Saturday, March 29, 2014

Obamacare Updates - March 29 , 2014 --Maryland to dump its ObamaCare exchange , 125 million down the proverbial drain...... 6 Big Unanswered Questions About Obamacare .......Enrollment data - unknown presently and will remain that way for awhile...... meanwhile the uninsured largely plan to stay that way - and the primary reason for Obamacare was what again ?

Maryland to dump its ObamaCare exchange


If you like your exchange … you can keep your exchange? And if you don‘t like your state ObamaCare exchange — because it hasn’t functioned properly in six months despite endless promises that Maryland would fix it — you don’t have to keep your exchange. The state will finally throw in the towel on its $125 million web portal, and will replace it with a copy of Connecticut’s:
Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.
The board of the Maryland exchange plans to vote on the change Tuesday, the day after the end of the first enrollment period for the state’s residents under the 2010 Affordable Care Act. …
It was not immediately clear how much more money Maryland may have to invest to get a fully functioning system, according to the two individuals, who spoke on the condition of anonymity because they were not authorized to discuss the changes.
How much more money will Maryland taxpayers have to cough up? Well, let’s take a look at results first. Maryland spent $125.5 million on the existing exchange. That was supposed to enroll 150,000 people by Monday’s deadline. They just recently cut their goal in half to 75,000, but the Washington Post reports that fewer than 50,000 have enrolled in private plans through the exchange, as of today. It’s not clear, though, that the Post confirmed these as actual enrollments where a premium has been paid, or just sign-ups to private plans without confirmation of actual enrollment. Given the way the media has reported on the government figures, it’s presumably the latter.
With those results in mind, one might imagine that it will take several hundred million dollars in order to salvage the database from this system while buying another system entirely from Deloitte, who built the Connecticut system. Of course, most of the original exchange database software and hardware can simply be converted to the new system to save taxpayers significant start-up costs, right? Wrong:
Some of the hardware that Maryland bought for its system, such as servers, can be salvaged, but the software and coding that are the guts of its online marketplace will be replaced, said the individuals familiar with the decision.
Only some of the hardware will work in a new system? Shouldn’t the web portal and database have been designed to be platform-independent? Maryland taxpayers had better brace themselves for another big bill. Maybe this time their money will actually buy a system that works.

6 Big Unanswered Questions About Obamacare

Whitehouse.govWhitehouse.govObamacare supporters are taking a bit of a victory lap today after yesterday’s administration announcement that six million people have signed up for private plans under the law, equaling the revised projection put out by the Congressional Budget Office after the botched launch of the exchanges last October. 
It’s a weak cause for celebration, given that success, according to Health and Human Services Secretary Kathleen Sebelius, was originally "at least" seven million people getting covered under the law by the end of March. And as an Obamacare factoid, the six million sign-ups figure just doesn’t tell us all that much about whether and how the law is working. There are still a lot of major unanswered questions about the law and its future.
1. How many people have actually enrolled? This is the big one. I’ve written about it a lot for a reason: The headline sign-up numbers are often described as enrollment numbers. They’re not. A significant portion of people who sign up for coverage aren’t paying their first month’s premium, and are therefore never enrolled. In California, it’s about 15 percent of sign-ups. In Wisconsin and Georgia, it’s closer to 20 percent. In Nevada and Vermont, it’s more than 30 percent. Until we know how many people have paid, we won’t know how many people got covered.
2. What percentage of those who are enrolled are between the ages of 18 and 34? After the launch of the exchanges last October, the White House repeatedly emphasized that they were less focused on the total number of enrollments and more concerned with the demographic mix—specifically, the number of young adults signing up. Young adults tend to be less expensive to insure, so their premiums are needed to balance out the costs of the older, more expensive enrollees. Early on the administration had been clear that it was aiming for 40 percent of enrollees to be in the youngest cohort. But so far, the administration’s reports have indicated that only about 25 percent of sign-ups are young adults.
3. Are the young people who are enrolling actually healthy? This one will be hard to answer, but it’s important. In the population as a whole, young adults tend to be healthier, and therefore less inclined to use lots of health care services, than their elders. But the characteristics of the 6 million or so folks who end up in the exchange population may not mirror the population as a whole. It’s entirely possible that the young adults who do end up signing up will be sicker, on average, than their peers. If so, that will complicate premium pricing down the road.
4. What are the sign-up totals, demographic breakdowns, and overall health of the individual state markets? The headline national numbers only tell part of the story. By the middle of this month, 13 states had exceeded initial enrollment projections, according to a count by Philip Klein of The Washington Examiner. But another 12 states were at less than half their projected sign-ups, and 24 were at less than two-thirds of sign-up expectations. What this means is that Obamacare is going to look very different depending on what state you live in. Some states will meet or beat enrollment expectations and presumably end up with viable insurance markets in the process. But others will have low enrollment totals and bad demographic mixes, and are likely to face higher premiums and fewer plan choices as a result.
5. How many of the people enrolled under the law were previously uninsured? And how many of them were previously among the long-term uninsured? Even once we find out how many of the people who have signed up for coverage have actually enrolled, we still won’t know the answer to another big question: How many of the enrollees were previously uninsured? Surveys and word from insurance industry insiders suggest that anywhere from a quarter to half of enrollments were previously uninsured—meaning it’s possible that the majority of enrollments are for people who were already covered before the law’s insurance expansion took effect. Moreover, when trying to figure this out, it’s worth thinking about who counts as previously uninsured: Many counts of the nation’s uninsured population count people who went without insurance for a few months, often while transitioning between jobs. But it’s the long-term uninsured—those who have gone years without coverage—we should be focusing on.
6. What will premiums look like next year? This matters both for the politics of the law and for its success as a policy mechanism. President Obama initially sold the health care overhaul as a way to reduce premiums, but recently the administration has trimmed back its promises, saying instead that premiums will still rise, just not as fast as prior to the law. But there are early rumbles from insurers suggesting that, when they set rates for next year, premiums could jump dramatically, with some warning that rates could double, or more. Because of the state-by-state nature of Obamacare’s insurance markets, those effects won’t be felt evenly. But if big hikes do appear in many markets, then you have to wonder: How many people will want to stay with their current plans? And what will this do to the already weak political support for the law?
Peter Suderman is a senior editor at Reason magazine.

How Many People Will End Up Enrolled Under Obamacare? 

We Don’t Know—and It May Be a While Before We Do

Whitehouse.govWhitehouse.govAfter a dropping to a slower-than-projected pace in February, the rate of private plan sign-ups under Obamacare appears to have picked up significantly in March. Administration officials say that sign-up totals hit 5 million by March 17, meaning that about 800,000 people had signed up in the first 17 days of the month. That's nearly as many as the 940,000 individuals who signed up in February. There are some indications that the number of sign-ups each day has increased since then, although it's hard to say by how much.
What this means is that the law is probably on track to see as many sign-ups in March as it did in December, the month with the highest number of sign-ups so far, and perhaps more. There were 1.8 million sign-ups in December. If March matches that number, then we'll end up with atotal of about 6 million sign-ups by the end of the month—equaling the revised projection of the Congressional Budget Office (CBO). Depending on how heavy sign-up traffic is during is during the final few days of the month, the final number could be somewhat higher. Relying on daily-rate calculations, Bloomberg View's Megan McArdle* projects about 6.22 million at the high end; other projections are even higher. 
No matter what, though, it now seems likely that the final totals will match or beat the CBO's latest projections—at least, that is, if you're looking strictly at sign-ups.
The problem, as always, is that the administration's sign-up totals don't give us a firm hold on how many people have actually enrolled, because many of the people who are counted as signing up have only selected a plan using the online system; not everyone who has selected a plan has gone on to pay the first month's premium. Nor do the administration's numbers give us any sense of how many people who end up paid and covered stay that way in subsequent months.
Right now, however, our understanding of how many people who have selected a plan and then completed the enrollment process is somewhat weak. Multiple reports from January and February suggest that about 20 percent of sign-ups never submit a payment and don't end up covered.
But that's a rough approximation based on early reporting from a handful of insurers. It's not systematic. We don't know if payment rates have increased or decreased over the last month, or if people who select a plan in the final surge are more or less likely to make a payment. We don't have hard data from every insurer or state. Mostly, what we've got are solid but scattered news reports relying largely on insurance industry insiders.
So the only thing we can be reasonably sure about is that the final enrollment rate will be significantly lower than the final sign-up tally. It might be 20 percent lower, but it also might be 16 percent, or 22 percent. When you're dealing with 6 million or more sign-ups, the difference could be substantial.
How long will it be before we get all of this sorted out? No one really knows.Solid numbers on paid enrollment at the end of March will exist, but they may be scattered amongst the insurers. The administration has not released any information on paid enrollments at all so far, and it's not even clear what's being collected. The Department of Health and Human Services (HHS) has indicated they do not have that information right now, but earlier this week, House Ways and Means Chairman Dave Camp (R-Mich.) accused HHS of withholding that information;insurance industry sources have also suggested that the administration has more information than has been revealed so far. (If the administration does know, and has chosen to stay mum, then that probably suggests the non-payment rate is on the higher side.) The special extended enrollment period announced yesterday may give the administration an excuse to hold off on collecting and reporting final numbers even longer.
So even though we can expect to see March sign-up totals fairly soon—and may get a milestone announcement of 6 million sign-ups in the next few days—we still won't know the true number of genuine enrollments. And it may be a while before we do. 
Update: According to the White House, total sign-ups have just crossed the 6 million mark
*...who is my wife. 

Half the Uninsured Say They'll Stay Uninsured

New poll numbers suggest the challenge the Obama administration faces as Obamacare's open enrollment period draws to a close. Half of the uninsured say they plan to remain uninsured, according to a new poll from the Kaiser Family Foundation. And 60 percent don't know when the sign-up deadline is.
Here's the chart:
Kaiser Family FoundationKaiser Family Foundation
Two thirds of the uninsured, meanwhile, say they haven't tried to get coverage yet. 
Numbers like these may help explain why the administration chose to extend Obamacare's open enrollment period. A sizable segment of the uninsured population is clearly not paying too much attention to the deadline details. With more time, it may be that the administration hopes to be able reach some of those people.
But there's also a risk that the extension, which comes via a special enrollment period for people who claim they had trouble signing up before, may simply add to the existing uncertainty. If lots of uninsured people didn't know about the deadline before, then extending it, while pretending not to extend it, might just confuse them further. 

Obama Administration Promises Obamacare’s Open 

Enrollment Deadline Won’t Be Extended—Right Before 

Extending Obamacare’s Open Enrollment

Whitehouse.govWhitehouse.govOn March 12, in a hearing before Congress, Health and Human Services Secretary Kathleen Sebelius was asked whether the Obama administration would extend Obamacare’s open enrollment period beyond its scheduled close date of March 31. “No sir,” Sebelius responded.
Later that day, a spokesperson for the Center for Medicare and Medicaid Services, expanded on that point. “We have no plans to extend the open enrollment period,” she said. “In fact we don’t actually have the statutory authority to extend the open enrollment period in 2014.”
The message was unmistakable: The administration would not, and could not, extend Obamacare’s enrollment period.
There’s just one catch. Last night, the administration confirmed to The Washington Post that the open enrollment period would be extended for anyone who wants it extended.
The gimmick here is that, technically, open enrollment will still end on March 31, as planned. But the administration now says they will allow for a special extended enrollment period for those people who tried to sign up before March 31 and, for some reason, could not complete the process. People will be able to request this extension until some not-yet-determined date in the middle of April.
And how will the administration determine if someone is eligible for this period? Here’s howThe Washington Post explains the verification process:
Under the new rules, people will be able to qualify for an extension by checking a blue box on to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.
The verification process is that there is no verification process. Absolutely anyone who checks the box will be able to get an extension. It’s a de facto extension of open enrollment for anyone who asks for it.
The upshot is that the administration is now doing exactly what they said would not do, and did not have the legal authority to do, simply by describing it in a slightly different way. To put it another way, the administration is using the fiction of a limited special enrollment period as cover for a lie and an illegal action.
This isn’t even the first time the administration has done this. On the same day that HHS Secretary Sebelius promised that enrollment would not be extended, she also promised that the individual mandate to purchase insurance would not be delayed. Again, it’s not—technically. But the administration expanded and clarified the rules for the law’s “hardship exemption” in such a way as to essentially give anyone a pass. There are 14 ways to avoid the mandate, the last of which is a vague catch-all category for unspecified hardships, no documentation required.
The pattern reveals the administration’s shallow commitment to keeping its word: When they promise they won’t do something, you can bet they won’t—but that they very well might do the exact same thing by a different name instead.