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.
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.
Occupy Wall Street group buys $14.7 million of Americans’ medical debt
Posted Nov. 13, 2013, at 6:29 a.m.
An Occupy Wall Street spin-off group has bought up $14.7 million worth of Americans’ personal medical debt and forgiven it over the last year as part of its Rolling Jubilee project, the group announced Monday.
The Rolling Jubilee project, organized by Occupy Wall Street’s Strike Debt group, so far has spent $400,000 to buy the debt, in the process relieving 2,693 people of the money they owed for medical services Occupy thinks should be free.
“Think of it as a bailout of the 99 percent by the 99 percent,” a post on the Rolling Jubilee project’s website said.
The project, which launched on Nov. 15, 2012, raises money through small, individual contributions, and then uses that money to purchase distressed and defaulted debt from the lenders, who in this case are hospitals or medical groups.
The lenders are willing to sell it very cheaply, often for less than 5 cents on the dollar, because they think there is little chance they will be able to collect.
Andrew Ross, a member of Occupy’s Strike Debt group and a professor at New York University, said the group was able to buy debt at a 50-to-1 ratio.
The group receives almost no information about the people whose debt they buy — only an address, Ross said. The group mails a letter to each address explaining the project and that the person’s debt has been “canceled,” Ross said.
The group does not work directly with debtors.
“One person wrote back and said that he had gone through periods of being homeless and he was trying to get back on his feet,” Ross said, calling the elimination of debt a huge relief.
Ross said the group has $200,000 left to spend, and they hope to target student loan debt next.
Fewer than 300 Mainers choose Affordable Care Act health plan
Posted Nov. 13, 2013, at 5:11 p.m.
About 6,500 Mainers have completed applications for health insurance during the troubled rollout of the Affordable Care Act’s online marketplaces, but fewer than 300 actually chose a new plan, according to data provided Wednesday by the Obama administration.
The Maine figures were included in long-awaited national enrollment data released by the U.S. Department of Health and Human Services. Administration officials had warned that the enrollment totals for the first month would be low given the technical flaws plaguing healthcare.gov, the federal government’s website for the marketplaces in Maine and 35 other states, since its launch on Oct. 1.
As of Nov. 2, 271 Maine people successfully navigated the website and selected a health plan, according to the U.S. Department of Health and Human Services’ report. They were among 106,185 people nationally who had selected a plan.
Those figures include people who have paid their first monthly premium — the definition insurers use for “enrolled” customers — as well as those who haven’t yet paid.
More than three-quarters signed up through a state-run marketplace, and the rest through healthcare.gov.
The numbers are a far cry from the half million sign-ups the Obama administration said it expected before the website’s launch.
Many more individuals finished their applications but hadn’t yet chosen a health plan. In Maine, the 6,500 people covered by 3,550 applications completed through the site or the mail learned whether they were eligible for a marketplace plan or Medicaid, and whether they qualified for federal financial help to afford coverage, according to the HHS data.
They represent just a fraction of the 65,000 to 104,000 Mainers that the state insurance bureau estimates are eligible to shop on the marketplaces.
About 5,000 Mainers completed an application and were deemed eligible to shop on the marketplaces, which serve a relatively small portion of the population. Also called “exchanges,” the marketplaces are open to small businesses and individuals who buy their own health insurance rather than receive coverage through work or government programs such as Medicaid and Medicare.
Democrats Threaten to Abandon Obama on Health Law Provision
By ASHLEY PARKER and MICHAEL D. SHEAR
WASHINGTON — Anxious congressional Democrats are threatening to abandon President Obama on a central element of his signature health care law, voicing increasing support for proposals that would allow Americans to retain the health insurance coverage they are losing because of the Affordable Care Act.
The dissent comes as the Obama administration released enrollment figures Wednesday that fell far short of expectations, and as House Republicans continued their sharp criticism of administration officials at congressional hearings examining the performance of the health care website and possible security risks of the online insurance exchanges.
In addition, a vote is scheduled Friday in the Republican-controlled House on a bill that would allow Americans to keep their existing health coverage through 2014 without penalties. The measure, drafted by Representative Fred Upton, the Michigan Republican who is the chairman of the Energy and Commerce Committee, is opposed by the White House, which argues that it would severely undermine the Affordable Care Act by allowing insurance companies to continue to sell health coverage that does not meet the higher standard of Mr. Obama’s health care law.
But a growing number of House Democrats, reflecting a strong political backlash to the rollout of the health care law, are warning the White House that they might support the measure if the administration does not provide a strong alternative argument. The approaching House vote is shaping up as an important test for both the health measure and the unity that Democratic leaders have so far been able to maintain around the health law despite a fierce Republican attack against it.
In a closed-door meeting Wednesday of House Democrats and White House officials, tensions flared as several lawmakers upbraided the administration, saying that the president had put Democrats in a tough political position by wrongly promising consumers that they could keep their existing health care plans. In fact, hundreds of thousands of Americans have received cancellation notices from their insurers because their health care coverage does not meet the minimum standards dictated by the new law.
“I’m frustrated in how it rolled out, and I let them know in no uncertain terms,” said Representative Mike Doyle, Democrat of Pennsylvania. “The point I was making in caucus to the administration is don’t give us this techno-babble that you’re going to do some administrative fix down the road. There’s a bill being put on the floor on Friday.”
http://www.nytimes.com/2013/11/14/us/politics/democrats-threaten-to-abandon-obama-on-health-law-provision.html?pagewanted=2&hp&pagewanted=print
Health Law Enrollment Figures Far Lower Than Initial Estimates
By SHERYL GAY STOLBERG and SUSANNE CRAIG
WASHINGTON — New data shows that just over 106,000 people picked health plans in the first month of open enrollment through the state and federal insurance marketplaces established by the Affordable Care Act, a figure far lower than the Obama administration initially estimated would sign up during that period.
The bulk of the new enrollees — roughly three-fourths — signed up through the 14 state-run exchanges, according to data released by the Centers for Medicare and Medicaid Services. It said 76,391 enrolled through state marketplaces, some of which have technical problems of their own, while 26,794 signed up through the federal exchange.
Kathleen Sebelius, the secretary of health and human services, disclosed the much-anticipated numbers during a conference call with reporters on Wednesday, after House Republicans spent the morning grilling the White House chief technology officer, Todd Park, and other administration officials about how HealthCare.gov went so awry, and what is being done to fix it.
The White House has spent weeks trying to lower expectations about the enrollment figures, which have set off a pitched political battle among supporters and critics of the health overhaul, each seeking political advantage in the numbers.
One point of contention is around the way the Obama administration defines who, precisely, is enrolled.
The administration counts new enrollees as those who have “selected a marketplace plan.” They are people like Hung Trang, a 60-year-old nail salon owner in Tampa, Fla., who has been trying for weeks to sign up for coverage. With some help from a counselor, called a “navigator,” he has picked a plan, but has not yet committed to buy it.
The health insurance industry, though, says people like Mr. Trang do not count until they have agreed to pay.
“Paying the first month’s premium is what needs to happen before coverage actually begins,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry trade association. “Until a consumer makes their first-month premium, they can make a different coverage decision — including whether they want to buy coverage or not.”
The administration reported that there were 846,184 competed applications in the state and federal marketplaces for plans that would cover a total of 1,509,883 Americans. It said 1,081,592 people had been “determined eligible to enroll in a marketplace plan.”
Health Exchange Enrollment Falls Short of Target
Just over 106,000 people picked a health insurance plan through the state and federal exchanges established under the Affordable Care Act in the first month of open enrollment, a fraction of the 495,000 projected by the Obama administration in a September memo. Nearly three-quarters of the new enrollees signed up through state-run exchanges, which were expected to sign up less than half of the total during the first month.
High and Low Premiums in Health Care
By THE EDITORIAL BOARD
The debate over the effect the Affordable Care Act will have on individuals and families who buy their own policies has mostly been waged in anecdotes. Supporters of the law point to grateful individuals who were previously unable to get insurance or paid exorbitant premiums but found affordable coverage on the new health insurance exchanges. Critics counter with frustrated people who liked their old policies but will now be forced to buy a more comprehensive policy and pay a higher premium for it.
As it turns out, there are estimates of how many people might fall into one category or the other. Up to seven million people may be able to get health policies without paying any premium at all. Some four million people may have to pay more for new (and better) policies, not all of whom will necessarily be upset at getting better coverage at a competitive rate.
As Reed Abelson and Katie Thomas reported in The Times last week, three independent estimates by Wall Street analysts found that five million to seven million people will qualify for federal subsidies that will exceed the cost of the cheapest plans for individuals and families on the exchanges. Neither the Obama administration nor the insurance companies, however, are promoting the plans vigorously. They believe that many consumers would be better off paying a bit more for a policy that would cover more of the out-of-pocket costs for a doctor’s visit or hospital stay.
In the wake of the federal website problems, there’s worry about whether the administration can reach its goal of enrolling seven million uninsured Americans in 2014. Surely the five million to seven million eligible for zero-premium policies would be an easy sell. About half of them are under age 39 and uninsured, the kind of young people the exchanges need to broaden the risk pools. Health officials should pull out all the stops to identify and enroll them.
There is no official estimate of how many higher-income earners who have been buying individual policies would pay more when forced to buy new policies. Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who played a role in shaping the Affordable Care Act, estimates 12 million people are currently covered by policies bought on the individual market. He says that, after factoring in subsidies on the exchanges, perhaps eight million will be covered by less costly policies next year, and four million will be covered by more expensive policies, which often provide richer benefits.
HealthCare.gov won't be fixed by end of the month: report
By Jay Busbee | Yahoo News – 10 hrs ago
Waiting for HealthCare.gov to get fully functional? You might be waiting a little longer.
The Washington Post is reporting that an official with knowledge of the technological demands on the government's online health insurance marketplace says it is not likely the site will be fully functional by the end of the month, as the Obama administration has promised.
The primary issue for the site is how to handle the large numbers of users seeking more information on insurance plans. The site was supposed to be designed to host up to 60,000 users at one time, but it is having problems when half that number log on at once.
Bug hunting by the site's primary contractor, CGI Federal, has been problematic as well; the Washington Post's source indicates that only about 60 percent of the site's problems have been effectively addressed.
President Barack Obama has assured the public that the “website is already better than it was at the beginning of October, and by the end of this month, we anticipate that it is going to be working the way it is supposed to, all right?” That's looking ever more unlikely, which would force Americans seeking insurance to use alternate means: telephone call centers or direct contact with insurance carriers.
But the problems radiate outward from the faltering HealthCare.gov site. While there are more than 10,000 employees at 17 call centers, those employees often lack the ability to make changes in customers' files. And insurance companies seeking to sign up customers directly must deal with the same problems in HealthCare.gov as individual users.
What went wrong with HealthCare.gov
HealthCare.gov, built by 55 contractors, is one of the most complex pieces of software ever created for the federal government. It communicates in real time with at least 112 different computer systems across the country. In the first 10 days, it received 14.6 million unique visits, according to the Obama administration. Read related article.
With Enrollment Slow, Some Democrats Back Change in Health Law
By ASHLEY PARKER and MICHAEL D. SHEAR
WASHINGTON — Anxious congressional Democrats are threatening to abandon President Obama on a central element of his signature health care law, voicing increasing support for proposals that would allow Americans who are losing their health insurance coverage because of the Affordable Care Act to retain it.
The dissent comes as the Obama administration released enrollment figures on Wednesday that fell far short of expectations, and as House Republicans continued their sharp criticism of administration officials at congressional hearings examining the performance of the health care website and possible security risks of the online insurance exchanges.
In addition, a vote is scheduled Friday in the Republican-controlled House on a bill that would allow Americans to keep their existing health coverage through 2014 without penalties. The measure, drafted by Representative Fred Upton, the Michigan Republican who is the chairman of the Energy and Commerce Committee, is opposed by the White House, which argues that it would severely undermine the Affordable Care Act by allowing insurance companies to continue to sell health coverage that does not meet the higher standard of Mr. Obama’s health care law.
But a growing number of House Democrats, reflecting a strong political backlash to the rollout of the law, are warning the White House that they may support the measure if the administration does not provide a strong alternative argument. The approaching House vote is shaping up as an important test for both the health measure and the unity that Democratic leaders have so far been able to maintain around it despite a fierce Republican attack.
In a closed-door meeting Wednesday of House Democrats and White House officials, tensions flared as several lawmakers upbraided the administration, saying that the president had put Democrats in a tough political position by wrongly promising consumers that they could keep their existing health care plans. In fact, hundreds of thousands of Americans have received cancellation notices from their insurers because their health care coverage does not meet the minimum standards dictated by the new law.
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