Data Points: More Backroom Chaos and Low State Numbers

Shifting Millennial Attitudes on Obamacare December 2013.
Harvard Institute of Politics. Dec 4th, 2013. Poll

A few observations after 10 weeks of Obamacare implementation.

The Obama administration released the first two months enrollment figures this week. With HealthCare.gov still struggling in November, the enrollment of 137,000 people in the 36 states was expected. The main event for the federal exchanges will play out in December now that most people can navigate it

What I found notable in the report was the lack of robust enrollment in the states. In states where the exchange has been running at least adequately for many weeks now, the enrollment numbers are far from what I would have expected.

California enrolled 107,000 people in private plans in the first two months. But California has cancelled 800,000 current individual health plans effective January 1––all of whom have to buy a new plan by January 1 or become uninsured. The only place those who are subsidy eligible can get a subsidized plan is in the California exchange.

In addition, California has about 2.5 million people uninsured and exchange eligible. A Robert Wood Johnson (RWJ) report estimated that California has 1.4 million of those people eligible for subsidies in the exchange. Given the $250 million in outreach and marketing money the federal government has earmarked for California’s exchange, the dearth of sign-ups so far is concerning.

Similarly, New York enrolled only 45,000 in an exchange plan through November but has over 2 million uninsured. The RWJ report estimated that 563,000 people alone are exchange subsidy eligible. The rule of thumb is that about half of those eligible for the exchanges will be subsidy eligible and half will not. That means that something close to the 563,000 subsidy eligible are also able to buy on the New York exchange.

Washington, the state most believe has done the best job building and running an exchange, has 959,000 uninsured, with RWJ estimating 223,000 are eligible for a subsidy in the exchange, but has only enrolled a total of 17,000 for private insurance in the first two months.

Kentucky has 646,000 uninsured and an estimated 132,000 eligible for subsidies yet has enrolled only 13,000 people in their exchange––both subsidy and non-subsidy eligible.

The rest of the states are either doing no better or are doing much worse.

Health plans I have spoken to are also worried about the people who have enrolled so far paying for their coverage. If an enrollee does not pay their first month’s premium by December 31, their enrollment will be void. So far, the health plans I have spoken to have seen only about 20% of their enrollees pay their premium.

Clearly, December is going to be a big month both for enrollments and premium payments. It’s sort of like going to church on Sunday morning. No one is in the pews 15 minutes before but they all come in the last 5 minutes.

While the open enrollment will continue to March 31, I would have to believe those anxious to get their pre-existing conditions covered, those who look forward having a premium subsidy for the first time, those who are losing their coverage at year-end, and those who just simply value having health insurance, will get themselves signed up by January 1. I will suggest the March 31 deadline is more the deadline for the procrastinators.

Particularly in the states that haven’t had big computer problems, the only thing we can say so far is that the church is pretty empty.

In terms of backroom issues, the problems continue:

  • As of this week, the 834 transaction error rates (enrollments sent from the government to the health plans) are better than they were in October and early November but are still running in the 5% to 10% range––a place they have been for a number of weeks now.
  • The Obama administration has still not built the reconciliation computer system needed to clean up the remaining enrollment data issues between HealthCare.gov and the health plans. The health plans have been told to expect an electronic file in the next few days, containing what the feds think are the health plan’s enrollments through November. The plans will then have to figure out how to reconcile the two lists and then fix the problems. Many plans will have thousands of enrollments to reconcile. There will be another such file coming in January for the December enrollments with likely tens of thousands of more names to reconcile. That means that any December errors will have to be fixed before people can be covered, thereby creating additional customer service issues until the files can be cleaned up.
  • The feds can’t pay the insurers their premium subsidy payments because a payment system has not yet been built. The government is asking the health plans to prepare their own bill and send it to the government for a preliminary payment until this is resolved.
  • The feds haven’t been able to transmit the proper Medicaid enrollment to the state Medicaid plans in the 36 federally run exchange states. So, the feds will be sending an abbreviated “flat file” until that system is built. In the meantime, the states will have to deal with much less eligibility data then they currently require.
  • There have been reports of HealthCare.gov enrolling exchange eligible people in Medicaid instead of the private plan they want (Federal Exchange Sends Unqualified People to Medicaid). No one seems to know how big a problem this is.

How many people’s enrollments––Medicaid and private plans––have been jeopardized by these backroom issues? Until the federal government can do a timely and efficient reconciliation of those who have applied compared to those whose coverage has actually been established by the health plans and state Medicaid programs, there is no way to know.

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.

56 replies »

  1. OK, just some clarification questions on your plan, and yes, I’m playing devil’s advocate, but the devil is in the details:

    1. What is your definition of “retirement savings?” Pension, 401-K, Roth IRA and other classified investment vehicle?

    2. “Anyone who does not have insurance…” I am considered un-insurable, where am I getting this insurance in your world.

    Are you doing away with pre-existing condition exclusions?
    I am also self-employed, so where is my insurance coming from? Private insurers?

    3. Who is on this “Healthcare Court?” Doctors? Politicians? Elected officials? Appointed officials? Who appears before it? Patients? Doctors?

    4. Price ceilings can be good for patients needing expensive drugs, but where is that ceiling placed? On the retail level or the manufacturers? That could stifle new drug development.

    5. Often times, patients with great medical debt become unemployed due to their illness, and sometimes dead…what if they cannot work to pay off the debt? Are all assets forfeit?

    6. Why no PPO? I have rarely encountered a “good HMO.” When I had a HMO, I had to fight and document to see specialists who told me to come back yearly (i.e. dermatologists…especially since 95+% of all GPs will miss skin cancer.) What if the HMO in network doctor will not treat me, or the plan does not have the specialist I need?

    BTW, I believe that politicians have no business designing health-care or illness-care. Health-care policy experts, insurance companies (it is THEIR gamble,) doctors and patient advocate groups should have had the greatest part in the design of the new system.

  2. Note to T:

    I do not know of any precise tax on small businesses by Obamacare.

    But going beyond that, if we are going to have an emergency health system that serves everyone, then everyone has to pay for it.

    Fire and police departments have worked that way since 1850 in most parts of the country.

    I grant that the whole issue is muddled by insurance, but the basic fact remains:

    If hospitals are funded largely by taxes, then they do not need to crush patients with user fees

  3. #2, so you believe a tax on the unemployed/under employed and small businesses is a good plan? That’s what we already have with Obamacare.

  4. Ok, G-Mom, I accept the challenge. What would my alternative solution look like?

    Here goes:

    1. Medicare Part A as the payer of last resort for hospital care. EMTALA claims are paid by Medicare if the patient has no insurance or no financial assets. (their home and retirement funds and $50,000 of savings are exempt).

    2. Anyone who does not have health insurance pays an extra 2-3% income tax, in order to help pay for the additional Medicare claims noted above.

    3. Any bill by any provider that exceeds Medicare rates can be challenged in a special Health Court. If the extra charge was disclosed, in writing, 15 days in advance of care, it may be defensible.
    For emergency care, all such extra charges can be reversed by Health Court judges.
    The court costs will be paid by government funds. No patient will need a lawyer.

    4. Price ceilings would be established for any drug which has no substitutes. The ceiling might be a 10 country international average.

    This one provision will slash the cost of cancer care, MS, athsma, diabetes, Crohn, and some parts of heart care.

    5. Patients who run up medical debts can be granted no-interest Medicare loans. The provider gets paid right away, and the patient repays the govt through payroll deduction.

    6. If people want a good HMO, let them buy it. Prepaid health care is a good thing.
    But any PPO plan with a $5000 deductible will be seen as a waste of money.
    And that is fine.

    Bob Hertz, The Health Care Crusade

    Bob Hertz, The Health Care Crusade

  5. I will also say that insurers are using car dealership tactics in the “low” monthly premiums quoted by ACA exchanges – but with looming high deductibles if care is needed.

    In the car business it’s, “sell the monthly payment, not the price”, this is particularly true for leases. The advertised monthly payments you see are lease payments because they can hide the buy-out price at the end of the lease. Health insurance premiums are no different, except that your body can’t be repossessed and you will be on the hook for that deductible.

    It’s a shell game any way you cut it.

    I have also read that even though insurers are required to cover pre-existing, they are not required to pay for expensive drugs. They can “game” the system by insuring the disease but not paying for the drugs needed to treat the disease.

  6. How would that solution differ for the assumed “healthy” majority versus the “un-insurable” chronically ill?

    Would it be progressive, based on income?

    What are YOUR list of covered, necessary procedures?

  7. What would a solution look like if it were crafted by those here? If complete single payer was NOT an option and hybrids were not off the table, and you were all actually willing to compromise to create the best option for the American public. Insurance, no insurance, what should healthcare look like?

  8. “$150 per test, take it or leave it, and no balance billing.”

    Bob, that’s essentially what Japan did – in a single-pay system. The result were much less expensive machines. If you look how corporations cut their budgets, they do across the board cuts and let individual managers and divisions decide what and where to cut. But corporations are essentially single-pay systems with accountability.

    Legacy and everyone, there’s nothing wrong with Medicare doing blanket reimbursement cuts, the failure is the providers, not looking at ways to make those cuts manageable because they have more than one income stream to keep the status quo.

    The weakness in the system that defeats cost cutting are all the different payers. As long as there is one payer willing to pay more, providers will say that the higher payment is the “correct” payment. There is no way to force the whole system to knuckle under – only premium payers are forced to knuckle under.

    Single-pay is the only way to force the entire system to cut costs. We will never get off this train heading for the cliff without it.

  9. I made reference to the relevant sections of the ACA in comments I made here shortly before it became law, an exercise I do not intend to repeat. Seek and ye shall find.

  10. Legacy Flyer is on target

    Both Medicare and private insurance overpay hospitals for imaging tests.

    The solution of course is something Germany or Japan would have done 20 years ago:

    $150 per test, take it or leave it, and no balance billing.

    Bob hertz, The Health Care Crusade

  11. I defer to your expertise, but you see what I’m driving at. I don’t see a realistic attempt here to curb the monkeyshines so persuasively documented by Dr. Gawande. I don’t doubt that much “overtreatment” results from a prudent desire to “be on the safe side,” but some are obviously “gaming the system.”

  12. I’ll tell you what’s “racist”: the crude racial preferences mandated by the provisions of Obamacare dealing with the recruitment and training of new providers.

  13. Nay-sayers? LOL, count me in. Because of the “Affordable” Care Act, I’m cancelling my plan. I will go without insurance at all next year. Insurance hasn’t been a good value for a long time. The “Affordable” Care Act simply accelerated the path to doom.

    I assume that those who call us “naysayers” and other schoolyard names have employer sponsored plans. If you didn’t? you wouldn’t be happy about the policy either. Trust me.

  14. archon41,

    As a Radiologist, I agree with your comment about “self referral” (or at least that is what I interpreted your comment to mean).

    What the government has done instead is to ratchet down the reimbursement for outpatient imaging – particularly on the “technical side” to a point where many imaging centers are folding. For the most part, this “cures” the problem of physicians referring to their own offices. It also penalizes those who own outpatient imaging facilities that are not based on self referral.

    However, as more physicians become employed by hospitals that own imaging equipment, I would not be surprised to see “self referral” spring up in this setting – employed docs being evaluated on how many cases they send to the “mothership”. And the prices for the same exam done at a hospital are much higher than when done at an outpatient center.

    Squeeze the balloon in one place and it will pop out in another.

  15. In times of desperation, when legitimate and respectable defenses can no longer be utilized, turn to the Saul Alinsky playbook. After all, isn’t this legislation really just about winning, not about caring?

    What is sad and unchangeable is there is an entrenched 25-30% of the public who will defend this legislation even if it approached the potential to cause violence to see it stay in place. And, I honestly believe those in power would not hesitate to see things deteriorate to that level. It is what extremist zealot ideology entertains.

    Let’s have a moment of brutal candor here, the Left/Progressives/Democrats, just like their polar opposites of the Right/conservatives/Republicans, don’t offer you the choice of a highway if we are not with them. Think about it per their rhetoric these past 12 years. January will be fun when the Right sabotages the budget efforts, and then the left uses the filibuster-absent Senate to pass a legislation without honest debate.

    Oh, my bad, that was done already. Obamacare!

  16. If the authors of the ACA had had any serious interest in controlling health care costs, as opposed to creating another “entitlement” for their partisan “base,” they would have, in light of the abuses disclosed by Dr. Gawande (and others), extinguished any financial interest physicians might have in diagnostics, particularly imaging. But they steered well away from that lion’s den, didn’t they? Still, they wear out creation with the claim that alternatives do not exist. It has not escaped the attention of the more cynical among us that some ACA cheerleaders stand to reap a financial benefit from it.

  17. Just remember anyone reading here who is unbiased and objective, and interested in seeing the system work as best able, there are plenty of commenters here who either cluelessly believe the system is infinite in paying costs, providing services, and access to products, or, they just pathologically want people to cling to false hope and faith and just strip all who are inattentive or gullible for every buck until they are spent, or dead.

    Yeah, that is a harsh statement above, so is this legislation and how it is being implemented to just favor cronies. What is going on now has gone beyond what borders as criminal, just too many Democrat hacks writing here don’t want that discussion gaining honest traction, eh?

    Oh, and as I have written before, now, and will later, I don’t look to Republicans to offer honest and responsible alternatives either. They just want to profit in other ways, they are chomping at the bit to go after Iran.

  18. You are on the mark, Cynthia, and how dare anyone dissent from the agenda of profiting in a system that can’t operate under frank boundaries of a business model alone. For the profit driven folks, death is just part of the ledger at the end of the day. As long as the losses don’t come from the bank statement!

  19. As a reply to Planet Florida, much of the attacks on those critical of Obamacare, and such attacks just allowing frank bureaucratic control be allowed without any hint of dissent, is just the ugly defense of projection by those who in fact are trying to profit from the legislation as is.

    My hypothesis with what goes on in positions of leadership and authority is there is a logarithmic growth of characterological disorders people running government, business, and other organizations that have a power structure to them. And with more narcissistic, antisocial, and histrionic people comes more chaos, dysfunction, and ruin.

    Oh, and nice illustrations to the defenses mastered by such impaired folks, the denial, projection, minimization, deflection, and pathological rationalization. Don’t you notice some of this here at the threads when someone writes a post slamming the consequences being seen by Obamacare?

  20. The phoenix of real health care reform and impact positively for the country can only rise from the chaotic ruins of failure. Frankly, I understand the blind loyalty, and with that complete lack of concern for the public nor attention to accountability, that comes with the partisan zealotry that trolls all the sites critical of Obamacare. What I don’t understand is why all the others not tied to a party agenda don’t call this exactly what it is.

    It is a full frontal assault on people’s choices and the patient-physician relationship. But, most here have already dumped concern and focus on patients being able to engage 1:1 with their doctors years ago.

    That lie was converted to a hideous truth from those years of spewing, thank you insurance industry and profit driven hacks.

    I just honestly look forward to reading these passionate Obamacare supporters have the nerve to try to share their stories of outrage when they or their loved ones get burned by the consequences of this law as we all continue to read it and find out what is in it.

    Sorry Mr Gladd, that is what the idiot from ‘Frisco said, save the spin for someone who is interested in hearing it again, and again, and again…

  21. “More Americans getting insured will be better for our country in the long run.”

    No, more Americans getting the appropriate medical care will be better in the long run. Insurance is not care, the “system” is not sustainable.

    Kim S., can you describe your policy and do you get a subsidy? Do you have an opinion on those of moderate income not receiving a subsidy but now forced to “pay top dollar”?

  22. The way it worked for me was that I got a bad news, good news letter. Bad news from Blue Cross was that my current plan was cancelled, the good news was that I would be automatically put into their silver plan, which was equivalent. (As noted above, you had to pay by Jan 1, with no grace period which given the backlog of paper processing a cushion on time probably needed.) Well, as it turned out the premium payment was indeed slightly less, but the deductible was much higher, so it would have been about the same slightly more, based on my past two years of healthcare usage.

    What was the shopstopper, however, and the information wasn’t available until late November and after persistent calling to Blue Cross, was that the doctors I had been using were not in network. So how is it insurance if it doesn’t cover what you need? Out of network would have needed to be paid at the non-negotiated rate and there was no out of pocket maximum. So basically NO insurance at all. In other words, I really got a bad news-bad news letter, although I guess I would get catastrophic coverage with the new policy offered.

    I ended up getting an off-exchange policy, which although costs more, at least provides me the coverage I need.

    I think for many people, in addition to the website issues, had issues understanding the details of the offered policies to make a sensible choice. I realize it is the first year of the exchange of policies, but even the off-exchange policy I am told I cannot get a detailed certificate for the plan, because they won’t be finalized until January and that includes the final provider negotiations.

  23. There are still a lot of misconceptions and misinformation about what the Affordable Care Act means. Like any new system, it’s met with ridicule, nay sayers and resistance.

    Is it perfect? Hell, no. Will it get better? It will as the problems get worked out just like with any system. Many believed the same about Social Security and Medicare.

    I was one of the first who enrolled once the website opened and I’m from Illinois. I’ve lived in an unfair system where if you don’t get insurance from your employer and you need good private insurance either you have to pay top dollar or you’re screwed. More Americans getting insured will be better for our country in the long run.

  24. The only people who are just fine with that are the profiteers and parasites of the medical-industrial complex. Everyone else is not fine with it at all.

  25. Wow–never heard that one. I guess “going Dutch” means only paying for yourself. Which BTW is not the case as for everyone the gov there pays 50% of premiums and 100% for the poor. It’s a very sensible and equal society, which used health reform to experiment with managed competition–with a social insurance background. Which is why I like their system (whatever wikipedia says)

    But I doubt THCB moderators would take much action against me, as it would be a bit of a career limiting move!

  26. Perhaps Mr. Holt was using the term “Dutch” system more in line with the derogatory British references made against folks from the Netherlands. I hope not, as these kind of racist remarks surely would trigger THCB moderators to take swift action. That said, I am not sure how these references would not apply equally to The Act.

    Since c.1600, Dutch (adj.) has been a “pejorative label pinned by English speakers on almost anything they regard as inferior, irregular, or contrary to ‘normal’ (i.e., their own) practice” [Rawson]. E.g. Dutch treat (1887), Dutch uncle (1838), etc. — probably exceeded in such usage only by Indian and Irish — reflecting first British commercial and military rivalry and later heavy German immigration to U.S.

  27. “17% of GDP will go to healthcare versus <9% in every other industrialized country in the world."

    A lot of people are just fine with that. Business is quite good for them.

  28. If you’re a primary care doc earning the most recent average amount, you make ONE ONE-HUNDRETH of the most recent reported compensation of United Health Group CEO Steven Helmsley ($13.89 million). 1/100th.

    Who adds more value to humanity?

  29. “all the plans proposed by Republicans that were summarily ignored”

    Does that include the 100 or so GOP amendments that were included in the final bill?

  30. What music more sweet, than the indignant squealing of our “moral elites”? Don’t miss With Affordable Care Act, Cancelled Policies for New York Professionals (Anemona Hartocollis, NYT, 12-13-13.)

  31. The proposals urged by my “progressive” friends share several conceptual flaws. They all assume that the costs of health care can be significantly reduced by eliminating “huge” insurer profits and “overhead.” When asked why, in that case, the savings of large, self-insured employers have been so modest, they have no credible response. These proposals also reflect a profound reluctance to take prompt and vigorous action against the abuses revealed by the studies of Dr. Atul Gawande. This situation has become intolerable.

    “…a quarter of all health care dollars are spent on defensive medicine–about $650 billion a year.” (How to Fix Obamacare: Listen to the Doctors, Dr. Matthew Moeller, Quartz) (Links to studies in article.) My “progressive” friends embarrass themselves with their rationalizations for preserving the current tort liability system.

    The recent uproar over exchange deductibles and premiums demonstrates that the broad middle class is simply not receptive to compromising its own quality of care in the interest of the “greater good.” They may be an ethically worthless lot, but they do vote.

    The difficulties of the “roll-out” are but a temporary distraction. The next shoe will drop when small employers begin informing their employees that they can’t cope with the costs and complications imposed by the ACA:

  32. ACA is a huge flop.

    It’s the half-baked, bastard solution to a very real problem that goes unresolved.

    All the ACA represents is the fact that all the political capital for healthcare reform has been wasted. US will have to wait for a real manifestation of crisis before healthcare reform is back on the political agenda. In the meantime, 17% of GDP will go to healthcare versus <9% in every other industrialized country in the world.

  33. Planet Florida- Thanks

    For every one of you there are hundreds of US doctors who became very wealthy practicing “free market based” US medicine and who don’t like it one bit if their lucrative incomes in any way are adversely impacted by long overdue change. When a doctor says to me that “they are killing me” I say show me the income decrement. Then my heart quickly stops bleeding for them

  34. Thanks to Judy for mentioning that some of the five million persons with cancelled old policies were given a chance to buy new policies. In MN this was an ‘opt-out’ procedure, you had to disclaim the new policy or you were automatically rolled over to it.

    I am dismayed to read that if a first payment is not received by 12/31, an enrollment would be void. \Even in the bad old individual market, the cutoffs were not always that harsh. Several times I made my first payments mid-month on new coverage.

    How in the heck is the insurer supposed to estimate the subsidy it is due on subsidized policies? Does each insurer have to review the tax returns of the applicant? Does each insurer have to reread the 32 page application?
    This move by CMS is close to comical though I know why they are doing it.

    Finally, I suspect that the uninsured are waiting until the website settles down before enrolling. They have been doing without for years in some cases, so a couple of more months is no big deal.

  35. Sadly Dr. Rick, the cheering for failure by Republicans does nothing to solve anything. I’m not confident though that voters will see it that way as they will hold Democrats responsible for the mess created by everyone. Would things have been better with a non-glitch start-up – not when already insureds were blind-sided to find their premiums going up AGAIN, with no explanation why.

    I won’t concede to Matt’s support of the Dutch system yet. But no system world wide can remain unchanged as all require constant oversight and “fixes”. Will anyone in the U.S. be able to afford health care in 20 years – not with the present trajectory of costs and incomes.


    “However, an assessment of the 2006 Dutch health insurance reforms published in Duke University’s Journal of Health Politics, Policy and Law in 2008 raised concerns. The analysis found that market-based competition in healthcare may not have the advantages over more publicly based single payer models that were originally envisioned for the reforms:”

    “The first lesson for the United States is that the new (post-2006) Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?”

  36. I am also a doctor, and I take issue with your characterization of people leaving the profession of medicine to make “mega bucks.” All my life I have chosen to work in hospitals that serve poor and disadvantaged populations, taking care to see unfunded patients “pro bono” while busting my hump to see enough paying patients –and give good quality service despite government constraints- to keep the lights on. I don’t earn a high salary,not that there’s anything wrong with that. I am not alone–most of my colleagues have chosen the same path.

    But we literally cannot pay the bills under the current circumstances. My patients are suffering, our ability to expand services and develop new ones has been hindered, and my personal quality of life has suffered a great deal since I am not practicing in my field when I sit around filling out paperwork and checking boxes.

  37. What naive people actually ever believed that changing 1/6th of the US economy (which should be 1/3rd for starters) would be easy?

    Greedy powerful vested interests resistant to ANY painfully obvious necessary change abound – supported by probably hundreds if not thousands of highly compensated prostitute lobbyists.

    We have turned a corner though and are not going backwards. The “good old days” of the excesses of free market based US medicine are gone forever. Also -hate to break it to you but we are not that “special” and “exceptional” as a nation. A dose of humility might serve us all well?

    If you want to make mega-bucks start a business with my blessings – but move out of the former profession of medicine so it can become a profession once more.

  38. Tres drole Arthur, but sadly what you write doesnt make sense. And I have already on these pages twice proposed a solution to the enrollment crisis that would be within the bounds of the law and the bill.

    And no I didnt love the bill, I wanted the Dutch system adopted lock, stock and barrel.

    But instead we HAVE a “plan(s) proposed by Republicans” and apparently the Republicans now dont like the Republicans then…(Chafee in 1993 & Romney in 2006)

  39. What a cock-up this ACA implementation has been. And now the constant executive fiats changing the law every couple of days makes it impossible for insurers to comply and confuses the populace, most of whom don’t understand the law as written much less the numerous confusing changes. I fear for the people who will think they have coverage come January but will not due to an incompetent government and President.

  40. Mr. Holt–you’ve been playing this one way for a long time. You loved the bill. But you didn’t love it because it solves the enrollment problem! It couldn’t have done that via automatic enrollment because that bill would never have passed. You loved it because it involves Democrats who did want a bill and eventually want complete nationalized health care even though this is strictly a Democrat idea that Democrats simply will not admit.

    So yes things could have gone better, but what’s your solution other than all the plans proposed by Republicans that were summarily ignored by this administration and the Democrat controlled congress? Or are you just enjoying what every honest person views to be a total failure?

  41. I’m from Washington state. Because of the premium and deductible increases due to Obamacare, insurance just isn’t a good value for me anymore.

    The only way I can become a “winner” with Obamacare is to opt out, save up for insurance for the following year. I’m cancelling my insurance as of December 31st, 2013 and going without for the year. If I decide the risk is too high, I can opt back in for 2015. Otherwise I may take 2015 off as well. That is the one benefit that Obamacare offers me. I can’t be denied if I take a year or two off of insurance so I have the option of opting out.

    If I stay insured in 2014, it will literally cost me $2000+ for the year over what it cost last year. This is for LESS coverage for my conditions than I had before. Soooo, if I stay insured, I become a loser.

    If I get sick during my opt out I have $8500 of premiums and deductible to spend on the illness. If I get cancer during my “time off” so what. The conventional “wisdom” is that early detection saves lives. The SCIENCE dictates that whether you live or die via cancer depends on the virulence of the type of cancer you have.

  42. Bob–you’ve been playing this both ways for a long time. You hated the bill. But you didn’t hate it because it didnt solve the enrollment problem! It could have done that via automatic enrollment. You hated it because it didn’t involve Republicans who did NOT WANT a bill at all and didn’t want a universal individual mandate even though it was a Republican idea.

    So yes things could have gone better, but what’s your solution? Or are you just enjoying what you view to be a total failure?

  43. At least in California, people whose policies were cancelled were rolled over to a ‘equivalent’ policy starting 1/1/2014. Especially due to provider narrowing and pricing, the policies aren’t really equivalent, but if people pay the premium on time, then they are covered with one of the policies that you could also get on the exchange. In Washington State, off-exchange policies offer expanded network providers at about the same cost as the on-exchange policies.

    So in reading this entry and seeing the gap between ‘eligible’ subsidized people and the number signing up, it makes me wonder how many people are being insured outside the exchanges (and missing out on the subsidy). Are the insurance companies doing a better marketing job?