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Saturday, April 26, 2014

Health Care Reform Articles - April 26, 2014

Behind the scenes, much of HealthCare.gov is still under construction
By: Kyle Cheney
April 25, 2014 06:01 PM EDT
The Obamacare website may work for people buying insurance, but beneath the surface, HealthCare.gov is still missing massive, critical pieces — and the deadline for finishing them keeps slipping.
As a result, the system’s “back end” is a tangle of technical workarounds moving billions of taxpayer dollars and consumer-paid premiums between the government and insurers. The parts under construction are essential for key functions such as accurately paying insurers. The longer they lag, experts say, the likelier they’ll trigger accounting problems that could leave the public on the hook for higher premium subsidies or health care costs.
It’s an overlooked chapter in the health care law’s story that has largely escaped scrutiny because consumers aren’t directly affected. Yet it bolsters the Republican narrative that the government has mishandled the implementation of Obamacare.
(Also on POLITICO: Full health care policy coverage)
“It seems like the insurers’ experience with Obamacare is a lot like that of far too many Americans: broken promises, frequent delays and constantly shifting rules of the road,” said Don Stewart, a spokesman for Senate Minority Leader Mitch McConnell. “It seems like there’s a lot more to the story than what the administration says in their pep rallies.”
Without a fully built and operational system, federal officials can’t determine how many of the 8 million Obamacare sign-ups announced last week will have actually paid their premiums. They won’t even know how many enrollment attempts were never completed. That, in turn, could affect the amount of money the government spends on premium subsidies. And once the system finally does all come on-line, the data delays could force a sharp revision in that celebrated 8 million figure.
Obama administration officials originally intended to have the major back-end components of HealthCare.gov working by the website’s launch in October. But the deadline slipped as officials focused their energy on the part of the website that consumers would use to enroll in coverage.
When that front end failed disastrously on Oct. 1, the administration diverted every resource to fix it, further delaying the behind-the-scenes technical functions. The deadline for completing those pieces gave way to January and then to mid-March. Senior officials said early last month that they hoped to have the entire system ready by the summer. Now, even summer appears to be a question mark.
(Also on POLITICO: Democrats race to embrace Obamacare in Pennsylvania primary)
Officials at CMS — the federal agency overseeing HealthCare.gov and new insurance exchanges — refused to provide an update on just how much of the back end remains incomplete, the current issues they face and their latest timetable.
The site was envisioned as an easy-to-use portal for insurers as well as their customers. It still needs to be that and more. It’s supposed to automatically calculate exact premium subsidies for enrollees and match them with government records to ensure accuracy. It’s also expected to trigger payments from the U.S. Treasury to insurers and measure whether an insurance company’s customers are sicker or healthier than expected — a determination that could affect future premiums.
The Obama administration posted a document earlier this month indicating that insurers will continue to be paid through an “interim” accounting process — pretty much a spreadsheet and some informed estimates — until at least September. When the permanent system eventually goes live, it could lead to a massive correction that either exposes taxpayers to more costs or puts pressure on insurance companies to raise prices.
“We have the mother of all reconciliations coming,” said insurance industry consultant Robsert Laszewski, using the official term for the correction. “It may be that the administration will not be able to give us a credible enrollment number until then because we really need a reconciliation to accomplish that.”

Oregon dumps its broken healthcare exchange for federal website

By Maria L. La Ganga
12:39 PM PDT, April 25, 2014
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DURHAM, Ore. — Oregon officials voted unanimously Friday to jettison the state’s disastrous health insurance exchange and instead switch to the federal website, admitting both disappointment and defeat in an arena where the state had been a trailblazer.
With its 7-0 vote, the board of directors for Cover Oregon acknowledged that the state exchange was too expensive and too troubled to fix. Although the state has spent an estimated $248 million to get its exchange up and running, it never enrolled a single private insurance customer online.
Alex Pettit, the state’s new chief information officer, insisted after the vote that the state’s vision did not fail, but that Oregon tried to do too much too quickly.
“It wasn’t anything wrong with the vision,” Pettit said. “The vision the state has is a very valuable, very lofty vision and should not be discounted. This was not a failure of policy. The failure was in the build …. My job is to improve the way the state of Oregon builds things.”
That vision was referred to here as “no wrong door.” The hope was that insurance customers could sign on to coveroregon.com and in one place shop for a private plan, find out if they were eligible for tax credits or Medicaid and enroll online in whatever insurance product was appropriate for them.
But the website where Oregonians were supposed to enroll in private plans, built by Cover Oregon's main contractor, Oracle, was troubled from the start.
After discovering a series of technical problems before the Oct. 1 launch -- including inaccurate calculations of the tax subsidies for which consumers would be eligible -- Cover Oregon decided to scratch its plans to go live along with the rest of the country and never managed to get online enrollment started.
The state turned instead to paper applications, bringing on some 400 workers -- some from other state agencies -- to help process each one. As of this week, about 70,192 individuals have selected private plans through Oregon's marketplace, according to a spokeswoman for Covered Oregon.
Oracle spokeswoman Deborah Hellinger said in a statement before the vote that the firm "looks forward to providing any assistance the state needs in moving parts of Oregon's healthcare exchange to the federal system if it ultimately decides to do so."
One option considered in the last month was to fix the technology using a new vendor. But an outside analysis revealed that such action would take too much time and cost an estimated $78 million, which the state cannot afford.

Health reform’s problems run deeper than a glitchy website

Posted Nov. 14, 2013, at 11:49 a.m.
Serious problems with the websites created by the Affordable Care Act continue, and probably will for a long time. Although frantic efforts at incrementally improving them are being made by the Obama administration, and some sites are working better than others, they are a long way from working well.
As I’ve written before, the causes of the website’s problems are far more serious than poor software design. They are baked into the law by its extreme complexity.
There is growing frustration and anger at the administration in Congress from both Democrats and Republicans. Much of it is being expressed by the same people whose hypocrisy and obstructionism is responsible for a failure to do the right thing in the first place. Calls from members of Congress to delay the ACA’s implementation or to repeal it entirely will intensify.
Instead of expanding our existing Medicare program, which has been working well for almost 50 years and is our country’s most efficient and least intrusive health care financing program, the ACA creates complex new law that perpetuates and reinforces the chaos and confusion of our hodgepodge of public and private insurance programs. Coverage and financial assistance continue to depend on an individual’s employment status, income, place of residence, age, conjectures about future health status, and many other factors, some of them subject to change with little or no warning and many impossible to predict.
Smooth implementation of the ACA depends upon the ability of many parts of government and thousands of insurance companies to seamlessly communicate with one another and agree on data drawn from myriad different public and private sources. Some in the health insurance field believe such a task will be difficult or impossible to achieve.
We have to ask ourselves, who are the winners from requiring us to go through the expense and confusion inherent in trying to implement a law of over 2,000 pages? The answer is clear. It’s a health insurance industry that profits from complexity and confusion, and providers of pharmaceuticals, medical supplies, devices and services who benefit excessively from the very weak cost controls inherent in our fragmented system of paying for services.
The losers are all the rest of us. The ACA’s objective, access to health care for all Americans, could have been accomplished much more easily with far less confusion, expense and complexity.
I talk to a lot of people from across the political spectrum about health care reform. There is a growing consensus that improved Medicare for all is the necessary first step in repairing our badly broken health care system.
During a trip to California last week, I ran into House Minority Leader Nancy Pelosi. When I explained to her that while I admired her efforts to reform our health care system, I remain an advocate for “Improved Medicare for All,” she responded, “Yes, we should have done single payer.”
Perhaps there’s still hope. Between Harry Reid’s recent comments and Pelosi’s epiphany, there seems to be a growing understanding of the problem, and its solution, in some parts of Congress.
But first, we will have to get rid of the obstructionist politicians whose only interest seems to be in preserving a health insurance industry that has become one of the most destructive forces in American society.
That task is up to us.

Southerners in Poll Oppose Health Law, and Its Repeal

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