Short version of this post: The implementation of Obamacare still leaves much to be desired. And when I write “much,” I mean it.
The long version of this post follows below.
First of all, let it be noted that the White House website still tells us that “You can keep your own insurance.” Either the administration is very slow when it comes to updating the White House website, or it is hoping that there are three or four people left in the country who actually continue to believe this claim. In the event that there are, I suggest that those three or four people–along with the rest of you–read this:
President Obama’s broken promise that people can keep their existing health insurance is much larger than we’ve been led to believe. Until now, attention has focused on the individual insurance market: people buying coverage for themselves and their families from insurance companies. Policies have been canceled because they don’t comply with the Affordable Care Act (ACA). But the individual market is small, representing about 5 percent of the non-elderly population . But cancellations, under today’s law, will ultimately spread to the largest insurance market: employer-provided coverage.
So Chapter Two of the broken promise looms. In 2012, 171 million Americans received health insurance from their employers, reports the Census Bureau. This dwarfs Medicaid (51 million) and Medicare (49 million), the next largest sources. Given the ACA’s complexity, it’s hard to know how many Americans with employer coverage might be hit with policy cancellations. But plausible assumptions suggest between 25 million and 50 million, mostly at small firms.
I generally take stories from British newspapers–especially the ones that give off a tabloidish vibe–with a grain of salt. But somehow, this seems credible to me:
Hospital staff in Northern Virginia are turning away sick people on a frigid Thursday morning because they can’t determine whether their Obamacare insurance plans are in effect.
Patients in a close-in DC suburb who think they’ve signed up for new insurance plans are struggling to show their December enrollments are in force, and health care administrators aren’t taking their word for it.
In place of quick service and painless billing, these Virginians are now facing the threat of sticker-shock that comes with bills they can’t afford.
‘They had no idea if my insurance was active or not!’ a coughing Maria Galvez told MailOnline outside the Inova Healthplex facility in the town of Springfield.
She was leaving the building without getting a needed chest x-ray.
‘The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the x-ray,’ Galvez said, her young daughter in tow. ‘It’s not fair – you know, I signed up last week like I was supposed to.’
The x-ray’s cost, she was told, would likely be more than $500.
Maybe my willingness to believe such claims is the consequence of reading stories like this one:
Paperwork problems almost delayed suburban Chicago resident Sheri Zajcew’s scheduled surgery Thursday, but Dr. John Venetos decided to operate without a routine go-ahead from the insurance company. That was after Venetos’ office manager spent two hours on hold with the insurer Thursday, trying to get an answer about whether the patient needed prior authorization for the surgery. The office manager finally gave up.
“I’m not a happy camper,” said Nate Zajcew, the patient’s husband. The couple signed up for a Blue Cross Blue Shield bronze plan through the federal HealthCare.gov site on Dec. 16. “I understand it’s just a matter of paperwork and yesterday was a holiday. I can be an SOB, too, at times, but since they’re going on with the procedure, it’s OK.”
Venetos, a Chicago digestive system specialist, described “tremendous uncertainty and anxiety” among patients calling his office recently. Some thought they’d signed up for coverage but hadn’t received insurance cards yet. Others had insurance policies that were canceled and weren’t sure if their coverage had been reinstated after [Illinois] Gov. Pat Quinn decided to allow one-year extensions of canceled plans.
Venetos said he has decided to take a risk and provide care for these patients, at least until there’s less confusion about coverage.
“We feel it’s the right thing to do,” Venetos said. “We may end up stuck holding the bag and not getting paid on these claims.”
Not to mention stories like this one:
There’s another quirk in the Obama administration’s new health insurance system: It lacks a way for consumers to quickly and easily update their coverage for the birth of a baby and other common life changes.
With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on.
Right now the HealthCare.gov website can’t handle such updates.
Apparently, no one thought that it might be a good idea to design a website that allows for the fact that new human beings tend to be born from time to time, and need to be added to insurance plans.
There are claims that Obamacare enrollees now number over 2 million. Philip Klein reasonably begs to differ:
With President Obama’s health care law scheduled to begin in earnest when the new year kicks off, Secretary of Health and Human Services Kathleen Sebelius claimed on a Tuesday conference call that as of Dec. 28, “2.1 million people have enrolled in a private insurance plan” through the program.
Later in the call, Sebelius emphasized that enrollments wouldn’t be completed until individuals paid their first month’s premiums.
But HHS officials still won’t disclose how many of the 2.1 million they claim enrolled through the federal healthcare.gov website or one of the state-based exchanges actually paid for coverage.
Though Sebelius left the call before the question-and-answer session, Centers for Medicare and Medicaid Services spokeswoman Julie Bataille declined several times to provide payment information.
“At this time we don’t have that detailed information,” Bataille said in response to one question. “What I can share with you in terms of the individuals who have paid their premiums that is something that consumers will do directly with their health plans. And as part of the outreach that we have been doing, we have reminded consumers that that is a step that they need to take to confirm enrollment and access their coverage.”
Later in the call, CNN’s Jim Acosta asked Bataille if she could at least say with confidence that a “very high percentage” of those 2.1 million had paid.
Instead of answering in the affirmative, Bataille said, “We are confident that those consumers have selected a plan and know what the next steps are for them in terms of securing coverage.”
You would think that if the administration’s numbers were correct, or if they had confidence in those numbers, or if the numbers weren’t the direct result of spin, that the answers to press questions would have been far more direct and to the point. Meanwhile, remember how those in favor of Obamacare argued that preventive care would drive down health care costs? Turns out that claim isn’t true, and there was never any evidence to support it. To be sure, preventive care is a good idea, and in general, it is always better to prevent a disease from occurring than to have to treat a disease that has occurred. But that is a different matter entirely. Note the end of Jonathan Adler’s post, which indicates that Democratic party operatives are continuing to push the false “preventive care saves money/reduces emergency room visits” argument.
Incidentally, you know that Obamacare is still in trouble when a former chairman of the Democratic National Committee comes out and tells us that maybe we don’t need to worry about that pesky individual mandate after all. Expect that argument to be amplified and repeated by others if the implementation of Obamacare continues to falter. Expect as well for Obamacare supporters to continue to present flawed explanations for the failures in implementation–like this one. There is, of course, no evidence whatsoever that enrollment is low because people think that Obamacare has been repealed, but I am sure that since the truth is inconvenient to the likes of Eleanor Holmes Norton, it won’t find a champion in her.
I would like to think that this story is about firings, and not about voluntary departures:
The No. 2 official at the Centers for Medicare and Medicaid Services, who supervised the troubled rollout of President Obama’s health care law, is retiring, administration officials said Monday.
The official, Michelle Snyder, is the agency’s chief operating officer. She is the second administration official to depart since problems at the website, HealthCare.gov, frustrated millions of people trying to buy insurance and caused political embarrassment to President Obama.
Ms. Snyder is in charge of the Medicare agency’s day-to-day activities and the allocation of resources, including budget and personnel. Technology experts who built the website for the federal insurance exchange reported to her, and she has been actively involved in the effort to fix the site’s problems.
Ms. Snyder’s departure follows that of the agency’s chief information officer, Tony Trenkle, who stepped down in November to take a job in the private sector.
A former agency official who had predicted Ms. Snyder’s departure said Monday: “She had to go. She was responsible for the implementation of Obamacare. She controlled all the resources to get it done. She was in charge of information technology. She controlled personnel and budget.”
Asked about Ms. Snyder’s plans, an agency official said Monday: “It’s her personal decision to retire now.”
Oh please, let it not just be a “personal decision.” Let it be a firing. And let it be that the Obama administration can and will credibly tell us that at long last, people have been fired because of the failures of the website. I would like to be able to think that the administration’s patience with incompetence has finally reached its limits.
The administration continues to hope that it will be able to meet its enrollment goals. Those hopes may be in vain:
Experts say the Obama administration faces a tall order in hitting the 7 million enrollees the Congressional Budget Office projected would sign up for ObamaCare in 2014.
After a surge of enrollees in December, 1.1 million people have enrolled in the federal exchange, and another 1 million have enrolled through the 14 state-run marketplaces.
That falls short, however, of the administration’s stated goal of 3 million enrollees by the end of 2013.
Perhaps even more importantly, the makeup of those enrollees remains unclear.
The idea behind the health exchanges is that young and healthy enrollees will offset costs from the older and sicker enrollees. If most of the ObamaCare recipients are old and sick, it will be tougher for the exchanges to work.
The administration hasn’t released a breakdown of who is enrolling, but preliminary data coming out of the state-run exchanges indicates a large number of high-risk consumers.
“I don’t see how they could have the balanced risk pool that they need,” said Joe Antos of the conservative American Enterprise Institute. “The younger people with lower incomes already have education loans, car loans, and such, and these are people who, even with a generous subsidy, it’s still going to cost them money out of their pockets.”
I suppose that one way to drive up the enrollment numbers is to tell AmeriCorps workers that their government health care plans do not meet Obamacare requirements (yes, you read that right). Those who believe that the larger the government, the more apt it is to do good for the people would be well advised to read the following excerpt:
Abby Grosslein, a Vista member in New Orleans, said she thought it was strange that the health benefits provided by a federal agency did not meet the standards of a law adopted more than three and a half years ago. “It would be nice if the government waived the penalty because we are a federally funded program,” said Ms. Grosslein, 24, who is completing her third year of service with AmeriCorps. “It’s as if the right hand does not know what the left hand is doing.”
Moreover, she said: “The Affordable Care Act has been on the books since 2010. Why are we hearing only now that our health plan is not compliant?”
Good question. I don’t anticipate a good answer anytime soon, but that’s par for the course when it comes to these kinds of debates.
Ed Haislmaier tells us that Obamacare is “now officially a hardship.” Quite true, as is Haislmaier’s point that the government is now telling Americans “We’re replacing your substandard coverage with our substandard coverage.”
If you do decide to sign up for Obamacare, bear in mind this post, which tells us that most Obamacare exchange plans only provide for local medical coverage and care, and that if one receives non-emergency medical care overseas, one will have to pay for it.
Despite all of this, I am supposed to believe that the implementation of Obamacare is going great and continuing to get better. Call me curmudgeonly and obstinate, but I’m afraid I’m going to have to decline.