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Monday, March 31, 2014

Health Care Reform Articles - March 31, 2014

Start-Up Health Insurer Finds Foothold in New York

By 
One afternoon in late March, Kevin Nazemi stood along a wall of the small, sweltering offices of the health insurance start-up Oscar in downtown New York, trying to rally the troops.
Noting that so far more than 10,600 New Yorkers had signed up for health insurance through Oscar, Mr. Nazemi, 32, a former Microsoft marketer who was a co-founder of Oscar last year, predicted long hours as individuals raced to meet the March 31 deadline for insurance coverage this year.
As Mr. Nazemi wrapped up, the 50 or so people in the room — most of whom appeared to be wilting in the heat thanks to a malfunctioning thermostat and in dire need of a Red Bull — clapped weakly before returning to their phones or computer screens.
Nearby, another founder, Joshua Kushner, 28, the scion of a New York area real estate dynasty whose venture capital firm has placed a sizable bet on Oscar, watched silently as he pulled his bright purple hoodie up over his head.
Oscar is Silicon Alley’s challenge to the staid business of health insurance. It is trying to use its tech-world skills to provide an easier experience to consumers. Its snazzy website is extremely easy to navigate (typing in “I have a stomachache” will pull up many options of types of doctors or facilities to visit). But what sets it apart, at least for now, is telemedicine, or unlimited phone calls with physicians, and greater price transparency.
http://www.nytimes.com/2014/03/29/business/start-up-health-insurer-finds-foothold-in-new-york.html?action=click&contentCollection=Business%20Day&region=Footer&module=MoreInSection&pgtype=article

Public support for health law drops in poll

But few think federal program will be repealed

By Ricardo Alonso-Zaldivar and Dennis Junius

WASHINGTON — Despite a late surge in sign-ups, support for President Obama’s health care law is languishing at its lowest level since passage of the landmark legislation four years ago, according to a new poll.
The Associated Press-GfK survey finds that 26 percent of Americans support the Affordable Care Act. Yet even fewer — 13 percent — think it will be repealed. A narrow majority expects the law to be further implemented with minor changes, or as passed.
“To get something repealed that has been passed is pretty impossible,” said Gwen Sliger of Dallas. “At this point, I don’t see that happening.”
Sliger illustrates the prevailing national mood. Although a Democrat, she’s opposed to Obama’s signature legislation. Yet she thinks the law is here to stay.
“I like the idea that if you have a preexisting condition you can’t be turned down, but I don’t like the idea that if you don’t have health insurance you’ll be fined,” said Sliger.
That central requirement that virtually all Americans have coverage or face fines remains unpopular. Forty-one percent said it should be repealed, about double the 19 percent who said it should remain in the law as passed.
Obama, insurers, and most policy experts consider the so-called individual mandate essential to creating a big insurance pool that keeps premiums affordable.
The poll was taken before Thursday’s announcement by the White House that new health insurance markets have surpassed the goal of 6 million sign-ups, so it did not register the potential impact of that news on public opinion.
Open enrollment season began with a dysfunctional HealthCare.gov website last Oct. 1. It will end Monday at midnight, on what looks to be a more positive note.

Maine lawmakers send Medicaid expansion bill to LePage

The bill to cover more than 60,000 uninsured Mainers faces a certain veto from the governor.

By Steve Mistler smistler@pressherald.com
Staff Writer
AUGUSTA – The state Senate gave final approval Friday to a bill that would expand the state’s Medicaid health care program to more than 60,000 uninsured Mainers and establish a managed care system for the 320,000 current beneficiaries.
he proposal faces a certain veto by Gov. Paul LePage.
The Senate enacted the bill without debate or a roll call vote, sending the compromise measure co-sponsored by two moderate Republicans to the governor. The bill was designed to attract support from conservatives, but a majority of Republicans in the House and Senate backed the governor’s staunch opposition.
A veto of the bill will face override votes by the Legislature, but will likely be upheld. An override requires votes from two-thirds of the lawmakers present and voting in each chamber. The bill, while passing, failed to win two-thirds support in roll call votes in the House and Senate.
LePage and Republican legislators have said that the state’s $2.5 billion Medicaid program is already unsustainable and should not be expanded.
Democrats have countered that the federal government will fully reimburse the state for the cost of expansion through 2016 before gradually reducing the funding to 90 percent, after 2020.
They say that if Maine does not expand Medicaid, it will increase the likelihood that more than 150 low-income Mainers with chronic illnesses will die, based on statistical projections about the uninsured population.
About 36,000 people would fall into a coverage gap because their earnings are below the poverty level so they don’t qualify for subsidized insurance on the federal marketplace established by the Affordable Care Act.

Is latest MaineCare expansion proposal right answer to state’s needs?

By Ed Youngblood, Special to the BDN
Posted March 26, 2014, at 12:27 p.m.
During the time that I have been in the Maine Senate, Medicaid expansion is, by far, the most difficult issue that I have encountered.
Over the past year, I have had many meetings to listen to the concerns of my constituents.
Many of their stories were difficult to hear. No one can argue that this great country isn’t taking care of the truly needy the way it should.
Last year, I was actively involved in creating an amendment to the expansion bill that did make it better, but not good enough.
I was also involved this past year with a small group that created what is known as the Katz/Saviello amendment to Medicaid expansion, and it, too, makes it a better bill. It includes a managed care provision that calls for the state to contract with private companies to manage Medicaid recipients’ health care.
I believe that the most efficient way to control costs in the long term is to convert to this type of system. This would improve access to health care in rural areas, assist the Department of Health and Human Services to transition to a model already working for other states, and keep the program within the budgeted money as it adds participants.
But there are issues that have given me many sleepless nights:
1. We have just completed a supplemental budget to balance our 2014 budget and at least the first half-year budget for 2015. DHHS said it needed an additional $45 million to meet its projected new needs. We were able to only give the department $31 million.
2. The MaineCare program without expansion is 23 percent of the state’s total budget and growing. It will consume about 30 percent of our total budget within five years. This is unsustainable.
3. Previously, the costs involved with the expansion of MaineCare were severely underestimated. That is the cause of many of our current budget problems such as the underfunding of education, municipal revenue sharing, nursing homes and important government services such as public safety and the court system. It’s also led to increased sales taxes and other fees, more than a half-billion-dollar debt to our hospitals and longer waiting lists for people with severe handicaps. The list goes on and on.
4. The bill has a sunset after three years, which gives a future Legislature the option of rolling back the expansion. This is a lot like giving someone a nice new home but telling them not to get too attached because in three years they’re going to be kicked out.
5. DHHS projects that the three-year trial period will require it to budget about $84 million to cover costs.
6. Free insurance, “MaineCare,” is provided to 319,000 individuals. Expansion, if projections are correct, will add 70,000 people almost immediately and up to 100,000 over the next 10 years.
7. If the bill passes, it will not become law until July. It would take another year or more for the Request for Proposal process to be completed to choose three or four managed care companies to run the program. We would already be two years into the three-year sunset. With only one year under our belt, can we really evaluate the effectiveness of the expansion?
8. Will the federal government pay the promised 90 percent starting in 2020? Even if it does, Maine’s share would be $100 million to $150 million per year. Thirty-eight percent of the state budgetwould be used to fund MaineCare. Devastating.
9. Will the federal government allow us to get out of the program after three years?
http://bangordailynews.com/2014/03/26/opinion/contributors/is-latest-mainecare-expansion-proposal-right-answer-to-states-needs/print/

Repercussions and Reprieves at Health Insurance Enrollment Deadline

By 
WASHINGTON — America’s health insurance marketplace closes on Monday night, the deadline for most people to obtain coverage or face a penalty.
The confusion and uncertainty of the last six months appear likely to continue as consumers, including some who have never had insurance, begin using new policies for the first time. Here are answers to some frequently asked questions.
Q. What happens if a consumer does not sign up for insurance by the Monday deadline?
A. The consumer may be subject to financial penalties, to be paid with federal income taxes next year. However, the federal government has said it will stretch the sign-up deadline for people who started an application and could not finish it for one reason or another.
To preserve their rights, consumers can call the federal insurance marketplace (1-800-318-2596) and request a “special enrollment period.”
Officials running the federal marketplace, which serves 36 states, will provide an unspecified amount of extra time to people who are “in line as of March 31,” and some states running their own exchanges have adopted similar policies.
http://www.nytimes.com/2014/03/30/us/repercussions-and-reprieves-at-health-insurance-enrollment-deadline.html?hpw&rref=health&_r=0&assetType=nyt_now

The Health Insurance Answer That Took 3 Months

In this episode, a rare collision of the Haggler and the news. Our letter comes from a couple who have been trying for months to sign up for health insurance through Healthcare.gov, also known as the Obamacare website. And Monday, March 31, is the enrollment deadline, though the administration recently announced exemptions for people who had trouble signing up.
In other words, this column is sort of timely. The Haggler would like some credit for this. He’d also like to note that it is unlikely to ever happen again.
Q. As a regular reader of your column, I know that you have successfully slain many corporate dragons. But do you have what it takes to take on the United States government? In particular, the health care exchange set up by the Affordable Care Act?
I signed up for health insurance for my wife and myself through the online marketplace last November. But in January, my wife, Mindy, was denied a benefit from the pharmacy and was told she was not listed on the policy. This is a disaster. My wife has survived cancer, and she needs health insurance.
Numerous calls to the Health Insurance Marketplace have ensued in which it has been established that Mindy’s name was, in fact, on the application I submitted and that for some inexplicable reason her name was not communicated to our insurer, Blue Cross and Blue Shield of Florida. We have been told on successive calls that there is no logical explanation for this, and that our complaint will be “elevated” and “expedited.”
I write this in mid-March. Mindy has had no health coverage since Jan. 1.
I think it only fair to tell you that employees at my congressman’s office have had no success in trying to rectify this situation. Is the Haggler ready for a big-time challenge? I hope so.
RICHARD AGLER, TAVERNIER, FLA.
A. The Haggler does enjoy a bit of goading. So, he contacted Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which oversees Healthcare.gov.
It would be fun to turn what follows into a lengthy tale, one in which the Haggler’s swashbuckling tactics, cunning and perseverance triumph over an intransigent bureaucracy. But the truth is duller. A day or two after an email to Mr. Albright, Mr. Agler wrote, “I think we have good news.”



In New Health Care Era, Blessings and Hurdles

By 
LOUISVILLE, Ky. — In a plain brown health clinic on a busy boulevard here, the growing pains of the Affordable Care Act are already being felt — almost too sharply for the harried staff trying to keep up with the flow of patients.
Tamekia Toure, 40, is typical of the clinic’s new patients, a single mother and recent arrival from Alabama with diabetes, high blood pressure, chronic pain and, for much of her adult life, no health insurance. For her, the new law is a godsend, providing Medicaid coverage that she would not have received before.
Then there is Donna Morse, 61, a widowed dental hygienist and yoga buff who is long overdue for a mammogram and blood work. She lost her insurance last year because it did not meet the new law’s standards. Now she has a new plan with much higher premiums, and which few doctors and hospitals will accept. So she too, warily, has landed at the clinic, one of seven here called Family Health Centers.
http://www.nytimes.com/2014/03/31/us/in-new-health-care-era-blessings-and-hurdles.html?hp&assetType=nyt_now

Obamacare has led to health coverage for millions more people

At least 9.5 million previously uninsured people have gotten health insurance since Obamacare started, surveys and reports show.

By Noam N. Levey
9:14 PM PDT, March 30, 2014
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WASHINGTON — President Obama's healthcare law, despite a rocky rollout and determined opposition from critics, already has spurred the largest expansion in health coverage in America in half a century, national surveys and enrollment data show.
As the law's initial enrollment period closes, at least 9.5 million previously uninsured people have gained coverage. Some have done so through marketplaces created by the law, some through other private insurance and others through Medicaid, which has expanded under the law in about half the states.
The tally draws from a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials nationwide.
The Affordable Care Act still faces major challenges, particularly the risk of premium hikes next year that could drive away newly insured customers. But the increased coverage so far amounts to substantial progress toward one of the law's principal goals and is the most significant expansion since the creation of Medicare and Medicaid in 1965.
The millions of newly insured also create a politically important constituency that may complicate any future Republican repeal efforts.
Precise figures on national health coverage will not be available for months. But available data indicate:
• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.
• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.
• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks withestimates from Avalere Health, a consulting firm that is closely following the law's implementation.
• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents' health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.
• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.
• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.
Republican critics of the law have suggested that the cancellations last fall have led to a net reduction in coverage.
That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans.
"We are talking about a very small fraction of the country" who lost coverage, said Katherine Carman, a Rand economist who is overseeing the survey.
Rand has been polling 3,300 Americans monthly about their insurance choices since last fall. Researchers found that the share of adults ages 18 to 64 without health insurance has declined from 20.9% last fall to 16.6% as of March 22.
The decrease parallels a similar drop recorded by Gallup, which found in its national polling that the uninsured rate among adults had declined from 18% in the final quarter of last year to 15.9% through the first two months of 2014. Gallup's overall uninsured rate is lower than Rand's because it includes seniors on Medicare.
Gallup Editor in Chief Frank Newport said that March polling, which has not been released yet, indicates the uninsured rate has declined further.
"While it is important to be cautious, the logical conclusion is that the law is having an effect," he said.
Although estimates vary, about 45 million to 48 million people are believed to have been uninsured before the marketplaces opened last year.
The survey data are bolstered by the experiences of insurance companies and state governments, which are tracking enrollment in public and private coverage.
"We are on target to exceed what was estimated," Lisa Sbrana, counsel for New York's insurance marketplace, said on a recent call organized by Families USA, a Washington-based advocacy group that supports the law. About 70% of New Yorkers signing up for coverage through the marketplace or Medicaid were previously uninsured, Sbrana said.
In Kentucky, about 75% of the state residents signing up on that state's marketplace or for Medicaid had no insurance, a state study indicates. As of Friday, more than 280,000 new people had enrolled in Medicaid in Kentucky, or nearly 91% of the residents officials estimated would become eligible for the program this year.
"We expect a huge net gain" in coverage, said Bill Nold, deputy executive of the state's marketplace
http://www.latimes.com/nation/la-na-obamacare-uninsured-national-20140331,0,1348898,print.story


Insurers already calculating 2015 premiums as Obamacare kicks in

Far more Californians than expected have bought plans through the state health insurance exchange. How sick they are will factor into next year's prices.

By Chad Terhune
5:00 AM PDT, March 30, 2014
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After months of head counts for Obamacare, it is the medical bills that will start to matter now.
Even before enrollment closes Monday, California has far exceeded its initial goals for signing up people under the Affordable Care Act. Although the sheer volume of 1.1 million policyholders is impressive for a brand new government program, the number of sicker patients is what's likely to draw the most attention.
How sick they are and the size of their medical bills will be front and center in the weeks to come as insurers begin drawing up next year's insurance rates, which will become public this summer.
The outcome — hefty rate hikes or more modest increases — in the pivotal state of California could help shape political races nationwide and the future of enrollment for President Obama's signature law.
WellPoint Inc., parent of California's leading health insurer in the exchange, Anthem Blue Cross, has already predicted "double-digit-plus" rate increases on Obamacare policies across much of the country.
Other experts discount the notion of soaring premiums because the Obama administration has programs in place to help health plans offset losses from higher-cost customers.
Meanwhile, most everyone involved is waiting to see how many additional people rush in by Monday, the last day to begin enrolling in Obamacare.
But health insurers aren't wasting any time sizing up what patients are costing them now and what that will mean for 2015 rates.
Hunkered down in conference rooms, insurance actuaries are parsing prescriptions, doctor visits and hospital stays for clues about how expensive these new patients may be. By May, insurance companies must file next year's rates with California's state-run exchange so negotiations can begin.
"If rates in California increase by 20%," said Robert Laszewski, a healthcare consultant in Virginia, "enrollment will go down and any healthy people will bail."
Those concerns are one reason the Covered California exchange, insurers and health-law supporters are trying so hard to persuade young and healthy people to enroll before Monday's deadline. The goal is to improve the chances of getting a balanced mix of policyholders and keep monthly premiums down.
No matter the final outcome, Covered California officials are confident they have done enough to avert upheaval in the market.
"I think we're in a position to be optimistic that if rates go up at all, it will be in the single digits," said Peter Lee, executive director of Covered California.
Harriet Davidson, 60, was one of the first people in line for Obamacare after being shut out of the market for years.
The self-employed consultant in Contra Costa County was rejected twice for individual health insurance because of her diabetes and a thyroid condition. The healthcare law removed that obstacle by guaranteeing access to coverage regardless of preexisting conditions.
That meant Davidson could buy a Silver plan from Blue Shield of California that costs her $92 a month — thanks to a federal subsidy.
"I probably neglected my health the last few years because of the expense," Davidson said. "Now I'm going to have every test known to man."
http://www.latimes.com/business/la-fi-obamacare-deadline-rates-20140330,0,7009095,print.story

HealthCare.gov Malfunctions on Last Enrollment Day

By DAVID S. JOACHIM

WASHINGTON — The federal website where consumers can sign up for medical coverage under President Obama’s health care law unexpectedly stopped taking applications for several hours early Monday, the last day of open enrollment, because of a software problem, the administration said.
The enrollment system on the site, HealthCare.gov, was taken offline for scheduled maintenance between 1 a.m. and 5 a.m., but then remained down for several more hours because of a software bug discovered by technology personnel during maintenance, said Aaron Albright, a spokesman for the Department of Health and Human Services.
Consumers who started an application and left their email addresses “will be invited back when the system is available,” Mr. Albright said in a written statement.
Mr. Albright added that the software problem was “not volume related.”
A surge of traffic has hit HealthCare.gov in the final days of open enrollment, the administration has said.
Last week, the administration said it would extend the deadline for people who tried to apply but were blocked by technical problems with the site. It also said that it had exceeded its revised goal of signing up six million people over the federal exchange and similar sites run by the states.

New York Curbs Medical Bills Containing Surprises

By 
Every year, thousands of New Yorkers find themselves responsible for a surprise medical bill from a doctor, like an anesthesiologist, who becomes involved in their care but, unbeknown to the patient, is not covered by their insurance.
Now a provision in the state budget agreement announced Saturday is intended to protect consumers by requiring that they be given a reasonable amount of notice when an out-of-network doctor will be treating them.
If they are stuck with a surprise bill, patients will be responsible only for whatever their co-pay would be if the doctor were in-network. The out-of-network doctor and the insurance company will have to hash out the bill using what is known as baseball arbitration, with each proposing a price and an arbitrator choosing one of them. The law will go into effect in one year.


“The heart of the bill came out of the fact that the No. 1 complaint on health insurance issues we receive year after year is people who get stuck with surprise balance bills,” Benjamin Lawsky, superintendent of the state’s Financial Services Department, which regulates insurance, said on Sunday.
Usually the doctors involved are not the primary physician whom the patient has come to know but a radiologist, pathologist or anesthesiologist involved in a procedure, like surgery or colonoscopy. Sometimes, patients make it to the operating table before they learn that the out-of-network doctor is involved in the operation.
Insurance plans typically either do not permit patients to go to doctors out of their prescribed network, or charge more when they do. Mr. Lawsky said that patients with plans restricting them to in-network doctors tend to be the patients who are most cost-conscious and can least afford surprise bills.
He said his department got several thousand complaints a year but suggested that many more people had the problem but did not complain.
“We think this is potentially a national model,” Mr. Lawsky said. “These surprise balance bills are very prevalent around the country.”

Tell Obama: ACA's a scam, we need Medicare for All

Why I am a conscientious objector to the ACA 

By Margaret Flowers, M.D.
PopularResistance.org, March 28, 2014
I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.
I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.
I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. See the petition here.
The issue is access to care, not the number who buy insurance
As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.
The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.
Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.
In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.”
The insurance scam
biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.


Obamacare in Oregon: A failed exchange
By: Jennifer Haberkorn
March 31, 2014 05:10 AM EDT
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
SALEM, Ore. — Oregon had all the right ingredients for a sparkling Obamacare success story: a Democratic doctor as governor, an eager Legislature and a history of health care innovation.
It ended up with Obamacare’s biggest technological disaster.
CoverOregon.com, the state’s equivalent of HealthCare.gov, is the only insurance exchange in the country on which people still cannot buy coverage entirely online. The flaws are so deep that Gov. John Kitzhaber concedes the state may give up on its own exchange and move to the federal HealthCare.gov next year. The challenges were so persistent that the state received federal permission to add a full month to its open enrollment season. The deadline for most of the country to become covered is 11:59 p.m. Eastern time Monday; here, enrollment will run through April.
The finger-pointing and political posturing have escalated as the exchange story has unfolded. Now, as states like Washington to the north and California to the south celebrate their progress, Oregon’s controversy is in full eruption. Kitzhaber, who is running for reelection this fall, faces mounting questions over whether he could have stopped the disaster. And the exchange board is hunting for its third leader since December.
(VIDEO: Timeline of Obamacare deadlines)
Oregon — a liberal state with an independent, hipster culture that embraces handlebar mustaches, composting and vintage shops — set sky-high expectations for what it could do with the Affordable Care Act. But Oregonians involved with the build-out interviewed here described a process that went awry early on: exchange designers who overreached, a contractor that didn’t complete the job and state officials who didn’t recognize the calamity unfolding right in front of them. That simple vision of expanding health care morphed into a byzantine mess of broken technology and political recrimination.
http://dyn.politico.com/printstory.cfm?uuid=E87EB453-DEF2-4D09-A439-738A7A0820F1

Obamacare in Washington state: 'No frills' success
By: Jennifer Haberkorn
March 31, 2014 05:10 AM EDT
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
OLYMPIA, Wash. — In this far corner of the Pacific Northwest, Washington state shows what can happen when an Obamacare exchange launches — and doesn’t crash and burn.
In contrast to the other Washington’s HealthCare.gov, this Washington’s Healthplanfinder has run fairly smoothly almost from the start. While programs elsewhere sputtered and the federal portal didn’t work at all, the state signed up more than 1 in every 5 Americans who enrolled in an Affordable Care Act plan during the first month.
The 2014 enrollment season is winding down Monday with the Obama administration touting numbers above 6 million, far better than many expected. States will soon start making decisions about their exchanges for next year and thinking about how to repair deep and persistent glitches. Some are calling Washington to see how to replicate its success.
“It’s important for the whole country to have an exhibit” that others can follow with confidence, Gov. Jay Inslee said in an interview. “We know that other states have had substantially more challenges … but I think what we’ve learned is, once you get the software systems, hallelujah, it works, and we’ve been getting numbers that are sustainable in the long term.”
http://dyn.politico.com/printstory.cfm?uuid=B0FB0C81-07BF-43A5-A982-84693C8303C9

The Obamacare enthusiasm gap
By: David Nather
March 31, 2014 05:10 AM EDT
Irony alert: The Democrats’ biggest challenge this fall is to get their voters excited about a law that they asked for.
Obamacare will be a huge voting issue for Republicans — that’s already clear. They’ll turn out in droves because they hate the law. What’s less clear is how Democrats will get their supporters to the polls to say, “hey, thanks for health reform.”
And yet, the Affordable Care Act only exists because Democrats and their supporters had pushed for health reform for decades. Republicans didn’t ask for it. Independents didn’t demand it. It was liberals who wanted coverage for the uninsured, and a better system for sick people, to plug what they saw as the last remaining hole in the social safety net.
(Also on POLITICO: The Obamacare report card)
Now it’s here, and as clumsy as the rollout was, it’s the law they wanted. So the task for Democrats is to figure out how to close the enthusiasm gap — and convince their voters that Obamacare should be a voting issue for them, too.
The reality is, it’s probably going to be a negative message rather than a positive one. Most Democrats believe they can motivate voters by shifting the conversation to the GOP repeal efforts — warning voters about all the things they’d lose if the law went away.
In their view, the best campaigns will be laser-focused on how bad the old health care system was for many patients, and hammer away at Republicans as defenders of the old status quo.
“Democrats will turn out to prevent Republicans from giving insurance companies the power to raise health care costs, raising the costs of prescription drugs for seniors, and leaving kids with pre-existing conditions out in the cold,” said Democratic Congressional Campaign Committee Chairman Steve Israel. “We win by reminding voters of the catastrophic costs of repeal.”
The rapid surge of last-minute signups will help — it will make it easier for Democrats to prove there’s real interest in the law. At some point, though, they’ll have to deal with the awkward part that’s on everyone’s minds: How much do you actually talk about the botched website and the canceled policies?
(CARTOONS: Matt Wuerker on Obamacare)
Increasingly, liberal Democrats and outside groups are convinced that the formula that party strategists had recommended until now — telling candidates to stress that they’ll fix what’s wrong with the law — is not going to work. Instead, they’re saying vulnerable Democrats need to declare that millions of people have coverage now, remind everyone how bad the old system was, and accuse Republicans of wanting to return to it.
http://dyn.politico.com/printstory.cfm?uuid=0C3E2295-6EC1-4F28-9063-5A4FA5F6FDC3


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