, he echoed that sentiment, saying, ““If [you] already have health insurance, you will keep your health insurance.”
  • However, many are finding that not to be the case. More than 300,000 cancellation notices have been sent out in Florida, according to Kaiser Health News, and another 180,000 in California. In New Jersey, the number of cancellations tops 800,000, the Star-Ledger reports.
  •  According to NBC News, approximately 50 to 75 percent of the 14 million Americans who buy their health insurance individually should expect to receive a cancellation letter over the next year “because their existing policies don’t meet the standards mandated by the new health care law.” This could result in millions of Americans being forced to purchase different policies, potentially at higher premiums.

So how did the Obama administration know the cancellations would be coming?

  • The Affordable Care Act states that people who had health insurance prior to March 23, 2010 — the day Obama signed the bill into law — will be able to keep those policies even if they don’t meet the requirements of the new law. However, the Department of Health and Human Services tightened that provision so that “if any part of a policy was significantly changed since that date — the deductible, co-pay or benefits, for example — the policy would not be grandfathered,” NBC News reports.
  • Because the market for individual insurance experiences significant turnover, the insinuation is the Obama administration had to have known many policies “grandfathered” in would not qualify for the Affordable Care Act. NBC News reports that the administration knew in 2010 that “more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.”
  • “This says that when they made the promise [that individuals could keep their plans], they knew half the people in this market outright couldn’t keep what they had and then they wrote the rules so that others couldn’t make it either,” Robert Laszewski of Health Policy and Strategy Associates told NBC News.

On Monday, former Obama adviser David Axelrod said on MSNBC’s “Morning Joe” that “most people are going to keep their own plan.” When asked about Axelrod’s admission of “most” as opposed to all, White House spokesman Jay Carney acknowledge that some individual’s plans will be canceled, but countered that the plans they switch to will be better and affordable.

“What the president said and what everybody said all along is that there are going to be changes brought about by the Affordable Care Act to create minimum standards of coverage,” Carney said. “… So it’s true that there are existing health care plans on the individual market that don’t meet those minimum standards and therefore do not qualify for the Affordable Care Act.”

Actually, what the president said back in 2009 was “[the Affordable Care Act] is for people who aren’t happy with their current plan. If you like what you’re getting, keep it. Nobody is forcing you to shift.”

Only now, some who like their plans are being forced, including Laszewski. According to NBC News, he has a so-called “Cadillac plan” — “the best health insurance policy you can buy,” he said — but recently received notice in the mail that it was being canceled.

*Modified from a Yahoo News article

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Some health insurance gets pricier as Obamacare rolls out

Thousands of Californians are discovering what Obamacare will cost them — and many don’t like what they see. Many middle-class Californians with individual health plans are surprised they need policies that cover more — and cost more. Nearly 2 million Californians have individual insurance, and several hundred thousand of them are losing their health plans in a matter of weeks.

These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years. 

  • The 16 million Californians who get health insurance through their employers aren’t affected. Neither are individuals who have “grandfathered” policies bought before March 2010, when the healthcare law was enacted. It’s estimated that about half of policyholders in the individual market have those older plans.
  • All these cancellations were prompted by a requirement from Covered California, the state’s new insurance exchange. The state didn’t want to give insurance companies the opportunity to hold on to the healthiest patients for up to a year, keeping them out of the larger risk pool that will influence future rates.
  • Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama’s signature legislation. “This is when the actual sticker shock comes into play for people,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “There are winners and losers under the Affordable Care Act.”
  • Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage. Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don’t qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.
  • Middle-income consumers face an estimated 30% rate increase, on average, in California due to several factors tied to the healthcare law. Some may elect to go without coverage if they feel prices are too high. Penalties for opting out are very small initially. Defections could cause rates to skyrocket if a diverse mix of people don’t sign up for health insurance.

Pam Kehaly, president of Anthem Blue Cross in California, said she received a recent letter from a young woman complaining about a 50% rate hike related to the healthcare law. “She said, ‘I was all for Obamacare until I found out I was paying for it,'” Kehaly said.

Blue Shield of California sent termination letters to 119,000 customers last month whose plans don’t meet the new federal requirements. About two-thirds of those people will experience a rate increase from switching to a new health plan, according to the company.

HMO giant Kaiser Permanente is canceling coverage for about half of its individual customers, or 160,000 people, and offering to automatically enroll them in the most comparable health plan available.

Peter Lee, executive director of Covered California, said the state and insurers agreed that clearing the decks by Jan. 1 was best for consumers in the long run despite the initial disruption. Lee has heard the complaints — even from his sister-in-law, who recently groused about her 50% rate increase.

“People could have kept their cheaper, bad coverage, and those people wouldn’t have been part of the common risk pool,” Lee said. “We are better off all being in this together. We are transforming the individual market and making it better.”

Lee said consumers need to consider all their options. They don’t have to stick with their current company, and higher premiums are only part of the cost equation. Lee said some of these rate hikes will be partially offset by smaller deductibles and lower limits on out-of-pocket medical expenses in the new plans.

Still, many are frustrated at being forced to give up the plans they have now. They frequently cite assurances given by Obama that Americans could hold on to their health insurance despite the massive overhaul.

“All we’ve been hearing the last three years is if you like your policy you can keep it,” said Deborah Cavallaro, a real estate agent in Westchester. “I’m infuriated because I was lied to.”

Supporters of the healthcare law say Obama was referring to people who are insured through their employers or through government programs such as Medicare. Still, they acknowledge the confusion and anger from individual policyholders who are being forced to change.

Cavallaro received her cancellation notice from Anthem Blue Cross this month. The company said a comparable Bronze plan would cost her 65% more, or $484 a month. She doubts she’ll qualify for much in premium subsidies, if any. Regardless, she resents losing the ability to pick and choose the benefits she wants to pay for. “I just won’t have health insurance because I can’t pay this increase,” she said.

A number of factors are driving up rates. In a report this year, consultants hired by the state said the influx of sicker patients as a result of guaranteed coverage was the biggest single reason for higher premiums. Bob Cosway, a principal and consulting actuary at Milliman Inc. in San Diego, estimated that the average individual premium in 2014 will rise 27% because of that difference alone.

Individual policies must also cover a higher percentage of overall medical costs and include 10 “essential health benefits,” such as prescription drugs and mental health services. The aim is to fill gaps in coverage and provide consumers more peace of mind. But those expanded benefits have to be paid for with higher premiums.

The federal law also adjusts how rates are set by age, a change that gives older consumers a break and shifts more costs to younger people. Rates by age can vary by only 3 to 1 starting next year as opposed to 6 to 1 in some cases now in California. People in their 20s just starting their careers may earn so little they qualify for subsidies. But that might not be the case for consumers who are slightly older and earning more.

“It has the effect of benefiting people in their 50s and 60s and shifting costs to people in their 20s and 30s,” said Patrick Johnston, president of the California Assn. of Health Plans. “Benefits are being increased for all, but it’s not government subsidies for all. Some will pay more.”

Rates would be going up regardless of changes from the healthcare expansion. The average individual premium will climb 9% next year because of rising healthcare costs and increases in medical provider reimbursement, according to Milliman’s estimates.

Some consumer groups have questioned whether insurers are inflating their rates under the guise of the healthcare law changes.

“We believe the prices are higher than they should be,” said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. “This is giving a bad name to the Affordable Care Act.”

State regulators checked the insurance companies’ math and underlying cost projections for next year, but they don’t have the authority to deny increases. Under federal rules, insurers can be ordered to issue rebates if they don’t spend a minimum amount of every premium dollar on customers’ medical care.

“The rates aren’t going up because insurance companies are pocketing more money,” Lee said. “That is what it takes to pay the claims and deliver the healthcare.”

*Modified from a LA Times.com article

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Why Obama Should Be Freaked Out Over Obamacare

President Obama said Monday he’s “frustrated” by the disastrous launch of an online computer marketplace for Obamacare. It’s worse than we know, this is the easy part, and millions of Americans could be hurt.

Here are five reasons why frustration isn’t enough. He should be frightened.

  • 1. It’s worse than his team has let on. The White House has tried to position the failed first days of Obamacare as mere hiccups caused by the site’s popularity. Obama called them “kinks.” An administration spokesman told the Washington Post on Sunday that the “main driver of the problem is volume.” This is intentionally misleading.

The White House has heard complaints from insurance companies, consumers, and health policy experts about issues embedded deeply in the online system. For example: inaccurate information provided to people about federal tax credits; low-income people erroneously told they don’t qualify for Medicaid; and insurance companies getting confusing information about who has signed up.

The administration refuses to say how many people have enrolled through the federal exchange, the key metric for determining how well the online service is working in states that didn’t set up their own exchanges. There are two possible explanations for the Obama administration’s unconscionable lack of transparency. Their process is so screwed up that they don’t have the data, which would be embarrassing. Or they have the data – and it’s embarrassing.

  • 2. This is the easy part. Finding and motivating people to take action online is the founding strength of Team Obama. This is what they do best. Managing a complex law is a different matter, and it’s fair to question whether the president and his team are up to it.

How do you convince healthy young Americans to pay for insurance they may not need in order to fund the program? Do companies shed workers and working hours to avoid coming under the law? Are people with cheap catastrophic plans forced to pay more in the exchanges? Tricky questions likes these will soon make the hard art of website design look like fingerpainting. “The online federal health care exchange, the heart of the Obamacare project, is such a rolling catastrophe that it may end up creating a major policy fiasco immediately rather than eventually,” wrote Ross Douthat in a New York Times column titled, “Obamacare, Failing Ahead of Schedule.”

  • 3. It reflects poorly on the president. Nobody expects the chief executive to be reviewing computer code or hosting East Room “hackathons.” But this falls on him. The CEO of a corporation or country is uniquely responsible for making sure the team is on task, and he or she is ultimately responsible if it’s not. In Obama’s case, did he demand thorough updates on the progress of the site? If so, did he ask the right questions? Did he put the right people on the job in the first place? Given the horrid first days of Obamacare, the answer to at least one of those questions must be “no.” 
  • 4. It reflects poorly on government. The public’s faith in government is at a record low, just as Obama is fighting Republicans on several fronts over the size and power of the federal bureaucracy. His administration needs to rapidly improve the online exchanges to stand any chance of convincing, say, young Americans to pay for insurance they don’t think they need. Beyond Obamacare, the Democratic Party’s reputation for competency is as stake.  The cost of the site is already $394 million, a massive amount compared to private-sector CMS work, and sure to grow.
  • 5. It could hurt Americans. For decades, politicians in both parties pledged to ease one of the leading causes of anxiety in the post-industrial age, the lack of affordable health care. Nearly 50 million Americans are uninsured, or about 15.4 percent of the population. Millions more are underinsured. Obamacare, enacted three years ago over the objections of Republicans, may or may not be the answer. But, as the White House likes to remind Republicans, it’s the law and it deserves a shot.

“The Affordability Care Act is not just a website,” Obama said Monday, “it’s much more.” True to a point, but the website is critical to the law’s purpose: helping millions of Americans bargain for better health care. Dismissing the extent of the problem and reminding voters that Republicans fought the law — which is essentially all Obama did in his Rose Garden remarks — is a deflection, which shouldn’t be confused with implementation or governing.

*Modified from a NationalJournalonline.com article

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Are they signing up for Obamacare, or for Medicaid (MediCal)?

How many people have tried to sign up for Obamacare? How many have completed the process? Those numbers are important, but let’s keep something else in mind here — there’s another important number that a lot of publications are failing to separate out. That is, how many people are enrolling in the private insurance plans within the Obamacare exchanges — as opposed to those applying who report very low incomes and get steered into the Medicaid program?

  • In terms of getting more people insured, it might seem like a minor detail. But the private insurance exchanges, a centerpiece of Obamacare, need a very large number of people to sign up if they are to be viable insurance pools. By the Obama administration’s estimate, they need about 7 million people to sign up for the exchanges nationwide. (They also estimate they need 2.7 million of those to be young/healthy types, a separate but related issue.) There is a separate goal of enrolling another 8 million poor people in Medicaid.
  • Yesterday, The Washington Post suggested that at least 185,000 people have signed up for Obamacare:. That sounds promising for the program even if it’s still well short of the pace needed to meet the goals. And then Oregon has just reported 56,000 enrollments. So isn’t everything going just fine?
  • In fact, no. When you see state enrollment numbers, you have to ask yourself this question: How many of those people are actually becoming Obamacare private insurance exchange customers, as opposed to people who (1) were always eligible but are just signing up for Medicaid for the first time, and (2) people who are newly eligible for Medicaid under the expanded coverage thresholds in some states?
  • In Oregon, that 56,000 number you’re hearing today is all Medicaid. Their online exchange doesn’t even work yet. Something similar is happening in many other states as well. Minnesota, for example, said it had 3,800 applicants. But when you scratch the surface, only 406 of these are Obamacare exchange applicants — again, most of the signups were low-income customers who were steered to Medicaid instead.  
  • California, has put 600,000 new people on Medicaid, but their last hard number of actual, completed applications for the exchanges was under 17,000. That’s over a week old, but I’m still skeptical when I see them say that 100,000 “are in some stage of applying for insurance on the marketplaces.” Why all those weasel words? Have those people completed applications — in which case California is doing great — or have they merely entered their zip code and started looking at plans? California may not release any reliable numbers on their exchange enrollment until next year.
  • Are these numbers going to add up to viable health insurance exchanges? A very sober assessment yesterday on the Corner, noting among other things that the slow trickle of signups, from the insurers’ perspective, is a true nightmare and even worse than if no one was signing up at all. If only “highly motivated consumers” are spending the hours it takes to get through right now, the exchanges are filling up with the people most likely to be very sick or old.

*Modified from a conservativeintel.com article

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Health Website Woes Widen as Insurers Get Wrong Data

Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified. Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans.

  • The latest round of problems has emerged after a technical bottleneck that blocked many potential customers from accessing the marketplace began to clear this week. People familiar with the development of the exchange said some technical problems improved this week.
  • HHS, which is running all or part of the marketplaces in 36 states, has repeatedly declined to answer specific questions about its handling of the rollout, including specific glitches, enrollment figures, or its plans to fix the problems. Health-department officials have pressured insurers to refrain from commenting publicly about the problems, according to executives at four health plans, who asked not to be named. The HHS declined to comment.
  • Of 209,000 users who began to register on healthcare.gov on Monday or Tuesday of this week, just over one-quarter finished the process, according to an estimate made by the analytics firm comScore for The Wall Street Journal. In the first week, only 10% did so. The estimates are based on a sampling of Internet users tracked by the company.
  • As more of those users attempted to sign up for plans this week, insurers began noticing problems with enrollment data. For now, they say they are largely able to manually correct the errors. But as enrollment increases—up to 7 million consumers are expected to sign up in the next 5½ months—that may not be possible, they worry.
  • After realizing that some applications listed up to three spouses in a single family, Blue Cross & Blue Shield of Nebraska, which has about 50 health-law enrollees, had to “stop those enrollments from going through the automated process,” said Matt Leonard, the insurer’s sales manager. “It takes an automated process and turns it into a manual process,” he said.
  • Sioux Falls, S.D.,-based Avera Health Plans has called each of its 21 incoming customers to make sure the data are correct. As consumers struggle to navigate healthcare.gov, some health-plan executives worry that only the sickest—those who most expect to need insurance—will persist in seeking coverage. If younger consumers who are on the fence about buying coverage find the process too onerous, insurers may end up with too few healthier members to offset the costs of less-healthy enrollees.
  • Tara Seidenberg, a 48-year-old paralegal from suburban Houston with multiple sclerosis, says she is likely to put up with all kinds of hurdles to buy coverage. After days of failed attempts to sign up on healthcare.gov, she is taking a break to wait for the glitches to resolve. She takes medications that cost $4,600 a month and her current coverage won’t be available next year. “I’m pretty much guaranteed to try it again,” Ms. Seidenberg said.

*Modified from a WSJ.com article

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