Saturday, December 21, 2013

ObamaCare update December 21 - 23 , 2013 - Did President Obama and HHS , by partially exempting millions from the Individual Mandate unilaterally , de facto repeal the Individual Mandate for everyone ? How can the act of Insurers following the law and canceling insurance plans that were not in accord with Obamacare ( rendering millions suddenly with out insurance plans ) , be deemed an " unexpected human caused event " ? In other words , is ObamaCare itself a " hardship " and if so , what other exemptions will be bestowed on random groups / subsets of citizens by HHS as ObamaCare continues to unravel ? As the economics fall apart , what subsidies will be unilaterally given to insurers ?

Ho ho ho !

Obamacare's California Portal Has Been Down For Hours One Day Ahead Of The Extended Deadline

Tyler Durden's picture


With the second consecutive extension to the Obamacare enrollment deadline announced hours 
ago, one would image the website's designers realized that in what would, hopefully (supposedly) be an epic scramble by tens of thousands, or just tens, of Americans to sign up in the last moment, that there could be a traffic surge and adjust appropriately. So the thinking goes, at least, in theory. In practice, however, for those trying to sign up for socialized healthcare in California, what they are being greeted with, instead, is the socialist equivalent of the BSOD, better known as "ERROR: Sorry, An Error Has Occurred in the System."
And to think the fawning media said so many times that was fixed, that people actually believed the lie.
Below is a screenshot of what everyone who clicks on the "Apply Now" screen in the Covered California state portal.

Needless to say, with fixed websites like these, who needs the Syrian Electronic Army?

Merry Xmas from HHS and the White House to late shoppers.... Not so much to the insurers...

Obamacare Deadline Extended One More Day

Tyler Durden's picture

Things are going so well for Obamacare that the administration has decided, at the very last minute, to extend the deadline to sign-up for Jan1st coverage through the end of Christmas Eve. As WSJ reports, this change - which follows weeks of last-minute policy shifts - gives young people and the uninsured 24 more valuable hours to decide but, as we have previously noted, initial sign-up tallies are falling dramatically short of expectations.


The deadline was originally set for midnight on Dec. 23, but contractors managing the site changed configurations to allow users to sign up for the first wave of health-law coverage through Dec. 24, people familiar with the matter said.

The change follows weeks of last-minute policy shifts for the administration. Last week, for instance, with only days before the enrollment deadline, the Obama administration said people whose plans were canceled would be exempted from a requirement that people buy coverage or pay a fee next year.


The late changes have rattled insurers and left some customers uncertain what options are available to them. Some health insurers say the changes could undermine their market by obscuring their ability to predict business risks and set prices accurately.


But initial sign-up tallies are expected to fall far short of expectations: Only 365,000 people nationwide navigated through technologically troubled online marketplaces to enroll in private plans in October and November. On Friday, President Obama told reporters a million more had enrolled in the first weeks of December, but the totals still fall short of a 3.5 million-enrollee target for the private plans by the year's end.
Of course, with the pitchman-in-chief busy on the links, we wonder how much difference this will make...

Merry Christmas, insurers: HHS secretly extends ObamaCare enrollment until midnight tomorrow


Try to see it from the White House’s perspective. They took an unholy beating in the media last week for dropping a new package of panicky “fixes” on the public with just days to go before the enrollment deadline. Faced with that hostility, how should a smart, adaptive PR team handle a new “fix” that pushes the deadline back again? Right: Simply … don’t announce it at all. There’s someone out there who’ll be sitting in front of his computer tomorrow, bummed that he spaced on today’s deadline, who’ll try signing up at on a lark in hopes of getting his coverage in place for January 1st anyway. And lo and behold, to his surprise, it’ll work! It’s a Christmas (Eve) miracle, courtesy of Sebelius Claus, even though enrollment is supposed to end at midnight tonight (and was initially supposed to end on December 15th). And no one in the mean ol’ media is the wiser. Until now.
The new deadline, by the way: Literally one minute before Christmas. If you work for an insurance company and you’re facing a 16-hour shift on Wednesday while your family’s home celebrating, just remember — this is what your boss gets for betting that Barack Obama could reinvent the industry, Hopenchange-style.
One individual familiar with the unannounced extension said that it is, in part, intended as a buffer in case the Web site has trouble if a last-minute surge of insurance-seekers proved more than the computer system could handle.
According to the two individuals, both of whom spoke on condition of anonymity about a matter that is not public, the one-day extension is automatic, built into the computer software, and cannot be overridden by individual insurers if they object
On Monday morning, one insurance industry official, informed by The Washington Post about the quiet deadline extension, said that it “creates further challenges to get people enrolled and get their coverage start in January.” The official asked not to be identified because the change hasn’t been made public.
Remember that bit about insurers not being able to override HHS’s fix. Lefties grumble whenever conservatives call this a government takeover of health care, but with every new half-assed, nakedly political HHS-mandated “fix,” that term becomes more accurate. I wonder, in fact, if HHS even gave the industry a heads up before deciding that they had no choice but to process applications filed at 11:55 p.m. on Christmas Eve. It’s possible. I remember more than one news story in November claiming that insurers were blind-sided by Obama’s ass-covering “okay, let’s go ahead and un-cancel some canceled plans” announcement. But that’s life now that the industry works for the government. When the CEO tells you you’re working Christmas Eve, you’re working Christmas Eve.
One silver lining for the White House, though: Per this same WaPo piece, they’ve now had nearly 900,000 people sign up through alone. As of November 30th, that number was somewhere around 127,000 or so. Predictably, sign-ups really did skyrocket in December with the deadline bearing down and the website now stable enough to handle many of them, if not quite all. Then again, who knows what “sign-ups” means at this point? Are these people whose 834 information was successfully relayed to their new insurer and who’ve paid their first month’s premium? Or are these people who placed a plan in their virtual shopping cart but didn’t purchase it; or who did purchase a plan but had their 834 converted into gibberish; or who signed up successfully but forgot that nonpayment means no coverage on January 1st even if you did everything else right? I’ll leave you with this from Pro Publica’s Charles Ornstein, published just four short days ago. Good luck, America:
I’ve heard from a number of consumers this week saying that they had not yet received invoices from their insurance companies, and so they have been unable to pay their first month’s premiums. Along the same lines, at a forum for health journalists last week, an official from the Community Service Society of New York said that she was told that three prominent insurance companies were only beginning to send out invoices to their enrollees.

Remember when Valerie Jarrett promised that President Obama would be signing up for Obamacare today? Shockah! That promise came with an important disclaimer: “To be taken with a squillion grains of salt.” You see, it was just a “symbolic” gesture:

So the White House has gotten so awful at PR it can’t even stage a fake health-care sign-up competently.

View from right and Left on Obama individual mandate exemption tossed out Thursday evening

Leftish view.....

Manchin: Hey, let’s delay all ObamaCare enforcement for a year


Alternate headline: Hey, maybe those Republicans had a point in September, huh? Senator Joe Manchin (D-WV) tells Candy Crowley on CNN’s State of the Union that Democrats and Republicans should come together to approve a one-year delay in any enforcement of the individual mandate in ObamaCare, considering the facts that (a) people can’t enroll through the government websites yet, and (b) the latest (illegal) change from the White House has more or less meant a de facto delay anyway. Why not make it official at this point, and see what happens?
“If it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown at that time,” the West Virginia Democrat said in an interview that aired Sunday on CNN’s “State of the Union.” “This transitional year gives you a chance to adjust the product for the market.”
Here’s the problem with that approach, and also with the latest change from HHS and the Obama administration.  This year’s premium prices were predicated on forcing everyone to buy comprehensive policies, even those who don’t really need them. Not only did Thursday’s change remove the moral argument that non-comprehensive plans are inadequate under all circumstances, it also gave millions of Americans a free get-out-of-comprehensive-insurance-jail-free card. Delaying the mandate will mean that insurance companies will beforced to escalate premiums even more sharply in the fall of 2014 for the 2015 year, and the dynamic that Manchin describes will be even worse than it is now.

ObamaCare is already collapsing under the weight of its own mandates, as anyone who understands risk pools predicted when the bill was being debated. The web-portal issues are just the icing on the cake.,0,5071725.story#axzz2o8H2TS6p

real Obamacare fix: Let thirtysomethings sign up for Medicare

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Copies of the application and instructions for the government health insurance marketplace from the Department of Health and Human Services. (Andrew Harrer / Bloomberg / December 6, 2013)

The Affordable Care Act may have just gotten a little more affordable. Or did it?
The Obama administration announced Thursday night that individuals whose health insurance plans are being canceled under the new provisions of Obamacare will be eligible for a “hardship exemption,” which will allow them to forgo coverage without penalty or to sign up for a cheaper “catastrophic plan” that had previously been available only to people under 30.
”This is a common-sense clarification of the law," Joanne Peters, a spokeswoman for Health and Human Services Secretary Kathleen Sebeliustold Reuters. “For the limited number of consumers whose plans have been canceled and are seeking coverage, this is one more option."
I’m one of those people with a canceled plan. I certainly don’t want to forgo coverage; that’s why I bought it in the first place. So immediately after hearing the news, I went on Covered California’s website and tried to get information on a catastrophic plan. After inputting my age and income, I was informed that I was ineligible for such coverage, and I was not even able to preview what benefits the plan offers.
I called the Covered California helpline for guidance and was told by an automated message that they were experiencing “high call volumes.” After hearing the same message in Spanish, I was hung up on.
Obviously this new iteration of Obamacare was just unveiled and the kinks still need to be worked out. But my current plan is being canceled at the end of the month. If I don’t sign up for a new one by Monday, I’ll either be automatically funneled into a costly Obamacare plan that I don’t especially want, or have no coverage come the new year.
In other words, this change is a little late, isn’t it?
But I have an idea: As long as we’re unveiling plans willy-nilly, how about letting thirtysomethings like me buy into Medicare? Information on the coverage is readily available, and I like what I see. Virtually every health provider in the country takes Medicare, so I won’t have to find a new doctor. Co-pays are reasonable. Count me in.
I’m exactly the type of young, healthy person the health exchanges want. So surely adding me to the Medicare pool could only help the system.
The move would undoubtedly cause a few million conservatives to spontaneously combust. But if the Obama administration is going to cover its screw-ups with desperate last-second patches to the system, it might as well go full bore with them: Use the chaos around Obamacare as a backdoor entry to the ill-fated “public option.” Because these functionally useless half-measures aren’t cutting it.

Why the Latest Obamacare Delay Is the Biggest One Yet

This time it's about fairness

Kathleen Sebelius Testifies Before House On ACA Implementation Failures.
Rod Lamkey / Getty Images
Health and Human Services Secretary Kathleen Sebelius testifies in the Rayburn House Office Building on Capitol Hill, December 11, 2013, in Washington, DC.

When fairness goes out the window, you know politics has caused the White House to take its Obamacare scramble to a whole new level.The administration saidThursday night that people with canceled policies will not be subject to the individual mandate in 2014. This is huge, but you wouldn’t know it from Health and Human Services Secretary Kathleen Sebelius’ letter announcing the change, which she sent in response to senators worried that those who saw their health insurance policies canceled this fall did not “consider” Obamacare replacement policies to be affordable.
In the letter to six Democratic senators, Sebelius tried to downplay the impact of announcing consumers with canceled policies would qualify for a “hardship exemption” from the Affordable Care Act’s requirement they have insurance in 2014. She characterized those affected as “a small number” and said “the population of individuals with canceled plans who do not have quality, affordable coverage for 2014 is clearly shrinking.”
But it would be a mistake to believe this most recent regulatory change is not very important.
Giving those with canceled policies a “hardship exemption” means they will be allowed to purchase catastrophic insurance through Obamacare exchanges. Previously such plans were only available to Americans under 30 or those who could not find ACA plans that cost less than eight percent of their income. As Ezra Klein has pointed out:
A 45-year-old whose plan just got canceled can now purchase catastrophic coverage. A 45-year-old who didn’t have insurance at all can’t. Why don’t people who couldn’t afford a plan in the first place deserve the same kind of help as people whose plans were canceled?
In other words, if you had individual market insurance before the ACA, you have more choices now than if you did not. Sebelius’s extension of the hardship exemption to Americans who lost their insurance this year creates just the kind of uneven playing field Obamacare was supposed to eliminate with a total reset of the individual insurance market in 2014.
In addition, Sebelius is essentially implying that a situation the Obama administration has rightly anticipated for years — that insurers would cancel plans in the fall of 2013 if the plans did not comply with ACA rules — creates a special kind of unforeseen “hardship.” The original individual mandate hardship regulations were issued long before insurers began canceling plans this fall. According to the Centers for Medicare and Medicaid Services (CMS), a person was to qualify for a hardship exemption if:
1. He or she experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan;
2. The expense of purchasing a qualified health plan would have caused him or her to experience serious deprivation of food, shelter, clothing, or other necessities;
3. He or she experienced other circumstances that prevented him or her from obtaining coverage under a qualified health plan.
There is no reasonable interpretation of these guidelines that lines up with what Sebelius is saying now. Even if the general public was surprised when policy cancellation letters started showing up in mailboxes this year, the termination of many individual market plans was hardly “an unexpected natural or human-caused event.” As Sebelius said in her letter Thursday, there’s huge turnover in this market every year. Likewise, there’s nothing about having a policy canceled that makes it more difficult to obtain new Obamacare coverage (let’s assume the administration does not believe that having your individual insurance policy canceled means buying a replacement policy will cause “serious deprivation of food, shelter, clothing, or other necessities”).
Offering further clarification in June 2013 about what would qualify a person for a “hardship” exemption, CMS said a person could get a hardship exemption if he or she:
  • becomes homeless;
  • has been evicted in the past six months, or is facing eviction or foreclosure;
  • has received a shut-off notice from a utility company;
  • recently experienced domestic violence;
  • recently experienced the death of a close family member;
  • recently experienced a fire, flood, or other natural or human-caused disaster that resulted in substantial damage to the individual’s property;
  • filed for bankruptcy in the last 6 months;
  • incurred unreimbursed medical expenses in the last 24 months that resulted in substantial debt;
  • experienced unexpected increases in essential expenses due to caring for an ill, disabled, or aging family member;
  • is a child who has been determined ineligible for Medicaid and CHIP, and for whom a party other than the party who expects to claim him or her as a tax dependent is required by court order to provide medical support. We note that this exemption should only be provided for the months during which the medical support order is in effect; or
  • as a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through the Marketplace, advance payments of the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through the Marketplace, noting that this exemption should only be provided for the period of time affected by the appeals decision.
With this latest change, a new circumstance is added to this list:
  • Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.
Up until this point, there was a plausible argument to be made that most of the other ACA exceptions, exemptions and delays announced in the last year were made in the name of fairness. Employers were supposedly having trouble getting their paperwork and computers systems in line to comply with the employer mandate, so it was delayed a year — for all employers. Consumers trying to buy new plans through were struggling to navigate a dysfunctional website, so the deadline to sign up for coverage was extended from Dec. 15 to Dec. 23 — for everyone shopping through
In contrast, the Obama administration’s changes in response to political fallout from individual market plans being canceled this fall — allowing states to extend existing plans for an extra year and this new hardship exemption — are something else. Thursday’s change puts those with canceled policies in a unique category that offers them a different kind of coverage and the ability to disregard the individual mandate, a major tenet of the law, which does not seem fair to those who did not have insurance prior to the law and who would very much like to buy a catastrophic plan but cannot. Republicans have already pounced on this latest change to argue that if Obamacare rules are simply too onerous for the small subset of Americans whose policies were canceled this fall, then they are too onerous for everyone else as well.

Obama Exempts “If You Like It You Can Keep It” Cancelees from the Individual Mandate

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By Lambert Strether of Corrente
And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow
In a six-part series on “ObamaCare’s relentless creation of second-class citizens,” I showed how people seeking health care through ObamaCare’s exchanges get randomly varying access to care because of age, geography (state and county), income, employment status, banking status, internet access, existing insurance status, language, demographics, and by CMS marketing category (123,45, and 6. In addition, people “on the bubble” for income eligibility are incentivized to corrupt the system by gaming it.)
These variations are in great contrast, both morally and economically, to single payer’s “everybody in, nobody out” model. None of these variations are in any way fair, or encourage equal access to health care, which Obama seemingly concedes is a right; they exist solely because of Obama’s determination to preserve the private insurance industry’s actuarial model, even though the private insurance industry is a wholly parasitical, rent extracting tapeworm on the body politic. All this would be true even the supposedly tech savvy Obama political operation had not turned into the debacle it has been.
Be that as it may, the administration has now added yet another whimsical and arbitrary misfeature to Obama’s “signature domestic initiative.”[1] David Lauter of the LA Times explains why some people who were going to Pain City are now going to Happyville!
Under the new policy, people who have received notices that their health plans are being canceled would qualify for
hardship exemptions allowed by the law. Under those exemptions, they could buy low-cost catastrophic health plans or skip buying health coverage altogether.
It’s worth noting that the rule change was not motivated by public policy, but — and I know this will come as a surprise to you — purely by political considerations.
The new policy stems from one of the biggest political problems Obama has faced with the troubled rollout of the healthcare law — his promise that the people who liked their existing health plans could keep them. When several million people nationwide began receiving notices that their plans would be canceled because the plans fell short of the new law’s requirements, Obama suffered a sharp drop in public trust.
Democrats in Congress, especially senators facing tough reelection challenges next year, were bitterly upset at the predicament in which Obama’s words had placed them. They have pressured the administration to respond to angry constituents.
Why is this important? (Consumer Reports, disgracefully, simply uses the story as click bait for its eligibility calculator.) Because the key feature of ObamaCare is “the marketplace” (the exchanges) and the individual mandate that forces people to buy products from that market[2], in order to guarantee the health insurance industry customers for the foreseeable future.[3] But this new hardship exemption blows a hole in the mandate. Reuters:
In the law, there are 14 categories of “hardships” that can be used to get an exemption from the mandate to buy insurance, such as a recent eviction or bankruptcy. But this is the first exemption prompted by the administration’s botched rollout of the law, and comes after months of insistence that there would be no delays in implementing the individual mandate.
No delays except for everybody and his brother who already got a delay, like employers, small businesses, health insurance companies, name it. Everybody but you. Until now! Again, needless to say, this delay is has no coherent basis whatever in ethics or policy. Even Ezra Klein is aghast:
A 45-year-old whose plan just got canceled can now purchase catastrophic coverage. A 45-year-old who didn’t have insurance at all can’t. Why don’t people who couldn’t afford a plan in the first place deserve the same kind of help as people whose plans were canceled?
Why, it’s almost like people who might cause Democrats electoral problems are a protected category, isn’t it? If lack of coverage for enough people like you makes Obama look bad, you’ve got a hardship. You’re a winner, and you get a ticket to Happyville! See how simple Federal rule-making can really be? Here’s how the exemption works, according to WaPo:
2. According to HHS, the exemption covers people who “experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan.”
Now, if I were Pajama Boy, that lovable little scamp, and I wanted to beat back my Obot Mom’s Christmas assault, I might reason in this way:
[thinks] Hmm…. “unexpected … human-caused event” — that would be ObamaCare — with an “unexpected increase in essential expenses” — that would be the cost of ObamaCare, ’cause yeah, my Mom says it’s essential… “prevent… from obtaining coverage”… Yeah! The narrow networks  definitely  prevent me from obtaining coverage. Because they’re narrow!
“Hey Mom! I’m going to Happyville! The HHS says that if the plans I’m eligible for are lousy, I get a hardship exemption!”
And seriously, if you’re going to give a hardship exemption to the cancelees, why not give a hardship exemption to the sticker-shocked? (Or, as we might say, the informed consumers who put in the many hours needed to figure out if the plans on the Exchanges were any good or not.)
I hate to quote a stopped clock like Megan McArdle but give credit, she got it right on the Exchanges when all the Obots were either silent or waving their pom poms, so here she is on the political implications:
However incoherent these fixes may seem, they send two messages, loud and clear. The first is that although liberal pundits may think that the law is a done deal, impossible to repeal, the administration does not believe that. The willingness to take large risks with the program’s stability indicates that the administration thinks it has a huge amount to lose — that the White House is in a battle for the program’s very existence, not a few marginal House and Senate seats.
And the second is that enrollment probably isn’t what the administration was hoping. I don’t know that we’ll start Jan. 1 with fewer people insured than we had a year ago, but this certainly shouldn’t make us optimistic. It’s not like people who lost their insurance due to Obamacare, and now can’t afford to replace their policy, are going to be happy that they’re exempted from the mandate; they’re still going to be pretty mad. This is at best, damage control. Which suggests that the administration is expecting a fair amount of damage.
Oh, and the dishonesty and immorality of treating politically useful segments as protected categories was built into ObamaCare from the very beginning: That’s why asbestos sufferers in Baucus’s district got Medicare, and not people with chronic diseases anywhere else. And Libby’s website, naturally, worked from day one.
[1] And how true, how very true that is.
[2] Obama keeps insisting otherwise, notably at his latest presser, but of course he’s lying. Again. The mandate and the exchanges are the only “core” features of ObamaCare; take them away, and all the other reforms, like children to 26 on their parent’s policies, or pre-existing conditions, could have been enacted as standalone pieces of legislation. It’s the exchange and the mandate that make ObamaCare ObamaCare — all the more because Obama ran against them in 2008, which Krugman called “poisoning the well for health care reform.” Had we but known.
[3] I meant to say, avoid the “free rider” problem. Sorry.

From the right.......

Six Problems with the Latest Obamacare ‘Fix’


Last night, the Obama administration announced two big changes to Obamacare, for people who have seen their individual-market insurance plans canceled this year: They won’t have to comply with the individual mandate, meaning they can go without insurance and not pay the not-insubstantial fine (1 percent of their income, basically); and if they do want insurance, they can buy a “catastrophic” plan on the exchanges, which is cheaper than any of the other plans available.
This will make life easier, in the short term, for some number of Americans — millions have seen their plans canceled, though the White House suggests just half a million of them still haven’t signed up for new plans, gotten Medicaid, or enrolled in an exchange plan. But as Ezra Klein bluntly put it, these changes could be “a very big problem for the law.” Here’s why:
1. The way it treats the uninsured is unfair and potentially politically unsustainable.
Now that the law’s requirements have been significantly weakened for people who did have insurance in 2013, it’s going to be hard to stand by them for people who didn’t.
In theory, this does reflect one of the principles of how the health-insurance market works: Under pre-Obamacare law, consumers were guaranteed the right to renew their policies (with some cost changes, of course). If you were uninsured, on the other hand, you could have a much harder time finding coverage on the individual market — which is why, for instance, people are allowed to maintain employer coverage for a certain period of time after leaving a job. But Obamacare is supposed to be about expanding coverage, and the inequities this change will create can be really problematic.
Philip Klein nicely lays out one of these scenarios: A previously uninsured 31-year-old California man making $32,000 will now have to pay more for the cheapest plan on the state’s individual market than would a 31-year-old who makes $100,000 a year but had his insurance canceled.
More simply, of course, people whose plans have been canceled will now simply be able to go without insurance, period, at no cost. People who were uninsured in 2012, meanwhile, will have to pay the penalty — for now. Klein and some others on the right (Yuval, and Megan McArdle) argue this could be the end of the individual mandate entirely — for 2014, at least. It’s not hard to see that: After trying to get as many people into the exchanges as possible by March 31, when open enrollment ends, the Obama administration would admit that it’s not reasonable to require people who didn’t get insurance last year to buy it this year, and offer them an exemption for 2014, too.
Once it’s been delayed for 2014, it’s possible the “tax” could be abandoned altogether. As Reihan points out, the mandate hasn’t been a major part of the pitch for people to enroll in the law so far — meaning the White House is almost betting it can make the law work without it.
2. The way it treats almost everyone else is unfair: The exchanges have been open for three months now, and plenty of Americans have committed to buy plans that were either more expensive than they want or that they didn’t want in the first place. If people whose individual-market plans have been canceled knew this was going to happen, they could have waited to buy a catastrophic plan, or bought one on the non-exchange market, or gone without insurance entirely. Marco Rubio put it reasonably on Thursday: “This is a slap in the face to the thousands of Americans who have already purchased expensive insurance through the Obamacare exchanges.”
3. Adverse selection: The people who had their plans canceled now have something called a “hardship exemption” for 2014, which grants them a number of exceptions from Obamacare rules (they’re also given to people in various other instances of distress, though it’s not clear how many people are getting them). One of the benefits: They can enroll in plans on the Obamacare exchanges at any point in 2014, while most people are restricted to buying plans during the open-enrollment periods (which runs through March 31, and will otherwise run from October through December).
This means people who might otherwise buy insurance — say, middle-aged people with potentially looming health problems — can go without it, and if a serious health-care problem comes up, they can just enroll in the exchanges. Not everyone will take advantage of this, but at the margins, it allows people who might otherwise worry about catastrophic health-care bills to stay out of the exchanges, and ensures some flow of very sick, expensive people into them. Health insurance companies can’t change their rates to take account of that, and that information disconnect is what economists call “adverse selection.” On the margins, it will raise premiums for healthy people on the exchanges, and make insurers more wary of participating.
4. More adverse selection: The catastrophic plans that the Obama administration will now let anyone with a canceled plan enroll in this year were originally set up for anyone under the age of 30, and for anyone who gets a hardship exemption. Now, they’ll see an influx of people who had their plans canceled, a group that insurers don’t actually know much about — and for whom they haven’t set their premiums.
5. Even more adverse selection: The catastrophic-insurance markets and the rest of the exchanges are separate risk pools. Within a given state, individual insurers don’t really have to worry about enrolling too many unhealthy or old people, because of something implemented by Obamacare called “risk adjustment.” Insurers with sicker groups get compensated, basically, by insurers that enrolled healthier groups. In all, the insurers want healthier and bigger pools, because they can take on more financial risk safely and make more money, but risk adjustment means it’s lot less useful for them to try to attract healthy enrollees.
The Obama administration is now going to alter the parameters for the catastrophic pool and the normal exchange pool in every state. If their claim that just half a million people who are getting hardship exemptions is accurate, this will also just be a marginal adjustment — but still one the insurance industry wasn’t expecting. All of those issues make it unsurprising to hear that, insurance consultant Bob Laszewski says, the insurance industry wasn’t consulted about these latest changes, and that its trade groups have criticized the maneuver.
6. Increased confusion: The White House (technically, the Centers for Medicare and Medicaid Services) announced the change in policy on a Thursday night, four days before the deadline to select a health-care plan that will work on January 1. While there are a lot of groups communicating directly with actual enrollees, the information trickling down from a CMS report, filtered through the media, is not going to help Americans make informed decisions about their plans. Even just silently added the change as a lucky 13th option on the list of ways to get a hardship exemption. President Obama didn’t make much of an effort to explain the move at his national press conference today, and it’s not surprising: It’s not an easy thing to defend, and the White House has never liked discussing the application of the individual mandate — they’d rather talk carrots than sticks. That all makes it harder to imagine that the sticks will actually work the way they were intended, or are now intended to work.

Obamacare Initiates Self-Destruction Sequence

Photographer: Jim Stratford/Bloomberg News
What happens to bad ideas.

On Wednesday, Politico’s Carrie Budoff Brownreported that the administration was saying fewer than 500,000 people had actually lost insurance due to Obamacare-induced cancellations. This struck me as a strange leak: Half a million is a lot less than many people (including me) have been estimating, but it is still not a small number, and the administration has tended to sit on negative information until the last possible moment.
Yesterday, we had a more official announcement from the administration: Anyone who has had their policies cancelled will be exempt from the individual mandate next year. The administration is also allowing those people to buy catastrophic plans, even if they’re over 30.
What to make of these two statements? On the one hand, the administration is trying to minimize the number of people who have been affected by cancellations, and on the other hand, it is unveiling a fix to the problem of cancellations. And these are not minor changes.
As Seth Chandler points out, doesn’t even let you see catastrophic plans if you’re more than 30 years old. Is now the time to be making technical changes to the website?
As Avik Roy points out, catastrophic plans aren’t that much cheaper than the so-called bronze plans. They’re also not eligible for subsidies. This is unlikely to be much help to folks who lost insurance; all it does is introduce some much-unneeded complexity to
As Aaron Carroll points out, insurers calculated their premiums for this year on the expectation that the relatively healthy folks who were already buying insurance would be buying policies on the exchange. The insurers are not happy about this latest change, and Carroll predicts that they will ask the administration to push more money to them through the “risk corridors.” I think he’s right.
As Ezra Klein points out, this seriously undermines the political viability of the individual mandate: “But this puts the administration on some very difficult-to-defend ground. Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it's wrong. But it's hard to argue that it's right for the currently uninsured but wrong for people whose plans were canceled … Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people whose plans were canceled more deserving of help than people who couldn't afford a plan in the first place?”
Arnold Kling put it more pithily: “Obama Repeals Obamacare.”
I’d ask this: What do you do for an encore? Will the administration force these folks to buy insurance next year? Or will they keep allowing special exceptions rather than take the political heat for changing health insurance that people liked?
I’m not sure the administration is thinking that far ahead. The White House is focused on winning the news cycle, day by day, not the kind of detached technocratic policymaking that they, and the law’s other supporters, hoped this law would embody. Does your fix create problems later, cause costs to spiral or people to drop out of the insurance market, or lead to political pressure to expand the fixes in ways that critically undermine the law? Well, that’s preferable to sudden death right now.
However incoherent these fixes may seem, they send two messages, loud and clear. The first is that although liberal pundits may think that the law is a done deal, impossible to repeal, the administration does not believe that. The willingness to take large risks with the program’s stability indicates that the administration thinks it has a huge amount to lose -- that the White House is in a battle for the program’s very existence, not a few marginal House and Senate seats.
And the second is that enrollment probably isn’t what the administration was hoping. I don’t know that we’ll start Jan. 1 with fewer people insured than we had a year ago, but this certainly shouldn’t make us optimistic. It’s not like people who lost their insurance due to Obamacare, and now can’t afford to replace their policy, are going to be happy that they’re exempted from the mandate; they’re still going to be pretty mad. This is at best, damage control. Which suggests that the administration is expecting a fair amount of damage.

( Can the President and HHS partially repeal the  Individual  Mandate of ObamaCare without completely repealing it ? )

Obama Repeals ObamaCare

Under pressure from Senate Democrats, the President partly suspends the individual mandate.

Dec. 20, 2013 6:41 p.m. ET

It seems Nancy Pelosi was wrong when she said "we have to pass" ObamaCare to "find out what's in it." No one may ever know because the White House keeps treating the Affordable Care Act's text as a mere suggestion subject to day-to-day revision. Its latest political retrofit is the most brazen: President Obama is partly suspending the individual mandate.
The White House argued at the Supreme Court that the insurance-purchase mandate was not only constitutional but essential to the law's success, while refusing Republican demands to delay or repeal it. But late on Thursday, with only four days to go before the December enrollment deadline, the Health and Human Services Department decreed that millions of Americans are suddenly exempt.
Individuals whose health plans were canceled will now automatically qualify for a "hardship exemption" from the mandate. If they can't or don't sign up for a new plan, they don't have to pay the tax. They can also get a special category of ObamaCare insurance designed for people under age 30.


So merry Christmas. If ObamaCare's benefit and income redistribution requirements made your old, cheaper, better health plan illegal, you now have the option of going without coverage without the government taking your money as punishment. You can also claim the tautological consolation of an ObamaCare hardship exemption due to ObamaCare itself.

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Editorial board member Joe Rago on the new health-care law's latest delay—a temporary mandate exemption for those with canceled plans. Photo credit: Getty Images.
These exemptions were supposed to go only to the truly destitute such as the homeless, bankrupts or victims of domestic violence. But this week a group of six endangered Senate Democrats importuned HHS Secretary Kathleen Sebelius to "clarify" that the victims of ObamaCare also qualify. An excerpt from their Wednesday letter, whose signatories include New Hampshire's Jeanne Shaheen and Virginia's Mark Warner, is nearby.
HHS and the Senators must have coordinated in advance because literally overnight HHS rushed out a bulletin noting that exemptions are available to those who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan." A tornado destroys the neighborhood or ObamaCare blows up the individual insurance market, what's the difference?
The HHS ruling is that ObamaCare is precisely such a "significant, unexpected increase." In other words, it is an admission that rate shock is real and the mandates drive up costs well into hardship territory. HHS is agreeing with the Senators that exemptions should cover "an individual whose 2013 plan was canceled and considers their new premium unaffordable." In her reply letter, Mrs. Sebelius also observes that some people "are having difficulty finding an acceptable replacement." She means the new plans are overpriced.
The under-30 ObamaCare category that is being opened to everyone is called "catastrophic" coverage. These plans are still more expensive than those sold on the former market but they're about 20% cheaper on average than normal exchange plans because fewer mandates apply and they're priced for a healthier, younger risk pool. Liberal Democrats hated making even this concession when they wrote the law, so people who pick catastrophic plans don't get subsidies.
Health and Human Services Secretary Kathleen Sebelius Getty Images
What an incredible political turnabout. Mr. Obama and HHS used to insist that the new plans are better and less expensive after subsidies than the old "substandard" insurance. Now they're conceding that at least some people should be free to choose less costly plans if they prefer—or no plan—and ObamaCare's all-you-can-eat benefits rules aren't necessary for quality health coverage after all.
But the White House is shredding ObamaCare's economics on its own terms. Premiums for catastrophic products are based on the assumption that enrollees would be under 30. A 55-year-old will now get a steep discount on care courtesy of the insurer's balance sheet, while other risk-tiers on the exchanges will have even fewer customers to make the actuarial math work.
Pulling the thread of the individual mandate also means that the whole scheme could unravel. Waiving ObamaCare rules for some citizens and continuing to squeeze the individual economic liberties of others by forcing them to buy what the White House now concedes is an unaffordable product is untenable. Mr. Obama is inviting a blanket hardship amnesty for everyone, which is what Republicans should demand.
The new political risk that the rules are liable to change at any moment will also be cycled into 2015 premiums. Expect another price spike late next summer. With ObamaCare looking like a loss-making book of business, a public declaration of penance by the insurance industry for helping to sell ObamaCare is long overdue.
The only political explanation for relaxing enforcement of the individual mandate—even at the risk of destabilizing ObamaCare in the long term—is that the White House is panicked that the whole entitlement is endangered. The insurance terminations and rollout fiasco could leave more people uninsured in 2014 than in 2013. ObamaCare's unpopularity with the public could cost Democrats the Senate in 2014, and a GOP Congress in 2015 could compel the White House to reopen the law and make major changes.
Republicans ought to prepare for that eventuality with insurance reforms beyond the "repeal" slogan, but they can also take some vindication in Thursday's reversal. Mr. Obama's actions are as damning about ObamaCare as anything Senator Ted Cruz has said, and they implicitly confirm that the law is quarter-baked and harmful. Mr. Obama is doing through executive fiat what Republicans shut down the government to get him to do.


The President declared at his Friday press conference that the exemptions "don't go to the core of the law," but in fact they belong to his larger pattern of suspending the law on his own administrative whim. Earlier this month he ordered insurers to backdate policies to compensate for the federal exchange meltdown, and before that HHS declared that it would not enforce for a year the mandates responsible for policy cancellations. Mr. Obama's team has also by fiat abandoned the small-business exchanges, delayed the employer mandate and scaled back income verification.
"The basic structure of that law is working, despite all the problems," Mr. Obama added. His make-it-up-as-he-goes improvisation will continue, because the law is failing.


Who Says Obama Hasn’t United the Country?


Yesterday the Obama administration suddenly moved to allow hundreds of thousands of people who’ve lost their insurance due to Obamacare to sign up for bare-bone “catastrophic” plans. It’s at least the 14th unilateral change to Obamacare that’s been made without consulting Congress.
“It shows that the Obamacare insurance products aren’t selling so, at the last minute, the administration is holding a fire sale on a failed launch,” says Grace-Marie Turner of the Galen Institute, a health-care advocacy group. “Just think how you must feel if you were one of the people who spent the last two months fighting their way through to buy a policy that will be thousands of dollars more expensive than this catastrophic insurance!”
Of course, like every other exemption from Obamacare the latest fix is supposed to last only a year, raising the prospect that people will be kicked off their catastrophic coverage as soon as the 2014 election is safely in the political rear-view mirror.
The fact that no one really knows just how Obamacare is doing (the administration is hiding the numbers) or where it’s going (it’s like an impressionistic painting in progress) may explain the public consensus that’s developed behind delaying its implementation. This week’s Fox News poll found Obamacare to still be a polarizing issue with 53 percent of respondents wanting it repealed and 41 percent wanting to keep it. But then this question was asked: “Setting aside how you feel about the law, do you think implementation of it should be delayed for a year until more details are ironed out, or not?” 
It wasn’t even close. By 67 percent to 28 percent people now want the law delayed. And every demographic group agrees: 57 percent of liberals, 65 percent of women, 67 percent of those under age 35, and 60 percent of lower-income voters. Even African Americans, the bedrock of Obama’s support base now favor a delay by 48 percent to 47 percent.
The public may not know the details of health-care policy, or how to navigate Obamacare’s website. But they can see the fiasco of Obamacare unfolding before them and they’re increasingly united on slowing it down. Look for more and more Democrats in Congress, who will have to face the voters next November, to join them.

12 questions the White House press corps could have asked Obama about Obamacare


Let’s start with the newsiest based on giant news that broke just hours before the press conference and move on from there.
1. Hey, from where do you derive the legal authority to change large parts of this law passed by Congress? And, if you believe you have the legal justification for it, what’s to stop a future president from simply deciding he won’t enforce large parts of it?
2. How exactly does the hardship exemption work? Do you have a ballpark number for how many Americans might be eligible? Is there an enforcement mechanism? For instance, will the IRS or someone demand to see a cancellation letter and proof a family couldn’t afford a new plan? If they don’t have the proper evidence would they later face any consequences?
3. Does the administration have the authority to exempt people from certain taxes on an ad hoc basis? From where does it derive this power? Are there other taxes from which people could be exempted by the president’s decree?
4. The demographic make-up of the group enrolled in the exchanges is extremely important to making the law work and avoiding a death spiral, or adverse selection. HHS has been extremely stingy with numbers and specifics about those demographics. Do you have them? Are you getting reports or any sense of what the pool looks like? Colorado, for instance, is enrolling large numbers of 45+ citizens. Does that suggest to you that the health of the pools is in danger? And, could we get some assurances from you that the administration will be transparent about these numbers as we move forward?
5. A report today reveals that Teresa Fryer, chief information security officer for the Centers for Medicare and Medicaid Services (CMS), thought was so full of security holes it should be denied its “Authority to Operate” certification but was overridden. Your HHS Secretary Kathleen Sebelius has said she had no knowledge of security concerns yet Fryer has reportedly told Congress members she briefed Sebelius and others. Were you aware of any security concerns before the launch? Are you at all confident Americans who are submitting sensitive information to the site are safe? Will the federal government be transparent about breaches when and if they happen?
Follow up: There have already been two “high-risk” security findings found as the site has been operating over the past months, along with several medium and low-risk findings. Are you kept abreast of these findings? How did the site launch with these security issues unresolved? Should it have been delayed until they were fixed?
6. Today, just hours before we came to this press conference, the website was down. It had a note on it referring to the crash as “scheduled maintenance.” Was it scheduled maintenance today or just another crash? And, if it was scheduled maintenance, why was maintenance scheduled just days before the extended deadline for enrollment?
7. Given the high number of cancellation notices that have gone out—estimates are rough, but some think it may be in the millions if you add up data available to us state by state—combined with the persistent problems with the website, isn’t it possible that the net number of insured will actually go up in the new year? As the formerly insured add to the uninsured pool because they cannot afford a new plan, or they can’t get through the process on, or take this latest exemption as a reason to put off purchasing altogether, wouldn’t that destroy this law’s raison d’etre? What does it mean if ACA, which was meant to get the uninsured insured, is a net negative in terms of insured Americans in 2014?
8. CMS/HHS officials have testified that the portion of that would actually pay insurance companies has not yet been built. HHS has said it will use a “workaround” that involves having insurance companies estimate what they are owed in subsidies and later resolving differences. How is it possible a payment mechanism for subsidies was not built into the original site, as launched. When will it be built? Do you feel confident the federal government can transfer subsidies via this workaround? Given the complexity of the subsidy formula, are you confident insurance companies even know where to begin in calculating what they’re owed? How will we know tax money is not lost on overestimations?
9. Many insurance companies have reported getting bad data and duplicative data from about enrollees. They also fear they are missing some data entirely. Is there a possibility that some of the Americans who were able to get through’s enrollment process might think they’re enrolled but they’re not? How can those people protect themselves from this possibility?
10. Your announcement about the hardship exemption to ACA’s rules allows those who feel they cannot afford a new exchange-eligible plan with all the Essential Health Benefits to avoid penalty for not being insured or to buy a catastrophic plan that was supposed to be for young people. Is the acknowledgement of this “hardship” an acknowledgment that the ACA has more problems than a broken website and bad publicity? That it has substantive problems too, such as unaffordability?
In doing this, your administration has deemed the ACA itself “an unexpected natural or human-caused event.” In other words, it is a hardship, is it not?
11. Ezra Klein of the Washington Post, longtime supporter and reporter on the Affordable Care Act, wrote today that your hardship exemption is the “first crack in the individual mandate.” He also warned that it might make it harder for you and Democrats in Congress to resist calls to extend the exemption to others. How do you justify exempting those who were formerly insured but now cannot afford a plan but not those who never were insured because they couldn’t afford plans? Why not do what some have suggested and delay the individual mandate for everyone?
And, finally, since the press loves so much to talk about the politics and feelings of things instead of the actual news causing millions to lose their insurance, I offer this one.
12. You are about to embark on a two-week Hawaiian vacation. While no one begrudges the president Christmas with his family, are you aware that two state-level Obamacare exchange directors have resigned over taking ill-timed tropical vacations within the last two weeks? Are you sending the wrong message by leaving for so long while your legacy law is in pretty great peril, while Americans are still reeling from cancellations and the prospect of being uninsured? What will you be doing from Hawaii to ensure’s problems are resolved? Should we anticipate any other law changes while you’re gone?
And, while we’re on the subject of resignations and such, let’s make this a baker’s dozen:
13. Thus far, not one person has been fired for the roll-out of ACA you yourself have called “screwed up.” Why not? Has anyone been disciplined? If not, why not? Will anyone lose their job over this now three-month-long calamity?
It is rare that the White House press corps asks exactly what I want it to ask, but today’s display, with a few notable exceptions, was truly irresponsible. Not only would critics of Obamacare like to know how Obama proposes to fix it, but I’m sure the law’s liberal champions would appreciate some more information and assurances as well. Real people are losing their real coverage in real life, and the press corps is wasting the bulk of its questions on this pitifully rare opportunity on how the president feels about this rolling calamity. Well, if the president’s mind-numbing self-reflection can cure your kids when they get sick, you’re in luck, America. Otherwise, you’ll have to wait for the next meeting of the White House Encounter Group for a shot at more answers from the man in charge.

A General WTF ? 

“We screwed it up” got lost in translation before landing in the headline of a story on CNN’s website:

My God, HHS is setting out to destroy the insurance industry.