Promised Fix for Health Site Could Squeeze Some Users
By ROBERT PEAR and SHARON LaFRANIERE
WASHINGTON — The Obama administration said Friday that it would fix problems in the federal health insurance marketplace by Nov. 30, just two weeks before the deadline to sign up for coverage to replace health insurance policies being canceled because they do not meet new federal standards.
To help meet that schedule, the Obama administration, in an abrupt shift, named a “general contractor” on Friday to oversee changes to the troubled Web site of the federal marketplace.
Such a condensed time frame raises the question of how hundreds of thousands of people whose current policies do not comply with the health law will obtain new coverage in time, and how millions who may qualify for subsidies will enroll. Some experts predicted a groundswell of demands from Congress and elsewhere to delay the deadlines.
Jeffrey D. Zients, President Obama’s troubleshooter on the project, said the general contractor, Quality Software Services Inc., a unit of the UnitedHealth Group, would now “manage the overall effort,” like a general contractor on a home improvement project. Notably, that company had a role in developing one of the most troubled components of the marketplace, which helped verify the identities of those registering.
Until now, the federal Centers for Medicare and Medicaid Services served as the project’s quarterback. Contractors complained that the agency did not have the expertise to lead such a complex and ambitious undertaking, requiring the integration of dozens of programs and databases.
People involved in the repair effort said the Nov. 30 deadline was challenging but not impossible to meet. Mr. Zients, a management expert who is in line to take over as the chief White House economic adviser on Jan. 1, said, “By the end of November, HealthCare.gov will work smoothly for the vast majority of users.”
“It will take a lot of work,” he said. “A lot of problems need to be addressed. But let me be clear: HealthCare.gov is fixable.”
Since it went live on Oct. 1, the Web site has frustrated millions of people trying to obtain insurance under Mr. Obama’s health care law. For the administration, making it work is increasingly urgent for both political and practical reasons.
In recent weeks, insurance companies have notified hundreds of thousands of people around the country that their current coverage will end on Dec. 31 because it does not comply with the Affordable Care Act. For example, the policies may not provide “essential health benefits” like maternity care and may not cover as much of the medical costs as required by new federal standards.
In a typical letter, about 25,000 policyholders of Independence Blue Cross in Pennsylvania were informed, “As a result of the health care law, your current health plan will be discontinued effective December 31, 2013.”
Roll Out the Health Care
By GAIL COLLINS
If you’re a citizen who tries to keep up with current affairs, your latest responsibility is having a strong opinion about the troubled rollout of the health insurance marketplace.
Really makes you miss the government shutdown, doesn’t it? Try leading a lively dinner table conversation on software coding errors.
The Democrats are depressed. The Republicans enjoy pointing out that the Obamacare rollout has been a mess. But they obviously can’t pretend to be upset that people are finding it hard to sign up for a program their party wanted to kill, eviscerate and stomp into tiny pieces, which would then be fed to a tank of ravenous eels.
Well, actually, they can.
“I haven’t heard one of you apologize to the American public,” Representative David McKinley of West Virginia sternly told government contractors who had worked on the HealthCare.gov Web site. McKinley’s party recently shut down everything from the national parks to preschool programs, while costing the economy an estimated $24 billion. Nobody apologized. Perhaps they’ll write a note this weekend.
“I’m damned angry that I and 700,000 Texans I represent have been misled, misled and misled,” said Representative Pete Olson. The only thing that could conceivably make Olson angrier would be if the Obamacare site was working so well that Texans could get health insurance as easily as they can order a chrome scarf holder fromAmazon.com.
On Thursday the House Energy and Commerce Committee held the first of what will be a very long line of Congressional hearings on the subject of the botched rollout. The private contractors claimed, in the most oblique language possible, that their own individual pieces of the operation had gone swimmingly.
Meanwhile, the committee members told the private contractors about their personal technological expertise, which sounded so extensive it’s a wonder that the House of Representatives hasn’t invented its own search engine.
“I was in small business for 22 years, in the radio business. We dealt with software upgrades and changes in systems and all that . . .”
“When I was in developing software . . .”
“Being a computer science major from Rice University and a former naval aviator who could not afford to have my computer drop off-line as I’m rolling in my plane to drop a torpedo to stop a Russian submarine from launching a ballistic missile, a nuclear missile at our country. . . .”
That last one was Representative Olson again.
It is very possible that you missed this hearing. Perhaps you were at work. Perhaps you have taken a vow never to listen to any discussion in which the word “functionality” is used on a regular basis.
The bottom line is that the start-up was terrible. We’re just going to wait and see how well the administration does in fixing things. White House officials have promised to bring in “the best and brightest,” which is encouraging unless you are old enough to remember that “the best and the brightest” was what they called the guys who gave us the war in Vietnam.
In the meantime, keep things simple and just find somebody to blame. A few suggestions:
Canada
The major contractor on the Web job was CGI Federal, which is a subsidiary of a Canadian company. Perhaps this is all a Canadian plot. Perhaps the Canadians were jealous that the United States was on the verge of creating a health care system so much more exciting than their own single-payer version. Remember, these are the exact same people who sent us Justin Bieber.
Maine experts think website was doomed from start
Yesterday at 12:13 AMBesides inadequate testing, the system for finding the best technology contractors is complicated and doesn’t work, they say.
The federal government should have given contractors more time to test the website for its health insurance marketplace instead of rushing to launch HealthCare.gov, two Maine-based technology experts said Thursday.
The two also agreed that the government’s bid requirements have become so complicated and burdensome that they keep smaller and more talented firms from bidding on contracts.
Glitches and all, Obamacare must offer quality insurance that doesn’t bankrupt you
Posted Oct. 25, 2013, at 12:01 p.m.
Every day in Maine, about eight people file for Chapter 7 or 13 bankruptcy. That adds up to about 3,030 residents each year, on average, officially declaring they cannot pay the debts they owe. Why? Most file because medical bills have in some way made their livelihoods precarious. What’s more, many of those people have insurance.
That’s right. Even though they contributed to a health plan, they might not be able to afford the deductible. Or they may have a limited plan that doesn’t cover the medical services they need. Or perhaps they managed to pay their medical expenses, but the illness or injury means they can no longer work and pay their bills.
It’s not known exactly what percentage of people in Maine file for bankruptcy due to medical expenses. National studies range from 17 percent to 62 percent depending on whether medical bills are considered the main cause or one of several causes leading to bankruptcy. Anecdotally, Maine lawyers say it’s common for medical bills to contribute to personal bankruptcy.
What is clear is that the U.S. health care system has suffered for a long time from a major flaw that can lead to bankruptcy: exorbitant costs. The National Academy of Sciences reports health care costs have increased at a greater rate than the economy for 31 of the last 40 years. The U.S. outpaces comparable countries in terms of both per capita spending on health care and the rate of spending growth itself.
What’s more, a report by the Institute of Medicine determined about $750 billion of total health spending in 2009 — about 30 percent — went to unnecessary services, excessive administrative costs, fraud and other problems. And this country doesn’t even have better health outcomes to show for all its spending.
So when experts inevitably turn to measuring the success of the Affordable Care Act, they probably won’t focus on whether it was difficult at first for people to sign up or how many people signed up in the first month. Rather, they should be examining whether those people can actually afford care under their new plans. The whole point of the law is to make coverage more affordable. But will it be affordable enough? One way to measure will be through a reduction in medical bankruptcies.
The same question should be asked of politicians considering a substitute to Medicaid expansion: Will it really be affordable? Maine has no concrete plan to pursue an Arkansas-like alternative, where low-income residents will receive subsidies to help them buy insurance instead of enrolling in Medicaid. But Gov. Paul LePage’s office has said he is evaluating alternative plans like the one in Arkansas.
Lawmakers should proceed with caution. The point of expanding Medicaid was to ensure reasonably priced coverage for low-income individuals, to encourage them to seek care before medical problems became emergencies. Medicaid expansion relies on a program that often has better cost control; Medicaid’s administrative costs, for example, are less than 7 percent, which is half the rate usually seen in the private sector.
There’s no question the Affordable Care Act aims to improve the current health care system. For instance, it lays out essential health benefits — such as maternity and newborn services, preventive care, and mental health and substance use disorder services — that must be covered by certain plans starting in 2014. And it will cap the maximum amount someone will pay out of pocket, including copayments and deductibles, at $6,350 in 2014.
But the danger is that the middle class and people with low incomes will remain underinsured — meaning they will have insurance, but it won’t adequately cover their medical expenses — as premium contributions, copayments or deductibles increase relative to income. After Massachusetts expanded health care access with its Health Connector program, for example, medical bankruptcy rates didn’t change much. Will the Affordable Care Act be different?
There are serious glitches with HealthCare.gov, where people are signing up for insurance on the new marketplace exchanges, and they shouldn’t be overlooked. But don’t let the political bickering about the technical problems distract you from the broader question at hand, which extends beyond whether people will be able to successfully sign up — they will eventually — to whether those plans will convert to quality, affordable care.
A common story: Caring for others without health care for oneself
Posted Oct. 25, 2013, at 12:14 p.m.
Editor’s note: In this monthly series, the authors will introduce you to people who are apt to be your neighbors, are struggling to make ends meet and have been affected by specific state policies. To share your story, write to Sandy.Butler@umit.maine.edu or call 581-2382.
Helen, 45, works seven days a week caring for other people. While she plays an essential role in our health care system as a home care provider for people with chronic health conditions, she herself lacks health insurance.
She earns $9.25 an hour and works irregular hours ranging from 20 to 40 each week. Helen, like many other hardworking Maine people, would have been eligible to receive health insurance through MaineCare — what Medicaid is called in Maine — if Gov. Paul LePage had not vetoed the bill to expand Medicaid this past June.
Helen, who lives in Whitefield, did not wish to use her real name for fear she would lose the work she needs to survive.
Helen has worked outside the home for the past 14 years. When her three children were young, she stayed home to care for them — one of whom had severe developmental delays. Helen is unable to afford health insurance, so she has been uninsured for 10 years.
For many years, Helen has had pelvic and hip pain — a condition that is exacerbated by the work she does. She has not received a straightforward diagnosis despite the many health care providers she has seen over the years.
“I think a lot of my bills that have racked up are because of that. I’ve seen a lot of different specialists,” she said.
As a result, Helen has mounting unpaid medical bills that have negatively affected her credit rating, and she regularly receives many unwanted calls from a collection agency.
She said, “It is really hard not to have health insurance. It really is. It is stressful to have a collection agency calling me all the time, all the time. I tell them I’ll try to send in something, but if I can’t do it, then I just can’t do it.”
When Helen was in her early 30s, she became certified as a personal support specialist, qualifying her to do personal care work for people in their homes — one of the fastest growing occupations both in Maine and nationally. The work has flexible, though often erratic, hours and ironically rarely comes with health insurance.
Nationally, 31 percent of personal care workers did not have health insurance in 2010. Thanks to the Affordable Care Act, however, personal care workers who live in one of the 28 states that have voted to accept federal funds to extend Medicaid coverage to the working poor will finally have access to affordable health insurance this coming January.
Unfortunately, Maine’s governor vetoed the bill that would have provided affordable health insurance to Helen and others like her. As a result Helen, like so many other uninsured individuals, hesitates to attend to her health needs because of the cost. When she spoke with us, she had had a sinus infection for months, for which she had not seen a doctor.
As she adamantly said, “I don’t want to rack up any more bills. So you have a choice: Either you go to the doctor and find out what is going on, or you don’t.”
Helen will continue to face her health issues without coverage.
Helen struggles to make ends meet and is grateful that her boyfriend helps pay for many of their living expenses. Her job requires a reliable car, and her car payment takes a hefty chunk out of her take-home pay each month.
When asked whether she thought she would be able to pay a monthly premium for insurance available through the marketplaces, she was doubtful, saying, “I have all that I can do to make that [car] payment. I have to have a decent vehicle because I do a lot of travel for work, and I struggle to do my monthly car payments.”
Helen wishes she had a job with health benefits and that she didn’t need to work seven days a week — a schedule that is not unusual for home care workers, who provide daily care to their clients even if their work is part time. She knows, however, that her options are limited due mostly to her lack of a high school diploma.
But she also knows she needs to work, “because, when I get older, I’m not going to have any income if I don’t.”
Helen was aware of the debate in Augusta this past spring regarding the expansion of MaineCare and was disappointed that the governor did not sign the bill that would have allowed her to be covered.
She laments, “He is hurting a lot of people, I think.”
And so, for the foreseeable future, like many home care workers in Maine, Helen will continue to provide health care to others while not having health insurance herself. The irony of her situation is a shameful reflection on our state’s policy choices.
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