Monday, January 6, 2014

Obamacare updates -- January 6 , 2014 -- 2014 picks up where 2013 left off - more lies and goalpost moves from the White house ( White House Guides Down Obamacare Enrollment Target, Says To Focus On Demographics; Refuses To Give Demographic Data ) ..... State Exchanges fumbles - Maryland and Minnesota in focus .... Highlights on Obamacare clusterfarks from earlier this year !

White House Guides Down Obamacare Enrollment Target, Says To Focus On Demographics; Refuses To Give Demographic Data

Tyler Durden's picture

As we reported previously, currently the biggest problem facing Obamacare is the sudden "realization" by as many as half of any given state's enrollees, that in addition to signing up for Obamacare, one also has to make a payment which is rapidly becoming a dealbreaker for many, and leading to total confusion at the doctor's office. However, even if one were to assume that payment is not a major hurdle (after all funding for a subsidized ponzi scheme can always be... further subsidized), there are various other key issues that still remain. Such as the administration's repeatedly stated target of 7 million enrollees by the end of March. Actually wait, it may have been 7 million once upon a time, as in the days before the rollout became an unmitigated disaster, but suddenly that bogey no longer exists.
Enter revisionist history:
“That was never our target number. That was a target that came from the Congressional Budget Office, and it has become an accepted number. There’s no magic to the 7 million. What there is magic to is that in the month of December a million Americans signed up for insurance.”
     – White House aide Phil Schiliro, interview on MSNBC, Dec. 31, 2013
Guiding lower? Happens all the time on Wall Street so it was only a matter of time before D.C. started as well. Watch:
The key points from the Jay Carney:
"We're not backing away from a number that we didn't put out originally.... "I think that others noted that 7 million is a fine target, but that that will not determine whether the marketplaces function effectively.... It's important to understand that it is not — that there's not some magic number: 6,999,999 and the system collapses; one more than that and it functions perfectly."
At this point it is worth remembering just how fudged the very definition of "enrolled" is: The White House counts “an enrollee” as anyone who has selected a qualified health plan. “Once someone clicks "enroll" and selects a plan, we consider them enrolled,” a senior White House official said. "We don’t know if they have paid or when they pay the company because it’s a private transaction between the company and the consumer." And as we explained before, up to 50% of "enrollees" haven't actually enrolled by making any payments.
So to summarize: the White House crowed about the 2.1 million Americans who have signed up for insurance either through the federal health-care exchange or state-run exchanges (even if the payment status is unclear). At the same time, Obama's henchmen backed away from the idea that they had suggested a "target" of 7 million enrollees when the enrollment period for 2014 ends in March. As Schiliro put it, "that was never our target number"... even though it was consistently framed, implied and suggested as precisely that.
The question then is: did someone lie? For the answer, we go to the authoritarian source on massaging spin when it comes to the administration: The Bezos Washington Post. Here is what D.C. favorite newspaper had to say:
The 7 million figure did originate asan estimate (not a target) by the CBO. Before launched, senior administration officials certainly embraced the number.

Here’s Health and Human Services Secretary Kathleen Sebelius speaking to reporters last June: “We’re hopeful that 7 million is a realistic target.”

And here she is on Sept. 30, in an interview with NBC News: “I think success looks like at least 7 million people having signed up by the end of March 2014.”

Moreover, on Sept. 5, 2013, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, sent Sebelius a memo titled, “Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014.”

The memo offered an estimate of 7,066,000, drawing both on CBO’s estimate and the experience of the universal health plan in Massachusetts, Medicare Part D “and conversations with employers, issuers and states.” It projected that enrollment would be 3.3 million by the end of December.

The 7 million figure, apparently, became less relevant as “a target” or a measure of success when it became clear that the Web site’s problems were making it difficult for people to sign up.

Instead, officials have argued that a more relevant figure is the mix of young and old people. That’s because younger people tend to be healthier and thus have lower medical expenses; if only older people sign up, premiums would soar.
WaPo's conclusion:
Whether or not the administration originally came up with the 7 million figure, officials certainly embraced it as a target in the months leading up to the implementation of the Affordable Care Act. We agree that the mix of young and old enrollees is perhaps the more relevant number, but it’s a bit odd at this point for the administration to minimize the 7 million figure.
Ok, so they lied. But if the mix of enrollees, however one defines them, is skewed toward the younger population, all should be forgiven right? Sure. However, there is a tiny problem:the administration refuses to give away the demographic split data! From The Hill:
The White House said Monday that it was still unable to provide the demographic data is describes as a "key element" to evaluating the overall success of ObamaCare.

White House press secretary Jay Carney insisted on Monday that "at this point" the administration did not have information about the makeup of early enrollees in the president's signature legislative program.

But the White House spokesman also pledged to make the data "available as soon as possible."

"If you look at how we've dealt with data as it's become available over the past several months, both good data and bad data, we've done our best to provide it to you when we are confident about the accuracy of it," Carney said.

Healthcare experts have warned of a "death spiral" if not enough young, healthy adults buy into the ObamaCare marketplace to offset the cost of insuring older and sick Americans. A study report by the Kaiser Family Foundation showed that 4 of 10 enrollees would need to be between 18 and 34 years old to prevent a rise in premiums in subsequent years.
So: first the lies about the definition of enrollment, then the lies about how many actually have insurance, i.e., have paid and are officially enrolled, then the realization that the schedule is hopeless off track and and the need to guide down, but only after misdirection pointing at "good data"...  which just so happens does not exist.
Oh, and something about a "death spiral" if not enough young, healthy... oh wait, look over there: the market is at all time highs (or just below them).
We truly wonder: how much longer will this patented and indefinitely repeated distraction scheme, aimed at the absolutely lowest common denominator, continue to work without a glitch?

Fumbled exchanges.....

Maryland Congressman: So, is it too late to switch over to the federal exchange website?


Governor Martin O’Malley finally declared their much-vaunted exchange “not glitch-free but functional for most users” in the middle of December, and yet the state’s enrollment is still lagging way behind both other states and their own goals with only 18,250 residents having signed up for health insurance as of the end of last month while reports of prohibitive website errors still abound. I have no idea how even just temporarily hitching a ride on the also highly imperfect federal exchange until their own site is out of the woods would work administratively (and indeed, Maryland officials still seem to be working on figuring that out), but it sounds like they are genuinely considering the idea — which I’m guessing means they know they still have major website problems, with no definitive end in sight. Via the AP:
Rep. John Delaney, a Democrat, formally asked the state’s health secretary for a specific assessment of the idea of switching to the federal health exchange while Maryland’s exchange is being repaired. He wrote in a letter to Dr. Joshua Sharfstein that Maryland could make the switch in whole or in part or on a temporary basis.Delaney cited recently released data from the White House that indicated 2.1 million people have signed up for private insurance nationally, including more than 1 million through the federal marketplace. The congressman compared that to 18,257 Maryland residents who have been able to enroll, which is 12 percent of the state’s goal of 150,000.
“We have fallen quite far behind the national average and we’re running out of time,” Delaney wrote, adding that he has heard from frustrated and concerned residents throughout his district, which stretches from Garrett County in western Maryland and includes a significant portion of Montgomery County near the nation’s capital.
On Friday, Gov. Martin O’Malley said he would keep the idea of moving to the federal exchange or partnering with other states under consideration.
And that wasn’t the only criticism coming their way, with a potential O’Malley successor throwing in his two cents on the irresponsible manner in which Maryland is currently directing their resources, via WaPo:
A leading Republican candidate for Maryland governor wants the state to stop spending millions of dollars marketing and promoting its problem-plagued health insurance marketplace and instead point residents directly to private insurance carriers and other options.
Harford County Executive David R. Craig (R) released a plan on Monday that calls on the administration of Gov. Martin O’Malley (D) to obtain a waiver from the U.S. Department of Health and Human Services to divert money away from promoting the state’s health exchange and toward a “public awareness campaign informing consumers of their right to obtain health insurance directly through carriers.”
“Up to $150 million dollars is going towards promoting a failing exchange, and throwing good money after bad needs to end now,” Craig said in a statement. “The administration must realize that their intended solutions are only causing more problems, creating mass confusion, ruining credibility in government and harming our quality of life.”
Things just get worse and worse for what was once supposed to be a model of ObamaCare excellence.
and.... glitch sending Maryland customers to navigators in other states


Marylanders who use the federal health reform site to search for navigators who can help them enroll in health plans in-person are getting directed to agencies in other states.
The problem lies with a glitch in the federal website that occurs when Marylanders type in their zip code. The website directs users to navigators in Pennsylvania, Virginia and other states.
Dori Henry, a spokeswoman for Maryland’s website, said state officials are “aware of the problem and we’ve reached out to (Health and Human Services) to ask them to get it fixed as expeditiously as possible.”
Well, who could expect the federal government to know…zip codes?
Now, why are Maryland citizens on the federal exchange? Don’t they have their own exchange, about which President Obama said this?
Folks in different parts of the country will have different experiences. It’s going to be smoother in places like Maryland where governors are working to implement it rather than fight it. (Applause.)
Yes, they do have their own exchange, which has managed to sign up only 12 percent of their target and has left the state in a sad tug-of-war between misplaced pride and hope in its $107 million exchange and a desire to get as many people signed up as possible:
Rep. John Delaney, a Democrat, formally asked the state’s health secretary for a specific assessment of the idea of switching to the federal health exchange while Maryland’s exchange is being repaired. He wrote in a letter to Dr. Joshua Sharfstein that Maryland could make the switch in whole or in part or on a temporary basis.
Delaney cited recently released data from the White House that indicated 2.1 million people have signed up for private insurance nationally, including more than 1 million through the federal marketplace. The congressman compared that to 18,257 Maryland residents who have been able to enroll, which is 12 percent of the state’s goal of 150,000.
“We have fallen quite far behind the national average and we’re running out of time,” Delaney wrote, adding that he has heard from frustrated and concerned residents throughout his district, which stretches from Garrett County in western Maryland and includes a significant portion of Montgomery County near the nation’s capital.
Gov. Martin O’Malley, who wants to run for president and planned to use his aggressive Obamacare implementation as a feather in his cap with the party and Democratic voters, is “keep[ing] the idea of moving to the federal exchange or partnering with other states under consideration.” Isn’t time running a little short, here?

MN legislative auditor calls for “top to bottom audit” of state ObamaCare agency


Minnesota may be mired in a deep freeze, but the politics around the state’s ObamaCare launch is about to get red-hot. The state’s “top watchdog over state government spending” has now demanded a complete audit of MNSure, and not just for its problem-plagued web portal. Citing “many red flags,” Jim Nobles wants a full audit to be the legislature’s highest priority when it reconvenes next month (via Andrew Johnson at The Corner):
Minnesota Legislative Auditor James Nobles tells 5 EYEWITNESS NEWS “MNsure has many red flags causing great concern and I would like my auditors to conduct a comprehensive audit of the program because it does not appear to be delivering what it promised to taxpayers.”
Nobles says everything at MNsure needs a “close examination” from the computer system to what the health care exchange is actually delivering to taxpayers and consumers. Nobles says there are computer problems at MNsure that have occurred in the past and, he says, “it does not look like we have learned from our mistakes.”
Nobles says MNsure, like any other state agency, needs transparency and accountability so “the taxpayers and public have confidence in the system.” Nobles says he plans to ask the Legislative Audit Commission for permission to audit MNsure and it will be his “top priority when the Legislature convenes next month.”
For those who wonder, the legislature is controlled by Democrats, but that has little to do with Nobles. He has served for 30 years as the legislative auditor while the legislature was under the control of both parties, and recently got appointed to a sixth six-year term. He’s known for keeping politics out of his work, which means that Democrats will not be easily able to disregard his recommendations for a “top-to-bottom” audit of MNSure.
It’s not the first time Nobles has slapped at MNSure, either. In November, he concluded that the agency itself was responsible for the collection and release of Social Security information for insurance brokers licensed in the state’s ObamaCare agency, and blew the lid off of the mismanagement that has become obvious since the rollout.  That eventually resulted in the resignation of MNSure’s top officer, who was then replaced temporarily by another Dayton official who was under investigation for his own dealings in the health-insurance sector.
I wonder what Nobles will make of that. I also wonder whether the legislature will authorize him to make anything of it at all.

Best from before........

Study: Medicaid patients use emergency room more, not less


A new study of Medicaid beneficiaries in Oregon makes a strong version of this case. The study, published today in the journal Science, finds that adult Medicaid beneficiaries rely on emergency rooms about 40 percent more than similar uninsured adults.
“When you cover the uninsured, emergency room use goes up by a large magnitude,” said Amy Finkelstein, a health economist at the Massachusetts Institute of Technology who served as a lead investigator on the study, in an MIT press statement accompanying the study.
There were no exceptions to the trend. “In no case were we able to find any subpopulations, or type of conditions, for which Medicaid caused a significant decrease in emergency department use,” said Finkelstein.
We’ve seen real-world evidence that Medicaid increases emergency room utilization before, in states like California. But the Oregon study should settle any lingering debate.
These results, reported by Peter Suderman at Reason, were reported in the journal Science and are based on the Medicaid study in Oregon that made news in May for showing Medicaid patients had no material health improvements over the uninsured.
The Oregon study is important because it’s a randomized controlled trial— the research gold standard we’ve reported on before in studies like the Tennessee Pre-K study and theWashington, D.C. Opportunity Scholarship study. Washington state held a lottery for access to Medicaid and then studied the both the cohort that got Medicaid and the cohort that did not. This means the cohorts were randomly selected within a group of people with similar motivations, economic situations, etc., making them more accurately comparable.
Suderman notes that Medicaid recipients are less likely to experience ” feel better after they are covered, and they are much less likely to be subject to large, health-related financial shocks,” making it largely a “financial buffer” instead of a health program. If our friends on the Left were as pro-science as they purport to be, they’d acknowledge it’s worth discussing whether we’re accomplishing what we want to accomplish with these very expensive programs. Research shows we’re not helping people as advertised. If we’d like to actually help people instead of just patting ourselves on the back for saying we’re helping them, we’ve got to rethink these programs instead of expanding them. If anything, the Oregon study offers a pretty decent argument for Republican governors that skipping Medicaid expansion wasn’t just the right fiscal decision, but the right one for general health outcomes and emergency room crowding.

Eleven state AGs protest ObamaCare “fixes” as “flatly illegal”


Alternate headline: Hot Air readers get results! In our year-end poll, readers chose as the most underreported story of 2013 the lawlessness of the Obama administration in its handling of ObamaCare. Eleven state Attorneys General share that opinion — and started off the year attempting to correct it. Led by Patrick Morrisey of West Virginia (no relation), the consortium of AGs protested the changes in a letter to Kathleen Sebelius (via Instapundit):
The attorneys general specifically criticize President Obama’s executive action that allowed insurance companies to keep offering health plans that had been canceled for not meeting ObamaCare’s more rigorous standards.
We support allowing citizens to keep their health insurance coverage, but the only way to fix this problem-ridden law is to enact changes lawfully: through Congressional action,” the attorneys general wrote in a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius. “The illegal actions by this administration must stop.”
They say the healthcare fix was “flatly illegal under federal constitutional and statutory law.”
Congress wrote the law in a manner that transfers much of its authority to HHS. The bill is chock-full of the phrase, “The Secretary shall determine …” in areas where Congress should have provided much more specific direction, which allows the executive branch wide latitude in a number of areas. However, the bill does have some specificity, especially on deadline dates for enforcement. HHS does not have the statutory flexibility that it has arrogated to itself for these “fixes,” nor does it have the constitutional power to change statute.
Morrisey and his colleagues are correct in their accusations. The question will be whether any of them will challenge those decisions in court. One would have to think they have standing to do so, especially as it relates to the impact on insurers in their states.  Congress also would have standing to bring a complaint to the federal court, and one has to wonder whether John Boehner and the House is considering such an action. If “the illegal actions by this administration must stop,” they have to know that a letter to Sebelius isn’t going to be the fulcrum of that change.
In other ObamaCare news, the confusion over sign-ups versus actual enrollments is keeping people from getting care:
Hospital staff in Northern Virginia are turning away sick people on a frigid Thursday morning because they can’t determine whether their Obamacare insurance plans are in effect.
Patients in a close-in DC suburb who think they’ve signed up for new insurance plans are struggling to show their December enrollments are in force, and health care administrators aren’t taking their word for it.
In place of quick service and painless billing, these Virginians are now facing the threat of sticker-shock that comes with bills they can’t afford.
‘They had no idea if my insurance was active or not!’ a coughing Maria Galvez told MailOnline outside the Inova Healthplex facility in the town of Springfield.
She was leaving the building without getting a needed chest x-ray.
‘The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the x-ray,’ Galvez said, her young daughter in tow. ‘It’s not fair – you know, I signed up last week like I was supposed to.’
The x-ray’s cost, she was told, would likely be more than $500.
She chose a plan that cost $450 a month but hasn’t received a bill yet, the Daily Mail reports, but she also has a $5500 deductible — which means she’d be paying for that chest X-ray anyway. There are plenty of more anecdotes from the front lines of the ObamaCare rollout in the article, so be sure to read it all.

Video: contractor forcing hospital to miss payroll — for weeks


The Weekly Standard’s Jeryl Bier has spent the last few months reporting on the relationship between HHS and Novitas Solutions, a health-sector systems provider hired by the Obama administration on a no-bid contract to build the back-end payment systems of Those would be the still missing back-end systems, but this report flagged by Jeryl from Houston suggests that it might not make much difference. Novitas, which provides the payment systems for Medicare, is so far behind in its payments to one Houston hospital that its employees have stopped getting paid. ABC’s local affiliate reports on the situation:
Dozens of employees at a hospital in northeast Houston have had to make it through the holidays without getting paid for weeks. The CEO of Saint Anthony’s Hospital on Little York is blaming a new Medicare payment contractor for his payroll problems.
Nearly 150 employees, ranging from doctors to nurses and administrators, haven’t been paid in nearly a month, and the CEO says it’s not his fault. …
The hospital is strapped for cash not because its not making money, but because Leday says a new Medicare payment facilitator named Novitas Solutions is taking too way long to pay out Medicare claims to the hospital.
Leday says he’s owed nearly $3 million in payments from Medicare and can’t make payroll.
It’s not the first time that problems have arisen in Novitas’ payment systems, Jeryl reminds us:
Novitas also runs the south-central region’s Medicare website which was launched just two days before the October 1 launch of  As THE WEEKLY STANDARD reported on December 19, that site has experienced problems reminiscent of’s troubles, and the site will not be fully operational until well into 2014.
The White House keeps insisting that their ObamaCare system has just experienced “glitches,” which will all get smoothed out shortly. However, the Medicare system used to be able to pay providers until Novitas got involved, and it’s possible that the hospital might have to cease operations for lack of staff. They certainly might choose not to accept Medicare assignments in the future, and I doubt that the issue is limited to St. Anthony’s in Houston.
Just imagine what will happen when Novitas brings its payment-systems expertise to private insurers looking for subsidies to cover premiums for ObamaCare enrollees. Will insurers wait weeks and months to get those premiums — or will they dump their enrollees for non-payment? Stay tuned.

New ObamaCare glitch: If you like your baby …


Add this to the list of items about which Nancy Pelosi warned we wouldn’t know until we passed ObamaCare. Opponents of ObamaCare warned that the federal government couldn’t possibly design a system that would account for the millions and billions of choices made and changes handled in the health-care sector, but most of us figured that they could at least design a system that handled the most basic change of all to families (via Instapundit):
There’s another quirk in the Obama administration’s new health insurance system: It lacks a way for consumers to quickly and easily update their coverage for the birth of a baby and other common life changes.
With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on.
Right now the website can’t handle such updates.
It’s a reminder that the new coverage for many uninsured Americans comes with a third party in the mix: the feds. And the system’s wiring for some vital federal functions isn’t yet fully connected.
That’s not the only family change that can’t handle properly. It can’t deal with marriages, or divorces, or deaths in the family, or income changes, or moving to new houses, according to Yahoo’s Ricardo Alonso-Zaldivar. In fact, it looks like the new system just assumes that everything will remain static from the enrollment period until … eternity.
Insurers warned HHS that they needed to have this functionality from the start. Bob Laszewski, who anticipated most of the problems in the rollout, calls this what it is:
“It’s just another example of ‘We’ll fix that later,’” said Bob Laszewski, an industry consultant who said he’s gotten complaints from several insurer clients. “This needed to be done well before January. It’s sort of a fly-by-night approach.”
It’s more like a freeze-by-night approach in effect. It raises significant questions about potentially significant gaps in the system for choices that are more nuanced than basic.  After all, if they couldn’t get a system to handle new babies, what else can’t it handle? This is right out of F. A. Hayek’s Road to Serfdom, which explains in great detail why central control over economies are doomed to failure.
By the way, Oregon has dumped its second high-ranking official over the ObamaCare failure in the state:
The man who led Oregon’s problem-plagued health insurance exchange has submitted his resignation. …
King came under fire when the online enrollment system failed to go live in October. The state’s online exchange still hasn’t launched and Oregon has had to rely exclusively on paper applications.
King is the second official connected to the exchange to resign. Carolyn Lawson, chief information officer for the Oregon Health Authority who oversaw most of the exchange’s development, resigned in mid-December.
Why hasn’t anyone been fired at HHS over this debacle?