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ObamaCare

healthcare.gov opens at midnight on the day of the government shutdown and lambert finds a bug

[And if you have your own experiences to share, and especially screen dumps, please add them in comments or contact me. Either Federal Exchanges, or state exchanges. I'm especially interested in Covered California! Thank you! --lambert]

Nice timing.

john.smith@gmail.com from Maine had a registration #FAIL at step 3. Here's the screen dump:

Read below the fold...

ObamaCare clusterfuck: Engineers, then and now

Here's the story of how one engineer made sure the United States chose the right engineering strategy for the Apollo moon landing project:

[John C. Houbolt's] efforts in the early 1960s are largely credited with convincing NASA to focus on the launch of a module carrying a crew from lunar orbit, rather than a rocket from earth or a space craft while orbiting the planet.

Houbolt argued that a lunar orbit rendezvous, or lor, would not only be less mechanically and financially onerous than building a huge rocket to take man to the moon or launching a craft while orbiting the earth, but lor was the only option to meet President John F. Kennedy’s challenge before the end of the decade.

NASA describes “the bold step of skipping proper channels” that Houbolt took by pushing the issue in a private letter in 1961 to an incoming administrator.

“Do we want to go to the moon or not?” Houbolt asks. “... why is a much less grandiose scheme involving rendezvous ostracized or put on the defensive? I fully realize that contacting you in this manner is somewhat unorthodox, but the issues at stake are crucial enough to us all that an unusual course is warranted.”

So, fast forward to ObamaCare. Read below the fold...

ObamaCare Clusterfuck: If you've got leukemia and good coverage, wait, and your policy will hit the lowest common denominator

An interesting paper from Millman, Inc (a provider of actuarial services):

2014 Individual Exchange Policies in Four States: An Early Look for Patients with Blood Cancer
The ACA rules do permit variation among exchange plans, and these variations can be significant for services important to people with blood cancer.

This variation among plans is high in the initial 2014 exchange launch, but the authors believe it may diminish in future years as competing insurers converge toward lower-cost and more restrictive features.

So if you like your plan, you won't be able to keep it. Read below the fold...

ObamaCare Clusterfuck: About the 8 million

(Wonkblog has improved since Ezra Klein went elsewhere, interestingly.) WaPo:

Last summer, the administration had hoped that 40 percent of exchange enrollees would be between 18 and 34, based on the Congressional Budget Office's estimates that 7 million people in all would enroll in 2014. Instead, the administration got 28 percent, which the White House and supporters very eagerly pointed out Thursday was nearly identical to youth enrollment in the first year of the Massachusetts health-care law that Obamacare was based on. ...*

The 2014 enrollment stories aren't over, however. We're still waiting to find out at least the following: How many purchased coverage off the exchanges, how many paid their premiums, what kind of coverage they purchased, how many joined Medicaid because of the expansion and more.

Yep. Read below the fold...

ObamaCare: ObamaCare's mental health coverage

One of ObamaCare's features not often touted is that mental health coverage is one of the essential benefits. Unfortunately, mental health coverage has all of ObamaCare's other coverage problem, except moreso. About the benefits:

Long-awaited improvements in insurance coverage for mental conditions and addictions are expected to become more widely available this year as a result of two major steps that the Obama administration has taken.

The president’s signature Affordable Care Act includes mental health care and substance abuse treatment among its 10 “essential” benefits, which means plans sold on the public health care exchanges must include coverage.

In addition, rules to fully carry out an older law — the Mental Health Parity and Addiction Equity Act of 2008 — were issued in November, after a long delay. The parity law says that when health insurance plans provide coverage for mental ailments, it must be comparable to coverage for physical ailments. For instance, plans cannot set higher deductibles or charge higher co-payments for mental health visits than for medical visits, and cannot set more restrictive limits on the number of visits allowed.

So far, so good. So, knowing what we know about ObamaCare, what would be the first question to ask? Read below the fold...

ObamaCare Clusterfuck: Democrat hack Joan Walsh makes Ezra Klein look like a paragon of integrity

It wasn't easy! Yeah, I subscribe to Salon's news feed, so every once in awhile I hold my nose and click through to Joan Walsh, "progressive":

Ezra Klein trolled the right by declaring that it means “Obamacare has won,” which is pretty funny given that he helped lead the national freak-out over Healthcare.gov’s troubles back in October.

Read below the fold...

ObamaCare Clusterfuck: Obama throws Sebelius under the bus, brings in a Rubinite

Politico:

Health and Human Services Secretary Kathleen Sebelius is resigning six months after a disastrous rollout of President Barack Obama’s signature health law, according to administration sources.

On Friday, Obama will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace her.

Sebelius, 65, gave no hint of her imminent departure as she testified Thursday before a Senate panel.

So, did she fall or was she pushed? I say pushed: Read below the fold...

mellon's picture

The bad actors in Washington can't even be original. Will the same-old 1994 good cop/bad cop scheme succeed again in 2014?

Assuming the reader has already read the two papers linked at the bottom, and keeping in mind the made for TV drama now playing itself out in Washington, now, please take a look at The Selling of "Clinton Lite", by Trudy Lieberman, from the March/April 1994 issue of Columbia Journalism Review, Read below the fold...

ObamaCare Clusterfuck: Paul Krugman's TINA hackery on single payer becomes floridly delusional

Get a load of this:

And as Sahil Kapur reports, at least a few of them are coming to a terrible realization: there is no alternative [TINA]. You can’t just support the popular pieces of reform, in particular coverage for preexisting conditions, and scrap the rest. As Jonathan Gruber taught me, and I and others have said many times, reform is a three-legged stool that requires community rating, the individual mandate, and subsidies; take away any leg and it collapses. And Kapur finds a GOP aide who admits to the awful truth: any workable GOP plan would look pretty much the same as Obamacare.

There is an alternative, even for Republicans: Read below the fold...

ObamaCare Clusterfuck: NEJM: ObamaCare delays "appear to exceed the traditional scope of the President's enforcement discretion"

Shorter: They're illegal.* The New England Journal of Medicine, the gold standard:

The Legality of Delaying Key Elements of the ACA
In the administration's view, the delays are a routine exercise of the executive branch's traditional discretion to choose when and how to enforce the law. As the Supreme Court noted in its 1985 decision in Heckler v. Chaney, 1 an executive agency “generally cannot act against each technical violation of the statute it is charged with enforcing.”

Read below the fold...

ObamaCare Clusterfuck: Will there be double-digit price increases in 2015, or will there be even crappier plans?

Insurance industry insider Bob Laszewski writes:

To properly price the exchange health insurance business going forward the carriers have to sharply increase the rates. A senior executive for Wellpoint, which sells plans in 14 Obamacare exchanges, is quoted in a Reuters article telling Wall Street analysts there will be big rate increases in 2015, "Looking at the rate increases on a year-over-year basis on our exchanges, and it will vary by carrier, but all of them will probably be double digits."

If the health plans do issue double digit rate increases for 2015, Obamacare is finished.

There are a ton of things that need to be fixed in Obamacare. But, I will suggest there is one thing that could save it.

Crapify the plans! Read below the fold...

ObamaCare Clusterfuck: Obama claims 6 million sign-ups, but as usual the numbers are soft

KHN:

The Congressional Budget Office originally estimated that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million. Federal officials have said they do not yet know how many people who have enrolled have paid their first month’s premium. Insurance industry officials have reported that about 70 to 80 percent of enrollees have paid.

So, the lowballed 6 million figure is really 6,000,000 * 80% = 4,800,000. But KHN misses the key point! Read below the fold...

ObamaCare Clusterfuck: Jon Walker discovers that rentiers charge rent

FDL:

[T]his working paper from Mark Duggan, Amanda Starc, Boris Vabson is about Medicare Advantage I think its provides some insight into the core problem with the entire design of the Affordable Care Act’s coverage expansion. It looks at what was the result off the government overpaying for seniors in Medicare Advantage, which is an exchange where seniors shop for subsidized private insurance. From the summary:

Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in [Medicare Advantage] plans. Our findings also reveal that only about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures.

If you spend a lot of money on a Rube Goldberg [hat tip, DCBlogger] system with middle middlemen some benefits will trickle down to regular people but huge amounts of money will be eaten up in profits and waste.

I don’t doubt the Affordable Care Act will actually help some people, but at an exorbitantly inflated price because of how inherently wasteful the design is. This creates a needless burden for all taxpayers and premium payers on the exchanges.

If only we had known this when ObamaCare was being passed! Read below the fold...

ObamaCare Clusterfuck: I'm not the only one saying ObamaCare is like a maze for lab rats

Here's the graphic that Kaiser (!!) is using:

Read below the fold...

ObamaCare Clusterfuck: Obama relaxes the deadline for the individual mandate

Bob Laszewski was right. WaPo:

The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.

Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension.

Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.

Nudge nudge wink wink. Boy, I bet all the people who took the mandate seriously are feeling pretty stupid right now. Read below the fold...

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