In the immediate aftermath of the disastrous rollout of HealthCare.gov, Ezra Klein was one of the few liberals willing to say that the website was a catastrophe, and that the unworkability of the website actually threatened the implementation of Obamacare as a whole. Afterwards, he dialed back his criticisms (maybe Joan Walsh had something to do with that), and started telling us that the website’s performance was improving day by day, and that pretty soon, complaints about the website and about the implementation of Obamacare in general would become a distant memory.
Well now, Klein’s website is back to exposing problems with HealthCare.gov, courtesy of co-blogger Sarah Kliff:
Enrollment records for close to 15,000 HealthCare.gov shoppers were not initially transmitted to the insurance plans they selected, according to a preliminary federal estimate released Saturday.
While these cases pose a challenge for the Obama administration, officials say they believe the situation is improving. Since early December, fewer than 1 percent of HealthCare.gov enrollments did not make their way to health insurance plans.
“The vast majority of the work is retroactive,” Centers for Medicare and Medicaid Services (CMS) spokeswoman Julie Bataille said in an interview Friday. “We’re making sure that as we do the intense data reconciliation, we identify the things that need to be resolved so consumers can confirm they’re enrolled.”
The preliminary estimate that fewer than 15,000 enrollments failed to reach carriers comes from a recently completed federal analysis that compared the number of shoppers who clicked “enroll” with the number of digital files HealthCare.gov fired off to health-insurance plans.
That analysis does not generate a list of specific shoppers whose enrollment files were never sent, but rather provides a ballpark estimate of the discrepancy between enrollments finished and reports generated. The federal government does not have a list of people whose sign-up forms were never sent to their insurer.
Still, the figure is one of the more concrete measures of the data errors that have plagued the back-end of HealthCare.gov and challenged the Web site’s ability to notify health-insurance providers when a new member enrolls in their products.
I would hope that few people take seriously the claim that “the situation is improving.” The situation always appears to be “improving” when it comes to HealthCare.gov and the implementation of Obamacare, but alas, it doesn’t seem to have improved enough to make the site, you know, workable. I wonder if Joan Walsh will issue another “Thou Shalt Not Speak Ill of Obamacare” commandment anytime soon, now that Kliff has gone rogue and decided to write truthfully concerning the site’s flaws and shortcomings. If she does, I hope that Kliff will have the gumption and sense of decency to refuse to shut up, but since the “reality-based community” always seems to be at war with reality, I am preparing for the worst.
Insurers and federal officials sifting through insurance applications under the health-care law have identified a raft of errors, including missing customers and inaccurate eligibility determinations that mean people may be enrolled in the wrong coverage.
Thousands of insurance applicants from HealthCare.gov—at least one in five at the height of the problems by one estimate—have received inaccurate assignments to Medicaid or to the marketplace for private plans, or have received incorrect denials, people familiar with the matter said. Eligibility determinations are an early step in the application process, before consumers choose plans.
In some cases described by a state official with knowledge of the matter, legal immigrants who aren’t yet eligible for Medicaid in Illinois—it takes five years of residence to join the state-run programs for low-income people—were nevertheless told they would be enrolled.
The risk that consumers could remain in limbo as the health law’s coverage expansion begins in January has been a continual political threat to the Obama administration, which has addressed flaws—ranging from a malfunctioning website to the cancellation of health policies that don’t meet the law’s requirements—with a patchwork of last-minute fixes.
Does this read like the description of a better, more functional website? Does it make you think that the worst is over when it comes to the performance of HealthCare.gov? Because I still see gremlins in the system, and I am willing to bet that I am not alone.
The Wall Street Journal article goes on to mention the following:
The Department of Health and Human Services on Thursday urged insurers to help avoid Jan. 1 mix-ups by loosening coverage rules. Officials asked companies to cover people retroactively who miss the Jan. 1 deadline to pay premiums and pay for drugs next month, even for customers who haven’t yet fully enrolled.
But insurance-industry executives warn that some of these data problems will only emerge once customers begin seeking care in January at physicians’ offices, pharmacies and hospitals. The result could be bureaucratic chaos as doctors and patients storm insurers’ phone banks and federal officials work to clean up the inaccuracies.
Oy. And also, vey. So now, the Obama administration is reduced to passing along the costs of its failures and incompetence to the insurance industry, and even if the insurance industry agrees to try to make up for the administration’s shortcomings, we may still face a host of problems and more chaos in the health care sector than you can shake a stick at. This editorial sees through the administration’s motivations for this most recent exercise in buck-passing:
So with a mere 11 business days to go before coverage is supposed to start on New Year’s Day, HHS is trying to pre-empt patient uproar by unilaterally ordering plans to backdate all exchange applications. People can sign up for a plan on the exchange as late as Dec. 23. If an application winds up in some technology void, or it is passed to the insurer inaccurately or too late to process, that coverage nonetheless begins on Jan. 1.
For decades, people have also paid the first month’s premium in full for coverage to start, but not under the new rule. Simply selecting a plan is sufficient as long as buyers eventually make a “down payment,” however much that might be. Upon receipt, the insurer is responsible for all medical claims incurred that month.
The White House seems to understand that hundreds of thousands of patients may soon discover that they face gaps in coverage through no fault of their own, but because their old plan was canceled and the exchanges malfunctioned. Some will have life-threatening illnesses, or be diagnosed as such, and require certain advanced or continuous treatments that they will not be able to obtain. ObamaCare will be blamed and rightly so, which is why the White House wants to transfer political accountability to the insurers.
HHS says the new rules are only suggestions to ensure “a more seamless transition,” but there’s nothing voluntary here. The regulatory fine print reveals that HHS intends to kick insurers off the exchanges if they don’t obey. Having destroyed the old individual market, HHS will only certify the new “qualified health plans” if insurers “adopt policies to prevent disruptions in treatment of episodes of care.”
Read the whole thing, especially if you get some kind of perverse pleasure out of tales of government bungling. More on this issue via Yuval Levin:
To “strongly encourage” insurers to take these kinds of steps (to use the Orwellian phrase of the HHS announcement), and to do it just a couple of weeks before the new system is supposed to start, suggests that the administration’s health experts mapped out how January is shaping up and had a collective heart attack. They seem especially worried about people forced out of old coverage and into new encountering horrible surprises and about the extremely low payment rate so far among people who have chosen new insurance plans on the exchanges. About two weeks before the deadline (after which, if they have not paid their first premium, people’s coverage will be voided) it looks like only about a fifth of the people who have signed up for exchange coverage have paid their first premium. If far more don’t do so soon, the (already very low) enrollment numbers the administration is looking at will fall far, far lower. And the Christmas season (with many distractions, and an overstressed postal system) isn’t a great time to squeeze all those invoices and checks into.
What the insurers are being asked to do here as a response, while not necessarily impossible as a practical matter, is very unusual, and it highlights a couple of things about the administration’s reactions to Obamacare problems. First, it’s another instance of pushing problems just a little bit further into the future. The administration has done this again and again: A lot of the steps they’ve taken as the rollout has floundered have evinced the hope that things will turn around very soon. This is the administrative version of the Democrats’ political strategy since Obamacare was first passed, which has also been built on the hope that public opinion was about to turn around any minute, and they just need a little bit of time. With this latest step, they’re pushing what appear to be huge problems off by a couple of weeks (in some cases days), and it’s not clear why they think things will be very different at that point.
The move also puts HHS in the position of playing the role central manager of the American health-care system—telling private insurers to do various things that have nothing in particular to do with the law, as though they work for the government. It is an eerie prefiguration of where the administration would like to get with this system, but it’s also surely something they didn’t want to be doing so publicly at this stage.
A Wall Street Journal/NBC News poll released this week asked uninsured individuals whether or not they thought the law was a good idea. Just 24 percent said they thought it was. In contrast, half the uninsured polled said they thought it was a bad idea. As the Journal points out, that represents an 11 point drop in support for the law amongst the uninsured since September. The same poll also finds that 56 percent of the uninsured believe the law will have a negative effect on the U.S. health care system.
Let that sink in: What that means is that regardless of how bad the old system—the system that for whatever reason left them uninsured—was, a majority of people without health coverage now think that Obamacare makes it worse.
I guess this means that the Obama administration has been about as successful in turning around its political fortunes as it has been in improving the performance of HealthCare.gov and the implementation of Obamacare in general.
Finally, res ipsa loquitur:
Many in New York’s professional and cultural elite have long supported President Obama’s health care plan. But now, to their surprise, thousands of writers, opera singers, music teachers, photographers, doctors, lawyers and others are learning that their health insurance plans are being canceled and they may have to pay more to get comparable coverage, if they can find it.
They are part of an unusual, informal health insurance system that has developed in New York, in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.
But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.
“I couldn’t sleep because of it,” said Barbara Meinwald, a solo practitioner lawyer in Manhattan.
[. . .]
It is not lost on many of the professionals that they are exactly the sort of people — liberal, concerned with social justice — who supported the Obama health plan in the first place. Ms. Meinwald, the lawyer, said she was a lifelong Democrat who still supported better health care for all, but had she known what was in store for her, she would have voted for Mitt Romney.
It is an uncomfortable position for many members of the creative classes to be in.
“We are the Obama people,” said Camille Sweeney, a New York writer and member of the Authors Guild. Her insurance is being canceled, and she is dismayed that neither her pediatrician nor her general practitioner appears to be on the exchange plans. What to do has become a hot topic on Facebook and at dinner parties frequented by her fellow writers and artists.
“I’m for it,” she said. “But what is the reality of it?”
These people chose . . . poorly.