The Big Kludge
By PAUL KRUGMAN
The good news about HealthCare.gov, the portal to Obamacare’s health exchange, is that the administration is no longer minimizing its problems. That’s the first step toward fixing the mess — and it will get fixed, although it’s anyone’s guess whether the new promise of a smoothly functioning system by the end of November will be met. We know, after all, that Obamacare is workable, since many states that chose to run their own exchanges are doing quite well.
But while we wait for the geeks to do their stuff, let’s ask a related question: Why did this thing have to be so complicated in the first place?
It’s true that the Affordable Care Act isn’t as complex as opponents make it out to be. Basically, it requires that insurance companies offer the same policies to everyone; it requires that each individual then buy one of these policies (the individual mandate); and it offers subsidies, depending on income, to keep insurance affordable.
Still, there’s a lot for people to go through. Not only do they have to choose insurers and plans, they have to submit a lot of personal information so the government can determine the size of their subsidies. And the software has to integrate all this information, getting it to all the relevant parties — which isn’t happening yet on the federal site.
Imagine, now, a much simpler system in which the government just pays your major medical expenses. In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American.
Of course, we don’t have to imagine such a system, because it already exists. It’s called Medicare, it covers all Americans 65 and older, and it’s enormously popular. So why didn’t we just extend that system to cover everyone?
The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get — and make no mistake, it will vastly improve the lives of tens of millions of Americans.
Still, the fact remains that Obamacare is an immense kludge — a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way.
Health Site’s Woes Could Dissuade Vital Enrollee: the Young and Healthy
The good news about HealthCare.gov, the portal to Obamacare’s health exchange, is that the administration is no longer minimizing its problems. That’s the first step toward fixing the mess — and it will get fixed, although it’s anyone’s guess whether the new promise of a smoothly functioning system by the end of November will be met. We know, after all, that Obamacare is workable, since many states that chose to run their own exchanges are doing quite well.
But while we wait for the geeks to do their stuff, let’s ask a related question: Why did this thing have to be so complicated in the first place?
It’s true that the Affordable Care Act isn’t as complex as opponents make it out to be. Basically, it requires that insurance companies offer the same policies to everyone; it requires that each individual then buy one of these policies (the individual mandate); and it offers subsidies, depending on income, to keep insurance affordable.
Still, there’s a lot for people to go through. Not only do they have to choose insurers and plans, they have to submit a lot of personal information so the government can determine the size of their subsidies. And the software has to integrate all this information, getting it to all the relevant parties — which isn’t happening yet on the federal site.
Imagine, now, a much simpler system in which the government just pays your major medical expenses. In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American.
Of course, we don’t have to imagine such a system, because it already exists. It’s called Medicare, it covers all Americans 65 and older, and it’s enormously popular. So why didn’t we just extend that system to cover everyone?
The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get — and make no mistake, it will vastly improve the lives of tens of millions of Americans.
Still, the fact remains that Obamacare is an immense kludge — a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way.
Health Site’s Woes Could Dissuade Vital Enrollee: the Young and Healthy
By ANNIE LOWREY
WASHINGTON — Sean Jackson, like tens of thousands of other Americans, has had trouble signing up for medical coverage using the HealthCare.gov insurance marketplace, despite several attempts.
“I was able to create an account on Oct. 2, and I haven’t been able to get into there since,” said Mr. Jackson, a sports journalist living in Ohio, a note of annoyance in his voice. “I’ll try at random times, like late at night or early in the morning. I sign in. It just goes to a blank screen.”
The economists and policy wonks behind the Affordable Care Act worry that the technical problems bedeviling the federal portal could become much more than an inconvenience. If applicants like Mr. Jackson decide to put off or give up on buying coverage, rising prices and even a destabilized insurance market could result.
The enrollment of people like Mr. Jackson, who is 32, is vital for the health care law — and, for that matter, the entire health care system — to work. Younger people, who tend to have very low anticipated medical costs, are supposed to help pay for the medical costs of older or sicker enrollees. Without them, so-called risk pools in Ohio and other states might become too risky, forcing insurers to raise premiums. Those higher premiums could dissuade more of the young and healthy from signing up, forcing insurers to raise prices again.
Economists call the process “adverse selection” and warn that in its worst iteration it could lead to a “death spiral” of falling enrollment and climbing prices.
Economists and health analysts said the chances of such a spiral were slim in most states because Americans who go without insurance would face penalties, starting next year. But they said that the endemic problems with the Web site posed a serious question about the enrollment balance in many state plans.
“If there are significantly more of the older and higher-cost people purchasing coverage than are expected, that’s going to have a significant impact on premiums for the following year,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a lobbying group for insurers covering 200 million Americans. He added, “It could ultimately destabilize the market.”
The Commitment to Fix Obamacare's Computer Systems By December 1––Because It Can Be Done By Then or Because It Has To Be Done By Then?
The good news is that it appears the adults are finally in charge of healthcare.gov.This week, the administration put a seasoned and trusted manager in charge of getting the Obamacare computer system working––Jeff Zients.
He quickly announced a methodical approach to the problem and that he had appointed one contractor to coordinate the daily work. Zients also appeared to be pretty open and honest about what's really going on.
All things that should have happened in the first place.
As the administration's point person, or perhaps better put the Obamacare czar, Zients, also said the current Obamacare computer system is fixable.
More importantly, he said it could be fixed by the end of November.
http://healthpolicyandmarket.blogspot.com/2013/10/the-commitment-to-fix-obamacares.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29
Two former Obama administration officials feud bitterly over health marketplace - Politics - The Boston Globe
WASHINGTON — They were two heavyweights of the Obama administration, both Harvard-educated wonks who ran the US government’s biggest social welfare agencies. Now they are trading bitter political insults like “incompetent” and “hack.”
The fissures between Michael Astrue and Donald Berwick, a Democratic candidate for governor, opened in early 2011 when Berwick, then administrator of the Centers for Medicare and Medicaid Services, summoned Astrue, then Social Security Administration commissioner, to his office.
Berwick wanted Social Security to help pay for a piece of the health care insurance marketplace, which was in the planning stages and due to go online almost three years later in October 2013.
Astrue said he felt bullied by Berwick and rebuffed him.
Now they have brought the fallout from their Washington dispute back to Cambridge, where, in new roles, they are locked in an increasingly fierce feud with implications for the 2014 campaign for governor.
Astrue, a Republican biotechnology chief executive and supporter of GOP gubernatorial candidate Charlie Baker, said in news media appearances in recent weeks and in an interview with the Globe that Berwick’s weak leadership and “dawdling’’ during his tenure at CMS in 2010 and 2011 were the root cause of the embarrassing failures this month of Obama’s insurance marketplace.
Berwick, asked by the Globe to respond, vigorously denied Astrue’s accusations. The former Social Security commissioner, he said, is a “hack’’ and a “right-wing pundit’’ who is “just not credible.’’
“His comments are basically ridiculous,” said Berwick, who is seeking his party’s nomination for governor while serving as a fellow at the nonprofit health care think tank he founded in Cambridge. “He’s uninformed, and he’s politically motivated. I met with that guy probably twice in my life.”
Ohio Governor Defies G.O.P. With Defense of Social Safety Net
By TRIP GABRIEL
COLUMBUS, Ohio — In his grand Statehouse office beneath a bust of Lincoln, Gov. John R. Kasich let loose on fellow Republicans in Washington.
“I’m concerned about the fact there seems to be a war on the poor,” he said, sitting at the head of a burnished table as members of his cabinet lingered after a meeting. “That if you’re poor, somehow you’re shiftless and lazy.”
“You know what?” he said. “The very people who complain ought to ask their grandparents if they worked at the W.P.A.”
Ever since Republicans in Congress shut down the federal government in an attempt to remove funding for President Obama’s health care law, Republican governors have been trying to distance themselves from Washington.
Gov. Scott Walker of Wisconsin schooled lawmakers in a Washington Post opinion column midway through the 16-day shutdown on “What Wisconsin Can Teach Washington.” Gov. Chris Christie of New Jersey, with a record of bipartisan support at home, remarked after a visit to the nation’s capital, “If I was in the Senate right now, I’d kill myself.”
But few have gone further than Mr. Kasich in critiquing his party’s views on poverty programs, and last week he circumvented his own Republican legislature and itsTea Party wing by using a little-known state board to expand Medicaid to 275,000 poor Ohioans under President Obama’s health care law.
Once a leader of the conservative firebrands in Congress under Newt Gingrich in the 1990s, Mr. Kasich has surprised and disarmed some former critics on the left with his championing of Ohio’s disadvantaged, which he frames as a matter of Christian compassion.
He embodies conventional Republican fiscal priorities — balancing the budget by cutting aid to local governments and education — but he defies many conservatives in believing government should ensure a strong social safety net. In his three years as governor, he has expanded programs for the mentally ill, fought the nursing home lobby to bring down Medicaid costs and backed Cleveland’s Democratic mayor, Frank Jackson, in raising local taxes to improve schools.
To some Ohio analysts, those moves are a reaction to the humiliating defeat Mr. Kasich suffered in 2011 when voters in a statewide referendum overturned a law stripping public employees of bargaining rights. Before the vote, Mr. Kasich’s approval in this quintessential swing state plunged.
Now, as the governor’s image has softened, his poll numbers have improved heading into a re-election race next year against the likely Democratic nominee, Ed FitzGerald, the executive of Cuyahoga County.
Health Site Puts Agency and Leader in Hot Seat
By SHERYL GAY STOLBERG
WASHINGTON — Ten days before HealthCare.gov opened for business, Marilyn Tavenner, the obscure federal bureaucrat whose agency oversaw the creation of the troubled online insurance marketplace, had a bad omen. It was a Sunday, and her mobile device was on the fritz, forcing her to go into the office.
“It reminded me that I can still be brought to my knees by a malfunctioning BlackBerry,” she joked in late September, recounting her technology woes to a group of insurance executives.
Nobody at the Centers for Medicare and Medicaid Services, the agency Ms. Tavenner runs, is joking now.
On Tuesday, she will be on Capitol Hill to face a grilling from House Republicans over the website’s failures. It will be an unusual turnabout for Ms. Tavenner, 62, who was confirmed overwhelmingly by the Senate in May on a bipartisan 91-to-7 vote and had the enthusiastic backing of the House Republican leader, Representative Eric Cantor, who knows her from her days as health secretary in his home state, Virginia.
Her testimony, before the House Ways and Means Committee, will serve as a warm-up for that of her boss, Kathleen Sebelius, the health and human services secretary, who will appear before another House panel on Wednesday. Republicans, who have scheduled a series of hearings to examine the problems with the troubled website, have demanded that someone in the Obama administration be held accountable for the problem-plagued rollout.
“There’s a lot of fault to go around when it comes to the launch of the Obamacare exchanges, least of which is trying to figure out who was in charge,” said Senator Orrin G. Hatch, Republican of Utah, who voted to confirm Ms. Tavenner. Referring to Ms. Tavenner’s agency and to the Health and Human Services Department, he added, “Was it C.M.S.? Was it H.H.S.? Was it the White House? That it’s this hard to unravel is unacceptable.”
While the Medicare and Medicaid agency has major responsibility for carrying out the president’s health care overhaul, there have been hints that Ms. Tavenner was kept out of the loop on some critical decisions.
U.S. Health Insurance Website’s Problems Continue Despite Improvements
By ROBERT PEAR
WASHINGTON — The Obama administration on Monday reported improvements in the operation of the federal health insurance marketplace, but insurers said that severe technical problems were still making it difficult to enroll new subscribers.
Administration officials said they had resolved a “network failure” that knocked out the federal website HealthCare.gov on Sunday. The officials blamed Terremark, a subsidiary of Verizon Communications that provides cloud computing services for the site.
Kevin H. King, a spokesman for Verizon, refused to discuss the problem. “We do not disclose information about the services we provide our clients,” he said.
Through March, Terremark received $15.5 million for work on the website and its “data services hub,” according to the Government Accountability Office, an investigative arm of Congress.
Julie Bataille, a spokeswoman for the Department of Health and Human Services, said the “Verizon Terremark outage” ended Sunday night. On Monday, she said the government was making changes to “improve the functionality and performance of the website,” where she acknowledged that “consumers have reported tremendous frustration” in trying to buy insurance.
The face of President Obama’s health care law — a smiling young woman — has disappeared from the site’s home page, replaced by four round symbols indicating that insurance applications can be filed by telephone, in person, on paper or online.
But some people trying to use the site on Monday afternoon received this message: “The system is down at the moment.”
After facing roadblocks on the federal website, many consumers have tried to sign up directly with insurers. But to obtain subsidies, they must get an official determination from the federal government, and many consumers have found that the transfer from an insurer to the government website does not work. Users often experience a “timeout” at the federal site.
In addition, many insurance agents and brokers said they had been thwarted when they tried to help consumers in the federal marketplace, or exchange. Many agents have taken the required training and passed examinations, but have been unable to complete the registration and certification process.
Agents and brokers often find themselves “stuck in a no man’s land” when trying to participate in the federal exchange, said Jessica F. Waltman, a senior vice president of the National Association of Health Underwriters. “We have lots and lots of agents in that predicament.”
Vermont is designing nation’s first universal health-care system
MONTPELIER, Vt. — As states open insurance marketplaces amid uncertainty about whether they are a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.
The state has a planned 2017 launch of the nation’s first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.
The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.
In such a setting, Vermont’s plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.
The result will be health care that’s “a right and not a privilege,” Gov. Peter Shumlin said.
The reasons tiny Vermont may be ripe for one of the costliest and most closely watched social experiments of its time?
White House grants extension on health law sign-up
Posted: October 28Updated: Today at 6:28 AM
Americans without insurance will now have until March 31 to sign up for coverage.
By Ricardo Alonso-zaldivar Associated Press
WASHINGTON – With website woes ongoing, the Obama administration Monday granted a six-week extension until March 31 for Americans to sign up for coverage next year and avoid new tax penalties under the president's health care overhaul law.
The move had been expected since White House spokesman Jay Carney promised quick action last week to resolve a "disconnect" in the implementation of the law.
It comes as technical problems continue to trouble the website designed as the main enrollment portal for people who don't get health care at work.
As a consequence, Republican lawmakers, and some Democrats as well, are calling for a one-year delay in the penalties most Americans will face starting next year if they remain uninsured. Monday's action by the administration stops well short of that, and amounts only to a limited adjustment.
Under the latest policy change, people who sign up by the end of open enrollment season on March 31 will not face a penalty. That means procrastinators get a grace period.
Previously you had to sign up by the middle of February, guaranteeing that your coverage would take effect March 1, in order to avoid fines for being uninsured.
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Obamacare and the limits of the wayback machine
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| The new Democratic talking point about Obamacare is full of optimism: After all, the launch of the Medicare prescription drug program was bumpy, too, but now the program is considered a huge success. It’s true, and there are parallels between the two rollouts — but that doesn’t guarantee that Obamacare will be vindicated in the same way, health care experts say. It just means that President Barack Obama’s signature health care law shouldn’t be written off just yet. Everything depends on what happens in the next few months. A full recovery is possible, if the federal enrollment website stops having comical breakdowns within the next month and the rest of the implementation runs more smoothly. If that doesn’t happen, none of the lessons of Medicare Part D’s rollout will be able to save Obamacare. (Understanding Obamacare: POLITICO's guide to the Affordable Care Act) “If it gets fixed, six months from now it will be remembered as a rocky episode and nothing more,” said Mike Leavitt, who presided over the Medicare Part D launch as President George W. Bush’s Health and Human Services secretary. But if the HealthCare.gov website is still failing by then, Leavitt said, “it will brand Obamacare in a very harsh light.” |
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