By way of Wombat-socho's "In The Mailbox: 09.17.15", the ever sensible Megan McArdle: How HealthCare.gov Went So, So Wrong
The Centers for Medicare and Medicaid Services inspector general has issued a new report on what went wrong with the Obamacare insurance exchanges. Or rather, one thing that went wrong: how the agency mismanaged the contracts so that they experienced significant cost overruns.So, basically, the people who wrote and passed the law were idiots (we already knew that), and the federal government was not the proper vehicle for such a project. Both problems get a lot of scrutiny. Read the whole thing.
You can take this report as a searing indictment of the agency and its contracting personnel. I took something rather different away from reading it:
- The architects of the law were incredibly naïve.
- Federal contracting rules are crazy.
More on the report and the catastrophe from HotAir: CMS audit of ObamaCare federal exchange shows incompetence, waste
. . . as Bloomberg’s John Tozzi reports, an audit by the Inspector General for HHS, details just how badly HHS bungled the job and wasted a large portion of $600 million in contracts:It wasn't wasted if it went to Obama and Clinton cronies. . .
The public employees responsible for overseeing $600 million in contracts to build healthcare.gov were inadequately trained, kept sloppy records, and failed to identify delays and problems that contributed to millions in cost overruns.
Obamacare enrollees must double to make budget projections workThat’s according to a new government audit, published today. It reveals widespread failures by the federal agency charged with managing the private contractors who built healthcare.gov. The audit is the first to document, in detail, how shoddy oversight by the Centers for Medicare and Medicaid Services (CMS), which manages federal health programs including Obamacare, contributed to the website’s early struggles.The Affordable Health Care act passed in March 2010. Less than two years later, the Obama administration issued new rules that required about three weeks of training for managing the large contracts used in the effort to build the federal exchange. That left HHS about 21 months to get those project leads the training required, but ….
To develop healthcare.gov, CMS hired and managed private companies to create vast, interlocking software systems that would allow consumers to shop for insurance policies. According to the report, issued by the agency’s inspector general, lapses in oversight of those companies started early on—well before the website’s limping debut, on Oct. 1, 2013. The site faltered for months, frustrating consumers until a scramble to repair it ultimately allowed millions to enroll in health plans.
President Obama will need to more than double the number of Americans enrolled in Obamacare exchange plans to reach 21 million next year, the target set in budget projections, in what is shaping up as the next major test for the health care law.Failure was baked into the pie, as is the inevitable call for "reform" leading to
As of June, the Department of Health and Human Services counted 9.9 million customers who have bought plans through the federal HealthCare.gov portal and a handful of state-run exchanges.
Industry analysts said the CBO’s estimate for next year is “overly optimistic” and a “stretch,” and that it will take more time for the law to attract that many people onto the Web-based markets, where consumers shop for private health care plans and typically qualify for government subsidies to reduce their monthly premiums.
An Obamacare Change to Medicare Is Backfiring
Medicare’s attempts to hold hospitals accountable for poor quality treatment is inadvertently penalizing hospitals that take care of sicker, poorer patients, according to a new study published in JAMA Internal Medicine.The administration loves poor people. That's why it make so many of them.
A provision in the Affordable Care Act requires Medicare to reduce payments to hospitals that have high readmission rates. The goal was to improve patient care and cut the costs of avoidable hospitalizations. Instead, the new study finds that the Obamacare change unfairly affects hospitals based on the patients they treat.
. . .
The study, conducted by researchers at Harvard Medical School, the Brigham and Women’s Hospital in Boston and Massachusetts General Hospital, found that about half of the difference in readmission rates among hospitals is due to variables linked to the patient population being treated, including education and income levels. “Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve,” the authors conclude.
As a result, the penalties that Medicare imposes could be depriving hospitals treating a disadvantaged population of money they need to treat those patients and their complex health issues.
Tough Going for Health Co-ops
Late last month, the Nevada Health Co-op became the third casualty among 23 insurance start-ups created under the federal health care law to inject competition for coverage in certain parts of the country.In other words, more gubermint money to prop up the idealized socialized medicine, but failure in the end, when they run out of other peoples money.
Set up as nonprofits with consumer-led boards, the co-ops were designed to provide affordable insurance coverage to individuals and small businesses. They were intended under the law to offer alternatives — and hopefully cheaper prices — to the plans sold by large established insurance companies in some regions.
But as the new co-ops begin failing just a year into the effort to remake the health care industry with more competition and lower costs, the marketplace is proving hostile to newcomers trying to break into an industry dominated by powerfully entrenched businesses.
Faced with these conditions, the federal government has promised to consider ways of helping them to get a firmer foothold, but some insurance experts doubt that government changes will be enough to prevent more failures.