Day Is Added to Deadline as Rush Hits Health Portal
By MICHAEL D. SHEAR and ROBERT PEAR
WASHINGTON — A record-setting crush of last-minute shoppers descended on HealthCare.gov on Monday, creating long wait times for users and putting new stress on the government’s much-maligned health portal as they raced against a midnight deadline to sign up for coverage that will go into effect on Jan. 1.
More than one million people had logged on to the site by 5 p.m., officials said, five times more than the previous Monday. The flood of visitors quickly triggered a backup queuing system that invites users to come back during less busy times. More than 60,000 people provided an email address on Monday to get invitations to return, officials said.
The high volume of visitors also prompted White House officials to abruptly establish a 24-hour grace period that will effectively extend the deadline, allowing those who sign up on Tuesday to still receive coverage from Jan. 1.
Officials compared the last-minute decision to the kind often made by election officials to keep a polling place open late into the night to accommodate voters already in line at closing.
The grace period was the latest example of the administration’s willingness to fiddle with deadlines that once seemed set in political concrete. The botched rollout of the website has forced the White House to adjust its plans repeatedly in an attempt to accommodate users and avoid further examples of signs that the program is not ready for prime time.
“We have taken steps to make sure that those who tried to enroll today, but had delays due to high traffic, have a fail-safe,” said Julie Bataille, a spokeswoman for the federal Centers for Medicare and Medicaid Services.
“People are having a really difficult time getting through,” David Oscar, an insurance broker in Fairfield, N.J., said Monday. He said frustrated clients were calling to say the website was sluggish. “My phone has been burning up. It’s the worst time of year to start this, and all these people who need coverage have so many other things that they’re doing.”
The Legitimacy Problem
By DAVID BROOKS
It’s pretty clear that the implementation of Obamacare will set the tone for how Americans think about government for years to come. There are two large questions to be settled, which you might call the questions of competence and coercion.
The first is whether the government is competent enough to manage large programs. Can the administration get the website to work, set rules for the right insurance products or impose efficiency measures to restrain costs?
These are still open questions. Democrats see the early messiness as the temporary teething pains inevitable to a new large enterprise. Republicans see them as the first stages in the unraveling of an unworkable Rube Goldberg machine. But the fact is that we can’t yet know who is right. Over the next few years, the implementation will either go more smoothly and build faith in federal competence or go as it has been and destroy it.
But we’re already getting a clearer answer on the question of coercion. Cast aside for a second any negative connotation to that word. Almost all large government programs, even very popular ones like Social Security, involve a degree of coercion. Government builds a system and forces everyone to operate within it.
Obamacare, as originally envisioned, mandated that people join the system in order to redistribute money from the healthy and young to the sicker and older. It coerces some people to do something they might not want to do, and which, in fact, may not be in their short-term interest to do.
Already, it’s very clear that millions of Americans — and not just Tea Party types — do not accept the legitimacy of the government to overrule individual decisions, even on something like health insurance. This is not the America of 1932 or of 1964. This is an America steeped in distrust of government. It’s an America that is, on both left and right, steeped in the ethos of individual choice. It’s an America steeped in a morality of authenticity, which says that it is right to listen to the individual voice within and immoral to be forced to conform to the external commands from without.
- It's worth reading the comments on the preceding article.
-SPC
California health exchange tops 400,000 enrolled prior to deadline
By Chad Terhune1:36 PM PST, December 23, 2013
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California's health insurance exchange said more than 400,000 people have signed up for health plans ahead of Monday's enrollment deadline as part of the Affordable Care Act.
The Covered California exchange said the latest figures are based on preliminary data through Sunday, when about 27,000 people picked an insurance company. Enrollment Friday was even higher, at 29,000 people, according to the exchange.
"We very much expect today will be a big day," Peter Lee, executive director of Covered California, said Monday. "We are seeing huge interest online."
The state's latest official figures were 156,000 enrolled in health plans through Dec. 7, and an additional 179,000 people who had qualified for an expansion of Medi-Cal, the state's Medicaid program.
State officials declined to give an updated enrollment figure for Medi-Cal.
The Obama administration announced Monday that it was giving consumers in 36 states who are using the federal exchange an extra 24 hours, through Christmas Eve, to complete an application to accommodate high demand.
California officials said they are sticking with the Dec. 23 deadline, but they vowed to help anyone who starts an application Monday to get coverage effective Jan. 1. They acknowledged that some consumers are running into website glitches and long wait times on the phone.
"We will help people get across the finish line who have started an application today," Lee said. "If you have made a good-faith effort to get started, you can finish it [Tuesday]."
If people don't get through, open enrollment under the federal healthcare law continues through March 31.
MaineHealth increasing spending on software system that was involved with billing glitches
MaineHealth will spend an extra $55 million, mostly for training staff, on a system that has led to costly errors.
The parent company of Maine Medical Center has increased its investment in a sweeping new computer system that was designed to make it easier for patients and medical professionals to access health records but caused the company problems in its first year.
MaineHealth officials said most of the increase, from $145 million to $200 million, will be used to expand employees’ training, to fix problems related to learning the Epic software that led to millions of dollars in billing losses.
With the new system, Maine Medical Center failed to send out accurate bills, which became a major factor in the hospital’s loss of $13.4 million in the first six months of its 2013 fiscal year, officials have said.
Bill Caron, president of MaineHealth, said Epic had a rough start when it was installed at the state’s largest hospital in late 2012.
“It’s a good investment once you get it right,” he said, because the system makes it easier for patients to see their own records and for doctors and nurses to track what care has been provided. The system will be installed by 2017 throughout the MaineHealth system, which includes more than a dozen hospitals.
DHHS kept critical internal CDC review hidden
Posted Dec. 23, 2013, at 7:49 a.m.
An internal review last spring by the Maine Department of Health and Human Services uncovered some of the very same problems at the Maine Center for Disease Control that were flagged last week in a state investigation.
But that internal review — released this week by DHHS in response to a Sun Journal Freedom of Access Act request — was not shared with the public or with frustrated lawmakers who had spent more than a year raising questions about the CDC. The review was shared only with DHHS leaders and kept within DHHS for eight months as the department considered changes to the CDC.
Many people didn’t know the internal review existed until last week when it was mentioned in a report from the state’s investigation.
“I brought [the CDC issue] up publicly several times and it was clear I was very concerned about this, so the fact there was [an internal review] and it wasn’t shared with us is troubling to me,” said state Rep. Peggy Rotundo, D-Lewiston, who has questioned problems with the CDC for a year and a half and had met with DHHS Commissioner Mary Mayhew to discuss those concerns.
And while the internal review found some problems, it did not look into broader allegations that have long troubled lawmakers and have caught the attention of the Attorney General’s Office.
At issue is the way the CDC in 2012 distributed more than $4 million to 27 community health organizations that were part of the Healthy Maine Partnerships program. In response to state budget changes, the CDC had cut funding to 18 of those organizations and had named the remaining nine “lead HMPs,” giving them more money and more responsibility.
Surprised by some of the HMPs that were chosen to become lead agencies, lawmakers and others questioned how the CDC made its decision. Then, last April, a CDC division director alleged that CDC officials had played favorites with HMP grant recipients and had ordered the shredding of public documents connected to it.
Mayhew, who oversees the Maine CDC, requested the internal review around that time.
The review was done by the DHHS Office of Continuous Quality Improvement, then known as the Office of Quality Improvement Services. The office was asked to gauge the integrity of the CDC’s scoring system and its methodology.
The office talked with top CDC officials involved in the HMP grant process and reviewed scoring sheets and other documents. It released its report on April 26.
The review found strengths in the grant process, including that a collaborative team was established to come up with scoring, multiple measures were used to assess HMPs, multiple questions were used to rate HMP performance and CDC employees were separated from one another during the survey period so they could rate the HMPs independently.
It also found weaknesses, including:
Weighing Health Plans: The Devilish Details
By TARA SIEGEL BERNARD
On the way home from a bar in the wee hours of the morning, Branden Eastwood, 29, managed to break his ankle stepping into a cab. He wasn’t insured, so it became an expensive night out: He received $42,000 in medical bills from a Georgetown hospital.
As he tries to negotiate a reduction in those charges, Mr. Eastwood, a Virginia resident, is also trying to buy a health plan from the federal online exchange. He knows he will need ankle surgery early next year, but he said it was still difficult to estimate how much he would owe out of pocket under different plans. “I’m leaning towards the expensive gold plan,” said Mr. Eastwood, a freelance photojournalist, who said monthly premiums were $300, though out-of-pocket spending was capped at $3,500. “The only thing I’m having trouble figuring out is how much the surgery will cost.”
Like Mr. Eastwood, many consumers are now trying to choose the most cost-effective plans that are suitable for them because a big deadline is looming: Most people need to enroll in a plan by Monday for coverage that will begin on the first of the new year, although several states recently pushed the deadline to Friday.
That means more people are digging into the plans’ details — a task that is becoming easier as the technical problems that plagued the exchanges continue to improve.
The new health care law makes it clear that there are hard limits on how much you can spend out of pocket. But how fast you approach those ceilings depends largely on the plan’s intricate cost-sharing arrangements, which requires looking beyond headline numbers like premiums and deductibles.
“Most people are looking at premium cost and looking to see if their physician is in network, and they back into the plan they buy,” said Kevin Counihan, chief executive ofAccess Health CT, the state-run exchange in Connecticut. “What they need to do is look more broadly at the total out-of-pocket expense.”
Picking a plan and estimating your outlays is a complicated and tedious task. Here are some factors that can influence how quickly you reach your out-of-pocket maximum, as well as specifics on deadlines and other recent changes:
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