THCB

Healthcare.gov Is Working. But Is It Working Well Enough to Withstand the Enrollment Surge?

From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up.

But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1?

Here are some of the press reports covering the December 1 HealthCare.gov relaunch:

  • Reuters: “A surge of visitors clogged the U.S. government’s revamped healthcare insurance shopping website on Monday, signaling that President Barack Obama’s administration has a way to go in fixing the portal that showcases his signature domestic policy.”
  • Bloomberg reporting on a navigator’s experience: “It’s still kind of glitchy. Now it just kicked me out. It went back to the front page. I’ve been here all afternoon and it’s been like that.”
  • Miami Herald: Long waits, error messages, unresponsiveness. Hallmarks of the troubled launch of the Health Insurance Marketplace at healthcare.gov continued to stymie South Florida residents and counselors trying to access the website on Monday––more than two months after the October 1 launch, and despite the government’s self-imposed deadline of Nov. 30 for the system to function smoothly for the ‘vast majority of Americans.”
  • Los Angles Times: “The Obama administration’s overhauled healthcare website got off to a bumpy relaunch Monday as a rush of consumers caused an uptick in errors and forced the administration to put thousands of shoppers on the HealthCare.gov site on hold.
  • Ezra Klein, Washington Post: “Of course, that means the site still suffers a disastrous outage rate.” And, “We have no idea whether the 200 fixes left on the list are really important ones, or really difficult ones. The repair job is likely proceeding quickly enough to protect Obamacare from the most severe threat to its launch: Democrat-backed legislation unwinding the individual mandate or other crucial portions of the law.

And then there is the backroom. The administration apparently decided that it was more important to fix the front-end of the system before the back-end was fixed. Do they think that big customer service issues come January, if the “834” back-end enrollment problems are not fixed by then, will be blamed on the insurance industry and not the administration?

  • Associated Press: “Private insurers complain that much of the enrollment information they’ve gotten on individual consumers is practically useless. It is corrupted by errors, duplication or garbles. Efforts to fix the underlying problems are underway, but the industry isn’t happy with the progress and is growing increasingly concerned.”

As I have said before, the Obama administration is likely in the midst of a four month project to properly fix and test this system. It will likely be at least late January or early February before not just HealthCare.gov but the other key information systems supporting the new law are built and repaired to just minimal standards.

Maybe the best news for HealthCare.gov is that you can finally look at actual plans and prices for your age and family in your community without having to open an account and sign-in. Finally, people can easily see for themselves just what kind of plan is available for them and at what pre-subsidy cost. They can also access a chart telling them if they are eligible for a subsidy or reduced cost sharing but not calculate it for themselves.

My definition of a fixed HealthCare.gov is a site that encourages enrollment rather than discourages it. Time will tell––but only about three weeks time before the December 23 enrollment deadline for having coverage on January 1.

Maybe, however haltingly, we are finally getting to the main event. The day when people can get a good idea for themselves just what value Obamacare presents for them. The premiums, the deductibles and co-pays, as well as the provider networks. Not just the people who are now uninsured or have had their policy canceled, but also those who don’t need Obamacare today but think they might someday. All of them voters focused on finding out for themselves what this Obamacare thing really is.

Nobody can spin the main event.

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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64 replies »

  1. Mark Blyth’s book about Austerity was just named one of the ten best books of the year by Financial Times. Look it up. Or if you have the time (and can understand his Scottish accent delivered at a NASCAR pace) here is a one-hour video you might enjoy.
    http://youtu.be/JQuHSQXxsjM

  2. I understand. I was being facetious about the blood transfusion example, but in the case of contraception we will have to agree to disagree. I dare not argue too strongly my case, though, since I am surrounded where I live by others who would be in agreement with you. In recent years I have found myself becoming an infidel, surrounded by good, salt of the earth people persuaded that one cannot be a good Christian without being Republican. Thank goodness that is off-topic in this thread.

    My cost argument is simple. Contraceptives are a normal part of good medical care for women which encompasses lots more than getting or preventing babies. In short, Contraceptives save more in the long run than they cost in the short run. Any discussion of contraceptives leads naturally to further conversations about abortions, which then becomes a political flash point. (My personal view is that preventing pregnancies is the most effective way to prevent abortions and other complications of pregnancy which in the long run saves more than it costs. But that is a slippery slope we need to avoid.)

  3. And the bottom line is, as long as our line of credit with the Chinese is still good, we can continue to eat the seed corn.

  4. “We have become uncompetitive, not only with the Chinese, but with Germans, Finns, Swedes, Japanese, and even the French.”

    The Germans, Finns, and Swedes set their minimum wages by collective bargaining, France set its minimum wage at about $12 U.S. in 2013 (35 work week) and Japan ranges from $8 to $11. All but China have some form of single-pay/government controlled health care.

    As for union membership I got this from Wikipedia as well.

    “In the mid-1950s, 36% of the United States labor force was unionized. At America’s union peak in the 1950s, union membership was lower in the United States than in most comparable countries. By 1989, that figure had dropped to about 16%, the lowest percentage of any developed democracy, except France. Other union membership for other developed democracies, in 1990 were:[1]
    95% in Sweden and Denmark.
    85% in Finland
    Over 60% in Norway and Austria
    Over 60% in Australia, Ireland and the United Kingdom.
    Over 30% in West Germany and Italy.
    In 1987, United States unionization was 37 points below the average of seventeen countries surveyed, down from 17 points below average in 1970.[1] Between 1970 and 1987, union membership declined in only three other countries: Austria, by 3%, Japan, by 7%, and the Netherlands, by 4%. In the United States, union membership had declined by 14%.[2]
    In 2008, 12.4% of U.S. wage and salary workers were union members. 36.8% of public sector workers were union members, but only 7.6% of workers in private sector industries were.[3] The most unionized sectors of the economy have had the greatest decline in union membership. From 1953 to the late 1980s membership in construction fell from 84% to 22%, manufacturing from 42% to 25%, mining from 65% to 15%, and transportation from 80% to 37%.[4][5]
    From 1971 to the late 1980s, there was a 10% drop in union membership in the U.S. public sector and a 42% drop in union membership in the U.S. private sector.[6] For comparison, there was no drop in union membership in the private sector in Sweden. In other countries drops included: [7]
    2% in Canada,
    3% in Norway,
    6% in West Germany,
    7% in Switzerland,
    9% in Austria,
    14% in the United Kingdom,
    15% in Italy.”

    Not sure what you’re nostalgic for #41 but I’m thinking a Dickens Novel might make you pine for debtors prison and child work houses. Maybe then we could get “competitive”.

    You might also wish to read “Who Stole The American Dream” by Bowden and Sinatra for a little down to earth truth to go with your smugness.

  5. You are correct that exports were once the backbone of our economy. It’s fair to say that exports are the foundation of every country’s economy, which is why “balance of payments” or “trade balances” are so damn important. Globalization made the whole world competitive and the developing world, thanks to technology and global communication, is leaving colonial exploitation in the dust, even if their politics leaves a lot to be desired. We’ve come a long way since the Swiss figured out that a pound of fine watches was worth much more than a pound of raw steel.

    Heck, some places even have national economies resting on exported human resources, from unskilled laborers doing grunt work in the Middle East to technical, mercenaries from Pakistan hired by oil-rich monarchs to keep their populations under control, and medical/scientific types from Asia, Africa and Central America — all places where the US is accused of doing “brain drains” — except that many of those people remit US dollars to their families back home. Alien workers have become a form of foreign aid. I worked five years in a hospital environment and was amazed how many languages I heard spoken by nurses, techs and others on the elevators.

    So looking around at home, we see an educational system that just this week turned in inexcusably mediocre scores for reading, math and science when ranked with the rest of the world. We discovered too late that all those relatively unskilled construction and factory jobs were easily exported to places where labor is cheaper. Even call-center jobs, the bottom of the totem pole, can be relocated any place that speaks the language. I was pleasantly surprised when we changed phone service a few years ago to a company with tech support in Kansas or Arizona instead of India or the Philippines. I heard this morning that New York banks that pay executives in million dollar increments, pay tellers so little that a third of them qualify for public assistance. New York is a very expensive place to live. And they are even exploring ways to reduce the number of living tellers (not everyone likes using ATMs). Banks now have ways for a single teller working a call-center array of screens, can interact with customers in real time and not need be close by. Those New York banks can hire a call center teller over in Jersey who can and will work for less than they would have to pay in Manhattan.

    The problem with unemployment (or the rise of unskilled jobs which amounts to the same thing from an economic standpoint) is that wages respond to market principles exactly the same as prices of goods — supply and demand. We understand why highly skilled jobs are paid well for what they do, but unskilled labor does not have the same basis for better pay. In fact, as more job seekers enter the labor market (yes, we call it a “market”) those at the low end of the wage scale become trapped in an ever declining feedback loop. As wages fall and more job seekers compete for a shrinking number of jobs, already low wages will drop even further.

    Without a safety net at the bottom, there is no point at which low wages will stop falling until economic changes come about, which is why a minimum wage law is important to protect the poorest from indentured servitude, share cropping and being forever indebted to the company store — all historic examples of what happens when the “invisible hand of the market” is allowed to work its magic.

  6. Note to John:

    I cannot agree with you on the contraception mandate. Although I am a liberal even a radical, I take the side of the plaintiffs like Hobby Lobby.

    The plaintiffs have never made the slightest attempt to prevent their employees from using contraception. They just do not want to pay for this product.

    Given that contraceptive devices I think cost about $50 a month, the corporation is not being a tyrant.

    There is a tendency in heated debates to say that if a health product is not insured, then the patient is being denied the product. If the product is a cancer drug, then this generality might be in effect true.

    But not for an inexpensive product.

    Thanks, bob hertz

  7. They was a time when we could sell everything we could produce, and it certainly wasn’t because employers were gratuitously paying employees more than their skill sets were worth on the open market. We have become uncompetitive, not only with the Chinese, but with Germans, Finns, Swedes, Japanese, and even the French. We have allowed the playing field to become so tilted that, when the employer (think Hostess) is threatened with a strike, his only realistic options are to knuckle under or to go into bankruptcy. We have allowed the backbone of our economy, construction, to become not only “work Americans won’t do,” but “work Americans can’t do,” because hiring is now done by word of mouth, from villages in Honduras, Guatemala, and Lord knows where. And the affluent become more affluent, because they reinvest most of their income. Strange how that works.

  8. “where the decisions that must shortly made by employer and employee alike are being laid on the table by HR managers.”

    You don’t think that was happening before ACA? I welcome more people getting bumped into the individual market, that will bring costs front and center and reduce the awakening to single pay.

  9. Scrawny is right.
    And it’s even worse than it looks, since the ten percent cap is only for insurance premiums. They will surely spend more than that for medical costs not covered by insurance — dental, optical, mileage, what’s left of the donut hole and who knows what else. I’d say that couple is in a pile of medical bills big enough to accelerate their Medicaid spend-down. Unless they have a pile of untapped assets, they are on a fast track to destitution.

    Medical costs need to come down faster and sooner if we expect to leave any assets for the next generation. Insurance costs are not the main problem (other than adding 20% to any costs they process thanks to MLR).

    Thankfully we have a lot of VA and Tricare beneficiaries which is something of a help. Medicaid and the VA have been allowed to negotiate lower drug costs (which should have happened with Medicare long ago, since that is the industry’s biggest single customer). And CMS is even more parsimonious, I’m told, than Medicare with reimbursements.

    ACA is a big experiment and the results won’t be clear for a long time. I’m optimistic, but I don’t expect to see good results in my lifetime. I’m hoping circumstances will be better for my kids and their kids. This dog-eat-dog, laissez-faire, austerity foolishness is as nutty as it is mean.

    In other news, I’ll be watching to see what SCOTUS does with the contraception challenge they have agreed to hear. If that stands, we can prepare to go without blood transfusions working for a company run by Jehovah’s Witnesses and nothing to eat during Ramadan if run by Muslims. The Lord only knows (literally) if Christian Scientists would forbid insurance on the property for religious reasons (like providing a no-smoking environment), or refuse to administer CPR or call 911 if someone stops breathing.

  10. “God bless us every one!” cried Tiny Tim, “and subsidies for all!”

    So how do we account for the ominous finding of recent opinion polls when, thus far, so few have been directly affected? I can give you one reason: All over the country, employees are being dragooned into “educationals,” where the decisions that must shortly made by employer and employee alike are being laid on the table by HR managers.

  11. And, you have to view such things from the perspective of the MARGINAL benefit (i.e., itemized deductible vs the std deduction).

    We are just addicted to our endlessly tweaked no-value-adding hypercomplexity.

    But, then, UnitedHealthGroup’s CEO Helmsley must continue to get his $14 million a year compensation package — a mere 100x that of the average primary care doc. He’s struggling to get by, too, y’know. The top hedge fund guys make multiples of his pittance.

  12. Note to John Ballard:

    Thanks for your thoughtful posts.

    You mentioned that better tax deductibility would help some persons afford insurance.

    First I agree that raising the threshold from 7.5% to 10% was a crummy part of the ACA bill. In so many cases, the drafters were terrified of raising taxes on the middle class or even the upper middle class. This led them to go dumpster diving for extra revenue such as extra 1099’s and tanning salon taxes.

    But my real point is that tax deductions are not always very effective.

    I may have the numbers wrong, but consider this example:

    a 60 year old couple making $75,000 is faced with an insurance premium on the ACA of $16,000 a year. They get no employer assistance.

    They buy the insurance .

    10% of their income is $7,500.. They can deduct $8,500 from their taxes.

    This saves them about $2500 on their total tax bill.

    Pretty scrawny subsidy though I guess it is better than nothing.

  13. I’m sure if we met in person, Aurthur, I would find you to be a very nice guy. Meantime, it’s probably best we agree to disagree about any comment I write.

  14. “A long-term goal should be uncoupling employment from health care altogether. That would end “job lock” and at the same time put health care costs in plain view of the two parties that should be paying closest attention — providers and their patients.”

    Sounds good until you consider the facts, like:
    1) HIPAA passed in 1996 “solved” the job lock problem, remember.
    2) When you uncouple health care from employment, you no longer have the employer (you know the evil profit driven bastards) doing all the leg work, including educating themselves, shopping, negotiating, and usually providing partial payment (ok, tax payer subsidized if you insist that all income initially belongs to the government) in order to provide the employee protection from catastrophic ruination.
    3) You believe all these new Medicaid folks are going to be hashing out the cost of care with the one physician in their state that still is willing to see them.

    At least half these people cannot figure out there is no free lunch, but you expect they will rush right out and purchase something near an optimal plan to cover their health care costs. Or, are you relying on the ACORN navigators to give them unbiased advice and education?

  15. I suppose you would also favor of having veterans and active duty military losing their actual government insurance (VA and armed forces medical service corps) and returning to the private sector. Oh, and don’t forget Tricare for dependents.

    Sarcastic comments like that make me wonder why I try to discuss anything in detail. It’s like pissing in the ocean…

  16. I was most gratified to read, this morning, that Harry Reid and other congressional democrats are exempting their staff from the burdens of Obamacare. I mean, these are people who really, really care, and they shouldn’t be punished like this.

  17. Good observation. Group insurance is by definition health care cost. It is also a human resource expense, not very different from the employer’s matching “contribution” to Social Security. (Don’t you love that word contribution? It makes it sound optional, doesn’t it?) Both outlays are an expense on the balance sheet, and are by definition an employee benefit. Fewer employees or lower wages means lower expenses against profits. Every dollar of group insurance provides the employer accounting credit against taxable profits.

    Making premiums non-taxable was a clever way of making group insurance more attractive than individual insurance to all parties concerned — employees, their employers and TPA’s (third party administrators, insurance companies contracted to manage group insurance for a fee). It appears to be a sweet arrangement all around but the end result is that no one has much incentive to watch costs.

    As long as co-pays, deductibles and OOP caps are seen as “reasonable” by employees, health care expenses become less important since the company picks up half the tab, sometimes more. From he employee’s point of view, it’s like getting access to an all you can eat buffet. After a certain point, anything more is virtually free.

    The company footing the bill gets an accounting expense for all health care related costs — just another expense, the price of doing business. And hey, employees don’t mind paying their part since it “reduces their taxes.”

    For the insurance administrator employer-paid plans are really better than their main line of work. Insurance is by definition risk management, and if the client company is picking up the whole tab, their task is minimal. I don’t know how those contracts are written, but if I were the TPA there wold be a surcharge for all claims (flat rate or percent) so the more we process, the more we earn. And actual risk? How about catastrophic claims only, with the company picking up the tab for anything under some horrendous amount?

    I dunno. I’m just speculating here. But the overall impact on actual health care costs is diluted in a big way. Everybody is riding the train and they don’t care how fast it travels (to use a contemporary analogy) until it hits a curve going too fast. That’s where we are with health care costs. And that’s why questions about distribution or redistribution strike me as mostly irrelevant. The amounts are diluted to the point that tweaking that part of the tax code one way or another will have little or no impact on health care costs, which is the real enemy.

    A long-term goal should be uncoupling employment from health care altogether. That would end “job lock” and at the same time put health care costs in plain view of the two parties that should be paying closest attention — providers and their patients. I suppose doing away with flex plans would be a step in the right direction. The those who itemize deductions would have at least a few more dollars to subtract from their taxable income. (As it is, there is zero benefit for those taking the standard deduction. Nothing. Nada.)

    As I have said so often I sound like a broken record, medical providers manage medical risks, insurance manages financial risks and everything else — marble floors, potted plants, luxurious waiting areas, valet parking, landscaping, and yes, employer contributions — are expensive, added distractions having little to do with medical needs.

    And this is not original thinking on my part Nor it is anything from the much-maligned bleeding-heart liberal quarter. It originated from solidly conservative thinking as outlined in this AEI paper from the days of George Bush.

    http://www.aei.org/article/society-and-culture/poverty/tax-reform-and-health-insurance/

  18. Mr. Laszewski delivered himself of a masterful exposition of this “hopeless mess” on The Kelly File last night. That was followed by a rant by Alan Colmes, which I’m sure John and Peter would greatly have enjoyed.

  19. A successful application is one thing, but who has received a notice from their insurer that they have been successfully enrolled.

  20. I don’t know, is the tax exemption on employer paid health care, redistribution or distribution?

  21. As for reducing the costs, I refer you to another rant elsewhere that starts “insurance is not the problem. Insurance is nothing more than risk management for how charges are to be paid (or not). The real problem is the amounts being charged, which are more often than not way more than they should be.”

    Costs have a lot to do with uneven distribution…
    ** Geographic — giant footprints in affluent areas and virtually non in poor and rural areas,
    ** professional compensation — extravagant executive compensation at the top and poverty-level wages at the bottom,
    ** huge amounts of non-medical expenses padding medical bills
    ** and little or no connection between actual costs and bills being generated.

    Link here– https://thehealthcareblog.com/blog/2013/12/01/i-would-rather-die-at-home/comment-page-1/#comment-477710

  22. With all due respect, friend, that “redistribution” trope pushes my button in a big way. There is redistribution, alright. But it isn’t what is advertised by most people who use the term. It has to do with new wealth and where it is going.

    I’m not talking about income but *wealth* and they are not the same. Income is the source of new wealth, but it is NOT wealth until it is calculated as a function of NET WORTH. That is the definition of “wealth.” Net worth = assets minus liabilities. Negative net worth means there is no wealth.

    Plenty of people have good, sometimes extremely good incomes. But if they also have serious debt, more debt than assets, that income cannot be called “wealth” until they get into positive net worth territory. A young family with student loans, mortgage debt, auto payments, credit card debts and other liabilities may have what appears to be a huge income. But they do not have wealth until those loans are paid down or off, equity in the house begins to be greater than the payoff balance, credit card debts are paid off monthly and there is enough in savings that their personal balance sheet shows positive net worth. Then and only then do they have wealth.

    And the only sources of NEW wealth are earned income, inheritance, gifts or gambling winnings. And for the last thirty years almost all NEW wealth has been (wait for it…) redistributed from those who have earned it to the top one percent of the population.

    I hope you can follow that. I tried to make it as clear as possible. So please, spare me this foolishness about “redistribution” because it’s nothing but a steaming pile of you-know-what.

  23. Perhaps we need to put aside this “redistribution of health care” approach (fueled by class and partisan animosity), and do the math on improving, to an acceptable level, the quality of care received by the indigent and uninsurable (along with measures that might actually reduce the cost of health care.)

  24. One way to help those a little further up the ladder would be lowering the tax destructibility threshold for medical costs. This year medical expenses not reimbursed over ten percent of AGI are deductible for those who itemize. That’s something of an improvement, but anybody whose medical expenses exceed ten percent of AGI is still in some deep shit. That really needs to change. How many people can afford to make ends meet on vinety perxent of what they earn? Very few, I think.

    Four or five percent would be more helpful, since dental, optical, drugs and anything else not covered by insurance can really add up. It’s a bleeding shame that interest income on mortgages for second homes is deductible for those rich enough to own second homes while many of us are trying to make ends meet on one home (or pay rent for those whose credit was torpedoed by medical cost bankruptcies — which is about half of all bankruptcies.)

    http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/

  25. Note to archon41:

    It is galling to me to hear well-paid tenured professors like Jon Gruber and Paul Krugman say that the persons over 400% of poverty who do not get subsidies are unimportant.

    Although I normally vote Democratic, I will not mind seeing Obama pilloried by the persons over 400% (which remember is just $62,000 of annual income for a couple.)

    I would however like someone in Congress to suggest that the subsidies be extended to higher incomes, and phased out gradually instead of having a “cliff” like so many other government programs.

    If any readers of this blog have done the math on extending the subsidies to higher incomes, please share.

  26. Soon, an Obama adoring media will be showing us with heart-warming accounts of how some have benefited under the ACA. There will also be losers, those who earn too much to qualify for subsidies. “Shocking” is hardly an overstatement of the premiums and deductibles they will be subject to. Many of them will conclude, with considerable justification, that they were cozened, by calculated misrepresentations, into supporting the architects of this act. They are not going to react well to homilies about being on the “wrong side of history.”

  27. Authors bio above reads “Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades”- that is exactly the problem = Washington is overflowing with “fixtures”.

    Change in US HealthCare is painful but long overdue. History is being made and those who continue to resist it will someday grow increasingly bitterwhich is bad for their health.

  28. We await your outstretched arm for the thumbs up or down as is your pleasure oh great leader.

  29. A significant barrier to our Great Leap Forward has now been removed. The government will be making advance premium and subsidy payments to insurers based on the “estimates” of the latter, the books to be “trued” later. This leaves only the problem of would-be insureds of whom the insurers receive no record before the “drop dead” date. That can easily resolved by another presidential edict. Forward, Ho!

  30. ACA changed the insurance rules and launched the notion of managed competition via “exchanges” which vary — because we haven’t any federal standards (other than what ACA established for the first time) — from state to state. Aside from that, not much is new. It seems the country is waking up from a nightmare and facing the outrageous costs of our broken healthcare system for the first time.

    New Years Day is the date after which the new rules come into effect. As Mr. Laszewski said simply, “many hundreds of thousands of people [are] eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1.”

    That date is not the end of insurance. That is the date it starts. It is true that group insurance plans typically have “open enrollment” periods that correspond with the calendar year, mostly because taxes and accounting systems are pegged to calendar years, with Medicare being the biggest gorilla in the health care jungle.

    But the exchanges are not about group insurance. The exchanges are about what the industry calls the “individual” market, health care insurance sold to individuals any time they choose to enroll. The only thing that is different is that newly insured people must enter into one year contract agreements with insurance companies of their choice in much the same way they buy telephone service or finance a car or some other purchase. Individual health insurance is like homeowners, auto or term insurance, but the agreement is only a year at a time. In some cases the terms are quarterly. After that, anyone not pleased with the company they have can drop them like a bad habit and enter into a new agreement with another company. Unlike group insurance, individual insurance is not locked into the calendar year.

    Most of the panic we are seeing is the result of many people “going naked,” without health insurance for a variety of reasons until they buy a policy (individuals previously uninsured now legally required to buy a policy, selected spouses dropped from group policies, individual policy holders receiving cancellation notices from policies no longer in compliance with the rules).

    Newly hired employees typically work some period of time before eligibility for a new employer’s group insurance, and people who become unemployed — even if they are fired — are entitled to a COBRA extension of their group insurance (if they faithfully pay the monthly premiums, which are shockingly huge — the full amount with no employer subsidy), presumably until they either furnish their own individual coverage or join another employer’s group plan.

    After January 1 the exchanges do not vanish. Individual insurance is not like group insurance. Unlike Medicare or company group plans that are “closed for new business” until the next open enrollment period, the individual insurance market, like that for other types of insurance, will still be soliciting business. Their sales forces will see to that. Depend on it.

    This is not a rock concert that is gonna play only on New Years Day, after which if you missed it that’s just too bad. I don’t mean to make light of the problem for those with medical problems living uninsured until they finally get accepted by a plan. But for that group little will change other than their wait, like that of the airline passenger whose flight is delayed by bad weather, will be extended. But for most people getting individual group insurance, the game is not coming to an end but instead is just beginning.

    Whether or not companies will be scrambling to get their policies listed with the exchanges remains to be seen. My guess is that the policies now being offered are bare-bones policies meeting only the strictest and cheapest of the various plan levels — bronze, silver, gold, platinum. But when the ball gets rolling, if the various state insurance commissioners and governing authorities are on the ball there should be competition among as many companies as possible wanting to get into the game to sell individual insurance policies.

    I have spoken briefly with a couple of young people who are not insured and have never even thought about it. It’s shocking how little many people know about the basics of insurance. After all, we are all insured already far more than we think about. Work related injuries and illnesses are covered by workers comp. Injuries on someone else’s property are covered by their liability insurance, Auto and other accidents are covered by a variety of insurances, I know that in Georgia one can get an “uninsured motorist” addition to auto insurance in case you are in an accident with someone driving illegally without insurance. So insurance terms — co-pays, co-insurance, deductibles, caps, reimbursements, out of network, POS, HMO, PPO — is like another language to those who have never had any experience with insurance.

    Any agent can tell you that before someone gets insurance they have to learn a lot they never knew about before. Insurance is NOT health care. It is a way to manage and balance the costs of health care. And those costs are not established by the insurance company but by the doctor or other provider. The owner of a new insurance policy for the first time is is in the same boat as someone who buys a PC and doesn’t know how to use a keyboard. He or she has a lot to learn.

    January 1, 2014 is not the end. It is a new beginning.

  31. The SCOTUS said Congress could do it to us under their power to levy taxes. They did not say it was a good thing. They in fact stated it was not their job to shield us from bad legislation. That was left to the ballot box to drive the politics of the law.

    It can be changed or repealed.

    Just stop trying to solve everything with a single law. Bitte=sized reform likely is much better government. They just want to avoid the political pain of cutting medicare, which is why they did this in the first place

  32. For those who warned of this trainwreck before it happened, daily “i told you so’s”. Sweet!

  33. I spent over 2 hours this morning reading the information on the california site. After deliberation with my wife I hit the enroll button and nothing is there. tried several time to connect and no good. Glad I’m retired so I didn’t have to waste this time on the clock at work.

  34. Makes you wonder if there are 50 people sitting around being paid by the taxpayer to wait for their system to come back up.

  35. Moot point. you can’t even get on the site today to enroll. What a joke. The administration must think we are a bunch of lemmings ready to jump off a cliff at their command. please vote for less government this election.

  36. “OK, well, the computer glitches will get sorted out, but the complexity that caused the computer glitches is baked into “Obamacare.” The exchanges have to deal with millions of enrollees and doing income verification. They have to deal with thousands of private insurance plans. It’s a very complex system. And unfortunately, that complexity also contributes to high expense. The private insurance industry that’s offering the coverage through the plans has overhead costs that are about four times as high as traditional Medicare. And in addition, we’re going to have overhead of about 4 percent added to insurance overhead just for the exchanges. So it’s a complex system, a very expensive system, and when we see the way it’s performing, we understand why we need a simple single-payer system that could save about $400 billion on administrative simplification.” – Steffie Woolhandler, MD, MPH, FACP, CUNY School of Public Health

    http://www.democracynow.org/2013/10/7/is_obamacare_enough_without_single_payer

  37. I don’t believe the medical system would have collapsed without the ACA, Peter. The ACA is an unreasonable bill that rewards those who cause the greatest damage. At best it is a kind of band-aid, a bit of duct tape here and there, but the overall plan is fundamentally irrational. There are dozens of great systems around the world (compared to ours) and we refused to even consider them. Alternative systems other that single-payer (namely systems based on non-for-profit insurance) were not even discussed by the politicians or the media. People who study the problems were ignored and political flacks were left to write the bill so that it pleased enough lobbyists to squeak by the ACA. We had an opportunity and we blew it — but at least a few of us have confirmed our suspicions about Obama, i.e., he’s a tool of the FIRE sector created to deceive and defang the Left.

  38. “Not bad at all, but the “killer” is a $6,300 deductible.”

    Yes, the kitten drowning clause.

  39. Archon 41 is correct. I represent a carrier with a terrific website where we have a quoting system with the Kaiser Foundation’s subsidy calculator on it. While not the Final Source of Truth, it’s close enough to tell one whether you should go to HC.gov. Othewise, browse, shop the carriers…then buy.

    Bob1

  40. Cynthia, apparently you are not against the “good” provisions in the law, just that it will cost more. That is not inconsistent with people’s views before it became law.

    “If voters had been told the truth in 2012 that Obama was going to raise peoples income tax to pay for the ACA, he would have never been re-elected.”

    It’s not income tax, it’s insurance premiums – it’s the cost of health care in this country – you’re paying more for more. It’s created winners and losers, unfortunately many of the losers have marginal income cushions to coup.

    I agree, the administration did not have an open and truthful discussion with us before the premiums were made clear. But Americans have been burying their heads in the sand for years, especially those with some form of subsidy. When I was insured my premiums went up 6% to 10% compounded annually with age bumps. Everyone’s costs were rising, people were loosing coverage, people were being denied coverage. if you feel these are issues that need to be solved then how would you solve them so it does not cost us more?

    The ACA is NOT the “solution”, it was written by the insurance industry, what would you expect from private corporations.

    While not a panacea single-pay would help to lower costs and spread the cost over a larger pool. We pay double what most countries pay – with or without the ACA.

  41. I’m drowning a few kittens this afternoon, Peter, and I’ll stick an extra one into the bag for you.

    Ah, these execrable insurers! Why couldn’t they have followed the path of Mother Teresa, instead of raising capital by promising a return on investment?

    Is there any reason for people to be struggling with the exchange network unless they expect to qualify for a subsidy? I just played around a bit on the site a major insurer pricing a 2014 individual policy, giving my age as 62. According to them, a subsidy would not be available for an individual earning more than $45,960 a year. It seems they have both HMO and PPO Bronze versions available, with monthly premiums ranging from about $300 to $400 a month. Not bad at all, but the “killer” is a $6,300 deductible.

  42. Peter — For a poor guy who makes $50,000 a year, that worker doesn’t get any subsidy on the price of the plans, and will find out that an individual plan will cost between $4,000 to $8,000 annually, way beyond anything they could possibly afford. Family plans cost even more! Even some of the “best” plans have $2,500 annual deductibles, which means the average healthy person will end up paying out of pocket for anything beyond a single annual physical (covered 100% by the federal statute), unless they experience a catastrophic disease, illness, or injury.

    The ACA is nothing but a stealth income tax on the middle class disguised as healthcare reform. The middle class gets hit twice. You pay higher premiums to subsidize others and then the government uses your income tax to also subsidize others. If voters had been told the truth in 2012 that Obama was going to raise peoples income tax to pay for the ACA, he would have never been re-elected.

  43. “It is no longer about the morality of forcing people to buy a service or product against their will.”

    Cynthia, those people buying with pre-exist or below 400% poverty with subsidies, are they being forced against their will? Are you against ban on lifetime caps, pre-exist elimination, women getting same rates as men?

  44. The government has done a brilliant job of marketing the (un)Affordable Care Act as being all about the functionality of a silly website. It is no longer about the morality of forcing people to buy a service or product against their will. Instead, it’s about broken links and buggered databases. In the mind of many therefore, once the website is fixed so will the ACA. Nothing could be further from the truth. People will still be forced to buy a product they have no desire to buy or be fined for not doing so. Despite what the black-robed idiots in the Supreme Court said, this is immoral.

  45. I’ve been seeing some acrimonious exchanges on Democratic Underground (hardly a hotbed of conservative activism.) People in their 50’s and 60’s, who don’t qualify for subsidies, are being whacked pretty hard.

  46. This would be barely tolerable if the prices, without subsidies, were worth the struggle – but they aren’t.

  47. Which brings up the point that just because you’re now insured doesn’t mean you’re going to get the care you need.

  48. The problem, however, it isn’t working. I can’t access my account at all this morning and just had this conversation with the call center:

    Me: “Hi – this is my sixth call to figure out how to unlock my account so I can complete the enrollment. I was told last week they would go into my account, fix some “glitch” and it would be ready to go. It isn’t.”

    Call center: “Did you clear your cookies?”

    Me: “What? Why?”

    Call center: “Sometimes clearing your cookies helps.”

    Me: “It unlocks my account in your system? That doesn’t seem right.”

    Call center: “I’m just offering a suggestion.”

    Me: “Shouldn’t you look at my account to see what the issue is before offering possible solutions?”

    Call center: “I would, but I can’t access any accounts right now.”

    Me: “Mine or any?”

    Call center: “Any.”

    Me: “You mean the system is down?”

    Call center: “Yes.”

    Me: “So there’s really no need for us to talk.”

    Call center: “Is there anything else I can help you with?”

    Me: “…”

  49. If I were looking for a performance metric, it isn’t the ability of consumers to complete and submit an application, but the ability of the system to transmit a clean, actionable 834 enrollment order to insurers. If the insurer cannot enroll you, you don’t comply with the law. Completing an application doesn’t make you compliant with the mandate. You have to actually be covered.

    I’ll bet Robert’s close to right on this. It will probably be early next year sometimes before healthcare.gov meets this performance criterion.
    We are in deep spin control mode right now. I think the Administration has a serious problem, and it isn’t the PR problem they are attempting to manage now.

  50. “The gift that keeps on giving.”

    For insurance companies and providers – yes. Less collections for you MD.

  51. The website is DOA whether people wish to admit it or not. The ability handle volume is but one problem and as the AP mentions data is getting snarled right and left. This means the different modules are not communicating properly, which is not necessarily an easy fix. Add to this the security is terrible something that will be understood over time.

    It appears the different modules were built in a vacuum so no surprise things don’t work; however, this is apropos as it perfectly mirrors how the series of fiefdoms known as Washington operate or don’t.

    The website needs to be rebuilt from scratch.

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