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ObamaCare clusterfuck

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: Howard Dean throws Gruber (and by extension Obama (and Clinton)) under the bus

This is interesting. Mediaite:

Reacting Wednesday to the now-infamous “Gruber video,” former DNC chair Howard Dean said it demonstrates how the Affordable Care Act was written by “elitists” who don’t understand America.

MSNBC’s Morning Joe played the 2013 clip of Obamacare consultant Jonathan Gruber explaining that a “lack of transparency” and “the stupidity of the American voter” helped get the 2010 health care law passed. Asked for his reaction by Mika Brzezinski, Dean went off:

The problem is not that he said it. The problem is that he thinks it. The core problem under the damn law is it was put together by a bunch of elitists two don’t fundamentally understand the American people. That’s what the problem is.

Dean was a long-time proponent of single-payer health care, rather than the standard insurance-based American system or its legislative overhaul.

Read below the fold...

ObamaCare Clusterfuck: Obama destroys public support for universal coverage

NEJM:

Over the past decade, there has been a cultural shift in Americans' attitudes about the principle of universal health care coverage, one of the main rationales for the ACA. In 2007, during the presidential primary season, public support for the view that the federal government has a responsibility to make sure all Americans have health insurance coverage was at 64% (Gallup, 2007). By 2014, this number had declined to 47% (Pew, January–February 2014). In addition, there has been a decline in overall public trust in the federal government to handle domestic problems such as health care from 51% in 2012 to 40% in 2014, which may also play a role in depressing public support for the ACA (Gallup, September 2014).

Now, to be fair, NEJM goes on to attribute this drop to paid advertising by ObamaCare opponents: Read below the fold...

ObamaCare Clusterfuck: Marketplace "consumers" denied the information they need to shop

The Times:

With health insurance marketplaces about to open for 2015 enrollment, the Obama administration has told insurance companies that it will delay requirements for them to disclose data on (1) the number of people enrolled, (2) the number of claims denied and (3) the costs to consumers for specific services.

For months, insurers have been asking the administration if they had to comply with two sections of the Affordable Care Act that require “transparency in coverage.”

In a bulletin sent to insurers last week, the administration said, “We do not intend to enforce the transparency requirements until we provide further guidance.” Administration officials said the government and insurers needed more time to collect and analyze the data.

The mind boggles, doesn't it? Remember, the whole (flawed) rationale for ObamaCare (assuming good faith) was that consumers, by shopping in the marketplace, would bring costs down by forcing competition on insurers[1]. Suppose -- bear with me, here -- I were ordering health insurance from Amazon.com; not so far fetched when you remember Obama compared using the marketplaces to buying a flat screen TV at Best Buy. At Amazon, you'd see (1) how many people bought the product ("the number of people enrolled"), (2) whether the shipper actually delivered on the product ("number of claims denied"), and (3) how much the product costs ("the costs to consumers for specific services"). On this last, yes, I know services are supposed to be covered by the policy, but with narrow networks and formularies, along with high deductibles and co-pays, it's hard to know. For example, I'd want to make damned sure, with a high-priced procedure, that the service provider was in network. Price breakouts would help with that.)

So, Obama wants you to be a smart shopper; he just doesn't want to give you the information that would make you smart (again, assuming the idea that shopping makes you a better consumer of health care works, which it doesn't). That's some catch. Read below the fold...

ObamaCare Clusterfuck: Covered California gives no-bid contracts to cronies

Corrente readers could see this coming in May 2013: "California exchange spending and contractors exempted from open records law". I'm sure there are plenty of rationalizations for exemptions like that, but it's hard to think of any good reasons. And so we come to today's story from AP:

AP Exclusive: California gives no-bid health pacts

LOS ANGELES (AP) -- California's health insurance exchange has awarded $184 million in contracts without the competitive bidding and oversight that is standard practice across state government, including deals that sent millions of dollars to a firm whose employees have long-standing ties to the agency's executive director. ...

Several of those contracts worth a total of $4.2 million went to a consulting firm, The Tori Group, whose founder has strong professional ties to agency Executive Director Peter Lee, while others were awarded to a subsidiary of a health care company he once headed.

Awarding no-bid contracts is unusual in state government, where rules promote "open and fair competition" to give taxpayers the best deal and avoid ethical conflicts. The practice is generally reserved for emergencies or when no known competition exists. ...

The agency confirmed some no-bid contracts were awarded to people with previous professional ties to Lee, but emphasized Covered California was under pressure to move fast and needed specialized skills.

What a steaming load of crap. They had four years to build the system,[1] and "specialized skills" are always a rationalization for cronyism. I mean, come on. The bidding process is meant to find out if the needed skills really are all that specialized! Read below the fold...

ObamaCare Clusterfuck: Federal judge strikes down subsidies in states without their own exchanges

Modern Healthcare:

In a legal setback for the Obama administration, a federal judge in Oklahoma ruled Tuesday that people in states that rely on the federal insurance exchange are not eligible for Obamacare premium subsidies to help them pay for coverage.

Judge Ronald White, a George W. Bush appointee, invalidated an Internal Revenue Service rule interpreting the Patient Protection and Affordable Care Act to allow the premium tax credits in states that have not established their own exchange. “The court holds that the IRS Rule is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law,” White wrote.

In his ruling, White rejected the argument that striking down the subsidies would cripple the entire healthcare reform law. “Congress is free to amend the ACA to provide for tax credits in both state and federal exchanges, if that is the legislative will,” he wrote.

Exactly. I have to say it, I'm with the conservative lunatics on this one (regardless of their motivations). If you want to have the rule of law, then you need to write the law so you aren't reduced to saying "But I really meant that!" when people read it, and the administration really did (modulo conspiracy theories) butcher the drafting.[1] There are other cases in the works: Read below the fold...

ObamaCare Clusterfuck: Getting sucked into ObamaCare is a lot like being on probation

I got a cheery note in the mail from HHS about "life changes" that the grateful recipients of ObamaCare must "report"[1] the following "life changes." Be on the lookout for the real piece of fuckery, because it's not obvioius at first glance:

Life changes to report

You must report a change if you:

  • Get married or divorced

  • Have a child, adopt a child, or place a child for adoption

  • Have a change in income

  • Get health coverage through a job or a program like Medicare or Medicaid

  • Change your place of residence

  • Have a change in disability status

  • Gain or lose a dependent

  • Become pregnant

  • Experience other changes that may affect your income and household size

  • Other changes to report: change in tax filing status; change of citizenship or immigration status; incarceration or release from incarceration; change in status as an American Indian/Alaska Native or tribal status; correction to name, date of birth, or Social Security number.

When and how to report changes

You should report these changes to the Marketplace as soon as possible.

If these changes qualify you for a special enrollment period to change plans, in most cases you have 60 days from the life event to enroll in new coverage. If the changes qualify you for more or less savings, it’s important to make adjustments as soon as possible.

Important: Do not report these changes by mail.

You can report these changes 2 ways:

  • Online. Log in to your account. Select your application, then select “Report a life change” from the menu on the left.

  • By phone. Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

Learn more from the IRS about how changes can affect the premium tax credit you may be eligible for.

Look. Wouldn't it be simpler if they just make ObamaCare recipients wear ankle bracelets?

As for the mindfuckery: Read below the fold...

ObamaCare Clusterfuck: Be sure to record EVERYTHING when you talk to your insurance company rep AND your ACA marketplace rep

Here's cheerful little horror story (and little horror stories are all we've got right now, because heaven forfend HHS or CMS or our famously free press or even Congress gather any aggregate data about quality of service). And do note the only reasons this citizen got any satisfaction is that (a) he recorded both flavors of weasel, the ObamaCare rep who did the sales job, and the health insurance rep who tried to deny the care, and (b) he could go to the press, once he had the recordings. Read below the fold...

ObamaCare Clusterfuck: Doctors moving north to single payer Canada

And why? Outright looting by insurance companies. PNHP, quoting the Canadian Medical Journal:

ORONTO -- With the prospect of greater pay, fewer bureaucratic headaches and the opportunity to provide better care for patients, the number of American doctors migrating north is rising, according to Canadian recruiters and Canadian Medical Association data. Read below the fold...

ObamaCare Clusterfuck: Ginormous medical bills because Nevada Health Link can't fix a typo

Las Vegas Review-Journal:

The family’s troubles began in February, when Amber Smith delivered daughter Kinsley five weeks prematurely. Kinsley spent 10 days in Summerlin Hospital’s neonatal intensive care unit, and Amber’s 40-day hospital stay included two surgeries.

The Smiths bought insurance from Anthem Blue Cross through Nevada Health Link in October and made two premium payments in January. Yet the claims are being denied because Amber’s birth year is listed incorrectly on the family’s insurance identification cards, Smith said. It’s one year off — written as 1978, when it should be 1979.

What a shocker. Health insurance companies will do anything to deny care when the bills get large. This is just rescission under another name! Like for post-existing conditions....

Nor has Smith been able to get baby Kinsley added to the family’s insurance, despite “dozens of calls” to Nevada Health Link and Anthem. So despite never missing a $1,300 premium payment, the Smiths are on the hook for all of Kinsley’s follow-up care. What’s more, some of Amber’s specialists have unexpectedly [oh?] abandoned provider networks, leaving the family with unexpected out-of-pocket expenses, he said.

The family’s grand total? Roughly $1.2 million.

That's a lot of money! And it's a two-fer! Not only denial for a post-existing condition, a narrowing network! Ingenious. And the Smiths aren't the only ones: Read below the fold...

ObamaCare Clusterfuck: Kayfabe continues, as Republicans fall in line with Democrats against single payer

I mean, come on. You don't think all those Republican votes to abolish ObamaCare meant anything, did you? Red meat for the base, purely. Even if the Democrats lose the Senate in 2014[1], Obama's got the White House 'til 2016, and the veto pen. If the Republicans were serious, they'd have held hearings about the ObamaCare website debacle, and asked -- as we asked -- "What did Obama know, and when did he know it?" And so what hearings are they holding now? That's right: Hearings that show problems in a single payer system. Isn't this all just a little transparent? Read below the fold...

ObamaCare Clusterfuck: If you want to control a Flexian infestation, don't leave food out in the open

From an earlier discussion of Flexians at work and play:

[Janine R.] Wedel's two key concepts [in Shadow Elite] are "flex nets" and "flexians" (I like "flexian" because it sounds like a breed of alien reptiles that I, for one, welcome, except not). I think the strength of the book will come in the examples of actual flex nets, but since I'm not all the way through it, I'll just quote the introduction on the concepts. Page 15 and following.

Beyond old boys

Like interest groups and lobbies, flex nets serve a long-established function in the modern state--negotiating between official and private. But while flex nets incorporate aspects of these and other such groupings, they also differ from them in crucial ways--and those ways are precisely what make flex net less visible and more accountable.

Four key features define both flexians as individuals and those influencers who work together as a flex net. Flexians functioning on their own exhibit the modus operandi embodied in all four features discussed below, as does a flex net as a whole. Because members of a flex net benefit from the actions of the collective, pooling resources and dividing labor, not all members of the flex net must exhibit these features individually.

Before getting to the four features (below), a pause to note that Flex Nets/Flexians arguably subsume/supersede notions like corruption, "money in politics," "the revolving door," and so forth. (Nancy DiParle is, I think, the candidate for Flexianhood we might be most familiar with: Wellstone VP -> Baucus CoS -> White House -> Big Pharma, leaving a trail of ruin and destruction, if you're a citizen or a patient, that is. We'd need to know more about her network, though).

And the four features:

[#1] Member of a flex net... form an exclusive informal network that serves as an intricate spine -- the corresponding (first) feature of flex nets. Flex nets draw their membership from a limited circle of player who interact with each other in multiple roles over time, both inside and outside government, to achieve mutual goals. While their roles and environments change, the group provides continuity. .... Members of what I call the Neocon core, an informal group of a dozen or so members and a successful flex net, have worked with each other in various incarnations for some thirty years to realize their golas for American foreign policy via the assertion of military power...

When such influencers work together in a flex net, they [#2] exhibit shared conviction and action -- the corresponding second feature of flex nets. ... Members of a flex net act as a continuous, self-propelling unit to achieve objectives that are grounded in their common worldview, and to brand that view to the public.

The corollary to flexians' juggling roles and representations is that [#3] members of a flex next form a resource pool -- the corresponding third feature of a flex net. The influence of a flex net derives in part from its members' effort to amass and coordinate both material and interpersonal resources. ... The Neocon core, for instance, is an example of how a ready-made network of players with its own private agendas can straddle a state-private seesaw...

Collectively, [#4] members of a flex net help create a hybrid habitat --- their corresponding fourth feature. A flex net's strength lies in it coordinated ability to reorganize governing processes and bureaucracies to suit the group's purposes.... As flex nets infuse governing with their supple, personalized, private-official networks, they transmogrify their environment, whether temporarily or more lastingly. While these groups might call to mind old notions such as conflict of interest, they illustrate why such labels no longer suffice. As a Washington observer sympathetic to the neo-conservatives aims told me, "There is no conflict of interest, because they define the interest." ....

(The key to spotting a Flexian, it seems, is to watch for the way they blur public and private and create a hybrid habitat; that what makes their Flex Nets different from the kind of personal network one sees on LinkedIn. It feels to me like spotting a Flex Net is a research project; I welcome suggestions from readers on how to do it, because I don't see how, right away.)

The excellent Health Care Renewal shows Flexians in transition , listing Robert Gibbs (Obama's former press secretary -> "consultant"), Daniel Fabricant (FDA -> dietary supplement shill), Brendan Buck (House Speaker John Boehner’s spokesman -> AHIP), and Rachel Sherman (FDA -> drug consulant). Note that, as good Flexians, these people will all return to "public service" at some future date, even if we can never be quite sure which public they serve. HCR summarizes: Read below the fold...

ObamaCare Clustefuck: Be sure to record any conversations you have with your insurance company

Via PNHP:

In their complaint filed in California state court on Wednesday, San Francisco residents John Harrington and Alex Talon accused Blue Shield of misrepresenting that their plans, sold on California's health exchange, would cover the full provider network advertised on the company's website.

They sued on behalf of a class of people who had purchased so-called "preferred provider organization" plans from the insurer only to realize that the doctor and hospital networks for their plans were limited.

Harrington bought a so-called silver plan on California's online exchange while Talon bought a platinum plan through the insurer's website. They said they made their choices based on Blue Shield's alleged representations that their doctors would be covered.

After receiving medical treatment numerous times between January and March, Harrington and Talon later discovered that their providers were not covered, forcing them to pay the charges out-of-pocket, the complaint said.

So, it's not just the narrow networks, it's that the insurers conceal how narrow the networks really are.

And: Read below the fold...

ObamaCare Clusterfuck: Medicare doesn't need a "CEO" because it's a simple, rugged, and effective single payer system, not an insanely complex Rube Goldberg device

Get a load of this from Reuters:

Exclusive: Obama allies revive push for Obamacare CEO

Aside from the obvious "jobs for the boiz" aspect:

A group of healthcare experts close to the White House is urging the Obama administration to appoint a new chief executive officer to oversee Obamacare's online health insurance exchanges and safeguard the next open enrollment period that begins in six months.

The recommendation, in a report due to be released by the Washington-based Center for American Progress think tank, calls for a major shakeup within the U.S. Department of Health and Human Services, which presided over last year's disastrous rollout of the federal market portal, HealthCare.gov.

The idea would be to take the exchanges out of the current bureaucracy and put them in the hands of a CEO with private-sector experience who could run them as true e-commerce sites. The CEO would answer only to President Barack Obama and his intended new health secretary, Sylvia Mathews Burwell.[1]

So, the so-called "progressive" Center for American Progress is fully on board with the neo-gliberal idea that "government should be run like a business,"[2] eh? Market state, here we come! Read below the fold...

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