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It’s Time for Another Obamacare Roundup

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.

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“Sorry” Seems to Be the Hardest Word

This latest Obamacare update features a semi-apology from the president of the United States:

President Obama said Thursday that he is “sorry” that some Americans are losing their current health insurance plans as a result of the Affordable Care Act, despite his promise that no one would have to give up a health plan they liked.

“I am sorry that they are finding themselves in this situation based on assurances they got from me,” he told NBC News in an exclusive interview at the White House.

“We’ve got to work hard to make sure that they know we hear them and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this.”

[. . .]

“Obviously we didn’t do a good enough job in terms of how we crafted the law,” Obama said in the interview Thursday. “And, you know, that’s something I regret. That’s something we’re gonna do everything we can to get fixed … We’re looking at a range of options.”

I call it a “semi-apology” because the president only apologized after he tried everything he could possibly think of trying in order to distract from the fact that he broke his promise to the American people. One such attempt to distract, of course, was the attempt to blame insurance companies for lost plans. Glenn Kessler gives this bit of spin three Pinocchios. He likely was too kind:

Blaming the insurance companies can only go so far. First of all, the administration wrote the rules that set the conditions under which plans lose their grandfathered status. But more important, the law has an effective date so far in the past that it virtually guaranteed that the vast majority of people currently in the individual market would end up with a notice saying they needed to buy insurance on the Obamacare exchanges.

The administration’s effort to pin the blame on insurance companies is a classic case of misdirection. Between 75 and 95 percent of the problem stems from the effective date, but the White House chooses to keep the focus elsewhere.

As Ron Fournier notes, the Obama administration’s disastrous management of the implementation of health care reform will likely have political consequences if the mess is not cleaned up and cleaned up quickly. The administration, its congressional allies, and all those who support Obamacare deserve the political pain for the way in which the law has thus far wreaked havoc upon the lives of millions of Americans.

Meanwhile, Kathleen Sebelius–who still has a job!–has informed us that there will be no delays in the implementation of Obamacare–this despite the fact that there have been parts of Obamacare that have been delayed in order to ensure that the administration does not suffer politically and in order to limit the likelihood of massive Democratic losses in next year’s midterm elections (see, e.g., the delay in implementing the employer mandate). In the same story, we see this:

. . . the Obama administration disclosed that the chief information officer at the Centers for Medicare and Medicaid Services would retire. His office supervised the creation of the troubled website.

The official, Tony Trenkle, will step down on Nov. 15 “to take a position in the private sector,” according to an email circulated among agency employees. He has supervised the spending of $2 billion a year on information technology products and services, including the development of the website.

Mr. Trenkle, reached by telephone on Wednesday, declined to discuss his plans. “I can’t speak with you,” he said.

His retirement is part of a management shake-up announced by Michelle Snyder, the chief operating officer of the Medicare agency, who was herself deeply involved in major decisions about the insurance marketplace.

Even as Ms. Sebelius testified about progress in repairing the website, HealthCare.gov, agency officials were reporting new problems on Wednesday.

“The site is performing slowly,” said Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services. “Some users have difficulty logging in and receive error messages.”

This is what passes for accountability these days. I guess that if you want some breaks from this administration when it comes to Obamacare, you have to be part of an approved political class.

That political class, mind you, does not include Obama supporters who do not wield political power. I do feel badly for Lee Hammack and JoEllen Brothers; they put their faith in the president, in his campaigns, in his administration and in his policy agenda, and they are being rewarded for their loyalty by having their health care plan, “a plan that offers solid coverage, not one of the skimpy plans Obama has criticized,” canceled because the plan still does not meet Obamacare requirements. The couple now needs to find a new plan, and “[t]he cost would be around double what they pay now, but the benefits would be worse.” Charles Ornstein, who wrote the piece covering Hammack’s and Brothers’s woes, fact-checked their story and found that it holds water. Despite the fact that Ornstein had “been skeptical about media stories featuring those who claimed they would be worse off because their insurance policies were being canceled on account of the ACA,” is now forced to conclude that without some kind of fix for the law, people like Hammack and Brothers are in trouble. They are going to have to pay a lot more for their health insurance, and they are going to get a lot less coverage in return.

I wonder if the president will apologize personally to Hammack and Brothers anytime soon.

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