Sunday, March 16, 2014

Ending or Mending Obamacare Schadenfreude

The weather here today has declined in quality since yesterday; temperatures are back down to 39 and declining, from the 70 ish we had yesterday, driven by the the 15 kt north wind bringing the cold air for the expected afternoon snow/snush storm. Oh goody.

Obamacare schadenfreude keeps going, just like our Fimbulwinter.

Republican try to "Mend it, not End it"; Shockingly, Democrats are not so happy about that:
Sure enough, the House advanced the five-year delay bill yesterday afternoon and is expected to pass it later today. Just three Democrats joined Republicans in yesterday’s procedural vote. Congressional Democrats are dead set against codifying the administration’s actions, which Ed noted earlier. As Cantor says, the White House routinely threatens to veto acts of Congress that would “mirror what [Obama is] secretly doing.” TheHuffington Post dutifully denounces the GOP plan, citing a CBO report indicating that a five-year postponement of the unpopular individual mandate tax would — gasp — raise premiums and result in 13 million more uninsured Americans. Question: What untold horrors might we expect from the president’s unilateral action to impose a sweeping, two-year “hardship waiver” for the mandate tax? Liberals are angry at Republicans for trying to formalize the president’s own decrees. Beyond that, Obamacare is already failing to attract the overwhelming majority of previously-uninsured Americans (due primarily to high costs), and is projected to leave at least 30 million people without coverage. And higher premiums, you say? Perish the thought. We already know that costly mandates, unsound risk pools, and endless uncertainty are forcing premiums up.
Is the Individual Mandate Dead? No. (But It’s Been Ailing for a While)
There’s no new magically broad exemption that’s shredding the mandate to help out people who become ininsured in the future and the currently uninsured. Now, there is an ambiguous “another hardship” that apparently wasn’t listed in one list of the possible hardships for the past few months. CMS just added it this week — which is absolutely a sinister move, but not one that is going to prevent people from streaming out of the law. Why?
The broad-sounding exemption applies to people who claim the following:
14. You experienced another hardship in obtaining health insurance.
Where people receiving other exemptions (such as bankruptcy in the last six months, which requires bankruptcy papers) are told what documentation they have to provide, there’s just a request:
Please submit documentation if possible
Sounds . . . easy, but a lot of people also seem to be under the impression that no further explanation is necessary, which isn’t true. On the exemption application, it says the following:
Unless you’re applying for hardship #12 (Medicaid ineligibility) or #13 (cancellation), please explain how this hardship kept you from getting health coverage for the time period for which you’re requesting an exemption.
So even if this isn’t a new feature, as some are implying, is it broad enough to essentially invalidate the mandate? That’s up to HHS.

“Simply filling out the form does not guarantee an exemption,” a CMS official informed NRO, and the requests will supposedly be reviewed manually. When a person fills out an exemption application, sends it in, and gets approved, he’ll have an exemption number to provide to the IRS when filing their taxes that they shouldn’t be liable for the mandate penalty.
And we know that what happens when the IRS starts manually reviewing applications for exemptions, don't we? Friends of the administration (or at least people with a reasonable chance of being administration supporters) get them, people who might be inclined to oppose the administration don't.

And more slack in the "deadline" (maybe that should be an "undead line", since it keeps moving).

Health Site Plans Deadline Leeway: Users Who Encounter Glitches—and Document Them—May Get Extension Past March 31
Federal officials are planning a workaround that would effectively extend the March 31 deadline to enroll for health-care coverage for some users if technical glitches hamper a last-minute surge of signups on, people familiar with the matter say.
. . .
Under the workaround plan, people who can demonstrate that they tried to enroll in a plan before the deadline, but failed because of website troubles, would be able to sign up after March 31.

Details are still being hammered out, including how long the so-called special-enrollment period would last and what documentation people might need to offer as proof they were blocked by glitches, say people familiar with the matter. If the final days of enrollment go well, the administration could opt to forgo the backup plan, one person said.
It's because they wrote the law so carefully. . .

How many Obamacare enrollees have paid is revealed by some states
CNBC is reporting today that nine states and the District of Columbia have reported those numbers, and they are "all over the map" -- ranging from 92 percent of enrollees have paid in Connecticut to 54 percent in Maryland.

Here's a list of the states, the number of those who have selected a plan and the percentage of those who have paid as reported by CNBC:
  • Connecticut, 57,465, 92%
  • Minnesota, 33,722, 90%
  • California, 923,832, 85%
  • Rhode Island, 19,690, 83%
  • DC, 6,516, 75%
  • Nevada, 30,015, 70%
  • Vermont, 24,326, 59%
  • Washington, 191,081, 57%
  • Maryland, 38,070, 54%
Given Maryland's website problems (hey, we're #2, Oregon is still worse!), that probably explains why people in Maryland who may actually intend to pay may be having problems.  But the rest?  How many of the insurance policies that the Obama Administration is touting as having been sold, are just sitting unremembered in a digital "shopping cart."?  It looks like 20% is a pretty fair guess.  And 20% of the 4 million sign ups the administration claims is still a lot of people.

Obama Admits: If You Like Your Doctor, You, Uh, Might Not Be Able to Keep Him
What we have said is, for example, if you’re in the middle of life-saving treatment with a particular doctor, then we will work to make sure that you can keep, uh, that treatment, and not shift. But for the average person, many folks who don’t who don’t have health insurance initially, um, you know, they’re gonna have to make some choices, and, they might end up having to switch doctors, in part because they’re saving money. But that’s true, you know, if, if, your employer suddenly decides: we think this network’s gonna give a better deal, we think this is gonna help keep premiums lower, uh, you gotta use this doctor as opposed to that one, or this hospital as opposed to that one. Uh, the good news is, in most states, people have more than one option. And, you know, what they’ll find, I think is that their doctor, or network, or hospital that’s conveniently located is probably in one of those networks. Now, you may find out that that network’s more expensive than another network. And then you’ve gotta make a choice in terms of what’s right for your family. Do you want to save on cost, or do you want to save on convenience?

Thanks for taking that choice away from us.  It was way too much for us ordinary people to contemplate, let alone wade through.

Finally, I'm struggling with this one.  I can't find an easily quotable block of any reasonable size that gets  to the heart of the issue.  Of course, it's by Megan McArdle, so it's fairly dense (or at least it makes me feel that way:

Obamacare Co-Ops Exploit Dodgy Pricing
One of the lesser-known provisions of the Affordable Care Act provided funding for the establishment of health insurance cooperatives, nonprofit local insurers that provide policies on the exchange. My colleague Alex Wayne reports on the major inroads they're making in some markets:
In Maine, the insurer that has enrolled the most Obamacare customers isn’t the state’s well-established Blue Cross Blue Shield plan, owned by WellPoint Inc. (WLP:US) It’s WellPoint’s only rival: Maine Community Health Options, a startup that didn’t exist three years ago.
The newcomer, funded primarily by taxpayer money lent under the U.S. health-care law, has won about 80 percent of the market so far in Maine’s new insurance exchange, exceeding its own expectations, said Kevin Lewis, the chief executive officer. ...
You can read this development in two ways. One is as the surprising success of an innovative business model. And the other is as a potential fiscal disaster. . .
My general understanding of health insurance markets is that they are very, very tightly priced. If a policy is significantly cheaper, it’s either because the policy offers fewer benefits, its provider networks are miserly, or the insurance company has found a way to select for unusually healthy patients. (My favorite example of this in recent years was the Medicare Advantage policies that prominently advertised free gym memberships. You can imagine which seniors this benefit appeals to.)
I guess the fear hear is that the high prices for fairly ordinary health care policies that have resulted from Obamacare has spurred a start up of many rivals for the insurance bucks.  Competition is all well and good, but

No comments:

Post a Comment