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Tag: Health Insurance Exchanges

The Federal Shutdown is Over. The Health Care Fight is Just Getting Started. Here’s What May Happen Next…

Social security numbers allegedly passed around in clear sight. Page after page of unworkable code. And no clarity on when it will all be fixed.

Just another day of trying to log in to healthcare.gov.

Two weeks after its launch, the federal health insurance exchange is a “failure,” says the Washington Post‘s Ezra Klein. Some officials deserve to be fired, according to Robert Gibbs, who until February 2011 was one of President Obama’s closest advisers.

And those are the Affordable Care Act’s supporters.

Even the president conceded on Tuesday that healthcare.gov had “way more glitches than I think are acceptable.”

Those glitches could take months — or even years — to fix, according to reports. But there’s a key deadline looming: Jan. 1, 2014, when the ACA’s individual mandate takes effect.

Under the mandate, millions of Americans who were expected to use the exchanges to obtain health insurance will face fines if they haven’t purchased coverage by Feb. 15, raising the question of whether the mandate or other Obamacare provisions should be postponed — an uncomfortable position for an administration already trying to implement a politically divisive law.

But at this late date, what parts of the ACA can legally be delayed?

“In a sense, all of it,” Timothy Jost, a Washington & Lee law professor, told me. But “there’d be a high political price to pay. And delay could result in litigation.”

Jost was among several experts who spoke with me about the health insurance exchanges’ bumpy rollout, the ripple effects for the mandate and other provisions, and what it could all mean for implementing the ACA.

What Agencies Can and Can’t Do
When considering a delay to Obamacare, it’s important to understand the difference between statutory and discretionary deadlines.

For example, the ACA’s language directly calls for many mandatory deadlines — like rolling out the individual mandate or implementing a slew of insurance market reforms on Jan. 1, 2014.

But the agencies also have had considerable leeway on how they’ve chosen to apply the law — like choosing an Oct. 1 launch date for the exchanges, a deadline that retrospectively seems ambitious.

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Of Course, Then There’s The Fact That You May Be Better Off Waiting To Buy Coverage, Anyway …

Will all the White House messages, the stream of breathless Twitter updates on the number of hits and enrollments, and the press hype surrounding opening day send the uninsured public into panic mode? Will they prompt buyers to consider only the premium and click to enroll ASAP? And why not? For weeks the administration, state exchange officials and supporters of the Affordable Care Act have been telling the public how cheap premiums will be — much cheaper than expected.

A Pennsylvania woman told me she was chomping at the bit to enroll because she was eager to dump her policy from Aetna for a cheaper model from Blue Cross. Never mind that she had no idea whether the coverage was better, the same, or worse.

A Nebraska woman heard there was a worksheet to fill out and it had to be completed by October 1. It was first-come-first-served, an agent had told her.

If cheap premiums were the only thing shoppers had to consider, this sense of urgency might be fine. But it’s not. Here’s the problem.

Selecting a health insurance policy is fraught with potential missteps and misunderstandings. As the Nebraska woman told me, “You’re walking into a chasm of uncertainty. It’s like shopping for a used car. You don’t know if you’re getting a lemon,” a lemon you’re stuck with until the next open enrollment.

For consumers, the key advice right now is: don’t rush into anything. Tuesday, October 1st marked the first day of a six-month open enrollment period, not the last. Coverage doesn’t even begin until January 1, 2014, so there’s no need to buy the first policy you see. If you do want coverage on January 1, the deadline for enrolling is Dec 15.

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What Covered California Got Right–And What Other States Did Better

On the day that Covered California went live — the very moment that Executive Director Peter Lee declared the exchange “open for business” — staff debuted a video celebrating the launch.

The video features photos of cheerful, ethnically diverse people — spliced between scenes of California — holding up signs written in English, Farsi, Korean and other languages that all translate to “open.” (You can watch Lee unveil the video, beginning at the 10:40 mark.)

One week later, Covered California brought the video back; once again, clips of grinning men and women toting signs that read “Ya abrimos” filled time before a webinar on Tuesday where officials shared updates on the exchange’s progress.

The smiling faces and multilingual message illustrate one of California’s major challenges in rolling out the ACA: The state is arguably the most geographically and demographically diverse in the union. Expanding health coverage to seven million uninsured residents will take time and a unique strategy.

But you can also forgive Covered California officials for wanting to remind the public that their exchange is live. During much of the first week, the site often sent a different message.

What Went Wrong
Covered California’s launch was supposed to be different. The state had spent years gearing up for the exchange’s rollout on Oct. 1. It had enlisted dozens of groups to help perform outreach. It had equipped some staffers with “Keep calm and go live” t-shirts.

But a triumphant debut turned out to be an oft-frustrating one. In California, like in most of the nation, most launch day stories didn’t center on the people signing up for coverage through the new exchanges, but on all the people who couldn’t.

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Out of Chaos, A New Beginning

As of last week, the heart of Obamacare is upon us with the opening of the health insurance exchanges (HIXs).  And while some think this represents the heart of darkness, it is hard to imagine that anything will stop January 1, 2014 from coming and, with it, a new legal requirement for all Americans to have health insurance.

Ushering in this new world order, the HIXs are essentially a “Match.com” to put people together with insurance products, representing a way that, for the first time, Americans will directly purchase healthcare without the prospect of being denied coverage or having their employers buy on their behalf.

In fact, the new HIXs create a direct relationship between consumers and health insurers in a way that has never existed before, and with that comes the need to fundamentally disrupt traditional methods of delivering health insurance products.  Not since the advent of employer-paid health insurance after World War II or the start of the Medicare program in 1966 has there been such a broad-scale opportunity for health system transformation.

There are few markets that are mandated by law to include virtually every single American man, woman and child, making the opportunity particularly juicy to investors.  For those entrepreneurs who figure out how to transfer the secret sauce from cheeseburgers that impair health to insurance-related products and services that improve it, the next few years offer an opportunity to turn market confusion into gold.

Among the biggest opportunities are investments in technologies and services that power the new healthcare exchanges.  Venture-backed companies, such as GetInsured.com, have emerged to provide the various state-sponsored exchanges with the back-end technology that enable comparison-shopping, financial transactions and enrollment support essential to operating the HIX marketplaces.

But while state and federal healthcare insurance exchanges are the main topic of conversation this week, much of the real action has and will continue to take place in private exchanges serving the large and small employer market, particularly as employers do the math and figure out it may be in their financial best interest to end their role as benefit plan intermediaries.

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How I Learned to Stop Worrying and Love Obamacare

There is an ancient Arabic proverb: “The enemy of my enemy is my friend.” With this in mind, I can’t help but think that whatever Senator and leading Tea Party blowhard Ted Cruz opposes must be good. When Cruz decided to try to shut down America because he opposes Obamacare , well that sealed the deal for me. I say “Obamacare forever.”

Readers know that I think Obamacare has too many rules that create problems for payers and providers alike, and relies on some questionable practices for funding. I don’t like the rush to form ACOs or the lack of serious cost-effectiveness analysis (admittedly a concession to Republicans.) But Obamacare beats the hell (sorry Ted) out of Cruzcare, which, as far as I can tell, goes something like this: “Didn’t put aside enough money for that life-saving operation? Here is a prayer that might help.”

I used to sort of be a Republican. I voted for Bush (I won’t say which one in order to avoid embarrassment) and voted against Obama more than once (living in Illinois I had several opportunities.) And I hate that Obama is playing at President like someone playing poker with a winning hand.

This isn’t supposed to be about which politician claims the biggest pot for himself. But I will take a selfish and somewhat scornful Obama over Ted Cruz and the Tea Cozies any and every day of the week. And I will work to find the best Democratic leaders if all the Republicans can offer is Cruz and his TCs.

Shut down the government to finally fund Medicare and Social Security? Maybe. Shut down the government to achieve a rational tax code? Sure. Shut down the government to balance the budget? Now we are talking. But shut down the government to block the opening of the health insurance exchanges? How absurd!

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How Identity Verification Caused Chaos on the State and Federal Exchanges

We may be getting a better idea why the federal exchange and so many state exchanges aren’t working.

An article in Saturday’s Baltimore Sun, regarding Maryland’s problems, provides insight I have not seen elsewhere:

Problems began immediately after the exchange launched Tuesday, as people tried to create accounts and log onto the site.

State officials blamed the account creation process, in which people were routed to a federal questionnaire to verify their identity. The system, they said, became overwhelmed when so many people tried to access it.

So, it appears all of the exchanges are facing the same bottleneck at the federal level–the identity verification software the feds are running for themselves and the state exchanges.

Then the Sun article provided more insight:

Requiring people to create accounts to access the system may be one of the problems, said Jonathan Wu, co-founder of consumer finance website ValuePenguin, who has a computer science background. Some states, including Kentucky [which as been about the only state running well], let people browse insurance plans without an account, which was only needed to purchase insurance. Kentucky did not have as big a backlog, he said.

“It’s kind of an architectural and software issue,” Wu said. “You are not accounting for how people want to use the system.”

With personal accounts, the computer system has to work harder, storing information about everyone who accesses the website, he said. It also has to repeatedly confirm the identity of the person, which also can bog down the system, Wu said. He noted that all the functions on the website that don’t require an account have run smoothly.

“It has to match your account every step you make,” Wu said. “This causes extra overhead.”

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One Man’s Quest to Sign Up for Obamacare

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Day 4:

After spending more than two hours in the waiting room, I once again tried to create an account at healthcare.gov so my family could #GetCovered – as instructed by President Obama and Secretary Sebelius.

My first attempt at setting up an account today was thwarted when healthcare.gov said the user name I attempted to use was no good:

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Ack! It says the username already exists? This was the username I had set up on Day One (backstory here), but the system ultimately didn’t recognize it. I feared some other Tony Jewell had used my cleverly placed underscore.

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Affording the Affordable Care Act

As enrollment in the Affordable Care Act’s (ACA) new health care markets, or exchanges as they are also known, begins, much of the debate over the law is focused on insurance: Who will get coverage? How much will premiums cost? Should our state expand Medicaid? Yet health insurance is not an end in itself.

The point of insurance is to help people get the health care they need at prices they can afford and, in the event of serious injury or accident, to protect them from catastrophically high medical bills. What often gets lost in the debate is how the new law will affect Americans’ ability to buy health care.

While relatively little will change for most people who already get their insurance through employers, an estimated 49 million Americans will be affected by the new law, either becoming newly insured or changing their source of coverage. How will these changes affect consumer health care spending? Will the Affordable Care Act live up to its name?

Of course, ultimately only time and experience will tell. But in the meantime, the law is being implemented, and policymakers and consumers confronting the new health care market are seeking answers about the law’s likely impact, beyond politicized charges and countercharges about whether it will succeed.

Using the COMPARE microsimulation model, my RAND colleagues and I examined how the ACA will affect spending by consumers who are insured for the first time or who change coverage as a result of the law. Specifically, we looked at out-of-pocket spending (spending at the point of sale — copays, deductibles, and coinsurance, which is the fraction of spending not covered by insurance); total spending on health care, which includes out-of-pocket spending plus insurance premiums; and consumers’ risk of high medical care costs.

The analysis focused on 2016, the first year in which penalties for not complying with the individual mandate will be fully in effect, and considered two scenarios: one in which the ACA is fully in place and another that estimates outcomes without the ACA.

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Descent Into Madness: An Account of One Man’s Visit to Healthcare.gov October 1st

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As the owners of small businesses, my family has been curious to learn how much insurance would cost us once the Affordable Care Act kicks in – and what our choices of networks, providers and whatnot would be.

With the arrival of the October 1 open enrollment period, my first computer stop was healthcare.gov to begin comparison shopping among the four ACA plans vs. the COBRA plan that we have through the end of 2014.

Here’s how it went:

October 1, 2013

7:30 a.m. – I first encounter the Health Insurance Marketplace waiting room.

7:33 a.m. – The drop-down boxes on the security questions aren’t working.

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Why Explaining the Affordable Care Act Turns Out To Be A Lot Harder Than We Thought It Would Be.

One of the chief aims of the Affordable Care Act (ACA) is the expansion of insurance coverage to individuals who at present either cannot afford it or choose not to purchase it. Unfortunately, many Americans lack the financial literacy needed to navigate the numerous and complex options thrust upon them by the ACA.

The ACA contains a number of mechanisms through which coverage will be expanded, including the individual mandate, the state insurance exchanges, and the expansion of Medicaid.

Yet, while many more Americans will be able to obtain health insurance under the law, the new policies present a complex new choice environment for consumers, one that contains new penalties, new subsidies, and a potentially vast number of plans to choose from.  Successfully navigating these choices requires consumers to be financially literate.

As recognized in research on related areas of financial decision-making – such as retirement planning, investing, and debt – consumers often lack the understanding, ability and confidence to make financial choices that are in their best interest.

To shed light on consumers’ ability to navigate the ACA, we recently examined the distribution of financial literacy by household income.  Our findings were recently posted on the Health Affairs Blog and in a working paper by RAND’s Bing Center for Health Economics.

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