Why the Federal Health Insurance Exchange and So Many State Exchanges Are Not Working
We may be getting a better idea why the federal exchange and so many state exchanges aren't working.An article in Saturday's Baltimore Sun, regarding Maryland's problems, provides insight I have not seen elsewhere:
Problems began immediately after the exchange launched Tuesday, as people tried to create accounts and log onto the site.So, it appears all of the exchanges are facing the same bottleneck at the federal level--the identity verification software the feds are running for themselves and the state exchanges.
State officials blamed the account creation process, in which people were routed to a federal questionnaire to verify their identity. The system, they said, became overwhelmed when so many people tried to access it.
Then the Sun article provided more insight:
http://healthpolicyandmarket.blogspot.com/2013/10/why-federal-health-insurance-exchange.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29
Urging Patience, Obama Says Problems With Health Care Sites Reflect Demand
By JACKIE CALMES
WASHINGTON — President Obama urged Americans who have flocked to the new government-run Web marketplaces for health insurance policies not to give up because of the technical problems attributed to greater-than-anticipated demand. Fixes are under way, he said.
Mr. Obama, in an interview with The Associated Press released on Saturday, said he did not have any figures to counter scattered reports that just a very small number of people have succeeded in signing up for insurance coverage since state and federal Web sites began enrollment on Tuesday for the so-called insurance exchanges. Those are a central part of Mr. Obama’s health care law, which was passed in 2010 to extend coverage to those who do not get insurance benefits on the job.
People “definitely shouldn’t give up,” Mr. Obama said. Citing the slow start to a similar program for Massachusetts residents several years ago, the president predicted that when the six-month window for enrollment ends in March, “we are going to probably exceed what anybody expected in terms of the amount of interest that people had.”
House Republicans — who forced a shutdown of the federal government, which also started on Tuesday, by demanding that the health care law be defunded or delayed as a condition for their approving financing for the government in the new fiscal year — were quick to jump on the snags as validation of their opposition to the program.
Yet Mr. Obama and other Democrats have countered that public demand caused technical problems with the new state and federal Web sites, evidence of the popularity of what the health care program has to offer.
“The interest way exceeded expectations, and that’s the good news,” Mr. Obama said in the interview. “It shows that people really need and want affordable health care” from insurers that have bid to compete in the insurance exchanges.
Why the Bad Rap on Generic Drugs?
By KATIE THOMAS
IN an episode of “Orange Is the New Black,” the Netflix series set inside a federal prison, a journalist rattles off a series of budget cuts that are making life difficult for the inmates. Closing the running track. Canceling G.E.D. classes. And switching to generic drugs.
It’s been nearly 30 years since Congress kick-started the generic drug industry by passing the Hatch-Waxman Act, the 1984 law that made it easier for pharmaceutical companies to sell copycat pills as long as they could prove the drugs were identical to the brand-name versions. Today, the Food and Drug Administration and nearly every other major health authority agree that generic drugs are safe and effective. Indeed, 84 percent of all prescriptions in the United States were dispensed as generics last year, and in many states pharmacists are required to dispense the generic version of a drug unless a doctor specifies otherwise.
The reason, from a public health perspective, is clear: Many generic drugs cost pennies per pill, yet pack the same punch as brand-name medicines.
So why can’t they get more respect?
Television writers aren’t the only ones who suspect that generic drugs are somehow subpar. In 2007, researchers at Brigham and Women’s Hospital in Bostonsurveyed more than 1,000 patients about their views on generic drugs. Participants agreed overwhelmingly that generics were “a better value” than branded drugs, and fewer than 10 percent believed that generic drugs caused more side effects. More than half expressed the opinion that Americans should be taking more of them. But when it came to the patients themselves, only about 38 percent said they preferred generics over brand-name drugs.
“It’s some bizarre thing that’s in the deepest part of their psyche,” said Dr. William Shrank, the study’s lead author. “They have all the pieces of information to make the right decision, but there’s something that’s holding them back.”
Some studies have found that lower-income patients — those who could benefit the most from generics — are among the groups that are most skeptical. In 2011, for example, researchers at the University of Alabama, Birmingham, noticed that participants in a community outreach program in rural Alabama, most of whom were poor and African-American, were using brand-name medications even though cheaper generics were available. Because of the higher cost, some weren’t refilling their prescriptions when they ran out.
Intrigued, the researchers set out to discover why. In an article published in 2012 in the journal Preventing Chronic Disease, patients gave some reasons that seemed straightforward: brand-name drugs were perceived as being of higher quality, or of causing fewer side effects.
But other explanations were more complex. Some of the patients said they felt forced to “settle” for lesser drugs because they were poor and black.
“I think that the doctors and manufacturers use us as guinea pigs to see which ones we will buy the most,” one woman told the researchers. Another said, “We settle for that because we’re trying to do the best we can with the fixed income we have.”
State lacks backup plan if it drops ride broker
Posted:TodayUpdated: 12:41 AM
DHHS also says it will keep the broker system even though past ride providers could quickly resume service.
The state Department of Health and Human Services has no backup plan for providing transportation to low-income Mainers if it drops a Connecticut ride service broker that has left thousands of patients stranded or late for medical appointments over the past two months.
DHHS also reiterated that it is committed to hiring private transportation brokers to coordinate the MaineCare ride service despite receiving thousands of complaints about Coordinated Transportation Services. The department has given the company a Dec. 1 deadline to fix problems with the ride service or its contract may be canceled.
“Our actions will be in support of sustaining the brokerage model,” human services spokesman John Martins said in an email Friday. “We are evaluating all of our options.”
The Business End of Obamacare
by James Surowiecki
Of the countless reasons that congressional Republicans hate the Affordable Care Act enough to shut down the government, the most politically potent is the claim that it will do untold damage to the economy and cripple small companies. Orrin Hatch has said that Obamacare will be “devastating to small business.” Ted Cruz argues that it is already “the No. 1 job killer.” And the vice-president of the National Federation of Independent Businesses called it simply “terrible.” So it comes as some surprise to learn that Obamacare may well be the best thing Washington has done for American small business in decades.
The G.O.P.’s case hinges on the employer mandate, which requires companies with fifty or more full-time employees to provide health insurance. It also regulates the kind of insurance that companies can offer: insurance has to cover at least sixty per cent of costs, and premiums can’t be more than 9.5 per cent of employees’ income. Companies that don’t offer insurance will pay a penalty. Republicans argue that this will hurt companies’ profits, forcing them to stop hiring and to cut workers’ hours, in order to stay below the fifty-employee threshold.
The story is guaranteed to feed the fears of small-business owners. But the overwhelming majority of American businesses—ninety-six per cent—have fewer than fifty employees. The employer mandate doesn’t touch them. And more than ninety per cent of the companies above that threshold already offer health insurance. Only three per cent are in the zone (between forty and seventy-five employees) where the threshold will be an issue. Even if these firms get more cautious about hiring—and there’s little evidence that they will—the impact on the economy would be small.
Meanwhile, the likely benefits of Obamacare for small businesses are enormous. To begin with, it’ll make it easier for people to start their own companies—which has always been a risky proposition in the U.S., because you couldn’t be sure of finding affordable health insurance. As John Arensmeyer, who heads the advocacy group Small Business Majority, and is himself a former small-business owner, told me, “In the U.S., we pride ourselves on our entrepreneurial spirit, but we’ve had this bizarre disincentive in the system that’s kept people from starting new businesses.” Purely for the sake of health insurance, people stay in jobs they aren’t suited to—a phenomenon that economists call “job lock.” “With the new law, job lock goes away,” Arensmeyer said. “Anyone who wants to start a business can do so independent of the health-care costs.” Studies show that people who are freed from job lock (for instance, when they start qualifying for Medicare) are more likely to undertake something entrepreneurial, and one recent study projects that Obamacare could enable 1.5 million people to become self-employed.
Jimmy John's CEO, Obamacare Opponent, Donated To Swanky Private Health Clinic
The Huffington Post | By Joe Van Brussel Posted: 11/15/2012 4:32 pm EST
A CEO who has publicly railed against the cost of providing health insurance to his employees has donated tens of thousands of dollars to a private health care clinic in his Florida community.
In an interview with Fox News host Neil Cavuto last month (see above), Jimmy John Liautaud detailed his plans to reduce workers' hours in order to avoid the Affordable Care Act's requirement to provide health coverage or pay a penalty.
Liautaud, who owns the Jimmy John's national sandwich chain, is listed as a "Super Founder" for the medical center at Key Largo's ritzy Ocean Reef Club. The club's website describes it as one of America's most exclusive club communities. Amenities include 54 holes of golf, a 175-slip marina, a private airport and its own school, which members' children can attend seasonally. In 2011, Liautaud paid $4 million for a home at theOcean Reef Club, according to a local business journal.
The club's medical center relies on donations from residents because it stays open year-round but only brings in significant income for six or seven months. The "Super Founder" list names those who have given at least $50,000.
While the clinic is geared mainly toward residents and members, it also provides services to any employees or vendors who work at the club, said Bill Enright, the clinic's director of operations. "Our focus is on the members primarily and our founders of course, but we care for all the others because their job is to care for the members," he said. "We care for them so they can get back to work quickly."
A spokeswoman for Jimmy John's declined to comment.
Liautaud is among a number of CEOs who have made news recently with public criticism of Obamacare. He has publicly attacked government levies before. He attracted attention in 2011 after telling local media in Champaign, Ill., that he was upset about a state tax hike. He said that he had already moved his family to Florida and hinted that he was planning to shift the company's headquarters to a more pro-business state.
Then in September 2012, Liautaud said he will move his company's licensing division to Florida.
According to Liautaud, Jimmy John's franchise restaurants employ around 60,000 hourly workers.
Obamacare is here. Get used to it.
By Eugene Robinson,
While Republicans were throwing their silly tantrum, Obamacare became a fact. There is no turning back.
The point of no return was reached when millions of people crashed the Web sites of the new Affordable Care Act exchanges while trying to buy health insurance. Republicans can fight rear-guard battles if they want, but last Tuesday they lost the war. All they can do at this point is harm the nation — and their political prospects.
Someday, if the GOP captures the presidency and both houses of Congress, President Obama’s health-care law could be altered or even repealed. But it would be replaced by some new program that does the same thing, because there is no politically viable way to snatch away the medical insurance that customers are buying through the exchanges.
Quite the opposite: As soon as the glitches are cleared up and everyone becomes a bit less hysterical, the question will be how to obtain coverage for as many as 30 million people who will still be uninsured — including upwards of 8 million ineligible for Obamacare because of a sabotage campaign by Republican governors.
Look at Texas, which the state medical association calls “the uninsured capital of the United States.” An estimated 22.5 percent of the population lacks health insurance, a higher percentage than in any other state. Many will remain uninsured because Gov. Rick Perry — a once and perhaps future GOP candidate for president — refused to set up a state insurance exchange and turned down billions in federal funds to expand Medicaid coverage.
Rejection of Obamacare may be popular in Texas now. But demographic trends are making the Lone Star State’s electorate more diverse, as the Latino population grows, and less reliably Republican. Small businesses that cannot afford to offer health insurance may soon worry about losing employees to states offering better coverage for the working poor through local exchanges and expanded Medicaid. Time is on the side of those who want to expand coverage, not those who want to restrict it.
I trust that conservative leaders will continue riling up the base with the untrue charge that Obamacare is “government health care.” It is nothing of the sort. Obama decided at the outset not to push for a government-run health system, such as those in Britain and Canada, or a single-payer system of any kind.
Instead, all of Obamacare’s insurance plans are offered by private firms — the same companies that also provide employer-sponsored insurance. Disappointing his liberal supporters, Obama declined to include even a single public, government-run health plan. All the apocalyptic right-wing rhetoric about socialism and the end of freedom is nothing but hot air. Soon, no one will take it seriously.
Those who are genuinely worried about the cost of a new entitlement should have their concerns taken seriously. But if money is the overriding issue, the obvious thing to do is go further and adopt a truly universal system like those in other industrialized countries.
latimes.com
California health exchange looks to speed up enrollment in week 2
By Chad Terhune
9:56 AM PDT, October 7, 2013
| advertisement |
After a weekend tune-up, California's health insurance exchange will try to overcome first-week glitches that frustrated many consumers trying to sign up under Obamacare.
The state marketplace, called Covered California, shut down its online enrollment system Saturday night through early Monday morning for what it described as "regular maintenance."
Last week, the state took enrollment offline two other times to address problems consumers had with repeated error messages and general slowness on the site.
Some people said they were finally able to create an account on the website after numerous attempts, but they still couldn't log in and complete the sign-up process for coverage under the federal Affordable Care Act.
Full coverage: Obamacare rolls out
Officials attributed the initial problems primarily to a larger-than-expected response during the first week of enrollment.
For now, consumers have plenty of time to consider their options and sign up. Enrollment in the exchange lasts until March 31. People must pick a plan by Dec. 15 to have coverage starting Jan. 1.
"We continue to make improvements and address issues as they arise," said Covered California spokeswoman Anne Gonzales. "The pages were loading more easily and quickly as of late last week."
Other state exchanges and the federally run marketplace in place for 36 states have experienced similar computer problems.
Some technology experts said it made for a poor first impression.
"It was an embarrassing start,” said Harold Tuck, the former chief information officer for San Diego County, who tried unsuccessfully to use the California and federal exchanges.
Citigroup healthcare analyst Carl McDonald said California's website performed better than some others, but it still had plenty of glitches.
"We experienced the system crashing during the application process, and there were extensive delays loading Web pages," McDonald said.
Central Maine Medical Center lauds ruling against Anthem
Posted:TodayUpdated: 12:04 AM
State regulator says the insurance provider can’t force customers to change doctors.
Central Maine Medical Center is a winner as Anthem must devise new plan for many policyholders.
The state’s top insurance regulator was right to decide that Anthem Blue Cross and Blue Shield should allow current customers to keep receiving care at Central Maine Medical Center in Lewiston and five other hospitals in Maine, a spokesman for the hospital said Monday.
Superintendent of Insurance Eric Cioppa made his decision Friday in response to a proposed insurance-plan restructuring that would have required some Anthem customers in southern and western Maine to change physicians.
Cioppa’s decision says that Anthem, the state’s largest health insurance provider, must devise a new plan for policyholders in southern and western Maine that imposes fewer restrictions on their options for subsidized care under the federal Affordable Care Act.
The decision was a win for Central Maine Medical Center and its parent organization, Central Maine Healthcare, which has been the most vocal critic of Anthem’s proposed changes.
Health care website still having glitches
Posted:TodayUpdated: 5:53 AM
After emergency repairs over the weekend, consumers in different parts of the country continue to report delays.
The Associated Press
The glitch-ridden rollout of President Barack Obama's health care law has opponents crowing: "Told you so!" and insisting it should be paused, if not scrapped.
After emergency repairs over the weekend, consumers in different parts of the country Monday continued to report delays on healthcare.gov, as well as problems setting up security questions for their accounts. The administration says the site's crowded electronic "waiting room" is thinning out. Still, officials announced it will be down again for a few hours starting at 1 a.m. Tuesday for more upgrades and fixes.
Despite the confusion, the insurance industry has held off public criticism. Alarmed that only a trickle of customers got through initially, insurers now say enrollments are starting to come in and they expect things to improve.
Posted Oct. 07, 2013, at 2:58 p.m.
On Saturday, Maine Sen. Susan Collins laid out what she described as a three-part compromise to end the federal government shutdown and start making the federal Affordable Care Act more workable.
She proposed repealing a 2.3 percent, manufacturer-paid tax on medical devices that’s included in the federal health care law; passing a resolution to restart funding for federal agencies; and allowing those agencies flexibility to implement $85 billion in sequestration cuts more strategically.
It seems increasingly likely that a deal to restart government funding will be connected to changes to the Affordable Care Act, and that’s disappointing.
But in that context, Collins’ bargain is a welcome effort to restart federal government operations. Finally, it’s a proposal from a Republican to adjust, rather than entirely undermine, the Affordable Care Act and reopen government.
We’re not fond of the focus on repealing the medical device tax. The tax is designed to raise $30 billion over a decade to help pay for subsidies that will make health insurance more affordable for the uninsured. And while the industry claims the levy will cost medical device manufacturers 6 percent of their annual revenue and force them to slash 43,000 U.S. jobs, a Bloomberg Government analysis found those numbers were based on flawed assumptions.
But if the repeal or delay of that tax is the key to reopening government and avoiding a default on the country’s debt obligations, Democrats should negotiate over it.
First, the medical device tax repeal is a change that can garner bipartisan support. Sen. Dick Durbin of Illinois, the No. 2 Democrat in the Senate, has said its potential repeal is on the negotiating table, and Democratic legislators from states that are home to medical device manufacturers are against the tax. In July, 79 senators — including 30 Democrats — favored a symbolic resolutioncalling for the tax’s repeal.
Second, Collins suggested a measure to offset the $30 billion, 10-year revenue loss that could help businesses struggling under the weight of pension plan obligations: allowing private businesses to postpone, or “smooth out,” tax-deductible pension payments. The federal government would collect additional revenue in the years when businesses postpone pension payments and claim fewer pension-related tax deductions as a result. Democrats have said they won’t entertain a proposal to repeal the tax unless the government can make up for the lost revenue.
While we disagree that the medical device tax is one of Obamacare’s problems, the GOP is right that Obamacare isn’t perfect.
Obamacare is a continuation of the business model for insurance
By Joseph Jarvis, M.D.
Deseret News (Salt Lake City), Oct. 4, 2013
Deseret News (Salt Lake City), Oct. 4, 2013
I agree with Dan Liljenquist that the cost of Obamacare has been grossly underestimated ("Obamacare will lead to single-payer health care," Sept. 26). It is also likely that many more employees than originally predicted by the smoke and mirrors estimates offered at the time of passage of the Affordable Care Act will lose their employment-based health benefits, thus the now increasingly strident opposition of organized labor to the implementation of this legislation.
Obamacare is neither affordable nor about care. But it is also not a stepping stone to single payer, nor was it ever intended to be. Dan Liljenquist offers no facts in support of his conspiracy theory that the end goal of Obamacare is to create "single-payer, socialized health care" in this country.
Rather than taking us halfway to single payer, Obamacare is a continuation of many decades of government preference for the most wasteful health care financing scheme ever invented: the private, for-profit health insurance business model.
Both parties are responsible for the continuing dominance of this useless business model. Federal tax policies and state regulations with bipartisan support over many decades have locked Americans into buying health insurance, despite the well documented fact that the health insurance business model features $400 billion per year excess administrative costs and still fails to hold down health care price inflation.
Despite all of the incredibly wasteful claims reviews, American health insurers cannot effectively discriminate between high and low quality care. The perverse incentives of the American health care system occur because providers of care can make better margins by being reimbursed from health insurers for mediocre care. Obamacare is just one more governmental intervention on the side of the health insurers and against patients and taxpayers.
During its deliberations preceding the passage of Obamacare, Congress explicitly excluded single-payer advocates from participating in hearings. Some single-payer activists were arrested when they tried to provide testimony at a Senate Finance Committee hearing. The public option, contrary to Liljenquist’s conspiracy theory, was explicitly voted down by Congress.
