The editors of the Chicago Tribune bring up an interesting point. What happens if Healthcare.gov isn’t suitable to task by the November 30 deadline the Administration has established? It won’t be a confidence-builder, that’s for certain. But it would have real world implications as well:
Losing October and November to the computer meltdown means that millions of people will have, at best, days to cram through the insurance enrollment system by Dec. 15 if they want coverage that begins on Jan. 1, writes James Capretta of the American Enterprise Institute. If they can’t, “it will be nearly impossible to process the enrollments fast enough to prevent breaks in insurance coverage at the beginning of 2014.” Capretta’s prediction: “some very large number of Americans — probably in the millions — will experience a break in insurance coverage at the beginning of 2014.”
It will increase the peak load requirements for the site making it that much more difficult for it to achieve its purpose. And it will very likely mean a break in coverage for some number, possibly a very large number, of people.
It would also have psychological and, presumably, political implications.
BTW, why did President Obama make such a point of people who liked their insurance being able to keep it? Because of the way Bill Clinton bungled healthcare reform twenty years ago, the first step in that ill-fated operation being to put his wife, Hillary, in charge of it.
Now who is urging President Obama to find a way to make good on that promise? Bill Clinton.
Again, the solution is something some GOP members called for: Delaying the individual mandate. A few months or a year, perhaps.
Another possibility is deploying in-person staff of HHS or other agencies (including state employees) signing up people in-person. You’d get a conditional approval in person, then verification in the mail (after income, etc. have been verified).
TimH, delaying the individual mandate will not help those who are losing coverage now.
That’s true, except that they won’t be forced to pay more for coverage. The insurance companies have decided to not offer some plans next year. Some people in exceedingly low-risk pools paid surprisingly little and had their insurance cancelled; unfortunately, the “pool” has let the water out, and it is virtually impossible to get the same water back in.
@TimH
The egg has been cracked. The contents have been scrambled, and they are waiting to go into the frying pan. The egg cannot be unscrambled and the shell reassembled.
The risk pools are gone, and the policies will no longer exist. The insurance companies are operating according to Obamacare rules. I am not sure how fast they could switch back, but I am guessing that it is not fast enough.
It was designed to make undoing it impossible. This is why Democrats spent three years crowing about how Republicans would be unable to repeal it. My how times have changed. Hubris has a way of biting you in the ass.
Sometimes you must let people learn the hard way.
Tasty,
There are so many ways to describe the current muddle of HC revelations plaguing the PPACA. Your’s, unscrambling a scrambled egg is one, and another thrown out today was putting the toothpaste back in the tube. What it all means is that once a system has been unpacked, revealing huge internal weaknesses and damaged parts, costly repairs and despair become overwhelming, and a better option seems to be just starting over with a new system .
What I find so disheartening, though, is how people refuse to place the causes for dysfunction anywhere but outside of the government. It’s like the dems tack up fly-paper, and then start throwing the blame around, hoping it will stick here and there, deflecting any cause-and-effect away from their own central planning and government management. For instance, dem operatives are calling the ‘bad actors’ in this mess the insurance companies. However, what is deceptively MIA is the agreement initially made between these ‘bad actors’ and the Obama Administration — that being, in order to qualify for government subsidies the insurance companies had to first cancel all policies not meeting the formidable criteria set by the PPACA.
@jan
The bottom line is that many people will soon be without health insurance unless they can afford the premium increases. Many people will soon be without health care unless they can afford the deductible. You and I know what this means, but a lot of people are about to get a hard lesson.
A lot of people are learning that they are the “free riders”. A large number of these people are or will be ex-Progressives. They may not become conservatives, but they will never believe the progressive nonsense anymore.
Democrats are tied to Obamacare, and they rise or fall with it. They will blame anybody and anything. The blame will probably go around a few times – insurance companies, Republicans, George W. Bush, Halliburton, insurance companies, Republicans, …
As the stench from this turd becomes more pronounced, the Democrats will be like a drowning person, and they will try to grasp anything to stay afloat. The best advice is to keep some distance. Republicans should offer to do anything to help. Never kick somebody when they are down.
Honey, get the popcorn, and enjoy the show. It’s about to get weird.
BTW/ my ramblings aside, I don’t have a problem with the Administration reporting the number of plans in “shopping carts.” Its probable that most of these will constitute purchases some day. I have a problem with them not separating those numbers out from the actual enrollments. It looks deceitful and hurts their credibility.
I intended to make that last comment in another thread.
Here, I wanted to agree that I don’t know how the Administration could do what Bill Clinton is suggesting. Red State Senators want to stop the insurance companies, but what would the hammer be? Jail, fines, kicking them out of the exchanges?
Passive remedial approaches (waiving, delaying, non-enforcing) are going to be easier than active approaches, like mandating insurance companies renew policies.
Tasty,
I cannot remember anything unraveling so fast, as daily revelations pour out opposing what was originally promised and marketed to be in the PPACA. It’s more than a joke. It’s a travesty, slapping those people, diligent in purchasing their own affordable coverage, with cancellations, mandates, or at best honeyed by government subsidies, at taxpayer’s expense.
This is what they call improving healthcare?
Oh yes, there was the “access memo,” repeatedly touted about millions of people not having HC insurance. However, most of those will be going into expanded medicaid programs, which studies have shown to have inadequate care, along with a growing number of physicians refusing to even take these people on as patients.
It’s stunning to me, what little was gained, compared to what is being lost in Obamacare!
Just to augment the futility of medicaid programs, as it relates to actual health benefits, a two-year medicaid expansion program in Oregon was examined and it’s results detailed here.
I have a problem with them not separating those numbers out from the actual enrollments. It looks deceitful and hurts their credibility.
I agree, PD. However, how has the entire PPACA, from it’s very start to now, been anything other than deceitful and an arm-twist, in it’s Sherman’s March approach to get passed?
The government is also not sorting out any demographic numbers — how many of them are in the young/healthy category, the ones needed to financially sustain this program, versus the old/sicker participants.
The PPACA has always been about putting it’s best foot forward — the non-costly advantages of it’s plans exhibited in the first 3 years — followed by the real nuts and bolts now, once it’s been entrenched for a while.
@jan
This is what they call improving healthcare?
It never was about healthcare. It was about political power and money. That is why the PPACA addressed health insurance, and this is why it never made any sense. Rich white liberals were tired of paying high premiums. They thought that they could lower their premiums and create a new entitlement for enhanced political power.
While I have a lot of problems with Medicaid, it is designed to get healthcare for the poor. This is why arguing about it was/is futile.
Note how this pile of fecal matter has morphed into a load of manure. It is fertilizer, and it will cause the insurance markets to bloom.
“You can fool all the people …”
@Tastybits, politically speaking its interesting that in the Quinnipiac poll today, those btw/ 18-29, were more likely to believe Obama “knowingly deceived” the public about healthcare than other ages, and are most likely to trust Republicans in Congress to do a better job handling healthcare than Obama. (46% trust Rep. Congress; 41% trust Obama)
Most of the other questions show this age cohort is still fairly liberal and supported the ACA, but I suspect they’ve discovered they’re “free riders,” and politics is not for idealists.
I suspect they’ve discovered they’re “free riders,â€
The horror.
@sam
The horror.
“Let them eat cake.”
@sam, IMHO, the cost-shift from the old to the young was immoral, as it was not based upon actual ability to pay. The young should be outraged.
Interesting thread. Anyway, from my point of view thank god we at least didn’t have a complete incompetent like Sarah Palin in charge. Project might have gotten screwed up or something……….
Wednesday night concert video (NSFW):
Ever Get the Feeling You’ve Been Cheated? (edit)
“Let them eat cake.â€
“The young should be outraged.”
Ah, well, let me tell you what I was thinking about when I wrote that. You guys know who Jean Shepherd was? He wrote some very funny short (and long short) stories. He wrote “A Christmas Story”, which is a staple of holiday TV now (he narrates it, too). Well, Jean wrote a short story about a guy who goes on a blind date. As you might imagine, the date doesn’t go all that well, and he guy is kinda pissed — grrrrrr, grrrrr, grrrrr to himself all evening long. But toward the end of the date, the guy has an epiphany: He’s the blind date. That’s how I think of those young folks who supported the ACA and now find out that, hey, Jesus, I’m one of those free riders they were talking about! Christ! The horror!!!
I like reading Jonah Goldberg’s fluid political pieces. They are filled with humorous cynicism, laced with poignant truths. Here is an excerpt from an internet musing called Schadenfreudapalooza:
@PD
I’m not sure I understand that claim PD. Actual ability to pay is taken into consideration. From Premium Increases for “Young Invincibles†Under the ACA and the Impending Premium Spiral
Now, all kinds of arguments can be — and are being– mounted against the scheme, but “not [being] based upon actual ability to pay” ought not to be one of them.
@sam
There are a lot of people who do not pass the means test. They do not qualify for subsidies, but this does not mean that they are not struggling. A lost job, reduced hours, divorce, deadbeat dads, natural disaster damage, etc. are a few reasons people are struggling to pay the bills. They are not destitute, but they have a tight budget.
Many of these people had a health insurance policy they could afford. It may not meet the theoretical standards of the shit for brains crowd, but it was serving their needs. These people are deemed “free riders” because they are not subsiding the premiums of the better-off.
When you do not pass the means test, nothing is free. You will be charged for expenses incurred at the ER, and those expenses will probably cost more than those with insurance.
The hospital will use any means to get its money. Non-payment is no different than any other non-payment. You will be sent to a collection agency. In a credit driven world, a low credit score is not good.
There is little difference between the people in a bad mortgage or in a bad insurance policy. Actually, there is a difference. People with a bad mortgage do not directly affect the mortgages of the well-off. If they did, we would hear about the “free riders” of the housing market.
The healthcare industry is running a much bigger scam than the financial industry, and a lot of people are about to learn the hard way. “Obamacare” is nothing more than an attempt to keep the scam going.
@sam, I’m talking about the Age-Band Compression; policies cannot exceed a 3:1 rato solely based upon age. People in their twenties are required to pay higher insurance premiums to prevent sticker-shock to those in their sixties. If the young were required to purchase insurance that was worth $1,500 per year that was worth $1,500 per year, that would be one thing. I see no moral justification for requiring them to pay $3,000 or more for that same insurance so that someone in their 60s who may be wealthier doesn’t have to pay full price.
Sure, the subsidies will ameliorate that for some, but part of the reason the subsidies are needed is to lessen the problem of the age-shift. And the reason for this state of affairs is that a full reliance on normal subsidies would not have been deficit neutral, so it wouldn’t have passed, i.e its a hidden tax on the young. And sixty-year-olds vote.
@sam, I’m talking about the Age-Band Compression; policies cannot exceed a 3:1 rato solely based upon age.
Ah, now I see your point. It wasn’t clear as you originally stated it.
“I see no moral justification for requiring them to pay $3,000 or more for that same insurance so that someone in their 60s who may be wealthier doesn’t have to pay full price.”
I’ll have to give that some thought. The “no moral justification” part. Intuitively, it sounds right, but I’ve learned my to distrust my intuitions.
@sam, I don’t expect people to agree with my sense of morality.
The counterargument that’s been made to me at OTB is that the young are buying into a program that will benefit them when they approach Medicare eligibility, and some liken it to Medicare. I don’t agree with that comparison. Medicare is a social insurance program, people pay for through their working life (and they pay as a percentage of income). All the ACA does is require everyone to buy an insurance policy every year and the premium paid is exhausted that year. And this argument has become more risible as some of the same defenders now predict with apparent glee that the ACA won’t work and have to be replaced with a single payer system.
BTW, if anyone would like to see contrasting positions on the issue PD raised, see
Unaffordable: Impact of Obamacare on Americans’ Health
Insurance Premiums by Christopher Carlson Principal and Consulting Actuary Oliver Wyman for the House Energy and Commerce Committee
Subcommittee on Health March 15, 2013
And, Urban Institute: Why the ACA’s Limits on Age-Rating Will Not Cause “Rate Shockâ€: Distributional Implications of Limited Age Bands in Nongroup Health Insurance
(Hope those links work here, they’re to pdfs.)
Dave, could you spring my last comment from the moderation queue? Thanks.
PD: “Red State Senators want to stop the insurance companies, but what would the hammer be? Jail, fines, kicking them out of the exchanges?”
I finally found a copy of the bill and I still don’t know the answers to these questions. It purports to give the insured a right to continue their policies, under the existing terms and without running afoul of minimum insurance requirements. The right doesn’t exist where the insurance carrier has left the market and is no longer selling insurance.
I’ve not seen any legal analysis of the bill, but the political analysis points to an insurance company in California that improperly cancelled policies and was forced by the state to retract. A company that actually violated the law is subject to civil/criminal penalties from the Dept. of Insurance and restitution claims from any insured injured by their misconduct. There was no misconduct here, the insurance companies apparently followed the law, and its not at all clear how or whether the federal government could close insurance companies procedurally or constitutionally.
In short, this appears to be venting legislation intended to allow politicians to claim they supported unicorns and rainbows, when really the bill wasn’t ever intended to become law.
When you do not pass the means test, nothing is free.
Tasty,
In the current scenario faceless millennials are the ones being penciled in as the sacrificial lambs in the redistribution of HC insurance. Their means testing involves the government’s assumption of attributing youth to having better health, and therefore tasked with a greater HC cost burden when their age falls below a certain level. However, even this group is subject to a uniquely divined categorization called government employee or FOO (friends of Obama), where subsidies or waivers are graciously employed.
Basically, we have a government — relished by some, detested by others — seeking equality of the masses, by arbitrarily taking the means (wealth or youth) of some in order to enable and meet the needs of others.
@sam, I don’t expect people to agree with my sense of morality.
PD, the issue goes to the fundamental question of justice in a society: What is the proper allocation of rights and duties among the citizens of a polity? And what is the justification of the principle or principles upon which we base that allocation?
@sam, I browsed a recent Robert Wright piece, where he points to some science showing that when people talk/think about morality or issues from a moral context, the “emotional” parts of the brain are fired off, whereas people who think strictly in utilitarian terms on an issue, show more activity in parts involved with logic. I found most of the article uninteresting, but I do think that moral issues tend toward difficult, emotional rhetoric and are not promising ground for consensus-building. But I think almost all people are naturally moral beings, and there isn’t much to do about it. Even their professed utilitarianism, doesn’t always hold up to scrutiny.
He might be relying on Joshua’s Greene’s book, Moral Tribes: Emotion, Reason, and the Gap Between Us and Them. I haven’t read it, but Thomas Nagel has and well, if you’re interested see his review, You Can’t Learn About Morality from Brain Scans – The problem with moral psychology.