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ObamaCare Clusterfuck: The 2014 and 2016 campaign season begins!

From selling "hope and change" to selling insurance. How transformative! Kaiser:

President Obama To Hit The Campaign Trail For Health Law
President Obama often tells audiences that he has waged his last campaign. But that’s not exactly true.

The White House is gearing up for a massive campaign this summer that will cover all 50 states, plus Washington, D.C. And the president’s legacy may hinge on whether it succeeds or fails. ....

David Simas[2012 Obama campaign director of opinion research], deputy senior adviser to the president, works in a quintessential West Wing office — a windowless basement room — where he oversees one of the top projects on the Obama agenda: implementing universal health coverage.

In the first year, the administration hopes to sign up 7 million people across the country. Simas says that will require TV ads, door knocking and lots of word of mouth.

“It is an on-the-ground effort,” he says. “It is a social media effort. It is a paid media effort. It is an earned media effort. But [it's] all leading to the same thing, which is that man or woman sitting in their living room online, comparing different prices for different products and deciding what works best for them.”

Simas's statement is just so wrong on so many levels:

1. Since health care should be a right, it follows that health insurance should not be a product (except for luxuries like Tommy Friedman's 'stache job).

2. ObamaCare does not mandate employer coverage for spouses. For some, then, Simas's statement should be revised to: "[T]hat man or woman sitting in their living room online, comparing different prices for different products and deciding what works best for each of them."

3. Not all Americans will be able to get coverage online, either from lack of Internet access, a slow machine, or crappy exchange software ("Let's just make sure it's not a third-world experience.")

4. "[C]omparing different prices for different products" assumes that the products are comparable. But although the prices are expressed in dollar terms, plans are commensurate only in terms of "actuarial value," and actuarial value is a crapshoot, as this Kaiser study proves.* ObamaCare doesn't enable comparing lemons to lemons.

Of course, a campaign year is not the time to be asking questions! So STFU until 2017....

And don't say we didn't warn you.

NOTE * If Expedia ticket "prices," instead of being fixed -- readers, please feel free to improve this -- were priced like actuarial value is, you'd pay (say) $1000 for the ticket, but at the gate your price would be adjusted by the actual cost of fuel at the time, DHS's schedule for a full body scan, the likelihood you'd ask for a second bag of peanuts, the amount of oxygen you'd be likely to breath (at current rates), et cetera. Of course, different airlines have different pricing for fuel, body scans, peanuts, and oxygen, in addition to having different operating procedures and labor agreements, and so the actuarial value of a ticket could be wildly at variance with the real cost of a ticket. And you'd find out only at the gate! Nice work if you can get it!


More to the point, all the states trying to make the law fail will look very stupid and terribly craven if California pulls this off. Their predictable claims that Obamacare is all screwed up won’t be very persuasive if a giant, historically mismanaged state like California can make it work well.

If it fails in California, though, that’s a disaster.

Thus, my hunch is that both the administration and California officials are unusually invested in getting it right [for some definition of "right"] there, more so than in any other state in the union. The other side of that coin, of course, is that conservatives will be heavily invested in finding ways to undermine it. Perhaps that’s why they’ve recently tried recently, and appropriately, to make issue of California’s attempt to conceal its exchange’s contractor spending from the public.

So, California is the key battleground state. Notice, again, how that sets the baseline very low, as well as appealing to a key Democratic constituency: Hispanics.

* TPM is a Democratic blog, just as much as Big Orange. So it's not surprising that TPM would characterize California's successful concealment of its contracts as an "attempt." From Beutler's link:

A California law that created an agency to oversee national health care reforms granted it broad authority to conceal spending on the contractors that will perform most of its functions, potentially shielding the public from seeing how hundreds of millions of dollars are spent.

The degree of secrecy afforded Covered California appears unique among states attempting to establish their own health insurance exchanges under President Barack Obama's signature health law.

An Associated Press review of the 16 other states that have opted for state-run marketplaces shows the California agency was given powers that are the most restrictive in what information is required to be made public.

Beutler's distortion is, of course, not journalism, but advocacy. Since ObamaCare is now a political campaign, that is exactly what we would expect.

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jo6pac's picture
Submitted by jo6pac on


Yep, say it enough times it becomes the truth, right. Please repeat after me blah blah, sure glad I live in the country and don't watch much tv.

Alexa's picture
Submitted by Alexa on

Does anyone know if the Mother Jones article is correct?

My understanding is that one of the unintended consequences of the law was that an unemployed spouse would NOT be entitled to a subsidy, if spouse's employer decided NOT to extend coveage to her/him.

Supposedly, this resulted from the so-called "accidental" writing of the law to go by ONLY THE employee's 'individual" cost of employer-based insurance coverage--in determining whether an individual, spouse or family is eligible to shop in the Health Exchange (if his employer's coverage is not deemed affordable by the 9.5% of income measurement).

I've read that they were looking at 'changing' this, but have never seen anything that says that it has been accomplished.

So, does anyone have a reference (link) that clarifies this, aside from the Mother Jones piece that is?

beowulf's picture
Submitted by beowulf on

I've read that they were looking at 'changing' this, but have never seen anything that says that it has been accomplished.
So, does anyone have a reference (link) that clarifies this, aside from the Mother Jones piece that is?

You can't go too far astray just assuming the worst.
Yes the Mother Jones piece is correct and no it hasn't been fixed, nor will it be.

Alexa's picture
Submitted by Alexa on

That's right.

What's worrisome to me is that I doubt we'll ever hear the truth about how well this works in California.

IOW, all we'll hear about is some small business owner who has benefited greatly, with reduced premiums. Which would probably be true.

The story of those who lose their group coverage, are reduced to 'skinny plans,' and the untold numbers that will eventually be thrown into Medicaid due to unemployement, and lose many of their assets, will NEVER make the MSM 'noisebox.'

I'm hoping that there are some California residents at Corrente who will keep us informed, after the ACA is implemented. I'm thinking that I've seen a couple, but can't remember who they are.

Alexa's picture
Submitted by Alexa on

Affordable Insurance Exchanges: More Choices, Competition and Clout

What is the Navigator Program?

The Affordable Care Act requires the Exchange to establish a Navigator program that informs individuals and small employers about the availability of qualified health plans within the Exchange and facilitates enrollment of qualified individuals into such health plans. Since the Exchange will determine eligibility for advanced premium tax credits, cost-sharing reductions, Medicaid, CHIP, and the Basic Health Program as applicable, the role of the Navigators also includes outreach and education efforts, and assistance applying for coverage in such programs. Having Navigators assist in both processes will help ensure a coordinated enrollment process and one that promotes streamlined access to coverage. The NPRM includes a list of the minimum set of activities of a Navigator.

The Affordable Care Act identifies entities that may be eligible to serve as Navigators.

We propose that the Exchange include at least two of the types of entities listed in the participation requirements for the Navigator program. The proposal also allows the Exchange to require Navigators to have expertise working with specific populations such as low-income populations or other target groups such as American Indians/Alaska Natives, people with disabilities, or individuals with limited English proficiency.

To ensure that Navigators provide unbiased and accurate information, we propose in the NPRM that Navigators may not have current conflicts of interests or receive compensation from health insurance issuers for facilitating enrollment of individuals, employers, or employees in qualified health plans.

Agents and brokers may serve as Navigators, provided that all Navigator standards proposed in the NPRM are met.

What role will agents and brokers play in the Exchange? Will they still help individuals and small businesses find and apply for health insurance?

Under the Exchange proposed rule, Exchanges will have flexibility to determine what role agents and brokers will play in the Exchange. The Exchange may choose to allow agents and brokers to assist consumers with applications for advance payments of the premium tax credit and cost-sharing reductions and enroll individuals, employers, and employees in qualified health plans.

States will maintain their current role licensing and overseeing agents and brokers. In many States, we expect that agents and brokers will play a role working with individuals and small groups in the Exchange.

So, like everything else about this bill, there is very little consistency, regarding the 'navigator system.' It's just a 'mishmash,' depending upon where you live.

What is the 'Basic Health Plan?' Is that referring to the "Young Invincibles'' catastrophic health plan?

[So much material's been posted lately, hope that this info is not redundant.]

Rainbow Girl's picture
Submitted by Rainbow Girl on

... ObamaCare (accidentally or not) allows the elimination of health insurance coverage for such unemployed spouses at the whim of the employed spouse's employer?* (I would not know where to find the numbers for the size of the population of Americans, but I hazard to guess it is considerable -- i.e., in the millions.)

Fascinating: So ObamaCare with one "hand" mandates the addition of the children of an employee with employer coverage and with the other allows the elimination of unemployed-spouse coverage -- e.g. in the same household! Way to make coverage "universal" or provide more security and peace of mind to families. If this is as much of a cruel sleight of hand as it appears ... man, oh man.

Please, please correct me if I'm wrong here I really want to be (wrong).

If I'm not, then Wow. Just Wow.

* Not that I'm assuming any employer would make the obvious cost-benefit decision of ditching spouse-coverage because it can.

Alexa's picture
Submitted by Alexa on

Can't get specific, since Mr. Alexa does not want to 'be discussed,' but we MAY be in that boat for 2014.

His company (a huge corporation, self-funded insurance administered by a major insurance company) has already 'threatened' that they may very well opt-out of offering health insurance beginning in 2014.

Now, for the past 2-3 years, they have already excluded 'working spouses' who are full time, and are offered insurance through their employment.

So, between the 'threat' last open enrollment period, and their already stringent spousal policy, we are already bracing for either one (me), or both of us being 'dumped' this year.

Time will tell, I guess . . .

Rainbow Girl's picture
Submitted by Rainbow Girl on

" ... require Navigators to have expertise working with specific populations such as low-income populations or other target groups such as American Indians/Alaska Natives, people with disabilities, or individuals with limited English proficiency."

I would like to know who drafted these qualifications for Navigator expertise in the matter of the intricacies of ObamaCare Insurance Exchange eligibility matrices, price matrices, penalty matrices, substantive benefits supposedly offered by policies, etc.

In fact, I'd like to hear directly from the people who will be hired to train these navigators because they might be able to answer some of the mind-busting questions we've been wrestling with here at Corrente.

Meanwhile, if this Thing that is ObamaCare Clusterf**k were as simple as Obama says it is -- sit at your PC and just comparison shop just like you would to find a flight to Miami -- there would be no need for "navigators." Right? Ach - Keerist on a Crutch.

Rainbow Girl's picture
Submitted by Rainbow Girl on

I mean, the skill set used by these nonprofit folks who have expertise doing community outreach with "special populations" does not strike me at first blush to transfer (intuitively or otherwise) to becoming an actuary or (like some of us here) an obsessive decoder of deliberately complex consumer fraud systems such as ObamaCare and its myriad gotcha-tripwires.

Submitted by lambert on

I have a post in gestation that will argue (a) the rollout will be targeted at demographic categories that (a) maximize "bang for the buck" in terms of (b) actuarial soundness of the program* (c) Democratic votes**, and (d) return on investment for marketing dollar***.

You will notice that need for health care is not on the list. Never has been, not even in their public pronouncements, which provides the clearest possible indication that ObamaCare is about, well, Care of Obama, and not about health care at all. Since otherwise, they'd make sure that those who needed health care were explicitly targeted.

* Youth (and not elders)

** Youth, Hispanics

*** Not the unengaged and vulnerable.

Rainbow Girl's picture
Submitted by Rainbow Girl on

And I was being kinda snarky --in fact, when I wrote my comment I was thinking exactly about your previous posts unmasking the laser-precision with which Obama's machine micro-targeted its sleezy sales pitches during the Pres'l campaign(s) and then in the ObamaCare clusterf***k.

Great stuff, LS. Thank you!

Splashoil's picture
Submitted by Splashoil on

Over at Orange Satan, a young Obama enthusiast was excited about getting his children into Medicaid. Yes it's targeted, and while some young enthusiasts may get some " free health care," some old and poor families will have their meager holdings clawed back for cost recovery. Thank you for writing about this stuff. I try to share the wealth ( of information) at the enthusiast sites. Sometimes you encounter another sentient soul even as you have fun with the likes of Bush Bites...

Rainbow Girl's picture
Submitted by Rainbow Girl on

" ... plans are commensurate only in terms of "actuarial value," and actuarial value is a crapshoot, as this Kaiser study proves.* ObamaCare doesn't enable comparing lemons to lemons."

Exactly right, Lambert. But not only will the initial cost of a Credit Card Obama Exchange Policy be virtually a crapshoot, there is nothing I've read about these insurance products that says ObamaCare prohibits insurance companies from changing terms and conditions at every renewal date. Have you ever heard of an insurance policy that doesn't increase by 10%, 20%, 30%, whatever percent from one year to the next, and then exponentially for however long the policyholder allows it to suck him/her dry?

Best case scenario. Mrs. Jane Doe gets in front of her computer, manages to follow the steps on the online system (miracle number one), and ends up on a page that tells her -- "Great News, Mrs. Doe, you only have to pay $200 a month for your Crap Loser Bronze/Silver Policy Obama Health Insurance Policy!" (In small type (or no type), further down the page, expect this or similar: "prices are subject to change at any time and for any reason by the insurer, this is only an estimate, blah blah blah." (See, e.g., credit card "contracts.")

She buys the policy. Spends a year getting bad surprises almost immediately -- this isn't covered, this doesn't go to your deductible, your deductible is $5000, you just got shoved into Medicaid-Private-Version, etc. Renewal time comes along, and suddenly, she sees that her checking account (assuming she has one!) has been debited $450 for the Month 13 premium. Whoa -- what the heck was that? There will follow hell on earth for Mrs Doe trying to reach someone, anyone, to explain to her why her premium went from $200 to $450. Then she'll find out the deductible got jacked up a couple thou. She decides to ditch the policy ... will she be able to? If so, she'll be right back where she was before FrankenCare.

Stephen King could never have imagined such nightmarish reality.

Rainbow Girl's picture
Submitted by Rainbow Girl on

Not sure what you meant?

katiebird's picture
Submitted by katiebird on

CA exchange policies more than double 2013 policy costs

How many people and families live in households making More Than 400% of poverty? I ask because they don't get any caps, any subsidies, any cost/price protections at all. The BEST they get is opting out of Health Insurance completely as inflation pushes the cost of the policies out of a sane person's price range. ...

Then what happens?

katiebird's picture
Submitted by katiebird on

According to this blog post an estimated 40% aren't eligible for subsidies .... which means they also don't get the 'benefit' of any sort of cap on maximum expenditures. Including Premiums and medical costs:

For those insured right now, and the estimated 40% that won't be eligible for a federal premium subsidy, that sure looks like rate shock to me. For the 60% who will get a subsidy, this means the taxpayers are going to have to fork out lots more money.

katiebird's picture
Submitted by katiebird on

It turns out some of the CA Exchange policies are more special than others (same source as above):

"But wait, that Blue Shield exchange plan in LA, for example, does not include UCLA Medical Center or Cedars Sinai. In fact, Shield's exchange network includes a total of only 24,000 physicians compared to 66,000 doctors in their full PPO network––only 36% of their usual network docs will be available.

Last week a national player told me there is a nationwide trend growing where the insurer offers a very limited list of providers exclusivity in their exchange plans for deeper payment discounts in the 30% range––the narrow network plan would be the health plan's only offering in the exchange. The tactic was described to me as a "quasi Medicaid strategy for the exchanges.""

katiebird's picture
Submitted by katiebird on

And how do you compare plans that are doing that? People are really supposed to dig into plans for a list of every hospital and doc?

And where do Cancer Research Hospitals or places like the Mayo Clinic or MD Anderson fit in the exchanges? Are they only available in the Gold Plans? Or no plans?

And just how many people WANT the option of choosing the lack of a good Cancer Hospital in their list of hospitals? Speaking only for myself, one of my biggest reasons for buying insurance is to cover decent treatment in the case of an horrific illness striking someone in my family.