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ObamaCare Clusterfuck: Simplified application form is a bet on successful backend implementation

(Or, more precisely, given that ObamaCare now includes a massive PR component, perceived successful backend implementation). First, let's look at what Scott Gottleib of Forbes thinks is wrong with the form. Good description, wrong analysis:

The length of the old application was largely driven by the need to ensure that consumers were actually eligible for the government subsidies that Obamacare offers as a way to offset the cost of buying health insurance.

Stop right there. It's the eligibility determination that's the fundamental architectural flaw. It cannot be fixed. Americans have to be thrown into different buckets in a complex and confusing system of eligibility determination, and inevitable get thrown in the wrong buckets, or there aren't even the right buckets for them. Adding to the mix is that buckets differ by state, both legally and in terms of insurance markets, and so what should be a simple, national system of Medicare for All instead creates second-class citizens all over the place, both within and between states. Obama chose to go that route. Under a single payer system, where health care is a right, the eligibility paperwork is very simple. There is one form, and it's already been filled out: Your birth certificate. That's the real policy discussion that's being hidden under the discussion about the length of the form.

Back to the complexity:

Those 61 pages of the old application were mostly filled with questions to make sure that people were eligible to get the subsidies. The government needs to verify their income, and make sure that they aren’t eligible for health insurance at work.

Under Obamacare, the government also needs to verify that people aren’t eligible for other public health insurance programs like Medicaid or Veteran’s benefits before they receive subsidies to buy coverage on the exchanges.

Is anyone in your household eligible to get health coverage from Medicare? Tricare? The Peace Corps? Are there any “other state or federal health benefit program” that they may be able to tap for health coverage? Is anyone in your household pregnant, and therefore eligible for other kinds of government assistance?

These were the kinds of questions that the old, long form asked. There were also a host of questions designed to ferret out income that might have been “misreported” on your tax return. The new form does away with all these questions, asking simply whether or not your enrolled in another government health program or are eligible for any supplemental income. Gone, also, are the questions designed to ferret out discrepancies in the income you report to the Internal Revenue Service, or whether you are ineligible for the subsidies because of other kinds of supplemental income.

And you know what? I'm betting none of those questions have to do with whether you've got a few hundred million stashed offshore in the Cayman Islands.

The new form largely takes your word for it all.

No, it doesn't, but we'll get to that.

This leaves one of three possibilities:

First, that the government is willing to tolerate a lot of fraud and waste as subsidies flow to individuals who weren’t eligible for the money in the first place.

Or the government is going to rely on the states and the private health plans to ask the probing questions, essentially foisting the vetting process onto other entities so that these actors (and not the Feds) are the targets of any political backlash.

Or third and most likely, it’s some combination of each of these devices

Gottlieb is wrong. There's a forth possibility: Software is going to figure it out. Walter Hickey, Business Insider:

The earlier form required applicants to list deductions, relationship status, voluminous information about employers and other details.

Most of the effort in the new forms will be completed on the back-end by the exchange. All applicants have to do is provide basic information and a Social Security number, indicate which federal health care programs they're involved with, and list estimations of annual income.

In other words, Obama -- yes, Obama; the new form is clearly a White House public relations effort -- just bet the farm on the exchange back-end being right; 70% of all IT projects fail. I don't know how the Federal exchange is going (though "train wreck" does not inspire confidence). What I do know is that the CO state exchange is slipping schedule, due to problems with the eligibility engine.

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editor_u's picture
Submitted by editor_u on

The whole thing makes my brain cramp up.

Eligibility engine? Great term. Inspires confidence. I'm certain I will use the expression in the future. I hope not to fall into that machine, though. I hate roller coasters, too.


p.s.: The indents/blockquotes are initially confusing in this post, though I figured out where it was you talking.

p.s.2: What happened to the PREVIEW button? You might have explained this before, and I missed it.

Submitted by jawbone on

Run you cursor over the Eye symbol, next to the Question Mark.

Preview (Ctrl+P) should show up (blue background on my browser).

Took me quite awhile to find it, by accident!

beowulf's picture
Submitted by beowulf on

Administration's only hope is to set their phaser's to "everybody's a winner!" and declare everyone eligible for credits.

It really is astonishing that Obamacare set 9.5% of income as the appropriate amount of income for a single person making between 300% to 400% of FPL- ($33k to $45k) to be paying in premIums-- copayments, of course, are on top of that.

There will be a trainwreck even if the software and the iron maiden eligibility engine work perfectly. Far more (as in tens of millions more) people will take the penalties because they can't afford the mandate.