One more quick point about fixing Healthcare.gov. I know that lots of fans of the PPACA are banking on the idea that once Healthcare.gov is fixed everything will be just peachy and everyone will be overwhelmed by how much they like the new regime.
I wonder if they’ve considered that once Healthcare.gov is fixed whatever structural problems the PPACA has might be revealed more quickly. Unforeseen secondary effects have a way of biting you in the butt.
More and more criticism seems fixated on revelations of the PPACA itself, and not on it’s website failures. In fact it is the PPACA diehards who use the non-functioning website as a “belief lifeline”, creating the basis for steadfast opinions that these problems are temporary and do not reflect poorly on the construction or viability of the law itself. When, the site begins to function better, and should the HC grief, resentment and general pushback remain, the only other option will be for them to blame someone/something else — most probably the republicans.
The website was a vital component of the success of the PPACA scheme. Without it operating, that success is endangered. I do not think it will work, but I could be wrong.
The cancellation of 5 million policies was intentional, and it is unconscionable to not have it running. Until it is working, most of these folks cannot get insurance, but those with an extra $3k/mo will be fine.
The ongoing debate is about Obamacare. It is political debate, and each side must defend its position regardless of reality.
If the PPACA is an overwhelming success, Republicans & conservatives can never concede that success, and if it is an overwhelming failure, Democrats & liberals can never concede that failure.
“If the PPACA is an overwhelming success, Republicans & conservatives can never concede that success”
I really don’t agree with that, Tasty. If that were to be the case this one would. Its just that every bone in my body said it couldn’t, the execution and “reading what’s in it after passing it” to date is variously corrupt to diseconomic to financially unsustainable, and there appears to be no realistic scenario to fix it.
And the Administration is variously still completely dishonest about it, arrogant about it and placing personal political goals before good public policy and the people they supposedly care about. That’s not exactly a formula for fixing it.
http://www.latimes.com/nation/la-na-obamacare-increase-20131119,0,6410053,full.story#axzz2l6L52bh8
So, where it’s available, Obamacare is hitting its enrollment targets. Which suggests that when healthcare.gov is fixed it, too, will begin surging toward the target for enrollment.
I know Jan and Drew will be relieved.
Tasty,
According to the myriad of website analysis posts provided on the strata-sphere blog, there is a host of intrinsic problems, spanning far beyond just it’s technical difficulties. A.J. Strata points to massive sign-up errors creating an unimaginable backlog of applications waiting to be processed, crassly juxtapositioned by millions of people having proof-positive letters in hand, notifying them of their HC policy cancellation.
And, then there is the matter of the HUB’s data complexity, and all the information it was to gather, integrate and then share with everyone for political and federal purposes. Obamacare, it seems. was the legislative epitome of putting Big Brother’s eyes and oversight on peeple for perpetuity.
@Drew
… If that were to be the case this one would. …
While you may sincerely believe that, every bone in my body tells me you would find a way to diminish that success, but you may be an exception. @Dave Schuler has called for an objective set measures to judge its success, but I have not seen many offered. Politically, this is the best policy.
For computing, system integration is difficult, and the website having major problems is not extraordinary. In the private sector, many of the problems are now manageable, but this type of fiasco was common 10 to 15 years ago. This is reality, but politically, Obamacare opponents cannot admit it.
I probably share much of your opinion about it, but without objective criteria, it is just an opinion. I believe that the stated goals are self-contradictory, and I am having trouble assembling any objective criteria.
Politics is negotiating, and I suspect that you have played “fast and loose” with the truth in your business dealings. A good salesman may not believe in a product, but he believes that the product will really benefit the customer. In the end, a happy customer will forget that the salesman stretched the truth, but getting caught outright lying is not forgettable.
If the website had worked as intended, a good salesman could have danced around the veracity of the sales pitch.
@jan
AJ Strata has worked with NASA for years, and I am familiar with the nuclear industry. In both, we are accustomed to backups to the backups to the backup. In many cases, there are three trains. This allows one to be offline for maintenance, and the primary backup will still have a secondary backup.
The website was a critical part of the contraption. The 5 million cancellations were intended to be become part of the 7 million exchange users. This is how the architects have stated it was supposed to work.
As such, there should have been at least one backup system, and a manual process should have been included. It would be labor intensive, but it would work. The website is taking information and verifying it against existing databases. Once the information is verified, it is used to calculate a policy.
The website is doing the same thing as a manual process, but it is not “sexy”. To the whiz kids running the show, bright and shiney means better. A manual backup system is like a landline phone. It may not do everything that a smartphone does, but it works, period.
Americans will tolerate government intrusion to some extent, but there is a breaking point. It is possible that this plus the NSA, IRS, etc. may do it. If so, the everlasting Democratic majority may be cut short.
I think our take are similar. Anybody who’s ever worked on business processes knows that you’ve got to have a manual system as a fallback. It’s basic.
My concern may be even more basic than yours. What worries me is that the “whiz kids” are so convinced that they have no steak to sell, it’s selling sizzle or nothing. The problem with this, as anybody who’s ever worked with government at any level knows, is that the government’s workflow systems are a cockamamie chain of 1940s, 1950s, and 1960s processes with a sprinkling of 70s, 80s, and 90s features thrown in. They’re mostly stuck with a WWII mindset for operations. And there ain’t no such animal as a smooth, efficient computer implementation of a 70 year old process.
I have heard that the vast majority of people that have gone through the process are getting dumped into Medicaid. Isn’t this in itself a failure? That’s likely going to end up costing more (for either the states of the federal government if it steps in with an ObamaCare fix), and will likely produce more bottlenecks for service.
Also, I read today on CNN (of all places) that one of the success stories from Obama’s big “See, it really IS working” press conference in October has now said that she has received corrections to her application indicating that she, in fact, cannot afford a new healthcare policy. Oops.
That’s what I’ve heard, too. Worse, I’ve heard that half of those qualifying for Medicaid qualified under the old rules, i.e. they’re “coming out of the woodwork”. That will increase the expenses for the states which, unlike the federal government, can’t just issue more credit, print more money, etc.
For those with medicaid expansion more enrolements will be government subsidized, for at least a few years. For those states who refused the expansion, it will be another story. The puzzle pieces are not fitting together for the PPACA, as it was ideally envisioned by the social progressives who created it.
Illinois is kicking people off of Medicaid — estimates of about a quarter to a half of those enrolled. IIRC, a private outfit from TX was hired and gets paid per person kicked off the rolls. It seems like other states are doing that too.
Two states with the highest enrollments in the exchanges as a percentage of expected enrollments are Rhode Island (11%) and Vermont (12%). They are also states removing people from the Medicaid rolls at the same time: Rhode Island (cut 6,700) and Vermont (cut 19,000). Wisconsin has cut almost 100,000. I suspect most of the people getting cut from Medicaid are getting back on “expanded Medicaid,” but it all makes the math damn tricky.
Its more complicatedthan I thought. In some of the places, Medicaid pilot projects are expiring; in others like Maine, Medicaid did not expand and people below the poverty level are expected to buy insurance without subsidies. Wisconsin is cutting and expanding Medicaid by about the same number of people, but the criteria for those getting cut don’t necessarily line up with those eligible for expansion. Its like a giant game of musical chairs with a lot of people losing their chair and we’re waiting for the music to stop to see who is sitting and where.
That’s as good as summary of my view of the PPACA as any. I just wish the music would go faster so that we’d be able to evaluate what the next step will be since there will be a next step. Sadly, that probably won’t be until 2020 or later when the problems will be even more serious than they are now.
“Unforesee……….or forseen. It just keeps getting curiouser and curiouser.
“…represented by the Obama Justice Department, submitted a brief to the federal district court in Washington, opposing Priests for Life’s summary judgment motion. On page 27 of its brief, the Justice Department makes the following remarkable assertion:
The [ACA’s] grandfathering provision’s incremental transition does not undermine the government’s interests in a significant way. [Citing, among other sources, the Federal Register.] Even under the grandfathering provision, it is projected that more group health plans will transition to the requirements under the regulations as time goes on. Defendants have estimated that a majority of group health plans will have lost their grandfather status by the end of 2013.
HHS and the Justice Department cite the same section of the Federal Register referred to by John Hinderaker, as well as an annual survey on “Employer Health Benefits†compiled by the Kaiser Family Foundation in 2012.
So, while the president has been telling us that, under the vaunted grandfathering provision, all Americans who like their health-insurance plans will be able to keep them, “period,†his administration has been representing in federal court that most health plans would lose their “grandfather status†by the end of this year. Not just the “5 percent†of individual-market consumers, but close to all consumers — including well over 100 million American workers who get coverage through their jobs — have been expected by the president swiftly to “transition to the requirements under the [Obamacare] regulations.†That is, their health-insurance plans would be eliminated.
Heh. If you know your policy stinks, lie, I guess.
I didn’t realize there was such a revolving medicaid scene happening in some states. It’s mind-boggling, all of it.
Tasty
Not sure I’m in the minority, or unique. I just call them like I see them. I may have strongly held views (who knew?) but I’m in a business where you get slaughtered if you can’t accept the empirical realities.
From where I sit there is only one commenter here today who is in complete and total denial. I think they have counselors for that.
I’m still waiting for the other shoe to drop, which is the lawsuit challenging the eligibility for subsidies in states without state exchanges. I’ve read a statement of the judge’s bench ruling, and he basically said both sides have presented a descent case, which he will examine in more detail in the briefings. I take that to mean its a 50/50 proposition. He says he can rule by Feb. 15th (*?!@!#)
The opponents of the Administration argue that the language of the law limits the subsidies to the “state exchanges,” and this was intended to encourage states to set up their own exchanges. This is an argument that has gained a lot of traction because of the problems with the exchanges, and those problems might interpret the law in a way they wouldn’t of, if the rollout had gone better.
So you guys are telling me that this ISN’T just a problem with a website?
There’s no point arguing. You’re all having great fun, so enjoy, by all means.
I’ll wait it out. Like I did the predictions of ever-rising deficits, the collapsing Euro, inflation, deflation, the eternally rising (er, flattening but somehow it doesn’t count) health care costs, the end of General Motors, the emptying out of California, the End Times and Seven-Headed Beast, and of course the election of Mitt Romney, and all the other Jan-Drew predictions.
Let’s not forget that Reynolds also predicted that we would have UE under 7.5% and falling rapidly by March of 2010, all troops out of Afghanistan by the end of Obama’s first term,an end to deficits by the end of Obamas fits term, rising incomes and falling inequality, too. Oh, and no more Guantanamo prison, no more massive violations of privacy by the government, and my personal favorite, Obama was going to usher in the Age of Competency. Woo hoo!
Real personal healthcare spending
Michael has left the building. I might, too, if my guy was getting slaughtered not just by the week, but by the day.
The under 7.5% claim has been shot down so many times that I think it should just be used as a marker for stupidity when one uses it.
Back on topic, a large early sign up for Medicaid was expected. You dont have to make a payment to Medicaid when you join. For my part, not being prone to hysteria, I will wait to see what happens. If people dont sign up, then we will know that most of the uninsured really do not want health insurance. In which case I , and a lot of other people, will need to rethink basic beliefs about how to reform health care.
Steve
That’s what I’m doing, steve, but I also think it’s worthwhile to think about what’s actually going on and try to think one step ahead.
” If people dont sign up, then we will know that most of the uninsured really do not want health insurance.”
So, what you’re saying Steve is that the criteria for success of the PPACA is measured by the number of uninsured signing up for HC, with little to no regard for those already having HC insurance and experiencing mass cancellations?
Ice:
All lies, but then, what else is new?
jan-It is a real bummer that they may have to go get new insurance. They may feel some uncertainty about getting new insurance. However, If they can afford insurance now, they will almost assuredly have insurance next year. It will be interesting to see if they pay more or less.
Now, as you are concerned about a few million people who likely end up with insurance anyway, but will have to suffer through some worries about maybe temporarily not having insurance, would you also be willing to express some sympathy for the much, much larger number of people unable to afford any insurance at all, or unable to obtain it because they are actually sick? What is your solution for those people? Elect the GOP again and watch them not address health care, again? Remember, as you yourself documented in the paper you quoted, the GOP does not put forth plans when they are in a position where they might be able to enact policy. Oops, forgot. They are willing to cut Medicaid.
Steve
“Now, as you are concerned about a few million people who likely end up with insurance anyway, but will have to suffer through some worries about maybe temporarily not having insurance, would you also be willing to express some sympathy for the much, much larger number of people unable to afford any insurance at all, or unable to obtain it because they are actually sick?”
Steve,
Forcing people off their HC insurance, in order to enable others who have none, is not my idea of a fairly conceived solution to cover the uninsured. It is part and parcel the government creating it’s own social petri dish of what it thinks to be right and wrong. That kind of manipulation usually sours and has unintended consequences along with negative outcomes.
Also, by now you should know that the number of people eventually experiencing HC policy cancellations will far exceed that 5% individual market number the dems are keen in quoting, once all the mandates and HC criteria are fully met and implemented. However, even the individual market count is understated and in error, as it denotes policy cancellations, not the number of people in a family covered by one policy. So, it’s disingenuous of you to continue to be dismissive of these ongoing cancellations, comparing their loss as diminutive in contrast to those currently uninsured, because they’re not.
@steve, “if people dont sign up, then we will know that most of the uninsured really do not want health insurance.”
If the uninsured pass on ice cream, we know they must not want ice cream. How about, they cannot afford the health insurance under this arrangement which favored comprehensive coverage to affordable care?
(One of the studies sam linked to on age effects made this point. If you the change the age rating band from 5:1 to 3:1, there will be more uninsured people. The law choose 3:1.)
jan- I have said that it was a mistake to not let the grandfathered plans stay. What they should have done is make people pay a fine if they wanted to enter the exchanges later.Of course, that would make it unaffordable for some people. What I keep saying, and am either not wording clearly or you are ignoring, I think the latter, is that these people are going to end up with health insurance anyway, for the most part. If you are spending $3000/month for health insurance and your plan gets cancelled, you can afford to buy a new plan.
The people who will have trouble affording insurance, maybe**, are really the people who earn enough money to put them just above the subsidy level. Not really sure that can be avoided in any plan with subsidies.
Finally, I was pretty sure you couldnt bring yourself to do it. You demonstrate why the GOP does not do health reform. You really are not willing to acknowledge that however many people may actually face difficulties with cancellations, a temporary problem, there are magnitudes more people who cannot obtain any insurance. People not being able to obtain health insurance has been a permanent problem.
** Maybe, because while you have clearly been reading the stories about insurance costing more, there are also a lot of stories with claims that people are saving money. You should be hoping that it saves money since it embraces so many reforms in the purported GOP plans. Transparency, markets and more skin in the game (deductibles).
Steve
Am I the only one who finds $3,000/month to be unaffordable. Other than very casual acquaintances, I may know one or two people able to afford $3,000/mo for health insurance. Because of medical circumstances, my wife is working part time, and 80% of her check goes for insurance.
We are not destitute, and we do not qualify for subsidies. I am fairly certain that we are closer to the average than the $3,000/mo people, but I could be wrong.
All lies, but then, what else is new?
So, you are claiming that you DIDN’T state that Obama would have the UE rate under 7.5% and falling by March of 2010? Is that your claim?
Well, you did. And since you said everything I said was a lie, this shows that you were indeed incorrect. I’d expect an apology, except that given that you are the most dishonest live person that I know (and only my dead brother comes close to your levels of dishonesty of the dead people I once knew), there is no chance that you will do anything other than lie about what you wrote before. It is, after all, your standard procedure in these cases.
Am I the only one who finds $3,000/month to be unaffordable.
No, you are not. That would pretty much leave us eating the grass in the front yard.
Finally, I was pretty sure you couldnt bring yourself to do it. You demonstrate why the GOP does not do health reform. You really are not willing to acknowledge that however many people may actually face difficulties with cancellations, a temporary problem, there are magnitudes more people who cannot obtain any insurance. People not being able to obtain health insurance has been a permanent problem.
Steve, you make an indelible right/wrong line between the inherent differences in the R’s and D’s philosophies, ideologies regarding the place and size of government oversight in people’s lives. Instead, it might be more constructive to reconcile differences when creating such large entitlement programs — taking what can be agreed upon, and leaving the rest for another day — rather than lobbing invectives at the opposition party, and dismissing different ideas from your own as irrelevant or nonexistent.
Regarding HC reform, the republicans have offered piecemeal proposals, all of which were belittled and given no consideration by the dems, in lieu of the social progressive’s eyes being trained only on their big master plan –government HC. However, the HC reform you defend was forcibly passed in an almost unprecedented democratic majority environment, generating overwhelming opposition, that has not subsided, by not only the R’s but also people across the country. To many this kind of reform was passed in bad faith, by a 100% partisan vote, unfairly targets middle class America to involuntarily bear the burden of a deeply flawed HC measure, while it rips the seams apart of our current HC system. Waiting for a better HC plan to emerge would have been far more responsible and less divisive, to an already deeply divided, fiscally weak country.
Finally, here is just one of a multitude of articles that look at the PPACA problems as neither temporary nor only effecting a few people, with respect to the numbers given free-low cost HC insurance.
… I didnt even comment on that post.
Steve
PD- Two studies below. Changing the age band from 3:1 to 5:1 wont really accomplish much. Those below 400% pov. still come out ahead or have minimal changes. Those above do see changes, but there would be more than a doubling of increases for older people, leading to total costs about the same.
http://rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404637
A bit more esoteric, and lots of math, but the more you decrease adverse selection, try to make insurance costs approximate what people actually spend, the higher the risk of unpredictable increased costs and total costs likely increase. (Working paper.)
http://conference.nber.org/confer/2013/SI2013/AW/Handel_Hendel_Whinston.pdf
Steve