Tuesday, December 24, 2013

ObamaCare updates - Christmas Eve Edition...... Ho ho Ho from HHS and the White House !

updates through 12/29....


Exclusive: U.S. government urged to name CEO to run Obamacare market

WASHINGTON (Reuters) - The White House is coming under pressure from some of its closest allies on healthcare reform to name a chief executive to run its federal health insurance marketplace and allay the concerns of insurers after the rocky rollout of Obamacare.
Advocates have been quietly pushing the idea of a CEO who would set marketplace rules, coordinate with insurers and state regulators on the health plans offered for sale, supervise enrollment campaigns and oversee technology, according to several sources familiar with discussions between advocates and the Obama administration.
Supporters of the idea say it could help regain the trust of insurers and others whose confidence in the healthcare overhaul has been shaken by the technological woes that crippled the federal HealthCare.gov insurance shopping website and the flurry of sometimes-confusing administration rule changes that followed.
The advocates include former White House adviser Ezekiel Emanuel, the brother of President Barack Obama's former chief of staff Rahm Emanuel, and the Center for American Progress, the Washington think tank founded by John Podesta, the president's newly appointed senior counselor.
The White House is not embracing the idea of creating a CEO, administration officials said.
"This isn't happening. It's not being considered," a senior administration official told Reuters.
Some healthcare reform allies say the complexity of the federal marketplace requires a CEO-type figure with clear authority and knowledge of how insurance markets work.
Obama's healthcare overhaul aims to provide health coverage to millions of uninsured or under-insured Americans by offering private insurance at federally subsidized rates through new online health insurance marketplaces in all 50 states and in Washington, D.C.
Only 14 states opted to create and operate their own exchanges, leaving the Obama administration to operate a federal marketplace for the remaining 36 states that can be accessed through HealthCare.gov.
The marketplace is now officially the responsibility of the U.S. Centers for Medicare and Medicaid Services (CMS) and its administrator, Marilyn Tavenner. Healthcare experts say there is no specific official dedicated to running the operation.
A CMS spokesman said exchange functions overlap across different groups within the agency's Center for Consumer Information and Insurance Oversight.
The lack of a clear decision-making hierarchy was identified as a liability months before the disastrous October 1 launch of HealthCare.gov by the consulting firm McKinsey & Co.
Obama adviser Jeffrey Zients, who rescued the website from crippling technical glitches last month, also identified the lack of effective management as a problem.
Former Microsoft executive Kurt DelBene has replaced Zients as website manager, at least through the first half of 2014.
"We're fortunate that Kurt DelBene is now part of the administration - there's no one better able to help us keep moving forward to make affordable, quality health insurance available to as many Americans as possible," Obama healthcare adviser Phil Schiliro said in a statement to Reuters.
The White House appears, for now, to be concentrating on ironing out the remaining glitches in HealthCare.gov to ensure millions more people are able to sign up for coverage in 2014. Good enrollment numbers are seen by both critics and supporters of Obamacare as a key measure of the program's success.
"So my sense is that they're not thinking about appointing a CEO in the short term," said Topher Spiro, a healthcare analyst with the Center for American Progress.
The CEO proposal calls for removing day-to-day control of the marketplace from the CMS bureaucracy and placing it under a leadership structure like those used in some of the more successful state-run marketplaces, including California.
The new team would be managed by a CEO, or an executive director, who would run the marketplace like a business and answer directly to the White House, sources familiar with the discussions say.
They point to insurance industry and healthcare veterans as potential candidates, including former Aetna CEO Ronald Williams, former Kaiser Permanente CEO George Halvorson and Jon Kingsdale, who ran the Massachusetts health exchange established under former Governor Mitt Romney's 2006 healthcare reforms. None of the three was available for comment.
Healthcare experts say the idea should have been taken up by the administration years ago.
"It's the right thing to do. It's just two years late," said Mike Leavitt, the Republican former Utah governor who oversaw the rollout of the prescription drug program known as Medicare Part D as U.S. health and human services secretary under President George W. Bush.
"The administration is confronted by a series of problems they cannot solve on their own. They do not possess internally the competencies or the exposure or the information," he told Reuters.
Emanuel, one of the administration's longest-standing allies on healthcare reform, recommended a marketplace CEO in an October 22 Op-Ed article in the New York Times, calling it one of five things the White House could do to fix Obamacare.
"The candidate should have management experience, knowledge of how both the government and health insurance industry work, and at least some familiarity with IT (information technology) systems. Obviously this is a tall order, but there are such people. And the administration needs to hire one immediately," he wrote.
The administration has adopted Emanuel's four other recommendations: better window-shopping features for HealthCare.gov; a concerted effort to win back public trust; a focus on the customer shopping experience; and a public outreach campaign to engage young adults.

Federal health market surpasses 1 million signups

Associated Press

FILE - In this Dec. 23, 2013 file photo, Lisa Donlea, left, and Susan Roberts, a certified enrollment officer, celebrate after working on Donlea's federal health insurance exchange enrollment online for one hour and 47 minutes in Laguna Beach, Calif. The Obama administration says following a December surge, more than 1.1 million people have now enrolled for health insurance through the federal government’s improved website. (AP Photo/The Orange County Register, Cindy Yamanaka, File)
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HONOLULU (AP) — A December surge propelled health care sign-ups through the government's rehabilitated website past the 1 million mark, the Obama administration said Sunday, reflecting new signs of life for the problem-plagued federal insurance exchange.
Of the more than 1.1 million people now enrolled, nearly 1 million signed up in December, with the majority coming in the week before a pre-Christmas deadline for coverage to start in January. Compare that to a paltry 27,000 in October —the website's first, error-prone month — or 137,000 in November.
The figures tell only part of the story. The administration has yet to provide a December update on the 14 states running their own exchanges. While California, New York, Washington, Kentucky and Connecticut have performed well, others are still struggling.
Still, the end-of-year surge suggests that with HealthCare.Gov now functioning better, the federal market may be starting to pull its weight. The windfall comes at a critical moment for Obama's sweeping health care law, which becomes "real" for many Americans on Jan. 1 when coverage through the exchanges and key patient protections kick in.
"As we continue our open enrollment campaign, we experienced a welcome surge in enrollment as millions of Americans seek access to affordable health care coverage," Marilyn Tavenner, the head of the Center for Medicare and Medicaid Services, said in a blog post.
The fledgling exchanges are still likely to fall short of the government's own targets for 2013. That's a cause for concern, because Obama needs millions of mostly younger, healthy Americans to sign up to keep costs low for everyone. The administration had projected more than 3.3 million overall would be enrolled through federal and state exchanges by the end of the year.
Tavenner said fixes to the website, which underwent a major overhaul to address widespread outages and glitches, contributed to December's figures. But the problems haven't totally disappeared. Thousands of people wound up waiting on hold for telephone help on Christmas Eve for a multitude of reasons, including technical difficulties.
The administration released the figures Sunday while President Barack Obama was vacationing in Hawaii. Although the president has spent most of his time relaxing with friends and family, he stepped into work mode late Friday for an update from aides on his signature domestic policy achievement. The White House said Obama told his team to focus on minimizing disruptions for those switching plans.
For Americans who successfully chose insurance plans by Dec. 24, coverage should start on New Year's Day for those who pay their first month's premium by the due date, which in most cases has been extended until Jan. 10.
But insurers have complained that another set of technical problems, largely hidden from consumers, has resulted in the government passing along inaccurate data on enrollees. The White House says the error rate has been significantly reduced. Yet with a flood of signups that must be processed in just days, it remains unclear whether last-minute enrollees will encounter a seamless experience if they try to use their new benefits come Jan. 1.
The political fallout from the website's calamitous rollout could pale in comparison to the heat that Obama might take if Americans who signed up and paid their premiums arrive at the pharmacy or the emergency room and find there's no record of their coverage. Republican critics, already on the lookout for health-law failures to exploit in the 2014 midterm elections, would be emboldened to argue that shortcomings with the law's implementation have jeopardized Americans' health.
As make-or-break January approaches, officials are also working to prevent gaps in coverage for millions of Americans whose individual policies were canceled this fall because they fell short of the law's requirements. In one of a series of last-minute tweaks, the administration in December said even if those individuals don't sign up for new plans, they won't face the penalty the law imposes on Americans who fail to get insurance by March 31.
A key indicator of whether state-run exchanges are keeping pace with the federal exchange will come next month, when the administration releases full December figures. Overall, the goal is to sign up 7 million Americans before the first-year open enrollment period closes at the end of March.
A few states offering their own updates have posted encouraging totals, including New York, where more than 200,000 have enrolled either through the state exchange or through Medicaid, a government program expanded under Obama's health law to cover more people. In California, a tally released Friday showed nearly 430,000 have enrolled through the exchange so far.
"The basic structure of that law is working despite all the problems —despite the website problems, despite the messaging problems," Obama told reporters before departing for Hawaii.
Another major unknown is whether the recent surge in enrollments skewed toward older Americans whose medical needs are expensive to cover, or whether the administration succeeded in recruiting younger and healthier people whose participation is critical to the law's success. Those details for December are expected to be released in mid-January.
Meanwhile, with the website now able to handle higher volumes without crashing or clogging up, the government plans in January to ramp up outreach to consumers to encourage more people to sign up, the administration said.

updates through 12/28....


‘How many paid?’ HHS releases Obamacare data; Certain details absent

Remember when Sebelius said they wouldn't have all of the Obamacare enrollment data till Dec 23, we're still waiting for it I guess.

updates through 12/27.....

Keep an eye on State action against ObamaCare in 2014 .....

Friday, December 27, 2013 6:30 PM

Obamacare Showdown: Missouri Bill to Gut Obamacare, Ban Penalties, Ban Healthcare Exchange; How Would Obama Respond?

If enough states act, we are on the way to a constitutional showdown over Obamacare. The Washington Times reports Missouri bill would gut Obamacare 
 Next month, the Missouri Senate will consider a bill which would effectively cripple the implementation of the Affordable Care Act within the state.

Following the lead of South Carolina, where lawmakers are fast-tracking House Bill 3101 in 2014, and Georgia, where HB707 was recently introduced by Rep. Jason Spencer, Missouri State Senator John T. Lamping (R-24) pre-filed Senate Bill 546 (SB546) to update the Health Care Freedom Act passed by Missouri voters in 2010. It passed that year with more than 70% support.

SB546 would ban Missouri from taking any action that would “compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system.” That means the state would be banned by law from operating a health care exchange for the federal government.

The bill also proposes suspending the licenses of insurers who accept federal subsidies which result in the “imposition of penalties contrary to the public policy” set forth in the legislation. Since it is unlikely that any insurer would then accept a subsidy, not a single employer in the state could be hit with the employer-mandate penalties those subsidies trigger.

Following significant portions of the Tenth Amendment Center’s four-step plan to nullify Obamacare on a state-level, Fox News Senior Judicial Analyst Judge Andrew Napolitano noted that such actions were not just legal, but effective.

“If enough states do this, it will gut Obamacare because the federal government doesn’t have the resources … to go into each of the states if they start refusing,” he said.

Tenth Amendment Center national communications director Mike Maharrey suggested that a large-scale effort against the Act would be coming. “Our sources tell us to expect at least ten states moving in this direction in the coming months. But that will only come true if people start calling their state representatives and senators right now. State lawmakers need to know they should introduce bills to ban the state from participating in any Obamacare programs.”
Nullify Obamacare

Inquiring minds are investigating the Nullify Obamacare website for further information.

States have always held the prerogative of whether or not they will enforce or participate in federal acts or regulatory programs.  This legislative package seeks to ban the state from enforcing or assisting in the enforcement of the federal Patient Protection and Affordable Care Act of 2010.  It also seeks to ban the State, along with all its political subdivisions, from operating or participating in the operation of a health care exchange under the federal act.  It also provides for penalties for violations of the act.


Step 1: Ban State Enforcement, Participation and Material Support
Step 2: Reject Medicaid Expansion
Step 3: Protect Residents from Mandates
Step 4: Challenge the IRS’s illegal ObamaCare taxes


The “approach is on sound legal footing”
-Mercer University law professor David Oedel, part of the legal team that represented Georgia in its court challenge to Obamacare

There is a long-standing legal tradition which supports the choice of the State to determine whether or not they will participate in a federal act.

James Madison, writing in Federalist #46, recommended state responses to “unwarrantable” (unconstitutional) or merely “unpopular” federal acts which included “a refusal to cooperate with officers of the Union.”

Supported by Supreme Court opinions spanning more than 150 years, the “anti-commandeering doctrine” is the legal principle that states are not required to help the federal government enforce federal acts or regulatory programs.

The cases are as follows:

* 1842 Prigg: The Court held that states were not required to enforce federal slavery laws.
* 1992 New York: The Court held that Congress could not require states to enact specified waste disposal regulations.
* 1997 Printz: The Court held that “the federal government may not compel the states to enact or administer a federal regulatory program.”
* 2012 Sebelius: The Court held that states could not be required to expand Medicaid even under the threat of losing federal funding.

Anti-commandeering is virtually undisputed by legal experts from both the left and right.


A number of states following this plan will “gut Obamacare.”
-Judge Andrew Napolitano on Fox News, 12-10-13
For more details on each of the steps, please see Model Legislation: Nullify Obamacare in 4 Steps

How Would Obama Respond?

Regardless of the constitutionality of this action by states, how could Obama act in response?

I suppose Democrats could cut off various state funding. But that would take a Democratic controlled Congress (and its pretty safe to assume that's not going to happen).

Would the Federal government setup health exchanges in states? With what funding?

This could get interesting if even three states nullify Obamacare, and allegedly 10 states are considering such action.

Mike "Mish" Shedlock

Surprise! Bronze plans may cost a lot more than you expect


Oh, not up front — although the bronze plan premiums do cost more than many paid before ObamaCare’s mandates went into effect. No, McClatchy and Kaiser Health News worry about the big hike in overall cost that will hit consumers who choose the so-called “affordable” low-tier plans in the ObamaCare exchanges. They may not cover what people think — or anything at all, until those consumers pay thousands of dollars out of pocket first (via Gabriel Malor):
If you buy one of the less expensive insurance plans sold through the new health law’s marketplaces, you may be in for a surprise: Some plans won’t pay for doctor visits before you meet your annual deductible, which could be thousands of dollars.
“This could be the next shoe to drop, as people don’t realize that if they’re buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny,” said Carl McDonald, senior analyst with Citi Investment Research, speaking at a conference last month in Washington.
Comprehensive plans with deductibles usually cover wellness checks from the start (especially in group plans) — or at least they did until ObamaCare made the entire risk pool a lot more costly. In order to trim costs, especially with millions of new policyholders expected to flood the risk pools, insurers have shielded themselves against the larger risk. Unfortunately, that will have a dampening effect on what Democrats said would be the biggest benefit of ObamaCare — heightened access to routine care:
Experts are worrying that some new enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. In Miami, for example, 40 percent of bronze plans require consumers to pay the full deductible before coverage kicks in, according to an analysis by online broker eHealthinsurance.com, a private online marketplace, for Kaiser Health News. The average deductible among the examined bronze plans in Miami is $5,735.
Patients in those plans who haven’t yet met their annual deductibles would have to pay the full cost of the visits, unless they were for preventive services mandated by the law. A typical office visit can run $65 to $85, while more complex visits may cost more.
Put it this way: If the average deductible is $5,735 and a doctor visit is $85, it would takesixty-eight doctor visits before the insurance kicked in — more than one visit per week. And it would start all over again every year.
In one sense, Karl is right:
  1. McClatchy: read fine print on those Bronze Plans. Some don't pay for doctor visits until annual deductible reached. http://goo.gl/gjfl74 
.@gabrielmalor @EdMorrissey BTW, that's not necessarily bad policy. But it's not what people were led to believe ACA would be like.

A proper reform of the health-insurance sector would eliminate (or at least greatly reduce) the footprint of third-party payers in most routine care, as well as transform health insurance into what it should be — a protection against catastrophe, not a club for medical care. That would introduce price transparency to the consumer, relieve most providers of a ridiculous amount of overhead, and reduce premiums to a realistic level for catastrophic coverage.

This, however, is the worst of both worlds. The law forces people to pay higher premiums for largely unnecessary comprehensive coverage — especially the middle class — and then forces them to pay for the routine care out of pocket anyway. Health-savings accounts that might have shielded consumers from the pain are now being discouraged, which means this comes out of their checking accounts, right along with the higher premiums.

The result? People will pay more for less coverage, and then spend thousands of dollars before seeing the first dollar in benefits, except for certain preventive tests that HHS deemed mandatory. This will discourage people from getting normal wellness care and quick intervention on illnesses, forcing them to wait until they’re very sick to see a doctor. And even that might be not so bad, considering how often people fill waiting rooms for cold and flu symptoms that could easily be handled with over-the-counter treatment, but it’s not what the Obama administration and Democrats promised.  And it’s certainly not “affordable care.”
This is just one reason why the unfolding of ObamaCare in 2014 will be the biggest longterm political issue. It will drain American bank accounts every day, all year long, and each unexpected cost will rub a little more salt in the wound of betrayal. Just wait until the employer mandates take effect, and businesses kick employees out of group-plan coverage and into the ObamaCare exchanges … right before the midterms.


Obamacare Whac-A-Mole 
Problems with the law pop up faster than the administration can bat them down.


The wheels began to come off Obamacare in 2011, when the administration announced that the CLASS Act, a provision to provide long-term disability care, was, in the words of Kathleen Sebelius, “totally unsustainable” and would be discontinued.
What was the problem? The White House website had boasted that: “No taxpayer funds will be used to pay benefits under this provision. . . . Safeguards will be put in place to ensure its premiums are enough to cover its costs.”

“Safeguards.” Sounds quaint now, doesn’t it, a bit like “If you like your plan . . . ” So why did HHS kill it? Because former senator Judd Gregg (R., N.H.) had inserted a provision requiring that the CLASS Act be entirely self-sustaining and ineligible for government subsidies. (Yes, wouldn’t it be sublime if most laws contained such a provision?) Because it contained neither a mandate to purchase insurance nor a taxpayer subsidy, most of those who enrolled would be those who expected to need disability care. Sound familiar?
At least the administration actually got Congress’s agreement to scrap that piece of the legislation (it was repealed as part of the fiscal-cliff deal at the start of 2013). As for the rest of the law, the administration is flinging whole chapters over the side without so much as a nod toward its coequal branch.
No one can safely plan in this environment. Jay Carney’s declarations have a shelf life of hours, not weeks, but the more lasting damage inheres in the idea that law can be dictated by the White House. The changes are not matters of implementation, but structural elements going to the heart of the law. The administration feels free to issue such changes — though doing so violates at the very least the Administrative Procedure Act and arguably the Constitution — because this president has successfully flouted the law since 2009.
Bankruptcy law was ignored in the auto bailout. Secured creditors were undermined in favor of unions purely on the president’s say-so. After the Gulf oil spill, the administration, without any authority, summarily ordered BP to set aside $20 billion for restitution. In the pre-Obama world, that would have been the province of the courts. Obama behaved like a dictator, and few protested. He then issued a moratorium on all drilling in the Gulf of Mexico — again, without authority. The president demonstrated the same contempt for law and procedure when he made flagrantly unlawful recess appointments.
Regarding Obamacare, the administration has issued 1,231 waivers to unions, businesses, trade associations, and others. In a display of government by decree, the administration has delayed or altered the law no fewer than 14 times (as of this writing).
After a string of denials, HHS announced that employers would not be required to offer health insurance until 2015 instead of 2014 as the law provides. Next, Obama decreed that small businesses would not have to enroll in online exchanges next year. HHS high-handedly ruled that next year’s enrollment deadline for individuals would be November 15, not October 15 (can’t imagine why). After the outcry over canceled policies, the president unilaterally allowed that insurers could go ahead and offer last year’s policies. Accelerating retractions and corrections come daily now — most without legal foundation. Individuals can take an extra week to sign up for plans; those who’ve had their policies canceled can sign up for “catastrophic” policies. It all depends upon Obama’s whim.
This last bit of executive caprice creates the illogical and utterly unjust outcome that people who could not afford insurance at all in 2013 are still subject to the mandate, whereas those who did have insurance but saw their plans canceled are not. The law contains a “hardship exemption” from the individual mandate, which had included the homeless, members of Indian tribes, those who’d filed for bankruptcy within the previous six months, and so forth. Now, according to the White House, having your insurance plan canceled because of Obamacare is itself a hardship. They’re getting warmer.
The president and his secretary of HHS seem to be playing a federal version of Whac-A-Mole. No sooner do they bat at one problem with the law than another pops up.
This isn’t just a problem with Obamacare. It’s a dangerous new level of government by decree. Adhering to the rule of law isn’t just a tradition — it is the essence of American liberty and success. Nations without it (look at Egypt, Venezuela, or Russia) have difficulty achieving stability and prosperity even if they are blessed with natural resources and other advantages.
Obamacare has thrown one-sixth of the economy into chaos — with results that are still incalculable. It’s even more dangerous that Obama has undermined the rule of law and gotten away with it.

updates through 12/26.....


Coming up next: ObamaCare taxes and fees


This reminder from the New York Post came on Christmas, when few paid attention, but it’s worth noting today. The disastrous rollout of ObamaCare is only the appetizer for Americans, the 2013 lead-in to higher costs and fees built into the so-called Affordable Care Act. What most people haven’t heard — yet — is the new fees that ObamaCare charges for access to those higher premiums:
The cost of President Obama’s massive health-care law will hit Americans in 2014 as new taxes pile up on their insurance premiums and on their income-tax bills.
Most insurers aren’t advertising the ObamaCare taxes that are added on to premiums, opting instead to discretely pass them on to customers while quietly lobbying lawmakers for a break.
But one insurance company, Blue Cross Blue Shield of Alabama, laid bare the taxes on its bills with a separate line item for “Affordable Care Act Fees and Taxes.”
The new taxes on one customer’s bill added up to $23.14 a month, or $277.68 annually, according to Kaiser Health News. It boosted the monthly premium from $322.26 to $345.40 for that individual.
These “fees” will add up to a considerable hike, as the Post notes. They include a 2% fee on the plans themselves for consumers, which will eventually raise $14.3 billion a year for the federal government. Insurers are paying a 3.5% fee for participating in the exchange, a cost to the risk pool that will get transferred — as all risk-pool expenses do — to the consumers in the form of higher premiums.  The medical-device tax has long been debated, and will also get passed to the consumer.
It’s going to cost consumers at tax time, too. Remember when you could deduct all of your medical expenses if they exceeded the normal threshold for itemization?
Americans are currently allowed to deduct expenses that exceed 7.5 percent of their annual income. The threshold jumps to 10 percent under ObamaCare, costing taxpayers about $15 billion over 10 years.
That means that consumers will pay more for their medical care than ever, thanks to the tax limitation.
That’s nothing new about ObamaCare, though. We’ve been pointing out for years that this is just a wealth-transfer system, not a cost-containment system. It manipulates price to disguise the increased costs, but those are becoming more and more apparent, as USA Today reportstoday in a piece about the lack of choice for middle-class consumers throughout the country (via David Frum on Twitter):
Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.
The USA TODAY analysis looked at whether premiums for the least expensive plan in any of the metal levels was more than 8% of household income. That’s similar to the affordability test used by the federal government to determine whether premiums are so expensive consumers aren’t required to buy plans under the Affordable Care Act.
The number of people who earn close to the subsidy cutoff and are priced out of affordable coverage may be a small slice of the estimated 4.4 million people buying their own insurance and ineligible for subsidies. But the analysis clearly shows how the sticker shock hitting many in the middle class, including the self-employed and early retirees, isn’t just a perception problem. The lack of counties with affordable plans means many middle-class people will either opt out of insurance or pay too much to buy it.
The prices of exchange plans have shocked many shoppers, especially those who had plans canceled because they did not meet the ACA coverage requirements. But experts are not surprised.
“The ACA was not designed to reduce costs or, the law’s name notwithstanding, to make health insurance coverage affordable for the vast majority of Americans,” says health care consultant Kip Piper, a former government and insurance industry official. “The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace.”
Of course that’s what it is. David points out how the middle class gets hammered:
ACA taxes were imposed only high-income people. But large costs fall on middle class too, in the hidden, kludgey form of rate hikes (5)


South Carolina Set to Block Implementation of Obamacare

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Barbara Hollingsworth
CNS News
December 26, 2013
Flag of South Carolina
Flag of South Carolina
In January, when key provisions of the Affordable Care Act go into effect, South Carolina’s Republican-led state Senate is scheduled to vote on fast-tracked legislation that would prohibit all state agencies, public officials and state employees from implementing the federal health care law.
Republican Gov. Nikki Haley, who has been a vocal opponent of Obamacare, is expected to sign the South Carolina Freedom of Health Care Protection Act (H 3101), which could become a model for other states.
“We will not pursue the type of government-run health exchanges being forced on us by Washington,” Haley said in May. “Despite the rose-colored rhetoric coming out of D.C., these exchanges are nothing more than a way to make the state do the federal government’s bidding in spending massive amounts of taxpayer dollars on insurance subsidies that we can’t afford.”


( December 24 , 20313 Deadline not a hard  deadline ? )

Quotes of the day


The Obama administration said Tuesday that it would provide more time for people to sign up for health insurance if they could show that they missed the Tuesday deadline for applications because of problems with the federal health care website…
“If you weren’t able to enroll in an insurance plan by Dec. 23 because of problems you had using HealthCare.gov, you still may be able to get coverage that starts Jan. 1,” the administration told visitors to the website. “Even though we have passed the Dec. 23 enrollment deadline for coverage starting Jan. 1, we don’t want you to miss out if you’ve been trying to enroll.
“Sometimes despite your best efforts, you might have run into delays caused by heavy traffic to HealthCare.gov, maintenance periods, or other issues with our systems that prevented you from finishing the process on time. If this happened to you, don’t worry — we still may be able to help you get covered as soon as Jan. 1.”
New York and Massachusetts are following the federal health exchange’s lead and extending their sign-up deadlines for coverage starting Jan. 1, those programs’ directors announced Monday afternoon.
Other state exchanges, including the ones in California, Washington state and the District of Columbia, are offering general flexibility for individuals who started but couldn’t complete their applications by the 11:59 p.m. Monday deadline. Residents there will still be guaranteed coverage starting Jan. 1…
New Yorkers now will have until 11:55 p.m. Christmas Eve to choose a plan, said officials, who described “very high enrollment activity” Monday.
Massachusetts residents have even longer, until New Year’s Eve, to enroll and pay their first premium if they are receiving a federal tax credit. Those choosing Massachusetts Health Connector plans who are not eligible for federal subsidies also benefit from the new Dec. 31 date and have through Jan. 10 to pay their initial premium.
“The amazing, ever-expanding deadline? It’s clearly a sign of desperation by the administration to do everything they can to increase the number of people signing up,” said health economist Gail Wilensky, who ran Medicare for President George H.W. Bush…
The insurance industry, too, has pushed back deadlines for payment, with most health plans allowing customers to pay by Jan. 10 and still get retroactive coverage to Jan. 1.
“With deadlines that keep changing, insurers want to alleviate confusion,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans. “Health plans are going to do everything they can to help consumers with the enrollment process.”
For a law that’s faced automatic Republican resistance from the start, the ball fumbling since Oct. 1 that President Barack Obama has repeatedly acknowledged hasn’t helped.
The president and his aides say every announcement has been the result of being responsive and flexible, trying to make the law work for everyone. But at this point, the administration appears to be demonstrating that it lacks either a full sense of what implementing health care entails, or a full sense of the kind of blowback that each shift in the rules, however small, will generate…
“This latest delay marks the third major change since Secretary Sebelius testified on Dec. 11 when she was asked point blank what changes were in store over the holidays, and she was mum. And yet, another day, another delay,” said Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee and a frequent critic of the law. “While the holiday surprises have become commonplace, the latest extension is another disappointment for the ‘most transparent administration in history.’ As we celebrate Christmas and prepare to ring in the New Year, we continue to ask, ‘what’s next?’”
Furman continued: “We’re obviously making — it’s not a Plan B — Plan A is to do the most aggressive enrollment efforts you can, with young people, using social media. You see the insurance companies doing paid advertising. It’s in the insurance companies’ interest to sign these people up.” Beyond relying on a social media campaign, Furman argued, the work done by private business on behalf of Obamacare could be critical. “We’re doing everything we can, but I think unleashing the private sector and the large amounts they’re going to spend on advertising might be even more important,” he said.
Schneider was still curious. “But you have no particular backup plan?”
“There’s a Plan A,” Furman answered. “Which is to enroll as many young healthy people as you possibly can.”
It now seems possible that no one will be paying the mandate penalties in 2014. Having exempted some groups from the mandate already, it will be politically difficult to start enforcing it on others. And, looking further into the future, why should we think Democrats will suddenly crack down and enforce the mandate in the run-up to the next presidential election?
This part of the law is like an unpopular, insecure person at a family reunion, who is walking on eggshells and making concessions right and left for fear of offending anybody. In the age of the Internet, people are used to decentralized systems and maximum personal choice. The mandated elements of Obamacare may look good on paper and they may be necessary to get the plan to work, but they probably can’t survive the public sense they are illegitimate.
Governing in an age of distrust is different than governing in an age of trust. Government now lacks the legitimacy to impose costs on losers, so politicians face unprecedented pressure to create situations in which everybody looks like winners. Government lacks the legitimacy to coerce. People like Social Security, but I bet you that Congress could not pass a Social Security law today. If people were unfamiliar with the concept, you couldn’t pass a bill that said: Government is going to confiscate money from each paycheck and spend it on other things, but don’t worry because you’ll get it back decades from now when you retire.
The erosion of the mandate won’t kill Obamacare over all. It’ll just make it much more expensive for the government.
The individual mandate is the heart of Obamacare. From the president on down, administration officials believe that without the mandate, the system won’t work. So the one thing the public hates most is the one thing Obamacare can’t do without. For many Democrats, voting against the mandate, even delaying the mandate, is tantamount to repealing Obamacare altogether. They can’t do it, no matter what the voters think.
That’s a political problem for Democrats and an opportunity for Republicans. In a private exchange not long after the implementation fiasco began, a senior House aide said GOP strategy is to “separate Obama from Congressional Democrats” on the issue of Obamacare. One way to do that is for the GOP to use its control of the House to force Democrats, all of whom face re-election next November, to re-affirm their support of the mandate.
More than 50 Democrats have arrived in the House since March 2010, when Obamacare became law. Fifteen Democrats have come to the Senate since that time. Will their devotion to a law they didn’t pass be as strong as that of more senior Democrats, who fought the original Obamacare battles?…
Republicans held dozens and dozens of votes on Obamacare in years past when the public had little idea what was at stake. Republicans warned that Obamacare would be a disaster, but voters didn’t know what was coming. Now, they do. Maybe it’s time for the House to start voting again.


Video: Big rush on ObamaCare, but how many will be insured?


As anyone could have predicted, the deadline for ObamaCare enrollment has prompted a surge in traffic to Healthcare.gov and state exchange websites. Mandate compliance will tend to focus attention, especially when the IRS could end up breathing down your neck for non-compliance. CBS News reports that record numbers of people signed up for insurance on the exchanges over the past week, but no one’s really sure if they actually will have insurance after January 1:
CBS calls these “enrollments,” but that’s actually the question. As CBS notes, insurers aren’t sure that the sign-ups will equate to actual enrollments for a number of reasons. Two of those reasons don’t get a mention in the report. First, the federal exchange and perhaps some of the state exchanges still have issues with their 834s, the electronic report that transmits enrollment data to insurers. The failure rate, by the administration’s own admission, is at least 10%. If the insurers don’t get the proper data, then they can’t enroll the customers. Second, the back-end subsidy payment system isn’t even in place, although the Obama administration’s workaround will be to have the insurers bill CMS for subsidy payments and to issue them without confirmation for a while. If enrollment data gets confused, customers might find their insurance cancelled even if they have been making their partial payments — unless insurers really want to go out on a limb and into the red on provider payments with short revenue.
Another curiosity is the level of sign-ups that CBS and ObamaCare exchanges offer as success. California signed up 100,000 people in a week? It’s a state of over 30 million people. The total only came to 400,000 before the deadline, or about 1.3% of the population, and that number included Medicaid enrollments:
California’s health insurance exchange said more than 400,000 people have signed up for health plans ahead of Monday’s enrollment deadline as part of the Affordable Care Act.
The Covered California exchange said the latest figures are based on preliminary data through Sunday, when about 27,000 people picked an insurance company. Enrollment Friday was even higher, at 29,000 people, according to the exchange.
“We very much expect today will be a big day,” Peter Lee, executive director of Covered California, said Monday. “We are seeing huge interest online.”
The state’s latest official figures were 156,000 enrolled in health plans through Dec. 7, and an additional 179,000 people who had qualified for an expansion of Medi-Cal, the state’s Medicaid program.
State officials declined to give an updated enrollment figure for Medi-Cal.
And according to the Sacramento Bee yesterday, many of those people who did sign up for private insurance can’t verify enrollment — even those who signed up right away rather than wait for the last minute:
Margaret Rhode didn’t procrastinate.
As soon as enrollment for health insurance plans began in October, she was on the Covered California website, seeking coverage for her 52-year-old son. Applying online, however, turned out to be more complicated than she had anticipated.
“I tried to apply online and it wouldn’t let me,” Rhode said, “I was able to connect over the phone and they told me the site was down, try again later.”
Rhode, a Rancho Cordova resident, finally gave up on the website and submitted a paper application in mid-November for a Blue Shield policy for her son.
Since then, silence.
Rhode will get confirmation by mail, if she gets it at all, because she submitted her son’s enrollment on paper.  Those with website sign-ups will only get a bill, if the insurers get their information and enroll them properly. They won’t find out whether that happened until the bill comes … or they try to use their insurance and find out they don’t have it.

Insurers Balk at Obamacare Concessions as Risk Pool Thins

Photographer: Andrew Harrer/Bloomberg
An "Apply Here" sign hangs at a health insurance education and enrollment event in... Read More

Americans have more time to pay for their new Obamacare health plans, thanks to the insurance industry. What they don’t have is more time to sign up.
The deadline to enroll in plans that begin Jan. 1 is today for most of the U.S., a cutoff that remains firm even as the Obama administration has urged insurers to allow retroactive sign-ups into next month. The industry also balked at leniency for new customers who go to doctors or refill prescriptions not covered by their plans.
The success of the health overhaul relies on a diverse pool of customers where younger, healthier participants balance the costs of covering older, sicker people. Insurers say they can’t make more concessions without putting themselves at risk that patients will wait and sign up only when they need care.
“It’s hard to be nice when it comes to the risk pool,” Dan Mendelson, chief executive officer of the Washington-based consulting company Avalere Health, said in a phone interview. “If it’s just a matter of getting paid later, the companies have sufficient cash flow to cover that sort of thing.”
Aetna Inc. (AET)Cigna Corp. (CI) and other insurers already agreed to begin coverage at the start of 2014 for at least 1 million people who selected a plan before today as long as they send their checks by Jan. 10. People who buy plans from tomorrow through Jan. 15 will have to wait until Feb. 1 for coverage. The last deadline to sign up in 2014 remains March 31.

Controlling Costs

President Barack Obama has struggled to smooth the path into the Patient Protection and Affordable Care Act, the biggest overhaul of the U.S. health-care system since the 1960s. His signature domestic initiative, known as Obamacare, has been hamstrung by regulatory delays, website outages, political backlash and public apathy.
Enrollment had been sluggish, with just 365,000 people selecting private plans on the new state and federal government-run health exchanges through the end of November. Enrollment accelerated in December, Obama said at a Dec. 20 news conference, with more than 500,000 people in the 36 states served by the federal exchange selecting plans in the first three weeks of the month.
“All told, millions of Americans -- despite the problems with the website -- are now poised to be covered by quality affordable health insurance come New Year’s Day,” Obama said.
At least 3.9 million people have been determined eligible for Medicaid, the state-run health program for the poor, or for state children’s health programs since the exchanges opened Oct. 1, the U.S. Centers for Medicare and Medicaid Services said in a report. It’s not known how many of those people have actually signed up for the programs.

Industry Concessions

Gaining concessions from the insurance industry would provide an additional boost, though the changes requested so far by Obama on retroactive enrollment and out-of-network coverage cut straight to the heart of how insurers manage costs.
“As it is, they’re dealing with a lot of uncertainty,” Ana Gupte, an industry analyst with Leerink Swann & Co. inNew York, said in a phone interview. “On top of that they have to also loosen their hold on their networks, which is the most important way for them to manage their medical costs for a likely sicker, less healthy population.”
Obama earlier pushed back a key application deadline, delayed a small-business health exchange and extended a program for “high-risk” pools of sick Americans. On Dec. 19, his administration said hundreds of thousands of people whose health plans are being canceled because their coverage doesn’t meet Obamacare rules will be exempt next year from the health law’s mandate that all Americans carry medical insurance.

Meeting Targets

“They’re trying to do everything possible to generate more enrollment,” Mendelson said. “They will be judged on enrollment at the end of the day. If they feel they can make these marginal modifications to enhance enrollment, they’re going to do it.”
The administration had set a goal of signing up 7 million people through the new federal and state insurance marketplaces by the March 31 end of the six-month enrollment period.
Most of the flaws in the enrollment system have been fixed, the administration said. Officials said they sent more than 2 million reconciliation e-mails and made 600,000 phone calls to people who experienced difficulty signing up in October and November.
U.S. Health Secretary Kathleen Sebelius urged the industry on Dec. 12 to be lenient with Obamacare customers who miss today’s deadline for enrolling in the program or are late with their initial payment. The request included honoring late sign-ups with retroactive coverage, letting people pay only part of their premiums and covering treatments for patients who go to out-of-network doctors and pharmacies.

Continued Care

Insurers say that they’ll follow existing policies on what’s known as “continuity of care” -- allowances made to new members so they don’t have to change doctors or medicines while being treated for an illness. At Aetna, the third-biggest U.S. health insurer, new customers have as long as three months to transition to doctors and drugs included in the company’s networks and formularies, said Cynthia Michener, a spokeswoman for the Hartford, Connecticut-based company.
“The benefits and networks we offer on the exchanges were all filed and approved by the states where we participate,” Michener said in an e-mail. “To alter those plans would require approval by state regulators. We would also need to make significant systems changes and/or increase service support, which are not viable.”

Serious Conditions

Continuity-of-care allowances are usually made for serious or long-term conditions such as cancer, pregnancy, mental illness, transplants and multistage surgery.
Joe Mondy, a spokesman for Bloomfield, Connecticut-based Cigna, said the company will abide by the Jan. 10 payment deadline and that “we continue to review” the administration’s other requests. He didn’t say when a decision would be made.
WellPoint Inc. (WLP), which operates Blue Cross Blue Shield plans in 14 states, said its continuity-of-care policies will allow customers “to continue receiving care from an out-of-network provider for a specified period of time.” The policies vary by state, Kristin Binns, a company spokeswoman, said in an e-mail.
Kaiser Permanente, the Oakland, California-based nonprofit health-care company, agreed to allow late payment for exchange plans but isn’t changing other policies in response to the government’s requests, spokesmen said. Customers who sign up after today will have coverage beginning Feb. 1, John Nelson, a spokesman for the company, said in an e-mail.
Matt Stearns, a spokesman for UnitedHealth Group Inc. (UNH), the largest publicly traded U.S. insurer, declined to comment.


( May the farce be with you.... ) 

Time to try another delay in the individual mandate?


Well, why not? Republicans tried this a number of times, only to be rebuffed by Democrats who insisted that ObamaCare would be totally awesome. In fact, Nancy Pelosi is still promising a “glorious” result:
House Minority Leader Nancy Pelosi (D-Calif.) says December has been a “great month” for Obamacare sign-ups, and she said things will only get better
as more people enroll.
“It’s worth the trouble. It’s going to be a glorious thing,” Pelosi told a conference call on Monday.
“It’s about life, a healthier life, liberty, the freedom to pursue our happiness. It honors the vows of our founders. A person can follow his or her passion and not be chained by a policy, so they could start a business, be self-employed, change jobs. It’s a very, very exciting thing. And it’s about wellness and prevention. It’s about the health of America, not just the health care for Americans.
“So we’re very proud of it, and our enthusiasm for it … strengthens our determination to make sure it works.”
I’d trust Pelosi on this one. After all, she did accurately predict that we wouldn’t find out what was in the bill until it passed, and now Democrats see three years too late what a political disaster it has become.
Well, at least some Democrats see it, like Joe Manchin, who argued Sunday for a one-year moratorium on enforcement of mandates.  That would take a Congressional change to ObamaCare (in most administrations, although arguably not this one), and Byron York argues that the time is ripe for another shot at the delay strategy (via Instapundit):
It’s time to take another vote on the individual mandate. Would those 174 Democrats who stood firmly behind the mandate in July still be there now? Or will the 22 who voted to delay the mandate be joined by more who are worried by what they’ve seen since October?
If House Republicans want to highlight Democratic nervousness about Obamacare, focusing on the individual mandate is a good way to do it.
The coercive, unwanted mandate is by far the most unpopular feature of the law. When the New York Times recently asked, “Do you approve or disapprove of the part in the 2010 health care law requiring nearly all Americans to have health insurance coverage by 2014 or pay a penalty?” a full 68 percent said they disapproved, while just 31 percent approved.
When the Times polled only those Americans without health insurance — the group supposed to benefit most from Obamacare — 77 percent disapproved of the individual mandate, while just 21 percent approved.
So almost nobody likes it. But here’s the thing: The individual mandate is the heart of Obamacare. From the president on down, administration officials believe that without the mandate, the system won’t work. So the one thing the public hates most is the one thing Obamacare can’t do without. For many Democrats, voting against the mandate, even delaying the mandate, is tantamount to repealing Obamacare altogether. They can’t do it, no matter what the voters think.
But is it? Former Medtronic CEO Bill George wonders whether Barack Obama himself has started to retreat from the individual mandate, and ObamaCare itself:
The latest announcement from the White House on Thursday, December 19, seems to indicate that even President Obama is backing away from Obamacare.
At the very least, he is bobbing and weaving like an exhausted prize fighter trying to avoid a knockout punch. For the President, that punch would be a disastrous rollout of Obamacare that leaves Americans so angry that the Democrats lose their five-seat majority in the Senate in 2014. That could happen with the never-ending fallout from the new plans. Not surprisingly, the latest White House retreat just before the December 23rd enrollment deadline was triggered by pressure from moderate Senate Democrats like Mark Warner (D-VA) and Mary Landrieu (D-LA). Landrieu faces a tough 2014 election campaign.
Thursday’s announcement said that six million Americans who have had their insurance plans cancelled are eligible to buy catastrophic policies and are exempt from penalties if they go without insurance in 2014. Not that the new catastrophic plans are cheap. In California the pre-Obamacare median cost for a 25-year old non-smoking male was $92 per month on eHealthInsurance.com. This compares to $205 per month for a bronze plan and $184 per month for a catastrophic plan. Tacitly admitting that for many Americans the cost of buying insurance on the federal exchange exceeds their current insurance cost, Health and Human Services Secretary Katherine Sebelius offered them the opportunity to apply for a “hardship exemption.”
This is the fourth major pullback by the White House from the Affordable Care Act. … All these changes are exposing the flawed premise on which Obamacare is based: that the healthy young are willing to pay much more for insurance in order to support the unhealthy elderly. This policy marks the first time in U.S. history that we are asking the young to pay for the old; historically, it has always been the other way around. Altruism would not have motivated the young to assume this new cost, so the Democrats used the mandate to force the young into the pools–subsidizing care of the elderly at much higher costs to themselves. The mandate eked through the U.S. Supreme Court on a 5-4 decision, thanks to the tortured logic of Chief Justice John Roberts who deemed it wasn’t mandate after all, but rather a tax. All this comes at a time when youth unemployment is still in double digits and many more young people are stuck in low-paying jobs that barely enable them to make ends meet.
The problem for Obama is that younger Americans have begun to figure this out — and they’re not happy.  But the bigger problem for Obama is that there is no Plan B, as York himself reported yesterday. A delay of the enforcement of the mandate will likely mean massive opt-outs, which will destabilize the risk pools and force premiums to skyrocket even further in 2015 in the “death spiral” scenario for insurers — with prices announced just a few weeks before the midterms. For that reason, the White House is likelier to just postpone enforcement all year in incremental steps rather than back a legislative change to the bill.
The opportunity to push the delay strategy again as an I told you so certainly may look enticing for the GOP, but accelerating that death-spiral process when it’s already begun means they will share in the blame for the result. Tinkering with the law in Congress will allow Democrats to later claim — with a small amount of justification — that Republican changes created or at least amplified the catastrophe to come. Republicans should consider that at length before allowing themselves to be drawn into the problem rather than insist on the true solution of repealing the entire mess and starting over from scratch. The better part of valor here is discretion. If Democrats want a delay, let Harry Reid pass it in the Senate first.

 Mish rounds up many pertinent items in the news over the past few weeks !

America’s Shopper-in-Chief Has His Staff Sign Him Up for ObamaCare (But Not His Family)

Posted on   by  

By Lambert Strether of Corrente
And in a genius PR move, the White House describes Obama’s act of successful shopping avoidance as “symbolic.” As indeed it is, although not in the way the White House thinks, or could be said to think. WaPo has the details:
President Obama has enrolled in the federal health-care insurance exchanges, selecting a bronze-tiered insurance plan on the D.C. marketplace, the White House announced Monday.
The Bronze? The metal for losers who can barely scrape together the meagre coin to avoid being forced onto Medicaid? WTF?
The president’s health care will continue to be provided by the military, according to a statement distributed to reporters from a White House official who demanded anonymity.
My Canadian friends tell me that in Canada — they have a single payer plan up there that covers everybody; they call it Medicare — medical services that are covered by Medicare cannot be covered privately (leaving profit-mongers to sell cosmetic surgery, for example, to the wealthy, and a very fine thing that is, too). That way, the Canadian Prime Minister and the lowliest prole all have the same incentive to make Medicare work well; they all have the same skin in the game; their own.
Obama’s premium will be less than $400 a month, but it only covers himself, not his wife, Michelle, nor their daughters, Malia and Sasha, according to a White House official.
But Obama, as you see, has no skin in the game at all; not himself, and not his family. Yet oddly, or not, Obama places great emphasis on others having skin in the game. (Troll prophylactic: Before anybody raises the argument that Obama couldn’t legally go on the Federal Exchange, or wasn’t eligible for the exchange because of income, remember that Obama’s the same guy who whacked a U.S. citizen with a drone strike without due process. Let’s also remember that ObamaCare is a hot mess of triaged requirements, slipped statutory deadlines, abandoned mandates, and rewritten regulations that reinterpret the law so loosey-goose-ily that the law might as well have been a ginormous stack of “This page intentionally left blank”s. In short, if Obama had wanted to put himself and his family on his wonderful Exchanges, like the rest of us, he could have. Let’s not kid ourselves here.*)
Although Obama was involved in selecting a plan, he didn’t sign up himself. The president’s staff did that for him, going in person to the D.C. exchange over the weekend, the White House official said.**
Ha ha. How I wish I had staff! And if the DC Exchange was really crash-proof, do you really imagine that the White House PR operation would have passed up the chance to make a YouTube of “tech savvy” Obama signing up on his own laptop from the Oval Office? And then propagating the YouTube to the “young invincibles”? No way. No, instead the White House operation has the staff go over the weekend, and then releases the news of our glorious leader’s enrollment on Monday of Christmas week, which is about the same as burying it at 5:00 on Friday.
But let us pass on from the pleasant duty of calling bullshit on Obama’s imperial prerogatives, which let him slide out from under the shopping experience he’s mandated for the rest of us — at least, those of us without staff — because there’s a larger point that I’d like to approach by way of example. Let us pass on, that is, from the airing of the grievances to the feats of strength. Here’s a report from the field (hat tip, BC) of one person trying to work the Federal Exchange in Missouri with the help of a Navigator
Success with HealthCare.gov takes patience, persistence
Aaron Swaney, the certified application counselor [Navigator] based out of the Family Health Center, first helped [Jeannie Wyble] make an account on the marketplace on Nov. 15. By the second of week of December, her account still says “in progress.” … They made another appointment to see each other the next day, hoping the sixth time would be the charm.
Shop ’til you drop! And now the key point:
Jeremy Milarsky, who, like Swaney, has been certified to help consumers enroll on HealthCare.gov, sums up the situation:
This is a system that lends itself very well to people who are organized and follow up. If you’re the kind of person who just sits back and expect everything to fall into place [as, for example, with Canadian-style single payer Medicare for all] you’re more likely to run into problems.
In other words, ObamaCare is optimized for shoppers; that’s really what what “patience, persistence” headline means when you think in systemic, as opposed to characterological, terms. In fact, given that statistically at least, lives are at stake, we might consider the ObamaCare marketplace as a Darwinian environment where those who do not display adaptability to the shopping environment — I hate shopping, since it’s a massive time sink — are more likely not to get the health care they need, and hence more likely to get sick, and hence more likely to die; some people call that a “nudge,” but I’d call it more like shooting the wounded.
Because — and this is the most important point — the neoliberal “market solution” is always about that truly transcendent human endeavor — shopping — isn’t it? Supposing for the moment that we consider the non-elite human, of course. As Corey Robin wrote (quoted by Yves):
In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives.
As did Jeannie Wyble, thereby giving productive employment, except not, to Aaron Swaney.
That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.
And so do Preznits!
The dream is that we’d all have our gazillion individual accounts—one for retirement, one for sickness, one for unemployment, one for the kids, and so on, each connected to our employment, so that we understand that everything good in life depends upon our boss (and not the government)—and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker, except of course that we’re not.
If ObamaCare is permitted to entrench itself, the next step will be to have a “Retirement Marketplace,” with Social Security as the “public option,” so that the rentiers can run the 401(k) scam a second time for more fees, because shopping.*** Does anybody really believe that won’t happen?
In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more.
That’s not a bug. It’s a feature.
What’s so astounding about Romney’s proposal [which became Obama's]—and the neoliberal worldview more generally—is that it would just add to this immense, and incredibly shitty, hassle of everyday life. One more account to keep track of, one more bell to answer. Why would anyone want to live like that? I sure as hell don’t know, but I think that’s the goal of the neoliberals: not just so that we’re more responsible with our money, but also so that we’re more consumed by it: so that we don’t have time for anything else. Especially anything, like politics, that would upset the social order as it is.
Indeed. A social order where the rich have staff to do their shopping for them, Presidents slide out from under the mandate to shop that they impose on others, and the rest of us… Well, here’s what we’re expected to do:
The key point to remember in all discussions of ObamaCare is that neither it, nor indeed the entire private health insurance “industry,” should exist. They are rent-seeking parasites, economic tapeworms. One does not improve a tapeworm; one removes it.
We’re mandated to keep that tapeworm fat, happy, and well-fed. By shopping for a defective product with time we have to steal from what we’d really rather be doing than shopping for insurance, and that means almost anything. The Canadians don’t have to crap around with any of this. Why should we?
Bush famously said “I encourage you all to go shopping more.” Leave it to Obama, not to “encourage,” but force us to shop!
NOTE * “If I elected, my family and I will purchase health insurance on the exchanges together” would be a great campaign promise for a populist campaign, especially when followed by “until such time as we pass Medicare for All, which I expect to do in my first term.” Bernie? Brian? No, not you, Elizabeth.
NOTE ** There’s also the argument that Obama would have had difficulty signing up because of Experian’s identity validation software might not have been able to handle his special case. Really? So have Obama get on the phone with support, like the rest of us. Symbolism, ya know. Symbolism. And don’t tell me he doesn’t have time; he’s on his way to a vacation in Hawaii!
NOTE *** We might consider making the experiment of mentally replacing “because free markets” or “because liberty,” when encountered, with “because shopping.” Could be interesting!
NOTE The Republican reaction is priceless:
“I’m glad he did it,” Rep. Jason Chaffetz (R-Utah) said in an interview Monday. “I’m not going to take a cheap shot at him for signing up.”…. [It's a tough job, but somebody has to do it!] Chaffetz added: “He’s the president of the United States. His health care is a little different than the rest of us.”
Not in Canada!

Monday, December 23, 2013 9:14 PM

Obamacare Support at Record Low 35%; Obamacare Named "Lie of the Year"; Bait and Switch; Obamacare Roundup; Meltdown Coming?

It's been a while since I commented on Obamacare. Given news comes out every day, nearly all of it negative, I have shown restraint. Tonight, here's a recap of what you may have missed.

Obamacare Support at Record Low 35%

Today, December 23, a CNN poll finds Obamacare support at all-time low.

Poll Details
  • 35% support the healthcare law, a 5 percentage point drop in less than a month
  • 62% oppose the law, up 4 percentage points from November.
  • 60% of women oppose Obamacare, up 6 percentage points from November
  • 43% oppose Obamacare because it is too liberal
  • 15% Oppose Obamacare because it isn't liberal enough
  • 63% believe the new law will increase what they will have to pay for medical care
  • 42% believe they will be worse off under Obamacare personally.

I have gathered a huge number of Obamacare links in the past few weeks that I did not have time to comment on. Here are a few of them. This is by no means a complete list.

Obamacare Roundup, Last Two Weeks

The final link above is interesting. The URL title is "obama-administration-secretly-extends-health-care-enrollment-deadline".

I guess it's not much of a secret.

Please note the political spectrum in the above links encompasses everything between the Huffington Post and Fox News. That's quite an accomplishment!

Meltdown Coming? 

Let's finish up with a highlight from the Washington Post:

Sen. Joe Manchin (D-W.Va.) says Obamacare could suffer ‘complete meltdown’
 Sen. Joe Manchin (D-W.Va.) said Sunday that Obamacare could be headed for a "complete meltdown" if costs rise too fast and people are unhappy with their coverage.

“If it’s so much more expensive than what we anticipated, and if the coverage is not as good as what we've had, you’ve got a complete meltdown at that time,” Manchin said on CNN’s “State of the Union.”

The senator said such a situation would result in the law collapsing under "its own weight."

Manchin has been pushing for a one-year delay in the individual mandate -- the requirement that people carry health insurance or pay a penalty. He said that delay would allow the product some time to work its way into the market.
Even Democrats are distancing themselves from this disaster.

Mike "Mish" Shedlock

From Hot Air......

Politico: While Obama vacationed, his staff signed him up for ObamaCare by visiting the D.C. exchange in person


The obligatory follow-up to Ed’s post earlier. When they said O was planning to enroll today, I thought they meant he’d take a break from the links for half an hour to punch in his info on the D.C. exchange website. Upon reflection, though, that was silly. Of course the president’s not going to entrust his vital info to one of these tinpot online exchanges. He knows better than anyone how vulnerable they are; the one he built himself was so grotesquely flawed, hisown security team wouldn’t sign off on it. Special procedures would be needed.
I think it’s fitting. By Team Hopenchange’s own admission, Obama signing up for coverage on the exchange is a publicity stunt, a “symbolic” act designed to show that he endorses the product he’s crafted with his own money. He’ll continue to get his health coverage through the military while president, but as a gesture of solidarity with Americans, he’s willing to sign up. Granted, he waited until the very last second to do it despite pleading with people for months not to wait. And sure, okay, his special status allowed him to bypass the website and delegate to his subordinates the aggravation of enrollment, unlike the millions of poor saps who had to be patient and keep trying during the Great 404 Meltdown of 2013. But there is one way that O’s walking the walk here: Now he’ll be paying hundreds in monthly premiums for coverage that he’ll never actually use, just like millions of “young invincibles’ who are being forced by the mandate to enroll. Their hard-earned money’s being expropriated to subsidize the sick; now a little of O’s hard-earned money is too. Why, he even bought the same type of plan — bronze — that’s likely to most appeal to young adults because of its relatively cheap premiums, even though the deductible is so high that it’ll discourage some of them from ever seeking treatment except in emergencies.
A perfect ending to an embarrassing three months.
Obama “was pleased to participate in a plan as a show of support for these marketplaces which are providing quality, affordable health care options to more than a million people,” the official added.
But Obama did not directly sign up for insurance. Rather, his staff went in person to sign him up, an official told POLITICO.
“Like some Americans, the complicated nature of the president’s case required an in-person sign-up,” the official said. “As you’d expect, the president’s personal information is not readily available in the variety of government databases HealthCare.gov uses to verify identities.”

As translated by John Sexton:

The President is there in the trenches with people who already have insurance and choose to buy more from Hawaii via staff.
Meanwhile, here’s what the hoi polloi’s being told today about HHS’s new half-assed enrollment deadline of midnight tomorrow:
Within hours of that delay being revealed to the public, however, White House communications official Jennifer Palmieri informed MSNBC’s audience that it would be “dangerous” for consumers to consider tomorrow to be the new deadline, even though it now is. She stressed that the problem-plagued website may fail and leave uninsured users without coverage at the start of the 2014.
So that’s why the new deadline was supposed to be “secret.” They figured that even if the site went down today under the crush of deadline enrollments, it might bounce back tomorrow as some discouraged users peeled off, reducing the traffic load and making it viable for the most dogged would-be enrollees. In other words, they still don’t trust Healthcare.gov enough to issue any full-throated encouragement for people to use it. With good reason, as it turns out.
Exit quotation from Nancy Pelosi: “It’s worth the trouble, it’s going to be a glorious thing.”

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 Healthcare.gov 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 Healthcare.gov 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.


If someone starts the app today & gets stuck because of tech issue, we will get you across the finish line, says Ex. Dir.
If you start the app you get help across the finish line? I can't even create an acct. going on attempt 18

Stuck with a technical issue with the clock ticking? It sounds like quite a few are having problems getting across the finish line on the Covered California insurance marketplace today.

Anyone else having trouble with website? Non-stop error messages!! high traffic volume?
is not working, guess I won't be getting insurance. Every time I've tried since October = fail @BarackObama

We’ve seen error screens like this before. Weren’t these sites supposed to be fixed?

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Uhh oh! Many people expressing frustration & receiving error messages from the @CoveredCA website.
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Here’s what I get when I try to apply for health care coverage on
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This is a snapshot from the Covered CA help site.Count how many items are wrong & how many ways they spelled “button”
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this happened when i had finished everything and was confirming it was ok.
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This definitely isn't a good sign when you see this 5 times now! @CoveredCA
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Do I still get fined if the Covered CA website isn't working, @BarackObama? @obamacare
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@CoveredCA Everytime I try click "Apply" I get this error message
HA HA HA waited for 35 minutes to chat with someone on the site about why it keeps crashing for me then they canceled my chat.
I'm helping my 26 yr old son get ACA insurance. Looks like he will be uninsured for the first time thanks to website crashes.
@CoveredCA Website problems, online chat is down, and no one is answering the 800 number. @latimes
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I am a tech person and my professional opinion is the website is unusable.