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November is the New October

• 7

By Charles Ornstein

Many health care experts and journalists, including me, felt that the month of October would be the key barometer of the success of Healthcare.gov, the online health insurance marketplace that is a cornerstone of the Affordable Care Act.

But as days became weeks, and the problems plaguing the website stubbornly went unfixed, the question now is whether the administration can make the website work well by the end of this month and salvage the president’s signature achievement. If Healthcare.gov, which handles health insurance enrollment for 36 states, is working well at the end of this month, it will leave consumers just two weeks to choose plans if they want them to take effect on Jan. 1, 2014.

In other words, November is the new October.

The din of partisan accusations and counter-accusations is deafening and only getting louder. But in the interest of finding out what’s really happening on the ground, I consulted Kip Piper, who advises large health care organizations on Medicare, Medicaid, and health reform policy, finance and business strategy.

Piper has served as senior advisor to the administrator of the Centers for Medicare and Medicaid Services (CMS), Wisconsin state health administrator, director of the Wisconsin Medicaid program, a senior Medicare budget officer at the White House Office of Management and Budget, among other roles. He is articulate and clear-headed.

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While Healthcare.gov Struggles, A Different Story Plays Out On The Private Exchanges

• 29

By LISA SUENNEN

All eyes are on the hullaballoo created by the challenges at Healthcare.gov and several of the states’ public insurance exchanges.  Yet all the while, like in a magic show, attention has been diverted from the real action going on elsewhere.  Quietly and in a relatively drama-free way, the private health insurance exchanges are busily taking over the world of insurance and, in my opinion, portend a radical set of changes in how our health insurance system operates.

Several years back, a number of companies began building private health insurance exchanges to initially help companies offload the incredible burden of retiree benefits.  Companies such as Extend Health (now owned by Towers Watson), Senior Educators (now owned by Aon), and several others provided a way for large employers to get themselves out of the business (and balance sheet liability) of providing group benefits for retirees, instead providing them with money to purchase their own individual health policies through then small, now large companies.  The private exchanges went about the business of building websites that work, call centers that buzz and a wide array of insurance product offerings at various prices.  Now, several years later, hundreds of thousands and possibly millions of individuals are out there shopping their little hearts out, choosing their own plans, and dealing with the consequences of high deductibles and the like.

These various private exchanges are now poised and ready to begin serving active employees in 2014 as guaranteed issue (the requirement that all can be insured and no one turned away) goes into effect as a result of the Affordable Care Act.  And lest you think this is a small marketplace, you are wrong.  In 2008 there were about 120 million total employed workers and just over half of these worked for companies of 500 employees and above (39 million worked for companies with 5000 employees or more).  In other words, we are talking about nearly half of American adults and that doesn’t even include the dependents they bring along into their insurance plan.

Interestingly, such large US employers as Walgreens and Petco and DineEquity (parent company of Applebee’s Neighborhood Grill & Bar® and IHOP® restaurants) are all-in on the private exchange program, committing to transfer all of their employees from group plans to the exchange to purchase individual plans come January 2014.  The exchanges of Towers, Aon, Mercer, Buck Consultants and a plethora of others are alive and well and open for business at exactly the time when employers are trying to figure out how fast they can reasonably get out of the middle of health insurance administration and run for the hills.

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Making Hospital Prices Matter

• 4

By PETER UBEL

 

I recently learned about a company called OpsCost, which has a very user-friendly website designed to help people figure out how much different hospitals charge for a wide range of treatments and procedures. The company makes use of the data that the Medicare program has recently made available to the general public, and then presents those data more elegantly than many other sites I have seen. You can go here to look at the company website, and you will quickly find yourself looking up prices for hospitals in your region.  (Disclosure: I have not received any money from any price transparency companies, nor entered into any business relationships.)

For example, I told the website that I wanted to look at hospital prices near Durham, North Carolina, for “Hip & Femur Procedures Except Major Joint Without Complications And Comorbities/Major Complications And Comorbities,” and the program showed me a list of hospitals and prices, with a Google map on the right-hand side showing where each hospital was located. Pretty nifty.

But is it useful?

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The ACA May Kill Me

• 51

By G-Mom

Through a bad roll of the genetic dice, I am the unhappy host for several, rare chronic diseases.  Any one of these would render me uninsurable, but the combination of them makes me incurable, and very difficult to treat.  The deadliest thing that I can encounter is a well-intentioned but uninformed doctor.

I have currently have excellent insurance through my husband’s job that allows me to see my varied team of treating physicians.  Two are in other states, and the rest are all heads of their departments, but none share a hospital or healthcare group. If my husband were to lose his job, I would be placed into the “high-risk-pool,” if there were any slots left, or forced onto the exchanges where my physician options would be cut significantly.

I would likely be forced to pay for healthcare coverage that I cannot use, since many doctors have been unwilling to even attempt to treat me, despite my “Cadillac” insurance plan.

I would likely have to pay cash to see my current team of physicians, which would be a tremendous financial burden on my family and likely end in bankruptcy.

I was cautiously optimistic when I heard of the end of the pre-existing condition exclusions for health insurance, but the current law will not help me at all.  It does not expand my insurance options, it will definitely NOT be less expensive than what I have now, and if I am forced to see a well intentioned, overworked and uninformed (or even distracted) doctor, it just might kill me.

BTW: I am NOT disabled, and do not take any form of government assistance.  I have owned my own business and paid that higher tax bracket for over 20 years.”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. Drop us a note.

I’m Male. A Non-Smoker. And in My Fifties. Can Somebody Please Explain Why I Have to Pay for Maternity Coverage?

• 59

By THCBist

A THCB Reader in Maryland writes:

“I realize many individual health insurance policies are being cancelled because they are not in compliance with the ACA’s new requirements. 

Do the new ACA requirements effect all individual plans sold or just those available in the exchanges?

In other words, if I am a self employed, single 50 year old male who does not want maternity, pap smears and mammograms; can I solicit an individual policy outside of the exchanges that meets these needs? For that matter, could I find a policy in the exchanges that meets these needs?”

If you’ve had a bad or good experience attempting to buy health insurance on the state or federal exchanges, we’d like to know about it. Drop us a note.

I Have No Kids. Why Do I Have to Pay More For My Coverage Than People With Children? This Seems Really Unfair!

• 20

By THCBist

A THCB Reader from California writes:

“I finally decided to go to the “Covered California” website to see how much a potential premium for my partner and myself would be given several different income scenarios.

First of all, the plan differences are so vast it appears to be a further seperation of classes through healthcare.  I wonder who decided that a $40 doctor co-payments is affordable!  Then you take a look at how the tax credits work and the antiquated undertones that others should pay for children.
I
It is amazing to me that people with kids are going to pay LESS than the coverage my partner and I will.  This isn’t just for one child, it is up to 3 or more! I do not have children but I understand that in a universal healthcare system the larger the pool, the cheaper the cost.  Those savings should also go to those whom have decided not to add additional risk to the system by adding children.  Why is a single persons insurance more than that of a family?  Why are the subsadies so large that it makes it cheaper?

At least charge as much as a single person, not less. Healthcare for all is something that everyone should pay into and the largest economy in the world should offer, but the distribution of costs need to equal the risk.  Kids are expensive choices that people make, why should people who have chosen to not bear the costs pay for others that have?”

Have a question about the Affordable Care Act? Drop us a note. We’ll publish the good ideas.

Can Everybody Please Just Calm Down?

• 18

By ANN MOND JOHNSON

This week, Health and Human Services Secretary Kathleen Sebelius apologized to Americans for the issues with the launch of the Obama Administration’s website, HealthCare.gov. In her testimony, Ms. Sebelius told Congress that we “deserve better.” And with that, the social media world was set on fire with a rage of backlash aimed at the Administration – something that has been growing feverishly for months now.

Yes, we agree that the American public deserves better – but not just from the Administration. They deserve more from the private sector, too. At this point, some of the biggest naysayers of the Fed’s exchange launch have been leaders in our industry. It’s disheartening to watch.

It’s clear by now that the private sector can offer the government a wealth of knowledge and best practices. But for the Administration to truly learn from those lessons and fix the problems, we need to step up and stop undermining this effort.

As a start, there are three things the private sector should do to counteract what much of the media refers to as a complete debacle:

1.  First, just calm down.Focus instead on helping clear up the confusion about deadlines, options and the law. For example, we should remind Americans that they can still get insurance, despite all of the issues HealthCare.gov is experiencing. Legally, Americans don’t need insurance until the end of March 2014. And, if they need something sooner, not only may short-term medical insurance be an option, but there are many off-exchange plans available to buy today from multiple carriers. In other words, HealthCare.gov is not the only source of coverage.

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Why the Medicare Part D-Obamacare Comparison Is Making Less and Less Sense

• 14

By Dan Diamond

With the possible exception of one phrase — “it’s a marathon, not a sprint” — defenders of Obamacare have repeatedly invoked the same warning.

Don’t be too critical of the Affordable Care Act’s new marketplaces. Medicare Part D had a rocky rollout, too.

“In terms of confusion, lack of knowledge, and misinformation, the current situation with exchanges resembles the situation that prevailed when Part D enrollment opened,” Daniel McFadden, a UC-Berkeley economist and Nobel laureate, told the Wall Street Journal‘s David Wessel earlier this month.

Part D, “at the time that it was passed was actually less popular than the Affordable Care Act,” President Obama said in an NPR interview on Oct. 1, the day the new marketplaces launched.

There are similarities between the two programs, from the political fight over their enactment to the difficulties in making the laws a reality. But the laws differ in some important ways, too, including ones that supporters haven’t fully acknowledged.

So what can we take away from Part D? Here is a quick guide to lessons from the drug plan’s rollout.

The political environment

How it’s similar: Just as Democrats fiercely resisted Republicans’ efforts to enact a Medicare drug benefit, the GOP refused to support the Democrat-led ACA.

How it differs: While Part D is seen as successful today — 90% of seniors were satisfied, according to a 2009 survey — Democrats say that their party deserves some credit.

“We lost the policy fight, and what did we do?” asked Rep. Bill Pascrell (D-N.J.), at a hearing on Capitol Hill on Tuesday. “We went back to our districts and we told our seniors although we voted no, we … will work with the Bush administration to make it work,” Pascrell added.

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Will You Be Able to Keep Your Plan? The Economics Behind the Obama Administration’s Latest Problem

• 34

By David Dranove & Craig Garthwaite

By now you’ve certainly seen the headlines: “Obama administration knew millions could not keep their health insurance,” or “Report: Millions will lose health plans as ObamaCare takes hold.”

This is not just the rumblings of right wing media outlets or scare tactics, it is now becoming clear that millions of individuals who used to buy their insurance in the individual market will not be able to keep their old plans. As a result of minimum standard for health insurance “quality,” between 50 and 75 percent of existing individual insurance plans will be canceled.

White House Spokesperson Jay Carney said that these cancellations will only affect “substandard policies that don’t provide minimum services.” But again, the devil here is in the undiscussed details. The “minimum services” bar for the Affordable Care Act is actually very high and as a result the new policies that replace those being canceled can be quite expensive.

For people who are in the unsubsidized portion of the exchanges, or even those who qualify for smaller subsidies, these minimum requirements are going to result in large premium increases. While many people might all believe that these individuals be buying better insurance, this is not the argument used to gain public support for the ACA.

We’ve both been vocal in our support of moving people onto the exchanges and away from employer provided coverage. One reason for that support has been that the exchanges allow a far better matching of individual preferences for health insurance and the products that people can purchase. Certainly that was our basis for our strong support of narrow network plans on the exchanges.

Beyond the size of the network, some people don’t want to pay for generous first dollar coverage. Instead, these consumers are willing to exchange lower premiums for higher deductibles or other forms of cost sharing. Others might not be interested in having coverage for every possible service, but instead might opt for a less generous set of benefits.

They will be thwarted by the ACA.

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Why Isn’t There a Healthcare.gov App?

• 6

By THCBist

A THCB reader who asked that we not identify him because his company does unrelated contracting work with the government writes in to ask:

“Why isn’t there a Healthcare.gov app? If the problem is that the system is failing because the poorly designed Healthcare.gov web site is being crashed by monster waves of traffic, wouldn’t putting out an app help?

I mean, ‘cmon guys. It’s 2013. Millions of Americans have iPhones, iPads, Androids and god knows what other mobile devices. In theory a freestanding app — even a simple one — that allowed browsing and “print my application” capabilities would help the traffic problem by giving people an alternative way to access the features available at the government web site.

If the problem is in fact the web site and not the data hub, wouldn’t that go a long way to solving the problem? How hard could it possibly be to put something together quickly and get it out there? Why isn’t this being done?

Knowing how this game works, I’m pretty sure the plan was to originally include something like this. Then the vendors and contractors involved quoted an astronomically high price tag that nobody was willing to go for. Then somebody else said something ominous about privacy and an awkward silence broke out at the table. The Healthcare.gov app was put in the “nice to have” – “we’ll get around to it when we can” – “bells and whistles” camp.”

Have a brilliant idea that could help save Healthcare.gov? Somebody has got to do something.  Drop us a note. We’ll publish the good ideas.

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