Posted: 11/17/2013 10:08 pm
The ancient Greeks liked to say that character is fate.
The colossal mess that Obamacare has become reflects both the character of the legislation and that of the president who sponsored it.
The Affordable Care Act, as a government mandate for people to purchase private insurance with an array of possible subsidies, had too many moving parts. It was an accident waiting to happen.
As many of us wrote at the time, Medicare for All would be simpler to execute, easier to understand, and harder for Republicans to oppose. If doing Medicare for All in a single stroke was too heavy a lift, start with 60-year-olds, then 55-year-olds, then young people under 25, and fill in the qualifying age brackets over a decade.
In the meantime, if we wanted to expand coverage for the working poor, Medicaid was a proven vehicle. Indeed, the one part of the Affordable Care Act that is not coming off the rails is the expansion of Medicaid, because it is a public program.
But this was not to be. Instead we got a program that was poorly understood by the public because it was almost impossible to explain and even harder to execute.
President Obama, looking to fund his initiative without raising taxes, hit on the idea of imagining a trillion dollars in yet-to-be specified savings in Medicare. Seniors, not unreasonably, became concerned that their own coverage would suffer. The mid-term electoral disaster of 2010 was one part older Americans deserting the Democrats for fear of the ACA's impact on Medicare, and one part the Republican right seizing an anti-Wall Street backlash because Obama's economic team was too cozy with the big banks.
Then the Democrats got lucky. Republicans nominated a weak presidential candidate in Mitt Romney. The voters finally got fed up with Republican fun and games with government shutdowns. Democrats led by Senate Majority Leader Harry Reid at last showed some spine and Republicans blinked first.
For a few weeks this fall, with Republican popularity at all time lows, it looked as if the Democrats would hold the Senate and possibly even take back the House in the mid-term elections of 2014. But then came the bungled roll out of Obamacare.
There is no easy fix for this mess. Delaying its effective date will only raise premiums across the board next year because insurance companies have set their prices on the assumption that millions of new, younger subscribers will sign up.
The White House hopes it can delay the chorus of political outrage long enough to repair the software. But by all accounts that will take months, and Democrats as well as Republicans want action now.
The president has lost control of both the narrative and the politics. The Republicans, who were unable to destroy Obamacare by holding the budget hostage, are now enjoying watching it fall of its own weight. The Democrats are divided into one camp uneasily standing by their president and another wanting to put distance between themselves and this mess.
Wendell Potter
The Real Reasons Insurers Are Canceling Policies
Posted: 11/18/2013 10:50 am
Now that President Obama has said it's OK with him if insurance companies keep their policyholders in health plans that don't meet the standards established by the Affordable Care Act, at least for another year, the big question is whether insurers will take him up on the offer.
The answer: it depends.
Some insurance executives will view the offer as one they can't turn down. Even though Karen Ignagni, president of America's Health Insurance Plans, the industry's big PR and lobbying group, had nothing good to say about Obama's proposal, keep in mind that she doesn't run an insurance company. While industry executives look to her to comment on what politicians do, they make their own decisions when it comes to their companies' bottom lines.
Here's what Ignagni was quoted as saying in a FOX News story Friday:
"The only reason consumers are getting notices about their current coverage changing is because the ACA (Affordable Care Act) requires all policies to cover a broad range of benefits that go beyond what many people choose to purchase today."
Not so fast. There are other reasons some folks are being told they'll have to change health plans next year. Many of them are having to switch plans not because of Obamacare but because their insurance companies want to move them into policies with higher profit margins.
Insurance companies have been sending similar notices to their customers for years. My son Alex -- and thousands of other customers of a Blue Cross plan in Pennsylvania -- got such a notice four years ago, months before Congress passed the health reform law.
Why? The insurer wanted to move those policyholders out of a plan with a reasonable $500 annual deductible and into one with a deductible ten times that amount. To accomplish that, Blue Cross notified its policyholders that their health plan would not be available in 2010. Their options were to switch to the high-deductible policy, which would still cost them a couple of dollars more each month, or to another plan with that reasonable $500 deductible. If they chose the latter, their monthly premiums would increase 65 percent.
Notices like the one Alex got have provided a mechanism for insurers to implement a years-long industry strategy of shifting more and more of the cost of medical care to their policyholders. And that strategy will continue until every last one of us is in a high-deductible plan.
Obamacare Rollout Week Seven: Better and Nowhere Near Good Enough
I can provide you with an Obamacare federal exchange rollout update from two decidedly different perspectives:
- The website is working much better with enrollment increasing at least three-fold over just a few weeks ago with backroom error rates considerably improved; or
- The enrollment, to give you a general sense of what's happening, for a health plan that might have to sign-up 100,000 people in order to get their share of the 7 million Obama administration's national enrollment objective, has grown from perhaps 10-15 enrollments a day a few weeks ago to 40-50 a day now. If this new higher trend continues, such a plan would sign up only another 12,000 people toward the 100,000 objective by March 31. Backroom error rates being committed by Healthcare.gov, when enrollment data are transmitted to the health plans, are still far too high to transition to high volume processing without serious customer service issues.
In Stance on Renewal of Old Health Policies, States Run the Gamut
By KATIE THOMAS, SUSANNE CRAIG and KAREN YOURISH
Just a few days after President Obama said that millions of consumers should be able to keep their old insurance plans for another year — even if they did not meet the requirements of his health care law — he is finding support among states that would not exactly be described as allies.
Of the 13 states that have so far said they will allow consumers to renew canceled plans, all but four are led by Republican governors and have generally been opposed to the new health care law. Of the eight that have said they will not carry out the policy, six are in Democratic-led states, many of which have actively worked to put the law into effect and have argued that allowing such an extension could undermine its success. They include New York, which announced its decision on Tuesday, and Massachusetts. Many other states, including California and New Jersey, are still weighing their options.
The new plans being offered under the Affordable Care Act require that insurers cover a wider range of benefits than many of the old plans. In addition, the insurers are prohibited from turning away people with existing medical problems or charging them more.
Mr. Obama’s announcement last week came after the political uproar prompted by millions of consumers’ receiving notices that their health plans were being discontinued because they no longer complied with the law.
Many states with low numbers of such cancellations were those that had let insurers temporarily avoid the law’s requirements by offering early renewal of existing plans. Those renewals allowed people to keep their existing plans though next year. The goal was to smooth the transition for consumers, commissioners in those states said.
“It turned out to be a good decision,” said Mike Chaney, the insurance commissioner in Republican-led Mississippi, who said fewer than 500 people in his state received notice of discontinued policies because he encouraged the major insurers to offer the option of renewing for an additional year.
Mr. Chaney said insurers could have chosen to cancel policies in his state anyway, but “I would have hammered them if they did.”
Several other Republican-led states, including Oklahoma, Utah and New Mexico, also reported few cancellations and cited their policies on early renewals as one of the reasons.
However, the final decision was up to insurers. For that reason, in some states that permitted early renewals there were still hundreds of thousands of canceled policies.
Perks Ease Way in Health Plans for Lawmakers
By ROBERT PEAR
WASHINGTON — Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.
That is true. As long as their constituents have access to “in-person support sessions” like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number — a “dedicated congressional health insurance plan assistance line.”
And then there is the fact that lawmakers have a larger menu of “gold plan” insurance choices than most of their constituents have back home.
While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.
Lawmakers and the employees who work in their “official offices” will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.
“D.C. Health Link set up shop right here in Congress,” said Eleanor Holmes Norton, the delegate to the House from the nation’s capital.
Insurers routinely offer “member services” to enrollees. But on Capitol Hill, the phrase has special meaning, indicating concierge-type services for members of Congress.
If lawmakers have questions about Aetna plan benefits and provider networks, they can call a special phone number that provides “member services for members of Congress and staff.”
On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans.
It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange.
Lawmakers can select from 112 options offered in the “gold tier” of the District of Columbia exchange, far more than are available to most of their constituents.
How Doctors Die
By DAN GORENSTEIN
BRAVE. You hear that word a lot when people are sick. It’s all about the fight, the survival instinct, the courage. But when Dr. Elizabeth D. McKinley’s family and friends talk about bravery, it is not so much about the way Dr. McKinley, a 53-year-old internist from Cleveland, battled breast cancer for 17 years. It is about the courage she has shown in doing something so few of us are able to do: stop fighting.
This spring, after Dr. McKinley’s cancer found its way into her liver and lungs and the tissue surrounding her brain, she was told she had two options.
“You can put chemotherapy directly into your brain, or total brain radiation,” she recalled recently from her home in suburban Cleveland. “I’m looking at these drugs head-on and either one would change me significantly. I didn’t want that.” She also did not want to endure the side effects of radiation.
What Dr. McKinley wanted was time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean. But most of all, she wanted “a little more time being me and not being somebody else.” So, she turned down more treatment and began hospice care, the point at which the medical fight to extend life gives way to creating the best quality of life for the time that is left.
Dr. Robert Gilkeson, Dr. McKinley’s husband, remembers his mother-in-law, Alice McKinley, being unable to comprehend her daughter’s decision. “ ‘Isn’t there some treatment we could do here?’ she pleaded with me,” he recalled. “I almost had to bite my tongue, so I didn’t say, ‘Do you have any idea how much disease your daughter has?’ ” Dr. McKinley and her husband were looking at her disease as doctors, who know the limits of medicine; her mother was looking at her daughter’s cancer as a mother, clinging to the promise of medicine as limitless.
When it comes to dying, doctors, of course, are ultimately no different from the rest of us. And their emotional and physical struggles are surely every bit as wrenching. But they have a clear advantage over many of us. They have seen death up close. They understand their choices, and they have access to the best that medicine has to offer.
“You have a lot of knowledge, a lot of awareness of what’s likely to come,” said Dr. J. Andrew Billings from his home in Cambridge, Mass.http://www.nytimes.com/2013/11/20/your-money/how-doctors-die.html?pagewanted=2&rref=health&hpw&pagewanted=print
The Obamacare Crisis
By THOMAS B. EDSALL
Health care as a necessity comes only after food, shelter and income security. The mismanagement of the website HealthCare.gov and the cancellation of millions of policies pushes an underlying question out into the open: is the federal government capable of managing the provision of a fundamental service through an extraordinarily complex system?
This system requires coordination of over 288 policy options (an average of eight insurers are competing for business in 36 states), each with three or more levels of coverage, while simultaneously calculating beneficiary income, tax credit eligibility, subsidy levels, deductibles, not to mention protecting applicant privacy, insuring web security, and managing a host of other data points.
A malfunction at any one of these junctures could prove fatal.
In enacting the Affordable Care Act, President Obama and his Democratic supporters in Congress took on the task of creating a set of information technologies that has to interconnect with the I.R.S.; the Departments of Labor, Treasury, Veterans Affairs, and Homeland Security; the Social Security Administration; state governments; insurers; employers; hospitals; and practitioners in the private sector.
Robert Charette, president of the ITABHI Corporation — a tech firm specializing in risk management — describes the problems:
“HealthCare.gov is a huge system of systems and it’s extremely difficult to manage these things even in the best of times. That’s mostly because you have so many different interfaces with so many different assumptions controlling how the individual systems operate. And they’re rarely built with enough flexibility to be used by lots of other systems. If you take a look at the IRS systems, the Department of Homeland Security systems, or any of the other ones we’re talking about, they were never created to be connected to something like HealthCare.gov.”
The seven million people officials initially estimated would sign up for the Obamacare insurance exchanges this year are putting their well-being and that of their families in the hands of government bureaucracies armed with demonstrably inadequate technological expertise.
The chaos surrounding efforts to activate HealthCare.gov reinforces a key conservative meme: that whatever the test is, government will fail it. Insofar as voters experience their interaction with government as frustrating and unreliable, the brunt of political damage will hit Democrats, both as the party of government and as the party of Obamacare.
Cumulatively, recent developments surrounding the rollout of Obamacare strengthen the most damaging conservative portrayals of liberalism and of big government – that on one hand government is too much a part of our lives, too invasive, too big, too scary, too regulatory, too in your face, and on the other hand it is incompetent, bureaucratic and expropriatory.
Americans Like Obamacare Where They Can Get It
As the Washington press corps reports that the Obama Administration is failing—and threatening to take down with it the entire philosophy of liberalism—a funny thing is happening out there across the country. In a number of states that have working online health-care exchanges, more and more people are signing up for the insurance coverage that is available under the Affordable Care Act.
In California, where local officials have launched a campaign to remind residents that the state’s new Web site, Covered California, is separate from the troubled federal site healthcare.gov, enrollment is rising fast. During the first two weeks of November, almost sixty thousand people signed up for private insurance policies or for Medi-Cal, the local version of Medicaid. That’s more than twice the figure for all of October. “What we are seeing is incredible momentum,” Peter Lee, the director of Covered California, said at a press conference on Monday.
Similar things are happening in other states across the country. An article in Tuesday’s Los Angeles Times cites Connecticut, Kentucky, Minnesota, and Washington as on track to exceed their enrollment targets. Here in New York, too, there are positive signs. Last week, officials reported that close to fifty thousand people had signed up for health insurance through the state’s new Web site, NY State of Health, with about half of them taking out private plans and half enrolling in Medicaid. “I would say we are seeing great interest in New York, and we are very pleased with our enrollment numbers,” Danielle Holahan, the deputy director for NY State of Health, said.
What these states have in common are state-run Web sites that are working pretty well; they are also all controlled by Democrats who are pushing the new reform. This progress points to something that has been absent in much of the reporting about the troubled rollout of healthcare.gov and the cancellation of individual policies: in places where Americans know about the comprehensive and heavily subsidized health coverage available under the Affordable Care Act and can easily access it, they are doing so in substantial numbers.
That’s hardly surprising. Prior to the reform, close to fifty million Americans didn’t have any health-care coverage, and many others were stuck with policies that had large gaps. The online insurance exchanges and the effort to make more people eligible for Medicaid were designed to remedy this situation, and in some places that strategy is working more or less as planned.
Similar things are happening in other states across the country. An article in Tuesday’s Los Angeles Times cites Connecticut, Kentucky, Minnesota, and Washington as on track to exceed their enrollment targets. Here in New York, too, there are positive signs. Last week, officials reported that close to fifty thousand people had signed up for health insurance through the state’s new Web site, NY State of Health, with about half of them taking out private plans and half enrolling in Medicaid. “I would say we are seeing great interest in New York, and we are very pleased with our enrollment numbers,” Danielle Holahan, the deputy director for NY State of Health, said.
What these states have in common are state-run Web sites that are working pretty well; they are also all controlled by Democrats who are pushing the new reform. This progress points to something that has been absent in much of the reporting about the troubled rollout of healthcare.gov and the cancellation of individual policies: in places where Americans know about the comprehensive and heavily subsidized health coverage available under the Affordable Care Act and can easily access it, they are doing so in substantial numbers.
That’s hardly surprising. Prior to the reform, close to fifty million Americans didn’t have any health-care coverage, and many others were stuck with policies that had large gaps. The online insurance exchanges and the effort to make more people eligible for Medicaid were designed to remedy this situation, and in some places that strategy is working more or less as planned.
Read more: http://www.newyorker.com/online/blogs/johncassidy/2013/11/americans-like-obamacare-where-they-can-get-it.html?printable=true¤tPage=all#ixzz2lCUsWxju
Maryland struggling with technological problems with online insurance exchange
By Lena H. Sun,
Maryland is wrestling with stubborn technological problems with its online insurance exchange, posting weak enrollment even as other states have signed up thousands of consumers for plans under President Obama’s new health-care law.
In October, the exchange’s first full month of operation, 1,278 people signed up for the private plans, and 465 signed up in the first week of November. Those low numbers raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March. The state has about 800,000 uninsured residents.
Backup options, such as paper applications, are proving time-consuming and cumbersome. Front-line helpers must manually enter information from paper applications into electronic ones, using an internal state Web page available from only some government buildings. That puts access out of reach for many helpers working at community organizations.
The Maryland exchange’s rocky start is in marked contrast to some other states running their own marketplaces, including California, Connecticut and Kentucky. The District’s exchange, after struggling with initial problems, is working well, officials say. But other states are struggling. In Oregon, exchange officials say they haven’t enrolled anyone in a private plan because of technological trouble. In Virginia, 1,023 people signed up in October, a low number that reflects the state’s reliance on the federal exchange, which has faced an array of problems.
Health-policy experts say states that have had success have several factors in common. For example, more bare-bones Web sites have turned out to be more reliable than the more complex ones. Maryland has scaled back some of its features to focus on the core functions needed for sign-ups.
Other states with healthy enrollment numbers are pursuing outreach efforts that go well beyond the Web sites, including aggressive campaigning by public officials. For example, in California, officials in various cities are competing with one another to sign up residents, said Peter Lee, director of that state’s exchange.
Maryland’s stumbles were unexpected, given that the state was one of the earliest and most enthusiastic supporters of the Affordable Care Act.
“What is surprising to me is that the state has been so supportive of the ACA.
The GOP’s scary-movie strategy
By Dana Milbank,
House Republican leaders could not have been more blatant in their attempts to frighten Americans if they had emerged from their weekly meeting wearing hockey masks and carrying chainsaws.
“The American people are very, very worried,” Majority Leader Eric Cantor (R-Va.) proclaimed to the cameras after emerging from Republicans’ gathering Tuesday morning. “Moms and dads are worried that they’re going to lose their health-care plan. . . . Individuals who are going onto the HealthCare.gov Web site are beginning to fear that perhaps their identity will be stolen.”
Of course Americans are worried and fearful. It was all I could do to keep my knees from knocking as I stood in an alcove in the Capitol basement, listening to Republican leaders describe all the terrible things that Obamacare has produced:
“Cancellation notices. . . . Broken promises. . . . Premiums are going right through the roof,” said House Speaker John Boehner (R-Ohio).
“You won’t be able to keep your doctor,” warned Majority Whip Kevin McCarthy (R-Calif.), who also noted that Consumer Reports “recommend[s] Americans not to go to the Web site because of the fear of having fraud.”
And the caucus chairwoman, Cathy McMorris Rodgers (R-Wash.), spoke of “helpless” and heart-heavy constituents put “on the casualty list” and doubtful about getting medical care.
Trembling with fear, I walked through an underground tunnel from the Capitol to the Rayburn House Office Building, where another hearing on Obamacare was just getting underway.
“Right now,” Rep. Tim Murphy (R-Pa.), who held the gavel, announced from the dais, “HealthCare.gov screams to those who are trying to break into the system: If you like my health-care info, maybe you can steal it.”
Rep. Michael Burgess (R-Tex.) added his considered opinion that, “rather than getting better, it may be getting worse” for the Obamacare rollout. “These initial problems break the surface of the deeper issues that lie ahead for not just the law but for the American people that must live under the law.”
Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple — much like the refusal by red-state governors to participate in setting up the exchanges in the first place. But those sabotaging the new law should be careful what they wish for: Instead of killing the law, they are likely to make it more expensive to taxpayers. Their efforts could have the effect of turning Obamacare, which relies on private insurance and the free market, into just the sort of big-government entitlement Republicans were worried about in the first place.
Maine hires controversial Medicaid reformist
The state will pay $925,000 to The Alexander Group to help with fraud detection and assess the potential cost of expansion.
Maine has hired the controversial former welfare chief of Pennsylvania to conduct a $925,000 review of its Medicaid program and the potential effects of expanding it through the federal health care law.
The Department of Health and Human Services announced Tuesday that it has contracted with The Alexander Group of Rhode Island to bolster ongoing “program integrity” efforts and assess the cost of expanding Medicaid – known here as MaineCare – under the Affordable Care Act.
The contract is worth $925,200, according to a copy of the document, and will employ the services of Gary D. Alexander, the former welfare chief in Pennsylvania who was criticized for policy initiatives that dramatically cut the state’s Medicaid rolls, eliminating health care coverage for 89,000 children.
DHHS Commissioner Mary Mayhew said in a media statement that Alexander’s firm brings much-needed expertise to evaluating social services that cost Maine $3.4 billion a year.
Democrats viewed the contract with suspicion, saying Alexander’s record shows that his review will not be impartial and will serve only to justify divisive initiatives favored by the LePage administration.
Owner of Anthem Blue Cross joins health care stocks surge
WellPoint shares set a record as Medicaid expansion under Obamacare promises more revenues for insurers who run state programs.
By J. Craig Anderson canderson@pressherald.com
Staff Writer
Staff Writer
Despite problems with the rollout of the Affordable Care Act, including a disastrous launch of the website that individuals use to buy health insurance, share prices for the country’s largest publicly traded health insurance companies are at or near all-time highs.
That includes Indianapolis-based WellPoint Inc., which owns Anthem Blue Cross Blue Shield, Maine’s largest health insurance provider. Shares of Wellpoint hit a record price of $92.87 on Tuesday.
Other health-insurance stocks, including UnitedHealth Group, Aetna Inc., Cigna Corp. and Humana Inc., have shown similar gains.
Why are investors so bullish about the much-maligned Affordable Care Act’s impact on health insurance companies? Analysts say the federal health care law appears to be good for large insurance companies so far, primarily because of its expansion of Medicaid.
In recent decades, most states, including Maine, have outsourced management of all or part of their Medicaid programs to companies known as managed care organizations. Most major health insurance companies operate such organizations. Last December, WellPoint dramatically expanded its Medicaid management business by acquiring the Amerigroup managed care organization for $4.9 billion.
Maine hires conservative firm to study Medicaid expansion, bolster welfare efficiency
Posted Nov. 19, 2013, at 2:17 p.m.
AUGUSTA, Maine — The state has contracted a conservative former welfare administrator with a history of slashing benefits to review Maine’s Medicaid system and other welfare programs.
The Alexander Group, based in Rhode Island and spearheaded by former Pennsylvania and Rhode Island welfare chief Gary Alexander, will be paid nearly $1 million over eight months for its services, which will include a report on potential costs of expanding Medicaid under terms of the Affordable Care Act.
Democrats twice advanced legislation earlier this year to have Maine take part in the eligibility expansion, but Republican Gov. Paul LePage vetoed both efforts. Democrats plan to introduce a similar proposal in the legislative session that begins in January.
In addition to studying the long- and short-term costs of Medicaid expansion, the Alexander Group also will work with the Department of Health and Human Services to assess every state welfare program, with an eye toward adding flexibility and efficiency and integrating disparate programs that often benefit the same people.
The contract with Alexander has been in effect for two months, though the LePage administration did not make the deal public until Tuesday. The group will be paid with a combination of state and federal dollars, including about $450,000 from the state’s general fund.
Sam Adolphsen, a former staffer at the Maine Heritage Policy Center who now works in the governor’s administration, will be one of the state’s designees to work with the Alexander Group. Adolphsen’s background is in business administration, not social services or health care, a fact that Democrats were quick to point out.
The consulting firm recently completed a similar four-month study in Arkansas, where it recommended across-the-board reductions in spending on welfare and a plan to push state-sponsored health insurance recipients into the private marketplace.
Arkansas paid $220,000 for the Alexander Group’s services. When asked why Maine was paying so much more, Health and Human Services Commissioner Mary Mayhew said she couldn’t comment on another state’s dealings but stressed that the work to be undertaken is substantial.
Although the group is looking into Medicaid expansion, that doesn’t mean LePage is any warmer to accepting Democrats’ plan to accept additional federal dollars for the program.
“[The governor’s] position has not changed,” said LePage press secretary Adrienne Bennett. “We have said we are seeking more flexibility from the federal government, but we haven’t gotten that flexibility.”
