lambert's blog

What, you think Obama -- and Wellpoint's Liz Fowler, who drafted ObamaCare for Max Baucus while his chief of staff -- would ever do anything to help the unions or collective bargaining? Kidding, right? The Hill: Read below the fold...

Jay Carney at a White House presser:

Q Do questions raised about HHS Secretary Sebelius and her efforts to raise funds through the private sector for Enroll Now fall into that category?

MR. CARNEY: We can go down the list of -- we could say what about the President’s birth certificate? Was that legitimate --

Q I’m not asking about that. I’m not asking about that. I’m just asking -- this is the last thing --

Read below the fold...

I really, really hate to quote the Washington Examiner, but unless the guy's actually into fabrication (like Breitbart, but I'm guessing), there are problems. (Oddly, or not, nobody on the "progressive" sites seems to be applying their undoubtedly superior critical thinking skills to ObamaCare's rollout at all.) Richard Pollock, Washington Examiner:

States and insurance companies are supposed to use an "Actuarial Value" calculator. The actuarial value measures benchmarks for the four state standardized plans.

An AV value of 60 means the state plan covers 60% of the costs and enrollees pay 40%. The four plans range from 60% to 90% coverage.

Employers are to use a "Minimum Value" calculator, which assesses whether an employee health plan meets minimal federal criteria.

CMS released "beta" versions of the calculators in November 2012 and a "final" calculator this February.

The most glaring problem, according to users, is that the calculators do not reflect real world conditions.

Paul Hencoski [is] a lead partner at KPMG, the audit and accounting firm [which] represents 19 states trying to set up health care exchanges.

"There's been some question around the results they've been getting. And whether they represent the true actuarial value of what was being offered, Hencoski told The Washington Examiner.

Julie Peper, a senior consulting actuary at Wakely Associates in Denver, CO whose firm is advising Oregon, Vermont and Massachusetts agrees. "There are some things that are different in the AV calculator than what will be in practice," she said.

Mark Jamilkowski, director of KPMG's actuarial services practice told The Washington Examiner the situation is so acute "There are some states we know of that are interested in launching their own calculator."* KPMG would not identify the states.

Insurance brokers who assist employers say the MV calculator contains flaws too. Susan Rider, an account executive with the Indianapolis brokerage firm of Gregory & Appel told The Washington Examiner, "they don't ask the right questions. There are a lot of things missing from it that I as a broker look for in a plan."

Rich Stover, a partner with New Jersey-based Bucks Consulting, an actuarial firm, says the MV calculator is so rigid it cannot accept special features in large employer plans.

CMS declined to be interviewed for the story. Never a good sign. Read below the fold...

(I should start by saying that this is a report from Jackson-Hewitt, and it couldn't have been more clear to me from my H&R Block experience this year that the tax preparers want a piece of the action from ObamaCare's stream of rents. I mean, here's the screaming headline on their corporate site: "April 15 is Now the Most Important Day in Healthcare.") That said, this report seems to make some good points. From the executive summary:

• More than one in four uninsured Americans eligible for the new premium assistance tax credits under the ACA does not have a checking account. Among the uninsured, non-elderly population with household incomes in the tax credit eligible range, 27 percent are effectively “unbanked.”

• Many insurance companies plan to require customers to pay premiums automatically through a checking account. While such restrictions may help insurers reduce administrative costs, unbanked customers will not be able to pay their required share of insurance premiums. Though contrary to the spirit and intent of the ACA, such restrictions are permissible under current federal guidance absent a policy clarification

• These restrictions will undermine efforts to expand health coverage under the ACA. Requiring enrollees to pay their premiums using a checking account would effectively deny coverage to the more than eight million unbanked Americans who are otherwise eligible for the new tax credits under the ACA. Unless addressed, such restrictions may hollow out the ACA’s expansion of coverage.

• The impact will be especially large among African Americans and Hispanic Americans, who are over 40 percent more likely to be unbanked relative to white residents in the same income category. This is particularly concerning given the existing disparities in access to health coverage and health status for minority groups. Further, as many as five million veterans and other Americans who receive federal benefits on prepaid debit cards may not be able use those same cards to pay their premiums for federally- subsidized insurance.

• The impact on the unbanked will be disproportionately large in states where the federal government operates a health insurance marketplace. Federal marketplaces will operate in 11 of the 12 states with the highest proportion of unbanked among those eligible for tax credits.

Hilariously, the administration is especially targeting Hispanics in the rollout. Jackson-Hewitt does have a solution: Read below the fold...

Sarah Kliff makes a good argument:

When Medicare launched, nobody had any clue whether it would work
Back in 1966, as Medicare was just about to launch, nobody knew whether the new program would provide benefits to millions or fail completely. Sound familiar?

Johnson signed Medicare into law July 30, 1965. Benefits would become available July 1, 1966. That gave the Johnson administration less than a year to reach 19 million seniors. Medicare was, as the New York Times put it in April 1966, bracing “for M-Day.”

The federal government launched “Project Medicare Alert,” a program that hired 5,000 workers to enroll seniors in Medicare. The “$2 million crash effort,” as described by The Post, was meant to “inform isolated elderly Americans of the availability of Medicare benefits.” Workers, hired for a 20-week stint, were paid $1.25 per hour.

On the whole, however, the enrollment effort worked. Of the 19 million seniors eligible for Medicare, 93 percent enrolled by the summer of 1966. Social Security Administration Commissioner Robert Ball “enlisted the U. S. Forest Service to send Forest Rangers out into the woods in search of elderly hermits whom he might be able to enroll.” And, much to Wonkblog’s liking, he held news conferences with charts that showed Medicare’s enrollment levels.

However, I think the analogy is a little superficial. Read below the fold...

It randomly rotated into place, and I thought, Wait a minute, I don't remember that one.... Read below the fold...

Rahm's little brother Zeke takes up some space in the Journal:

Setting up the exchanges will pose a host of technological challenges, such as digitally linking an individual's IRS information (which determines a subsidy level) to the insurance offerings in the individual's home area and to employment data [and DHS data for citizenship* and credit reporting data] —while simultaneously factoring in Medicaid eligibility [which varies by state].

Bugs in the computer software are bound to pop up, and the quality of the user experience will undoubtedly need improvement. ... But IT problems aren't the ones that should keep you up at night. Such glitches will be ironed out within a few years, and certainly by 2016 browsing your health-insurance exchange will be very much like browsing Amazon and other online shopping sites.

That's their story and they're sticking to it.** So now to the Young Invincibles, who are key to the success of ObamaCare: Read below the fold...

WSJ:

Employers Eye Bare-Bones Health Plans Under New Law
Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage.

Benefits advisers and insurance brokers—bucking a commonly held expectation that the law would broadly enrich benefits—are pitching these low-benefit plans around the country.

The idea that such plans would be allowable under the law has emerged only recently. ... Many employers and benefits experts have understood the rules to require robust insurance, covering a list of "essential" benefits such as mental-health services and a high percentage of workers' overall costs. ... The idea that such plans would be allowable under the law has emerged only recently. Some benefits advisers still feel they could face regulatory uncertainty. The law requires employers with 50 or more workers to offer coverage to their workers or pay a penalty.

Many employers and benefits experts have understood the rules to require robust insurance, covering a list of "essential" benefits such as mental-health services and a high percentage of workers' overall costs. Many employers, particularly in low-wage industries, worry about whether they—or their workers—can afford it.

But a close reading of the rules makes it clear that those mandates affect only plans sponsored by insurers that are sold to small businesses and individuals, federal officials confirm. That affects only about 30 million of the more than 160 million people with private insurance, including 19 million people covered by employers, according to a Citigroup Inc. C +0.29% report. Larger employers, generally with more than 50 workers, need cover only preventive services, without a lifetime or annual dollar-value limit, in order to avoid the across-the-workforce penalty.

Hilarity ensues! Read below the fold...

WaPo's Editorial Board:

Obamacare’s tricky next phase

Yeah. Implementation. Read below the fold...

Forgot to renew the domain! Read below the fold...

No image! Still on the borage, or squash, or whatever the heck they are, I was happy to see some sudden little pale green tendrils in the same general area from, I hope, some self-seeded plants from the wildflower mix l planted last year, and very successfully, too. Actually, let me add a picture, since that will show how this bed should be in a month or two, if what was growing there last year comes back:

Read below the fold...

The bus company for the downwardly mobile (as for example).

From (I love the source) Art in America:

Cooper Occupation Exceeds One-Week Mark
In the latest development in an ongoing conflict, students at New York's Cooper Union have occupied the office of school president Jamshed Bharucha for a full week. They have vowed to continue their protest until Bharucha steps down. "It's very evident that he does not believe in the mission of the school," second-year art student Angus Buchanan-Smith told A.i.A. during a visit this week to the East Village college.

So they have a demand. Read below the fold...

Citizen's Council for Health Freedom, reader-funded attendance at an ObamaCare conference in DC

"States haven't made a lot of progress yet in connecting to the data hub; systems don't 'talk' to each other. Hope that systems will be in place perhaps by 2015." -- Susan Dentzer, RWJF

"Will they be ready? No one knows the answer to that. There's a political and a technical consideration...If a state chooses not to cooperate, then it's very difficult for the feds to put up a very successful, exchange in a state." -- Brett Graham, Leavitt Partners.

"It's a three year implementation being done in 10 months. By its nature, it's unrealistic." -- Keven Counihan, Access Health CT

"The truth is, it's not going to be fully functioning on 10-1" -- Christine Ferguson, RI (Exchange)

"And October 1 is very very soon." -- Cynthia Crose, Arkansas Insurance Dept.

"I don't know what happens this fall if it's not ready. -- Sandy Praeger, NAIC

Oh, I know what happens: Obama makes a massive public relations push, says "it's ready," the career "progressives" chime in, and our famously free press rolls over (and what do any of them care, becaue they're already covered! Read below the fold...