Health Insurance Exchanges Scramble to Be Ready as Opening Day Nears
PORTLAND, Ore. — Rocky King, the executive director of Oregon’s new health insurance exchange, has done everything in his power to tamp down expectations for its opening on Tuesday.
He rejected the idea of a flashy downtown news conference that morning. He postponed a series of ads meant to drive customers to its Web site, coveroregon.com. In fact, Mr. King is not even allowing people to sign up for health coverage online without assistance at first; they will have to go through an insurance agent or a community group until at least mid-October.
Tuesday is the long-awaited kickoff of President Obama’s signature health care law, when millions of Americans can start signing up for new insurance options. Yet across the country, officials are issuing warnings that despite fevered efforts, their new insurance exchanges — online markets where people can shop for health plans and see if they qualify for federal subsidies — will not be fully operational for weeks or even months.
Last week, the District of Columbia’s exchange announced that it would not immediately be able to determine online whether people qualify for Medicaid, which about half the states are expanding under the law, or for a federal subsidy to help cover the cost of private coverage. In Colorado, for the first month, people who want to know if they are eligible for a subsidy will have to call a customer service line.
In Nevada, home to a large Hispanic population, a Spanish-language version of the exchange Web site will not be ready until mid-November. And in Maryland, small businesses will not be able to buy insurance for their employees through the state exchange until January. Federally run exchanges are having similar problems.
Many of the 16 directors of state-run exchanges are describing October as a “soft launch” period, when Americans can start exploring their coverage options — but on Web sites that may be incomplete, vulnerable to glitches and perhaps not ready for an onslaught of customers.
“I have no idea what this thing’s going to look like on Oct. 1,” Mr. King said one afternoon last week as dozens of tense-looking programmers, scattered through the exchange offices outside Portland, rushed to finish testing and fix problems. “We could crash and burn and have to close it down.”
U.S. Plans to Unveil New Insurance Options
By ROBERT PEAR
WASHINGTON — The Obama administration plans on Monday to announce scores of new health insurance options to be offered to consumers around the country by the Blue Cross and Blue Shield Association and the United States Office of Personnel Management, the agency that arranges health benefits for federal employees, according to administration officials.
The options are part of a multistate insurance program that Congress authorized in 2010 to increase options for consumers shopping in the online insurance markets scheduled to open on Tuesday.
Congress conceived multistate plans as an alternative to a pure government-run insurance program — the “public option” championed by liberal Democrats and opposed by Republicans in 2009-10.
“The multistate program will help deliver choice and high-value health plans in the new marketplace, expanding quality, affordable options for uninsured Americans,” an administration official said.
The administration plans to unveil the program on Monday, the official said, even as Congress fights over the future of President Obama’s health care law, intended to provide coverage to more than 25 million people within three years.
Federal officials said they had signed a contract with the Blue Cross and Blue Shield Association to offer health insurance next year in the marketplaces, or exchanges, of 30 states and the District of Columbia. In later years, the officials said, they hoped to see at least two multistate plans in every state, as Congress envisioned.
Under its federal contract, Blue Cross and Blue Shield will offer different products in different states — a total of more than 150 products, including health maintenance organizations and preferred provider organizations, which give discounts for using selected health care providers. In many of the products, consumers will have access to a nationwide network of doctors and hospitals.
The federal government negotiated the benefits and premiums for the Blue Cross and Blue Shield products, so this plan carries a federal seal of approval.
In negotiating with insurers, the Office of Personnel Management leveraged more than 50 years of experience in the Federal Employees Health Benefits Program, the nation’s largest employer-sponsored health insurance program, covering more than eight million federal employees, retirees and dependents. Blue Cross and Blue Shield plans are, by far, the most popular among federal employees, with more than 60 percent of the enrollment.
By JEREMY W. PETERS and JONATHAN WEISMAN
WASHINGTON — The Senate is expected to reject decisively a House bill that would delay the full effect of President Obama’s health care law as a condition for keeping the government running past Monday, as Senator Harry Reid, the Democratic majority leader, expressed confidence that he had public opinion on his side.
Angering Republicans who lead the House, Mr. Reid kept the Senate shuttered on Sunday, in a calculated move to stall action on the House measure until Monday afternoon, just hours before the government’s spending authority runs out at midnight.
Without a complete capitulation by House Republicans, large sections of the government would close, hundreds of thousands of workers would be furloughed without pay, and millions more would be asked to work for no pay.
Polls show that the public is already deeply unhappy with its leaders in Congress, and the prospect of the first government shutdown in 17 years would be the latest dispiriting development. With a temporary shutdown appearing inevitable without a last-ditch compromise, the battle on Sunday became as much about blaming the other side as searching for a solution.
House Republicans, who insisted that they had passed a compromise over the weekend that would avoid a shutdown if only the Senate would act, blamed Mr. Reid for purposely running out the clock.
“Unlock those doors, I say to Harry Reid,” said Representative Ann Wagner, a Missouri Republican who stood on the steps of the empty Senate on Sunday with a dozen of her House colleagues. “Come out and do your job.”
But Mr. Reid sees little incentive or political advantage in bowing to those demands. He has held his 54-member caucus together so far. And because of support from some Senate Republicans who have called it a mistake for House Republicans to try to force changes to the health care law in an unrelated fight over the budget, Mr. Reid’s hand has been strengthened.
Senator Susan Collins of Maine became the latest Republican to criticize her House colleagues, saying on Sunday that an effort to link the health care amendments to the budget was “a strategy that cannot possibly work.”
Psychotherapy’s Image Problem
By BRANDON A. GAUDIANO
PROVIDENCE, R.I. — PSYCHOTHERAPY is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent.
This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.
As well they should: for patients with the most common conditions, like depression and anxiety, empirically supported psychotherapies — that is, those shown to be safe and effective in randomized controlled trials — are indeed the best treatments of first choice. Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.
So what explains the gap between what people might prefer and benefit from, and what they get?
The answer is that psychotherapy has an image problem. Primary care physicians, insurers, policy makers, the public and even many therapists are largely unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries — industries that, not incidentally, also have the money to aggressively market and lobby for those practices.
For the sake of patients and the health care system itself, psychotherapy needs to overhaul its image, more aggressively embracing, formalizing and promoting its empirically supported methods.
My colleague Ivan W. Miller and I recently surveyed the empirical literature on psychotherapy in a series of papers we edited for the November edition of the journal Clinical Psychology Review. It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).
In the short term, these therapies are about as effective as medications in reducing symptoms of clinical depression or anxiety disorders. They can also produce better long-term results for patients and their family members, in that they often improve functioning in social and work contexts and prevent relapse better than medications.
Given the chronic nature of many psychiatric conditions, the more lasting benefits of psychotherapy could help reduce our health care costs and climbing disability rates, which haven’t been significantly affected by the large increases in psychotropic medication prescribing in recent decades.http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?hp&pagewanted=print
As key parts of Obamacare kick in, the stakes are high for both parties
Republicans are worried that the law's new benefits will prove popular, while Democrats could become targets if the law drives up costs.
By Noam N. Levey
9:12 PM PDT, September 29, 2013
WASHINGTON — The debate over President Obama's signature healthcare law enters a crucial phase this week as the real effect on consumers starts to come into focus after more than 3 1/2 years of partisan claims and counter-claims.
For both sides in the protracted battle over what has come to be called Obamacare, it is a moment of political peril.
The president has staked his legacy on tens of millions of Americans who don't get health benefits at work being able to start signing up for insurance coverage, even if they have a preexisting medical problem.
A meltdown in this new system would be politically damaging for Obama and his Democratic allies, who have said since the law passed in 2010 that Americans would embrace the Affordable Care Act once they realized its benefits.
For Republicans, the stakes also are high. Warning of an impending catastrophe, the GOP has waged an unprecedented campaign to stop the law from taking effect — including the current threat to shut down much of the federal government if Obama does not yield. A relatively drama-free rollout of the law this fall could shatter what has been a key pillar of the Republican agenda.
More worrisome still to some Republican strategists: The law's new benefits may prove popular with millions of Americans who have been unable to get health insurance.
"We are replacing years of fighting with a reality, and that reality will shape public attitudes from here forward," said Bill McInturff, a veteran Republican pollster. "If it works, attitudes about the law could change. But this country will have limited patience and tolerance if it doesn't."
Enrollment is scheduled to begin Tuesday in new state-based insurance marketplaces authorized by the law. Consumers who don't get health benefits at work will be able to shop on the marketplaces for health plans, which must provide a new basic set of protections. The coverage will take effect Jan. 1.
Few on either side think opinions will change overnight, as a relatively small number of consumers will initially use these markets. Only about 7 million people are expected to enroll in 2014, rising to 25 million by 2018, according to the nonpartisan Congressional Budget Office. An additional 12 million low-income Americans ultimately will sign up for government Medicaid programs under the law, the budget office says.
By contrast, more than 160 million people will continue to get health benefits through the decades-old system of employer-sponsored coverage, according to the projections.
Obama and his allies, however, are counting on a gradual transformation in public opinion. As millions of Americans get guaranteed health insurance and begin sharing personal stories with friends and neighbors, what has largely been a political debate will start transforming into a discussion about consumer experiences, they believe.
Supporting this effort, a vast network of grass-roots groups, some linked directly to Obama's 2012 reelection campaign, have fanned out across the country to enroll consumers in health coverage.
Health clinics key to success of Obamacare1:00 AM
PORTLAND - Community health clinics that serve low-income residents and the uninsured will play a greater role under the Affordable Care Act, even though the way they operate will shift because more people will have health insurance as the law takes effect, experts say.
"The clinics are a key part of the strategy," said Dora Anne Mills, vice president for clinical affairs at the University of New England and a former Maine health official. "The ACA increases support for the community health centers. With more people insured, there needs to be a larger primary care workforce."