1:05 p.m.: TIME contributor Eben Harrell is walking around Boston and emailed this observation: “Almost every business is closed. The ‘shelter in place’ guidance has essentially shut down a major American city. It creeps me out how easy it has become to [paralyze] the entire city.”
Update: An earlier version of this post included comments by TIME stringer Eben Harrell that have been revised [note the lack of agency]. The original post stated that “It creeps me out how easy it has become to [paralyze] the entire city — after all that talk of ‘tough’ Boston.” Harrell says, “As a Bostonian who has witnessed first-hand the incredible resilience of this city, I was attempting to question whether the lock down was too restrictive and whether the police should just let Boston be Boston.”
I don't expect the implementation of Obamacare to go smoothly. It's big, it's complex, it's underfunded [huh?]*, and Republicans desperately want it to fail. This makes problems inevitable. Nevertheless, pouncing on every reported hitch as a harbinger of doom is taking schadenfreude too far. HHS has consistently claimed that they'll be ready to go by October 1. Maybe that's overoptimistic. But although it will probably take several years for Obamacare's uptake rate** to reach its goal***, I'll bet that by this time next year it will be up and running and basically doing its job. It's a little early to be writing its obituary.
A caveat:* The actual premiums health insurance companies will charge for plans sold on the exchanges isn't yet known and will vary widely based on where people live, how old they are and other factors. Insurers in Vermont and in Rhode Island have projected their premium increases for 2014 with wildly different results.
In other words, the "handy online calculator" is at best a toy, and at worst monstrously deceptive. I mean, support some trusting soul who makes like $10 an hour at Walmart uses Kaiser's calculator to make financial decisions for 2014 today, the calculation turns out to be wildly wrong, and they've got no margin to recover from the error? What do they do? Email Kaiser's programmer and ask for an apology? And that's not such a far-fetched scenario. Read below the fold...
We surveyed families participating in unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority, an exchange created prior to the 2010 national health reform law, and found high levels of financial burden and higher-than-expected costs among some enrollees. The financial burden and unexpected costs were even more pronounced for families with greater numbers of children and for families with incomes below 400 percent of the federal poverty level. We conclude that those with lower incomes, increased health care needs, and more children will be at particular risk after they obtain coverage through exchanges in 2014. Policy makers should develop strategies to further mitigate the financial burden for enrollees who are most susceptible to encountering higher-than-expected out-of-pocket costs, such as providing cost calculators or price transparency tools.
Wow, shocker. Remember that MA Connector was the first implementation of the Heritage Plan that was designed to head off single payer and later became ObamaCare, and that whenever ObamaCare supporters wanted a success story, they would point to it. Read below the fold...
Let me begin by admitting that the top-grade ObamaCare plan -- available only to the most virtuous -- is not Gold, but Platinum.* I don't know how I've been missing Platinum; I must have been thinking Olympic medals, not credit cards. Anyhow, the plan for losers for minimum coverage is still Bronze. Alrighty then. So how are we citizenshapless dupes consumers supposed to compare plans and, by making informed choices in the marketplace, do our bit to bring heath care prices down? Kaiser explains [PDF], and by "explain" I mean "embarks on a lengthy explanation that involves three studies." The paper is from 2011, but the analysis is still good:
The ACA identifies a range of services that must be included in the benefits package that all individual and small business plans must use – and requires preventive services to be covered with no patient cost-sharing – with further details to be developed by the Secretary of Health and Human Services (HHS). These requirements apply to all tiers of health insurance coverage, meaning that differences in the levels of coverage will reflect variation in cost-sharing, not differences in the underlying benefits.
The ACA specifies that beginning in 2014 insurance newly sold to individuals and small businesses in an Exchange or otherwise must be at one of four actuarial value levels: 60% (a bronze plan), 70% (a silver plan), 80% (a gold plan), and 90% (a platinum plan).
These tiers do not apply to coverage already in existence meeting certain conditions (so-called "grandfathered" plans). The ACA also requires that plans cap the maximum out-of-pocket costs for enrollees, based on the out-of-pocket limits in high-deductible plans that are eligible to be paired with a Health Savings Account.
The current limits are $5,950 for an individual and $11,900 for a family, and will be adjusted over time after 2014 based on increases in premiums.
Now, I know you're dying to know what "actuarial value" is, because last I checked, I don't have any of that in the coffee can on the kitchen table with the money, if any, in it, so I'm curious to know if ObamaCare is going to tell me what I'm going to have to actually pay, as opposed to making me set up a some kinda spreadsheet to figure out what I might pay, some day, if I can wrestle it out of the kindly call center folks if and when they ever pick up the phone: Read below the fold...
While many young adults are now covered by the Affordable Care Act, able to remain on their parents' insurance until age 26, the rules are different for those like Cox-Reed, who grew up in the foster care system.
There are more than 400,000 children in foster care in the United States, the Department of Health and Human Services said last year. All are provided with health care coverage as long as they are wards of the state.
When foster kids turn 18, they age out of the system and instantly lose their coverage.
That's about to change, when another part of Obamacare takes effect on January 1, 2014. Medicaid coverage will be extended for former foster youth until they reach 26, as long as the individual was in foster care and enrolled in Medicaid until the age of 18.
Chao was frank about the stress and tension of the compressed time frame involved in setting up the exchanges. “We are under 200 days from open enrollment, and I’m pretty nervous,’’ he said. “I don’t know about you,” he added, to murmurs from the insurance industry audience. Members peppered Chao and Cohen with many questions about the format for the health care policies they will [will?!?!] submit to HHS for approval so the plans can be marketed in the exchanges.
Chao said the main objective is to get the exchanges up and running and signing up the uninsured.* “The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” he said. “Let’s just make sure it’s not a third-world experience.”
Well, dear Lord. I know that you can't buff a turd, so I don't envy Chao's job overseeing ObamaCare (with all the needless complexity and dysfunction that comes from trying to integrate a parasitical and anti-health insurance system for profit system not only with non-profit Medicaid, but (to determine eligibility) the IRS and the DHS, not to mention 17 separate state health exchanges). But any UX ("User Experience") designer will tell you Chao is totally off base. Uber UX guy Jacob Neilson on fonts: Read below the fold...
At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.
We keep hammering on this problem: Too damn many buckets to throw people into, and too many damn people who fall between buckets, or not into any bucket at all.
Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans—which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.
That's not a bug. It's a feature. The suffering and desperation of some make the others all the more anxious to get what they can. It's like a "Reserve Army of the Uninsured."
It's not a question of whether some individuals can "afford" care; it's a question of whether the whole country can "afford" this health care system, which ObamaCare does not change, except insofar as it loads up the system with more fragmentation and inefficiency. Read below the fold...