Consumer Power Report #399
The White House promised the problems with the federal health insurance exchange would be solved by November 30. That day having arrived and passed, now things should be working just swimmingly. Except they aren’t. At all.
After a glowing news conference yesterday citing “night and day” progress on HealthCare.gov, I decided to log in this morning and take the Web site for a test drive, as I’m sure many others are doing. Early reports had been promising. What I found was hardly encouraging — long delays loading pages, an endless circle of tasks (some already completed) and ultimately an error message. … Additionally, once I had completed and submitted my application and verified my identity, the site told me that I was missing information and had to review it again. Nothing was missing. Ultimately, I got an error message telling me to come back later.
Though most users can now navigate the site with relative ease, there are still lingering problems with what happens after they finish the application process. Insurers reportedly received incomplete or inaccurate information from the health care site for many users, with enrollment notices sometimes missing key information about premiums and subsidies. In some cases, insurers reportedly didn’t receive any notification about would-be enrollees who thought they’d signed up for coverage.
The Health and Human Services progress report said nothing about the back end process, so it’s difficult to quantify the extent of the technical failure between Healthcare.gov and private insurers. But essentially, the administration prioritized fixes from the “consumer view from the outside looking into this website,” John Engates, a private tech official, told NPR. Users can navigate the site just fine, but still be stopped short of completing the full enrollment process. In a worst case scenario, people could think they’ve obtained coverage, only to find out at the doctor’s office that they’re uninsured.
Some insurers say they have been deluged with phone calls from people who believe they have signed up for a particular health plan, only to find that the company has no record of the enrollment. Others say information they received about new enrollees was inaccurate or incomplete, so they had to track down additional data — a laborious task that would not be feasible if data is missing for tens of thousands of consumers. In still other cases, insurers said, they have not been told how much of a customer’s premium will be subsidized by the government, so they do not know how much to charge the policyholder.
This is the awful truth CPR readers have known all along: So long as the back end of the Web site isn’t functioning, it’s not working at all. That’s one reason the administration continues to dodge questions about exactly that.
We don’t know how many inaccurate 834 transmissions went out. Three reporters – one from the Los Angeles Times, one from The Wall Street Journal and I – asked [Medicare spokeswoman Julie Bataille] for information on how many of the 834s sent out so far have had an error. This is a question that I’ve asked on three previous calls, a point made by the Los Angeles Times’s Noam Levey as he asked for his second time. This is where Monday’s media call started to get more tense than the dozens that have happened in the past, with reporter after reporter asking about the numbers of 834 errors and not getting a response from the administration.
It’s noteworthy that CMS doesn’t want to reveal the truth. And there’s little wonder they don’t – because the more the American people learn about the truth of Obamacare, the more they dislike it.
From the outset, Obamacare’s architects have been possessed of the unshakable belief that if they could only properly acquaint the public with the many virtues of their initiative, the people would finally turn on to the law. Just one more presidential speech; one more Thanksgiving dinner-table push; one more Twitter campaign. Then America would love it.
It has never happened. A new poll from Gallup may help to show why, suggesting as it does that those who are familiar with Obamacare are much more likely to oppose it than those who are not. Among those unfamiliar with the law, 40 percent approve and 43 percent disapprove. Among those familiar with the law, however, 40 percent approve and 59 percent disapprove. It seems that the more you know, the less you like.
The next few weeks are critical for the success of the Obamacare project. They are lagging well behind the 800,000 people they expected to have signed up by this point. They have to fix the problems with the existing system, cram as many people as possible into the queue, and hope the dominos of doc shock and coverage shock in January don’t deal the death blow to this enterprise.
It doesn’t sound like the recipe for a very happy holiday, to me.
— Benjamin Domenech
IN THIS ISSUE:
2) The website’s problem is demand and once the front-end problems are fixed, it’ll work great.
No, it’s not – in fact, the website couldn’t even handle 500 visitors without problems according to internal documents from the Centers for Medicare and Medicaid Services, released in hearings last week (the all-caps emails are the best ones). The real problem with the website at this point isn’t capacity at all: it’s the extremely delayed back-end – major portions of which apparently haven’t even been built yet – which are supposed to hand off people to the actual insurers they select, and handle the payments for plans (the point at which people are actually “enrolled”). Collecting these premiums and making sure insurers get them has always been the heaviest lift under Obamacare, and the lack of these systems is far more problematic than just the front-end frustrations of delays and glitches. It’s along the lines of having an Expedia-like site that “works” because you can select your flight, but doesn’t actually have the capability for sellers to charge you, or reserve your ticket. Which is, let’s face it, kind of key. There is no public deadline for these remaining critical fixes, and they’ve already missed their first deadline for the front-end.
3) Only a few young and healthy people will pay more – for most people, they will keep their plans or have something better.
No, actually, premiums are going up just about everywhere, and for most people. In 41 states, premiums in the individual market are going up by an average of 41%. Only eight states – generally those with the most heavily regulated markets – will see premium reductions ranging between 3% and 40%. But according to The Manhattan Institute’s analysis, for those who have it bad, it’s really bad: the eight worst states are seeing huge premium hikes, including Nevada (+179%), New Mexico (+142%), Arkansas (+138%), North Carolina (+136%), Vermont (+117%), Georgia (+92%), South Dakota (+77%), and Nebraska (+74%). While the young and healthy get the brunt of these increases, the older folks aren’t exempt, either – and even if their premiums don’t increase that much, it’s likely they’ll see larger deductibles and narrower networks.
4) The pre-Obamacare health insurance market was a “free market” full of “junk” insurance plans, which screwed people over and dropped their insurance when they got sick.
No, this simply isn’t true. The American health insurance system prior to Obamacare was in some senses the worst of both worlds: one torn between single payer and third party payer, where while most of the care offered was superior to the rest of the world, the chief problem was explosive growth in costs … because no one cares what something costs when someone else is paying for it (in this case, your employer or the government). No one in their right mind would describe a reality in which the government holds so much market sway, and in which consumers have near-zero price transparency, as a free market system. And as for screwing over people who got sick: it’s been illegal for insurers in the employer market to drop people who get sick since 1997 (thanks, HIPAA!). This means the problem only applies to the individual market (10% of private health insurance), where people were dropped less than 4/10ths of 1% of the time, typically after an appeals process.
SOURCE: The Federalist
To be sure, these Obamacare evangelists are not insurance saleswomen. They’re not closers. They don’t actually sign people up for policies in the Obamacare marketplace, but rather, direct them how to do so. They sing the attractively anodyne highlights of the program–“financial help is available,” no discrimination for preexisting conditions. They give phone numbers and information to help people meet in person with a Navigator (a contractor paid to guide enrollees through the process) and circumvent the plagued website. They are goodwill ambassadors. They are, in a sense, storytellers. And it’s a hard gig to be an Obamacare storyteller these days, because for the last two months, there have been so many stories told. Not good stories, either. In fact, if Obamacare threatens to bankrupt any industry, it’s the liberal-media-bias-watchdog industry. Since now, news outlets across the spectrum are falling over each other to tell Obamacare stories, mostly about how lousy Obamacare is.
With their microtargeted lists, we start hitting likely uninsured addresses in a semi-sketchy, palm-fronded neighborhood of cramped condos and low-slung bungalows, the kind with window-air units and burglar bars. On a Saturday evening, nobody’s home most places. Some, emphatically not, with lock-boxes on their doorknobs and the mailboxes taped shut so no junk mail–say, a Lillian Vernon catalog or an Affordable Care Act flier–can be placed in them. At one condo, after Katie introduces herself, a harried man speaks to us from behind the door, his dog going off in the background, the red tendrils in the whites of his eyes illuminated like warning flares. “This is a bad time,” he says. He looks like he’s had a few of those.
Others already have insurance. Or they’re in a hurry and can’t talk now. The girls remain stalwart, dutifully soldiering on. I ask Katie if she has insurance from the Obamacare exchange. She’s insured through Enroll America, she tells me, and is quite happy with it. “If you like it, and get it through your employer, you can keep it,” she says, almost touchingly.
SOURCE: The Weekly Standard
The Obama administration is delaying yet another aspect of the health care law, putting off until next November the launch of an online health insurance marketplace for small businesses.
The move, announced Wednesday, was needed because repairs are still under way to the troubled HealthCare.gov website, which is the primary way for individuals to apply for insurance, and that has priority, federal officials said.
In a conference call with reporters, administration officials said employers who want to buy marketplace plans for their workers now will need to go through an agent, broker or insurance company this year, instead of using a government website. The administration said the plan will still allow small businesses to buy coverage but avoid slowing technical repairs to the hobbled federal online site.
The HealthCare.gov site, where individuals without employer-sponsored health care can shop for insurance, is now smoothly handling 25,000 users at the same time and is on track to meet its goal of handling 50,000 simultaneous users by Saturday, said administration spokeswoman Julie Bataille. “We have a lot of work left to do in the next few days,” she said.
The small business marketplace, also called SHOP, was supposed to provide employers a new way to shop for coverage, and the delay was met with frustration …
Wednesday’s setback was the latest in a stream of missed deadlines, including a postponement for a Spanish-language sign-up tool announced this week. The administration also recently pushed back the enrollment deadline for individuals: People who sign up by Dec. 23 can get coverage that starts on Jan. 1. In an earlier delay, businesses with more than 50 workers were given until 2015 to meet the requirement to provide health insurance without paying a penalty. And the deadline date for individuals to avoid penalties for failing to get coverage was pushed back six weeks.
SOURCE: Associated Press
Doctors seeing Medicare patients face a 24 percent cut in reimbursements beginning January 1. But almost no one has grasped that those cuts will hit Medicaid too–thanks to Obamacare. Unless Congress acts, we’re likely to see a huge exodus of doctors who will not accept either Medicare or Medicaid patients.
In 1997 Congress passed legislation, known as the “sustainable growth rate” (SGR), to try and reduce Medicare spending. If Medicare spending grew faster than a predetermined amount, doctors’ Medicare reimbursements would be cut the next year by enough to offset the overspending.
Not surprisingly, Medicare spending didn’t hit the target rate, and, again not surprisingly, Congress didn’t want doctors to take the financial hit. So Congress has passed legislation, known as the “Doc Fix,” multiple times to postpone the cuts and keep the reimbursement levels roughly the same.
But those postponed deficits keep piling up, and come January doctors will see, on average, a 24 percent cut in Medicare reimbursement levels. And here comes the double whammy: Medicaid reimbursements will face the same 24 percent cut.
Medicaid pays doctors about 59 percent of what Medicare pays them–which is why doctors increasingly refuse to take new Medicaid patients. As I pointed out last week, the Centers for Medicare and Medicaid Services (CMS) recently released a document showing that 9,500 doctors who had previously accepted Medicaid patients refused to do so in 2012.
In an effort to gain–some might say “buy”–physician support for Obamacare, drafters required Medicaid programs to pay doctors the same rate as Medicare for 2013 and 2014–and that’s all states, not just the ones expanding Medicaid. (I am told that some states have yet to pay the additional 2013 Medicaid reimbursements, claiming they will do that retroactively in 2014.) So if Congress doesn’t pass a Doc Fix and Medicare rates go down by 24 percent, then so will Medicaid.
Wyoming Gov. Matt Mead (R) said Friday he doesn’t want his state to accept federal funding to expand Medicaid coverage, due to problems with the rollout of the Affordable Care Act so far.
Mead, a longtime opponent of the law, said the federal health-care exchanges set up under the ACA have hurt more than they have helped, undercutting his confidence in the federal government’s commitment to cover 90 percent of the costs of Medicaid expansion into the future.
“We were going to get people into the exchange, a lot of young, healthy people into the exchange, and in doing that you’re going to ultimately cut costs for everyone,” Mead told reporters by phone from the Middle East, where he spent Thanksgiving meeting troops from Wyoming, according to the Associated Press. “And when you see the exchange, in my view, doing more to kick people off of insurance instead of putting them on, sort of the whole notion, the whole pretext of how this is going to work is in doubt.”
Wyoming’s Republican-dominated legislature last year voted against accepting federal funds to expand Medicaid. While some Republican governors have been able to expand the program by executive action, the Wyoming legislature’s bill prohibits implementation without express legislative action, according to the Kaiser Family Foundation, which keeps tabs on state action on Medicaid expansion.
SOURCE: Washington Post
Many Americans browsing the Obamacare exchanges are finding the Affordable Care Act isn’t living up to its name.
It’s not just premiums that are bringing up the costs. Consumers are finding high deductibles, co-payments and other expenses that make the Obamacare policies seem more like catastrophic plans than comprehensive insurance.
Those picking a bronze plan, which carry the lowest monthly rates, may have to spend $5,000 or more before the insurance kicks in. The next highest level of coverage, the silver tier, can carry $2,000 deductibles. And once they hit their deductibles, policy holders still have to pay for doctor visits, lab tests and medication.
“All we ever heard about Obamacare is that it would lower our deductibles and premiums,” said Jennifer Slafter, 40 of Mabel, Minn. “That’s just not what’s happened.”
Slafter and her husband, Steve, are scrambling to find affordable care for themselves and their two children. The exchange’s Blue Cross Blue Shield plan was $1,087 a month with a $6,000 deductible, while a Medica plan was $877 a month with a $12,700 deductible. Both are steeper than their current plan.
“Everything got higher,” said Slafter, who is still waiting to hear whether they qualify for a premium subsidy. But even if they do, she said she’d still find it very tough to meet the deductibles.