Dataproblems,hackerscontinuetoplagueObamacareexchanges

Data problems, hackers continue to plague Obamacare exchanges

posted at 7:21 pm on July 3, 2014 by Mary Katharine Ham

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Two reports from the government watchdog for Health and Human Services this week revealed serious data discrepancies among the sign-ups the Obama administration hailed as Obamacare’s triumphant comeback. Those data problems may mean some people got subsidies they shouldn’t have and would have to pay back hefty amounts to the federal government. Phil Klein reports:

Applications for insurance coverage through President Obama’s health care law submitted in the final three months of 2013 contained millions of inconsistencies in which information such as income and immigration status could not be independently verified by the federal government, according to a June report from the inspector general of the Department of Health and Human Services.

The inconsistencies may have resulted in individuals receiving an improper amount of subsidies, or subsidies that they shouldn’t have been eligible for in the first place — something that could require them to repay the money in future tax bills.

In other cases, inconsistencies led to bizarre outcomes. According to the report, “one marketplace cited situations in which infants and young children included on applications were erroneously identified as incarcerated.”

At issue is the information that individuals are asked to submit when they apply for coverage, such as income, citizenship status, Social Security number, or incarceration status. In theory, once data are submitted, they are supposed to be checked in a massive storage database known as the “hub,” which gathers data from multiple federal agencies.

Between October and December 2013, there were 2.9 million such inconsistencies in applications, according to the report, 2.6 million of which remain unresolved. As Klein makes clear, this doesn’t mean there are 2.9 million separate applications with mistakes because there are many potential data problems on each person’s application. The most common inconsistency had to do with citizenship and immigration status, with income shortly behind. In some cases, the federal government and states with exchanges were not using the verification processes required by their internal rules (well, knock me over with a feather). The AP reports:

Digging out from under the data problem is one of the top challenges facing newly installed HHS Secretary Sylvia Mathews Burwell.

The administration says it is doing just that. Spokesman Aaron Albright said more than 425,000 inconsistencies have been resolved so far, more than 90 percent of those in favor of the consumer. The administration is hoping to clear up the majority of cases this summer, but may yet have to resort to an extension allowed under the health law.

The inspector general found that the federal insurance exchange reported a total of 2.9 million inconsistencies with consumer data from Oct. 1, 2013 through Feb. 23 of this year.

At the time, the administration had limited technical capability that would have let officials resolve roughly 330,000 of those cases. Only about 10,000 were actually cleared up within the period. Albright said the situation is much improved.

The inspector general said several states running their own insurance markets were having similar problems.

Guy Benson reports on the inspector general’s take on state exchanges:

Democrats celebrated that “8 million new enrollments” figure in a failed attempt to improve public perceptions of the law. That number has always been highly exaggerated — not accounting for duplicates, a substantial non-payment rate, a high percentage of enrollees who were previously insured, and applicants whose coverage may be disrupted by these ongoing data issues. The watchdog report stated that approximately 1.2 million additional “inconsistencies” marred applications processed through state exchanges. More: “During our review, 4 of the 15 State marketplaces reported that they were unable to resolve inconsistencies” at all, including some of the usual suspects such as Oregon. How many data snags have affected the millions of applications filed over the first three-plus months of 2014? The final number will almost certainly be significantly higher.

Meanwhile in Vermont, considered one of the better state exchanges:

A Romanian attacker hacked the Vermont health exchange’s development server last December, gaining access at least 15 times and going undetected for a month, according to records obtained by National Review Online.

CGI Group, the tech firm hired to build Vermont Health Connect, described the risk as “high” in a report about the attack. It also found possible evidence of sophisticated “counter-forensics activity performed by the attacker to cover his/her tracks.”

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Tags: data, exchanges, healthcare.gov, implementation, ObamaCare

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Surprise:LunderganGrimescan’tsaywhethershewould

Surprise: Lundergan Grimes can’t say whether she would have voted for ObamaCare

posted at 9:41 pm on May 21, 2014 by Mary Katharine Ham

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Part of a series.

Another red-state Democrat in a competitive race can’t quite manage to decide if she’s for the law her party claims it was totally going to be running on in 2014:

Democratic Senate candidate Alison Lundergan Grimes on Wednesday twice refused to say whether she would have voted for President Barack Obama’s signature health care law.

Asked two times whether she’d have voted for the 2010 overhaul, the Kentucky Democrat who is challenging Senate Republican leader Mitch McConnell told The Associated Press: “I, when we are in the United States Senate, will work to fix the Affordable Care Act.”

Grimes added: “I believe the politically motivated response you continue to see from Mitch McConnell in terms of repeal, root and branch, is not in reality or keeping … with what the facts are here in Kentucky.”

Grimes is somewhat protected by the fact that Kentucky’s state exchange has been far less disastrous than in most other states, and the exchange has gained considerably more confidence from voters than Obamcare, as a result:

In Kentucky, a new Marist poll conducted for NBC News finds that 57 percent of registered voters have an unfavorable view of “Obamacare,” the shorthand commonly used to label the 2010 Affordable Care Act. That’s compared with only 33 percent who give it a thumbs up – hardly surprising in a state where the president’s approval rating hovers just above 30 percent.

By comparison, when Kentucky voters were asked to give their impression of “kynect,” the state exchange created as a result of the health care law, the picture was quite different.

A plurality – 29 percent – said they have a favorable impression of kynect, compared to 22 percent who said they view the system unfavorably. Twenty-seven percent said they hadn’t heard of kynect, and an additional 21 percent said they were unsure.

“Call it something else, and the negatives drop,” said Marist pollster Lee Miringoff.

The Kynect numbers, though better than Obamacare’s, aren’t knocking anyone’s socks off. And, I’d argue when Kentuckians give their state exchange better marks than the overarching federal Obamacare law, it’s not just an issue of a rose by any other name. Kynect has been demonstrably less of a calamity than the federal law, with fewer online travails, so why wouldn’t it get better marks from voters?

That being said, the exchange’s unhorrific performance does give Grimes more breathing room than other red-state Democrats. Democrats are left to wonder what would have happened electorally if they’d managed to muster enough competence to get other states’ and the federal exchange to limp along more convincingly than they have. I wish Americans had higher standards for government performance, but the fact is, they’re incredibly forgiving far too often. The barest bit of competence would have gone a long way. But they didn’t have it.

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Tags: Alison Lundergan Grimes, implementation, Kentucky, Mitch McConnell, ObamaCare, Rand Paul, state exchanges

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Sebelius:Why,no,wehavenoideawho’s

Sebelius: Why, no, we have no idea who’s paid for their ObamaCare plans

posted at 8:41 pm on March 12, 2014 by Mary Katharine Ham

The Big Data campaign meets the Most Transparent Administration in History:

The government agency charged with implementing Obamacare has no idea whether any of its enrollees have paid their insurance premiums, Health and Human Services Secretary Kathleen Sebelius said Wednesday.

“I can’t tell you that because I don’t know that,” Sebelius told the House Ways and Means Committee when asked how many enrollees had actually paid.

Sebelius pushed blame to the insurers, saying that the companies only gave HHS “aggregate data” on those enrolled.

)

She also admitted, again, that HHS is not measuring the very metric ObamaCare was created to improve: the number of uninsured.

Here’s what she does know:

On call, Sebelius touts Gallup poll showing "dramatic increase" in the percentage of Americans who have insurance. http://t.co/bpKp42Q3M6

— John McCormack (@McCormackJohn) March 11, 2014

Gallup shows 15.9% of Americans are now uninsured. It was 16.1% at this point in 2011 http://t.co/bpKp42Q3M6 #dramatic

— John McCormack (@McCormackJohn) March 11, 2014

And, here’s what we do know about ObamaCare’s paying and non-paying customers, from mid-February:

Fully one-fifth of the new enrollment numbers that HHS has been waving around are bogus. Their target for the end of January was 4.4 million sign-ups; a few days ago, they told the country they’d made it three-quarters of the way there with 3.3 million. In reality, once the deadbeats are bounced from the rolls by their new insurers, they’ll be in the ballpark of 2.6 million, or 60 percent of their target. And that’s after HHS pressured insurers to extend the payment deadline from December 31 into January, hoping that a little more time for slackers would pad the enrollment figures even more.

Is it “only” 20 percent who haven’t paid, though, or is the actual number even bigger? The Times is guesstimating based on what they’re being told by different insurers, but read down into the piece and you’ll see that the biggest companies are seeing payment rates below 80 percent — another detail flagged by Laszewski when he wrote about this a few days ago. Eighty percent is probably the best-case scenario[.]

And, always remember, the number of “sign-ups” the administration is hawking is people who went on an exchange site and selected a plan, not those who necessarily paid for that plan. As in, if you went to Amazon and put a garlic press in your virtual cart, you’d be considered a happy purchaser of said garlic press by the administration. The press giving that nonsense metric any credence at all is a willful misrepresentation of what’s going on, here:

On Tuesday, HHS said that 4.2 million people had signed up for private insurance plans under Obamacare through the end of February. That’s way off pace for the administration’s initial goal of 7 million enrollments this year, now viewed as unattainable. Even reaching a revised target of 6 million projected by the Congressional Budget Office after the disastrous rollout of HealthCare.gov is a daunting challenge. A new report Wednesday by Avalere Health said reaching the lower goal was highly unlikely, estimating 5.4 million enrollments by the end of March.

The answer to how many of the sign-ups have paid is important because that’s who will have actually gained insurance under the law. The number is bound to be significantly less than those who have simply chosen plans — four large insurers estimated to POLITICO this week that 15 percent to 20 percent of people who signed up hadn’t paid.

But who’s counting? No, really. Who is counting?

Tags: ACA, Affordable Care Act, exchange, implementation, ObamaCare, sebelius

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Sebelius:Why,no,wehavenoideawho’s

Sebelius: Why, no, we have no idea who’s paid for their ObamaCare plans

posted at 8:41 pm on March 12, 2014 by Mary Katharine Ham

The Big Data campaign meets the Most Transparent Administration in History:

The government agency charged with implementing Obamacare has no idea whether any of its enrollees have paid their insurance premiums, Health and Human Services Secretary Kathleen Sebelius said Wednesday.

“I can’t tell you that because I don’t know that,” Sebelius told the House Ways and Means Committee when asked how many enrollees had actually paid.

Sebelius pushed blame to the insurers, saying that the companies only gave HHS “aggregate data” on those enrolled.

)

She also admitted, again, that HHS is not measuring the very metric ObamaCare was created to improve: the number of uninsured.

Here’s what she does know:

On call, Sebelius touts Gallup poll showing "dramatic increase" in the percentage of Americans who have insurance. http://t.co/bpKp42Q3M6

— John McCormack (@McCormackJohn) March 11, 2014

Gallup shows 15.9% of Americans are now uninsured. It was 16.1% at this point in 2011 http://t.co/bpKp42Q3M6 #dramatic

— John McCormack (@McCormackJohn) March 11, 2014

And, here’s what we do know about ObamaCare’s paying and non-paying customers, from mid-February:

Fully one-fifth of the new enrollment numbers that HHS has been waving around are bogus. Their target for the end of January was 4.4 million sign-ups; a few days ago, they told the country they’d made it three-quarters of the way there with 3.3 million. In reality, once the deadbeats are bounced from the rolls by their new insurers, they’ll be in the ballpark of 2.6 million, or 60 percent of their target. And that’s after HHS pressured insurers to extend the payment deadline from December 31 into January, hoping that a little more time for slackers would pad the enrollment figures even more.

Is it “only” 20 percent who haven’t paid, though, or is the actual number even bigger? The Times is guesstimating based on what they’re being told by different insurers, but read down into the piece and you’ll see that the biggest companies are seeing payment rates below 80 percent — another detail flagged by Laszewski when he wrote about this a few days ago. Eighty percent is probably the best-case scenario[.]

And, always remember, the number of “sign-ups” the administration is hawking is people who went on an exchange site and selected a plan, not those who necessarily paid for that plan. As in, if you went to Amazon and put a garlic press in your virtual cart, you’d be considered a happy purchaser of said garlic press by the administration. The press giving that nonsense metric any credence at all is a willful misrepresentation of what’s going on, here:

On Tuesday, HHS said that 4.2 million people had signed up for private insurance plans under Obamacare through the end of February. That’s way off pace for the administration’s initial goal of 7 million enrollments this year, now viewed as unattainable. Even reaching a revised target of 6 million projected by the Congressional Budget Office after the disastrous rollout of HealthCare.gov is a daunting challenge. A new report Wednesday by Avalere Health said reaching the lower goal was highly unlikely, estimating 5.4 million enrollments by the end of March.

The answer to how many of the sign-ups have paid is important because that’s who will have actually gained insurance under the law. The number is bound to be significantly less than those who have simply chosen plans — four large insurers estimated to POLITICO this week that 15 percent to 20 percent of people who signed up hadn’t paid.

But who’s counting? No, really. Who is counting?

Tags: ACA, Affordable Care Act, exchange, implementation, ObamaCare, sebelius

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HHS:Why,no,wearenotmeasuringthe

HHS: Why, no, we are not measuring the very metric ObamaCare was passed to improve

posted at 8:31 pm on March 6, 2014 by Mary Katharine Ham

Allahpundit mentioned this in his earlier post, but I just want to emphasize it.

The federal government is not even measuring the very number ObamaCare was created to bring down. How many times did we hear 47 million uninsured? How many times did we hear it was necessary to pass a huge revamp of the entire system to insure them? Later we heard the prediction for how many of those 47 million we’ll actually insure is quite underwhelming. Now, we ask: Hey, how many of the uninsured are we actually insuring?

A: “That’s not a data point we are really collecting in any sort of systematic way.”

There is no clearer dereliction of duty for this law. They created an irresponsible reform behemoth, they failed to implement it responsibly, they spent irresponsible amounts of money building a bunch of exchanges that don’t work, and now they’re not even responsible enough to bother checking how much help or damage they’ve done with the most straightforward metric available.

They don’t care about how much of your money they spend and they don’t care about figuring out if they’re helping people with that money because they might have to admit to not caring about how much of your money they spend. This is why having government tackle complicated problems can be a problem in and of itself.

If only we could go back to the bad old days of the intolerable status quo.

Depressing:

There’s a lot we don’t know about how Obamacare enrollment is going. Apparently that’s also true even within the Obama administration.

Gary Cohen, the soon-to-be-former director of the main implementation office at the Health and Human Services Department, stopped by an insurance industry conference Thursday to offer an update on enrollment. The main points were familiar: People are signing up (about 4 million have picked a plan so far), and the administration is going all out to promote Obamacare over the last few weeks of the enrollment window.

But Cohen didn’t have much more to offer insurers—who need this to work just as much as the White House—on some of the biggest unknowns about the law’s progress:

How many uninsured people are signing up?

The Congressional Budget Office estimates that the health care law will reduce the number of uninsured people by about 24 million over the next few years, and that about 6 million previously uninsured people will gain coverage through the law’s exchanges this year. So, is enrollment on track to meet that goal? Overall enrollment is looking pretty decent, but how many of the people who have signed up were previously uninsured?

“That’s not a data point that we are really collecting in any sort of systematic way,” Cohen told the insurance-industry crowd on Thursday when asked how many of the roughly 4 million enrollees were previously uninsured.

New York state is collecting that data, and it says about 70 percent of its enrollees were not covered before, while about 30 percent are changing their coverage rather than gaining it.

How many people signed up directly with insurers?

When HealthCare.gov was broken in October and November, HHS and insurers agreed on “direct enrollment” as a workaround—encouraging people to sign up directly with insurance companies. It’s also an option for people who are too wealthy to get a subsidy to help cover their premiums (the main benefit of using the exchanges), or who had a plan canceled and want to stick with the same carrier. Cohen was asked Thursday how many people have signed up outside the exchanges.

“I don’t think we have done anything to try to collect that sort of data,” he said.

This is the law’s purported raison detre, as we were told countless times. But they can’t even be bothered to count. It’s easier to claim you’re helping people when you refuse to collect data that might say otherwise.

Tags: exchanges, implementation, ObamaCare, state, uninsured

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Carneyonexchangeaccountability:Hey,California’sdoingpretty

Carney on exchange accountability: Hey, California’s doing pretty well!

posted at 9:21 pm on March 3, 2014 by Mary Katharine Ham

The failures of Obamacare implementation have been so many and so varied that nearly lost in the coverage is the near-criminal (In Oregon, maybe literally criminal) amount of money spent on both federal and state exchanges that don’t work. Fox News’ Wendell Goler asks Jay Carney today about accountability for these failures and the amount of money, much of it federal, wasted on these projects. Carney claims to have no information about this, despite the fact it’s his job to have information about this, and suggests Goler call CMS. In reaching for something to fill the time, Carney sites California’s exchange, which could perhaps be characterized as the least dysfunctional of the state exchanges, but is no picnic.

The Free Beacon notes how very low this bar is. Do the Limbo Rock!

“California hit its target in the middle of February in terms of enrollees. So that’s one working pretty well, I guess,” Carney said.

Apparently Carney’s bar for “working pretty well” is incredibly low. Maybe Carney forgot California’s online exchange was shut down for five days last week due to software problems, or the lingering problems consumers encounter when trying to sign up for Covered California.

California has also faced problems enrolling enough Latinos. Latinos comprise 50% of the uninsured population in California, but only accounted for 21% of signups through mid-February.

Elsewhere in Great Moments in ObamaCare Success That Never Were, a new study suggests even Medicaid enrollments aren’t what the White House has claimed. This is because the White House is playing the same games with those numbers as private insurance enrollments— counting a determination you’re eligible for Medicaid enrollment as enrollment.

A new analysis of Medicaid enrollments is challenging the Obama administration’s account that nearly 10 million people are in the process of signing up for the program under ObamaCare.

Figures released Monday by consulting firm Avalere Health found that only 2.4 to 3.5 million people have newly registered for Medicaid since October under the healthcare law.

The disparity highlights the cloudiness of Medicaid numbers released by the administration, which counts those who have been “determined eligible” for the program rather than those who have actually signed up.

Some of the 8.9 million people counted by the administration were also eligible before the healthcare law expanded access to the program.

Tags: California, exchange, implementation, ObamaCare

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ObamaCare’sheadaches:Arealloftheseuntrue,too?

ObamaCare’s headaches: Are all of these untrue, too?

posted at 9:21 pm on February 27, 2014 by Mary Katharine Ham

The implementation of this law has broken down at every single level. Harry Reid has chosen to defame those who speak out about their giant, life-threatening problems with Obamacare, but what of the thousand daily headaches the law is causing due to bad design, unintended but entirely predictable consequences, and the error cascade that followed the exchanges’ disastrous launch? Sen. Harry Reid would call these mere trifles since he’s willing to dismiss women with cancer losing their coverage. But I don’t think it’s politically wise to argue that that the people living this stuff every day are not really living it. Or, that their time and trouble means nothing so long as we’re marching forward toward Reid’s dream of a health care system, where ladies with cancer are slandered on the Senate floor for not thanking the Senate for the chance to have a plan they liked taken from them to gamble on the unpredictable, expensive, subpar plans Obama wants them to have.

This came from NPR, so is this a lie, Senator? Julie Boonstra’s life means nothing to Reid. Sheila Lawless’ time will mean even less. But it should mean something to us:

Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty–incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges.

Open enrollment doesn’t end until March 31, but people who have already bought Obamacare plans are beginning to use them. “We had a spattering in January—maybe once a week. But I think we’re averaging two to three a day now,” says Lawless.

That doesn’t sound like many new customers, but it’s presented a major challenge: verifying that these patients have insurance. Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process,” she explains. Those sorts of hold times add up fast.

In the past, offices have been able to make sure patients are insured quickly, by using an online verification system. But for exchange patients, practices also have to call the insurer to make sure the patient has paid his premium. If he hasn’t, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made.

More than an hour on hold per exchange patient just to do the routine verification that the private sector pre-Obamacare status quo we hear was so horrible had down to a several-second online process. This is one of these instances where Obamacare’s chestnuts are ironically pulled out of the fire by its failures, to some extent. Imagine how bad this would be for Lawless and her countless counterparts all over the country, if the error-ridden system with its pay-is-optional design had actually managed to attract 7 million Americans. It’s easy to think this isn’t a huge deal, especially when compared to someone with cancer losing coverage for her medication. But Lawless is a symbol for many other Americans and many other actors in the health care system. How much attention to other patients is being eaten up by the 6-8 hours she’s spending making sure three or four are actually enrolled in Obamacare? This was reform that was supposed to bring more attentive patient care and less administrative worry. So much for that. So much for whatever work Lawless did instead of verifying Obamacare patients for hours a day, and for the time she maybe spent with her family or doing a hobby, which is now spent playing catch-up on the rest of her normal verification work.

And, then there’s this. When they attack my pizza, they attack me:

Tucked deep in the Affordable Care Act is language requiring all restaurants with at least 20 locations to list nutritional information alongside each and every item on their menu.

That edict is now creating headaches for small business owners across the country, particularly pizza chains.

Take Domino’s. There are 34 million different pizza combinations available at the chain, when all crusts and cheeses and toppings are factored in.

Now imagine walking into a Domino’s and navigating a menu board with 34 million different options on it.

Executives say figuring out the small print will be a big burden.

“Our company, like many pizza enterprises, is individual small business franchisees, so these are people that own three or four, or one or two Domino’s pizza stores,” said Domino’s spokeswoman Lynn Liddle. “To have to redo the menu boards every time something changes on a calorie count would cost them several thousand dollars.”

Even some Democrats have turned against the calorie count requirements, as they’ve turned on other onerous Obamacare requirements after they voted for them:

“What the FDA did, I think, was really an overreach,” Rep. Loretta Sanchez, D-Calif., told Fox News.

Sanchez backs legislation that encourages the FDA to allow certain restaurants — especially places that deliver frequently — to provide information online or through an app, or offer information for a variety of toppings and combinations.

The Common Sense Nutrition Disclosure Act of 2013 has bipartisan support in Congress.

Hey, just a couple thousand dollars per small business. Just a couple hours per Obamacare verification. Just a couple doctors you can’t see, cancer patient.

And, your headache will last forever and ever, whether you like it or not:

Tags: exchange, Harry Reid, implementation, ObamaCare

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Greatmomentsinstateexchangesuccess:Marylandfires

Great moments in state exchange success: Maryland fires its contractor

posted at 9:21 pm on February 24, 2014 by Mary Katharine Ham

“It’s going to be smoother in places like Maryland where governors are working to implement it rather than fight it. (Applause.)” — President Barack Obama, Sept. 26, 2013

Five months in, Maryland’s state exchange is still barely limping along. Lt. Gov. Anthony Brown, who headed up the exchange build, has no apologies. The exchange director resigned after she went on a Cayman vacation while the site was imploding. The situation is bad enough that this essentially one-party state has devolved into a fight over whether they should abandon their $100 million dysfunctional site for the federal site, and Democrats running for governor are whacking each other with its failure.

Now, another contractor bites the dust:

Maryland has fired the contractor that built its expensive online health insurance marketplace, which has so many structural defects that officials say the state might have to abandon all or parts of the system.

The Maryland Health Benefit Exchange voted late Sunday to terminate its $193 million contract with Noridian Healthcare Solutions. Columbia-based Optum/QSSI, which the state hired in December to help repair the flawed exchange, will become the prime contractor, while Noridian will assist with the transition.

“We worked very hard with [Noridian] to find a path forward,” said Isabel FitzGerald, the Cabinet secretary in charge of information technology. “And the decision now is that we are just not making the progress that we had hoped.”

Maryland was one of 14 states that chose to build their own health-insurance marketplace to implement President Obama’s Affordable Care Act, which politicians and residents in the state strongly support. Gov. Martin O’Malley (D) boasted that the marketplace and the Web site Marylanders would use to access it would be among the best in the country.

But the site failed within minutes of its Oct. 1 launch, blocking residents who were trying to get health insurance. The system has limped along since then. Ultimately, state officials say, they may have to rely at least partially on the federal health-care Web site or on sites operated by other states.

As of Monday, Maryland had paid Noridian $67.9 million for its work and had unpaid invoices totaling $12.9 million, state health officials said.

Predictably, state officials are blaming the contractor and the contractor is blaming the state’s unrealistic desire for a quick turnaround and frequent changes:

McGraw said his company met its contractual obligations under “tremendous pressure and constant changes by the state,” which amounted to hundreds of adjustments and fixes.

In attending Maryland’s Health Exchange meetings over several years, I can confirm that they did keep adding capabilities to the technologists’ plate, sunnily predicting an exchange to beat all other state exchanges with seemingly very little knowledge of what was necessary to make the project happen. I cannot emphasize enough that Maryland was supposed to among the best prepared states in the country for this boondoggle. They were foiled by their own ambitions, their lack of understanding of the magnitude of this tech undertaking, a system without anyone accountable for its success, and the federal government’s withholding important information until after President Obama was reelected, which compounded all of the above problems by making the timeline even shorter than it already was.

Tags: exchange, implementation, Maryland, ObamaCare

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CaliforniaObamaCareexchangesitegoesdownjustas

California ObamaCare exchange site goes down just as marketing campaign debuts

posted at 9:21 pm on February 20, 2014 by Mary Katharine Ham

No, it’s not the traffic because the marketing campaign was so successful. It’s just more glitches, meaning all the money spent on the marketing campaign was wasted once again.

Amid a big marketing push, California’s enrollment website for Obamacare coverage has suffered an unexpected outage due to software glitches.

The website problems come at a crucial time as the Covered California exchange tries to persuade more uninsured people to sign up ahead of a March 31 deadline.

The state exchange unveiled new TV commercials and radio ads this week aimed in particular at Latinos, who have been slow to enroll so far. The exchange is also urging more people to visit enrollment counselors, who rely on the state’s online system.

Covered California took its enrollment system down for scheduled maintenance and upgrades for 24 hours this past weekend. But problems have persisted and Thursday consumers were greeted by a message saying “the enrollment portion of the site is being worked on.”

You can still browse the site for expensive plans and compare expensive prices, and hey, maybe if you manage to put something in your cart, presumably the Obama administration can count you as an “enrollee.” But you can’t actually enroll.

California remains among the most successful of the state exchange efforts. As Joe Biden might say, this is “a hell of a start.”

Tags: California, Covered California, exchanges, implementation, ObamaCare

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Pelosi:No,therewon’tbeamandatedelay

Pelosi: No, there won’t be a mandate delay for the little people because this is sound policy

posted at 7:21 pm on February 14, 2014 by Mary Katharine Ham

A variation on the “you’re gonna love it once it’s fully enacted” chorus of fibs we’ve been hearing since this thing was passed in 2009. It isn’t really news, per se, that Rep. Nancy Pelosi is willing to support a pass for employers for this law that doesn’t go to individuals about to be hit with the mandate tax. It’s not news that she’s willing to ignore the many failings of the law and its implementation and refer to it as utterly “sound policy,” even as the worst Jenga tower every constructed is crumbling before her. But it is illustrative of the Democratic plan to put blinders on and say “but, but, we passed a law!” when faced with the unfairness of the system they’ve created and the waivers they’re granting. It’s also illustrative of how lazy an answer Democrats offer on this stuff. “It’s a totally different issue,” she says. Well, that settles that. Enjoy your sound policy. Unless their sound policy took your formerly sound policy away.

For more on the lazy answer front see this from Sen. Joe Manchin, who thinks we should delay the whole thing. Imagine that!

“You’re just picking and choosing,” the West Virginia Democrat said of the administration’s decision. “First it’s basically the large employers, then it’s medium groups, then it’s 50 to 100 — medium-sized. If there’s a problem, there’s a problem.” He said there’s bipartisan support for legislation postponing the implementation of the entirety of the Affordable Care Act until 2015. “We’re sure in a transition period and they keep changing the dates,” the senator said, frustrated. “So I wish everyone would come to grips.”

Sen. Barbara Mikulski, via Betsy Woodruff, who does push the senator and gets more silliness:

“I think it’s more important than we get it done right than fast,” she told NRO. “So I support the president’s decision. Typically these businesses that have to negotiate and — so I support the president’s decision.”

When I asked her if she thought it was valid to argue that delaying the employer mandate but not the individual one favors companies over individuals, she said, “I think I support the president’s initiative.”

And, Sen. Jon Tester:

“You know, it’s probably the right thing to do,” he told NRO. “I mean, he probably looked at some metrics that caused him to make that decision. The rollout was rocky, everybody knows that.”

These are the people writing the “sound policy” that would shape a sixth of the American economy. What could go wrong (that hasn’t already)?

Tags: ACA, exchange, implementation, ObamaCare

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ObamaCareroll-outsobadinMaryland,Demcandidates

ObamaCare roll-out so bad in Maryland, Dem candidates smacking each other with it

posted at 9:21 pm on January 30, 2014 by Mary Katharine Ham

“It’s going to be smoother in places like Maryland where governors are working to implement it rather than fight it. (Applause.)” — President Barack Obama, Sept. 26, 2013

Again, I remind you, Maryland was among the most prepared states in the union for Obamcare.

Now, Maryland is having a gubernatorial race to replace Gov. Martin O’Malley, who put his state all in for Obamacare as soon as it passed in hopes of parlaying the law’s success into fuel for his presidential aspirations. The Democratic Party in this (nearly) one-party state is holding a gubernatorial primary, which features O’Malley’s lieutenant governor, who oversaw (and I use the word lightly) the Maryland exchange build, that attorney general who got caught on Instagram partying with high-schoolers, and State Delegate Heather Mizeur who has yet to distinguish herself with a screw-up warranting national news coverage. How does she expect to get her name recognition up?

Lt. Gov. Anthony Brown declined to apologize for the exchange’s failed launch, and the state has opted to keep running its own exchange instead of sending Marylanders to HealthCare.gov.

Douglas Gansler, the Instagram keg-party guy, is now hitting Brown on the decision not to use the federal site (Politico Pro $):

Gansler has been attacking his Democratic rival Lt. Gov. Anthony Brown over his role in the state’s implementation.

“The Affordable Care Act was a great accomplishment, and Maryland should have led the way in implementing President [Barack] Obama’s legacy legislation,” Gansler said in a statement. “But in the nearly four months since the website launched, most Marylanders still are unable to use it to buy insurance.”

“It’s unfortunate that we have yet to hear any viable solutions proposed by Lt. Governor Brown to help uninsured Marylanders who can’t purchase coverage because of the broken website,” said Gansler’s running mate, Jolene Ivey. “We’re waiting for an explanation from him about how he spent $170 million in taxpayer dollars on a broken website,” said Ivey.

Four months into this debacle, Gansler is betting even a deep-blue electorate’s patience is running out:

Now, as O’Malley and his appointees have scrambled to get the state exchange back on track, Gansler has laced into Brown over the performance of the state exchange, arguing that it has “failed miserably” and given “fodder for Republicans” who want to scrap the ACA altogether. Having spent months mocking Brown as an empty suit, Gansler points to the health care mess as a case in point.

“Brown and others were so boastful about Maryland leading the country, [but] here we are behind such states as Nevada and Kentucky, let alone California and states like that,” Gansler said, emphasizing that while he is a supporter of the president and the ACA: “I think it’s certainly appropriate for Democrats to question what has gone on in individual states regarding people’s ability to enroll in an exchange.”

In some respects, the Maryland race is a unique one: No other state on the 2014 map features an open-seat contest for the heart of the Democratic base between two major candidates, one of whom was directly tasked with implementing a state health care exchange. For health care reform critics, Gansler is an obviously imperfect messenger, a combative politician who replaced his campaign manager last week in an effort to steady his listing bid for governor.

Even still, the success or failure of Gansler’s biting message could reveal just how frustrated — or how serenely patient — rank-and-file Democrats may be with the progress of a law that was supposed to cement a new era of activist government. There’s little chance of a competitive general election in Democratic Maryland, but success by Gansler could also presumably cheer Republicans who have put the ACA’s implementation woes front and center for their 2014 message.

Tags: exchanges, implementation, Martin O'Malley, Maryland, ObamaCare

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AetnaCEO:Wemighthavetopullout

Aetna CEO: We might have to pull out of ObamaCare because it’s not attracting uninsured

posted at 9:21 pm on January 23, 2014 by Mary Katharine Ham

One of the nation’s biggest health insurers is worried enough about a scenario in which it would have to pull out of Obamacare exchanges that its CEO is willing to talk about the possibility on national TV from Davos. It may be partly a signal to the administration to get this train moving, but it’s no doubt also a reckoning with reality. Obamacare is not attracting the uninsured, and if the administration would stop changing the rules long enough for insurers to get a handle on who is in the exchange population, they’d no doubt find that population is far more sick and expensive than it was supposed to be.

Aetna CEO Mark Bertolini told CNBC on Wednesday that Obamacare has failed to attract the uninsured, and he offered a scenario in which the insurance company could be forced to pull out of program.

The company will be submitting Obamacare rates for 2015 on May 15.

“Are they going to be double-digit [increases] or are we going to get beat up because they’re double-digit or are we just going to have to pull out of the program?” Bertolini asked in a “Squawk Box” interview from the World Economic Forum in Davos, Switzerland. “Those questions can’t be answered until we see the population we have today. And we really don’t have a good view on that.”

He said that so far, Obamacare has just shifted people who were insured in the individual market to the public exchanges where they could get a better deal on a subsidy for coverage. “We see only 11 percent of the population is actually people that were firmly uninsured that are now insured. So [it] didn’t really eat into the uninsured population.”

For Obamacare to work better, it needs more flexibility and choice of insurance programs, Bertolini said. “We need to make it a lot more simpler for people. There needs to be more choice. When you get more choice, you make it more of a market and you get more people in the program.”

Bertolini’s comments illustrate the bind the insurance industry is in—and, yes, they jumped in with Obama on this deal expecting a bunch of people to be forced to buy their product. Obamacare has failed in such a way as to force them to raise rates dramatically. If they raise rates dramatically, the very administration that needs them to stick with the program will be calling them bad apple patent medicine salesmen because vilifying them will be the only hope for politically extricating itself from its policy failure, at least temporarily. And, in the meantime, the industry can’t even get a handle on who is in the exchanges because the administration keeps changing the rules every five minutes. A couple of industry folks told me last week, even if the news about the make-up of the exchanges is bad, it’d be better to figure it out, get some experience with the population, and gauge what can be done for cost containment. Obama’s short-sighted game of switcheroo doesn’t allow much actuarial science to take place.

As to Bertolini’s prescription for more choice and market forces, something like this, perhaps?

This week, health care analyst and Obamacare opponent Megan McArdle went to the Upper West Side and debated the proposition that Obamacare is already doomed…and won. Her analysis, coupled with Bertolini’s message should be chilling to Obamacare fans:

Obamacare’s exchange facility was conceived as a “three-legged stool”: guaranteed issue, community rating, mandate. Guaranteed issue means that an insurer can’t refuse to sell you a policy. And community rating means that they can’t agree to sell you a policy — for a million dollars. The problem is that if you set things up this way, it makes a lot of sense to wait to buy insurance until you get sick, at which point premiums start spiraling into the stratosphere and coverage drops. Enter the mandate: You can’t wait. You have to buy when you’re healthy or pay a fine…

Unfortunately, whenever someone has voiced discontent with the way things are going, the administration has taken a hacksaw to another leg. For example, some folks who had policies they liked before were being forced to drop them and buy new policies they didn’t like so much. That caused an outcry, followed by an emergency grandfathering rule.

McArdle offers a timeline for Obamcare’s demise, stipulating that its few popular provisions will survive:

Many of the commentators I’ve read seem to think that the worst is over, as far as unpopular surprises. In fact, the worst is yet to come. Here’s what’s ahead:

· 2014: Small-business policy cancellations. This year, the small-business market is going to get hit with the policy cancellations that roiled the individual market last year. Some firms will get better deals, but others will find that their coverage is being canceled in favor of more expensive policies that don’t cover as many of the doctors or procedures that they want. This is going to be a rolling problem throughout the year.

· Summer 2014: Insurers get a sizable chunk of money from the government to cover any excess losses. When the costs are published, this is going to be wildly unpopular: The administration has spent three years saying that Obamacare was the antidote to abuses by Big, Bad Insurance Companies, and suddenly it’s a mechanism to funnel taxpayer money to them?

· Fall 2014: New premiums are announced.

· 2014 and onward: Medicare reimbursement cuts eat into hospital margins, triggering a lot of lobbying and sad ads about how Beloved Local Hospital may have to close.

· Spring 2015: The Internal Revenue Service starts collecting individual mandate penalties: 1 percent of income in the first year. That’s going to be a nasty shock to folks who thought the penalty was just $95. I, like many other analysts, expect the administration to announce a temporary delay sometime after April 1, 2014.

· Spring 2015: The IRS demands that people whose income was higher than they projected pay back their excess subsidies. This could be thousands of dollars.

· Spring 2015: Cuts to Medicare Advantage, which the administration punted on in 2013, are scheduled to go into effect. This will reduce benefits currently enjoyed by millions of seniors, which is why they didn’t let them go into effect this year.

· Fall 2015: This is when expert Bob Laszewski says insurers will begin exiting the market if the exchange policies aren’t profitable.

Emphasis mine, and Mark Bertolini’s.

Tags: Aetna, exchanges, health care, implementation, insurers, ObamaCare

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