Sarah Kliff at the Washington Post has a good account of the first week of the Obamacare Exchange Federal war room:
Thirty-four states decided to either operate an insurance marketplace in partnership with the federal government, or leave the entire task to the Obama administration. That means, that in about two of every three states, its the people in the CCIIO War Room, and their colleagues, who are managing the back end of the exchange….
it wasn’t clear that this extra workload would be a huge factor. There were arguments about whether the federal government’s work could be easily scaled. If you’re building one insurance marketplace, the thinking would go, its easy enough to plop that model down in any state where the feds are running the show.
In terms of the Web site’s consumer facing design, this worked: Each state on the federal marketplace uses the same homepage for HealthCare.gov. The application process looks the same, whether you’re buying coverage in Alaska or Wyoming.
But behind the scenes, the war room notes paint a completely different narrative, where each state’s idiosyncratic issues didn’t lend themselves to scale. Alaska and Wyoming, in other words, had totally different problems — ones that couldn’t be addressed with a singular fix.
On Oct. 4 alone, three separate states reported three completely different issues…..
This makes a lot of sense. The front end is a single user experience but the back end is thirty four seperate pathways of fail. This is not unexpected:
State built exchanges have three significant advantages over the Federal Exchange. The first is that there was political will to make things work so active problem solving has been an ongoing process. Secondly,the number of unique data interfaces at the state level is far lower than the number of data interfaces that the Feds must manage. Finally, most states that are building their own Exchanges are working with insurers where there was a pre-exisiting working relationship…..
The original plan for PPACA was to have forty to forty five state exchanges and a few small states piggybacking on federal efforts but sabotage and massive resistance to improving the standards of living of the non-1% has been the name of the game for the past four years. And so we get a kludge of system that seems to be working better now but not working well enough yet.
Gene108
Personally amazed it is working at all, given lack of funding, states jumping in at the last minute and a very firm deadline that could not be moved.
Amazon, Blizzard, etc when faced with technical problems have the luxury to push back deadlines. If Diablo 3 got delayed by a few more weeks, for example, after waiting years for its release, the fall out would not be catastrophic.
Not do much with rolling out the cornerstone of Obamacare.
Berial
No matter how many of the poor may be helped by the PPACA some of the middle class are being hurt, therefor it’s the worst thing EVER, the Republicans were right and this was Obama’s ‘plan’ all along!
At least that’s what the guys at this econ site seem to be selling. And he’d have gotten away with it too if it weren’t for them!
EDIT: In case it wasn’t clear, the opinions at that site do not conform to my own.
Just Some Fuckhead, Thought Leader
Bamz hired felons and screwed everything up.
/my facebook
fuckwit
@Gene108: And, they’re not interfacing with 40-year-old fucked-up systems written in COBOL with EBCDIC character sets and using token ring networks and serial modem connections.
jo6pac
Richard Mayhew, Thank You for the great work your doing on this nightmare being forced onto Main Street Amerika. It would have been so easy if this was Medi-Care for all in Amerika.
El Caganer
I’m a single-payer/Medicare-for-all person, but I’d like to give ACA a chance, since it looks like it could be better than the status quo. Unfortunately, with the amount of sabotage going on at the state level, it might be years before we really get a fair test of the system.
Keith P.
Could someone in the know help me out here: I talked to my brother last night, and he just canceled his insurance & is going to pay the penalty for not having it. His reason is that his company’s group is $400/month, whereas he was paying $180/month for a policy with a $1500 deductible. Under his exchange (note: he lives in Alabama), he can get a bronze policy for $200/month but with a $6500 deductible. He figures this is no good because of the ultra high deductible, hence his choice. I asked him about a subsidy, but he said he is just out of range of qualifying.
My question is: are these his only choices, or is there some other way for him to get a better policy that is closer to his original?
mai naem
@jo6pac: No, no, no Medi-care is only for old white people who vote Republican.
Davis X. Machina
@fuckwit: You say that like it’s a bad thing. (Posted via UUCP.)
piratedan
http://angrybearblog.com/2013/11/the-truth-about-obamacares-exchanges.html#comments
Violet
Trying to figure out what health plan to choose. Employer-based. What do you do when the HR people can’t answer your questions? They tell you to call the insurance company. The insurance company can’t answer your questions (in this case, about prescription benefits/costs) and tell you to call the pharmacy benefits company. Who do not have ANY info for the 2014 plan. Zero.
How the hell do you find out anything to estimate costs between the plans? No one can tell me anything. No information at all. Do prescription costs count toward the annual out-of-pocket and/or deductible? Is there a separate prescription deductible? No one knows! No one knows if you reach your out-of-pocket maximum whether or not you’ll have to continue paying the difference between brand name (required by doctor) and generic. No one knows! No one can tell me how to find out! It’s a mystery!
Given that the costs can be upwards of $200 a month, it sure would be nice to know. Sorry! We don’t have any info for 2014!
Violet
GAH! In Moderation. Let me try without the offending words:
Trying to figure out what health plan to choose. Employer-based. What do you do when the HR people can’t answer your questions? They tell you to call the insurance company. The insurance company can’t answer your questions (in this case, about prescription benefits/costs) and tell you to call the ph arm acy benefits company. Who do not have ANY info for the 2014 plan. Zero.
How the hell do you find out anything to estimate costs between the plans? No one can tell me anything. No information at all. Do pres cription costs count toward the annual out-of-pocket and/or deductible? Is there a separate pres cription deductible? No one knows! No one knows if you reach your out-of-pocket maximum whether or not you’ll have to continue paying the difference between brand name (required by doctor) and generic. No one knows! No one can tell me how to find out! It’s a mystery!
Given that the costs can be upwards of $200 a month, it sure would be nice to know. Sorry! We don’t have any info for 2014!
Gene108
@jo6pac:
Medicare is plenty confusing enough as it is, with all Part A, B , C, and D options.
Expanding it would not be as easy as people think and probably harder than Obamacare has been, because you will be replacing so many more existing insurance plans.
FlipYrWhig
@jo6pac: of course while Medicare for all is kickass in terms of equity and efficiency, the number of stories of upset people would be massive, because all of the currently employer-insured people would be up in arms, and the dystopian fantasies about rationing and interminable queues would be raining down on everyone’s head.
Mnemosyne
@Keith P.:
His state government decided he shouldn’t have any additional options. It might be fun to fake your way onto, say, the California exchanges and show him how much better he could have done if his state government wasn’t filled with assholes who don’t care if he gets sick, but I’m kind of a jerk like that.
But that’s the basic problem — he lives in a state that decided to screw him over.
@Violet:
I had the same problem with my employer. I ended up choosing the “gold” type of plan that had a copay for prescriptions because I couldn’t get a straight answer from Express Scripts about whether or not I had to pay full list price for my generic.
Belafon
@Keith P.: Is this correct:
He’s getting insurance through his company:
1. His current policy is $180/month with a $1500 deductible.
2. The new policy will be $400/month I’m assuming with the same deductible.
If he goes on the exchange, his policy will be $200/month with a $6500 deductible for the bronze plan?
Burnspbesq
@Violet:
How good are the whistle blower protection laws in your state? I’m thinking an email to the CEO, with copies to all the directors, is in order here. Unless somebody tells them, they have no reason to know that HR is a nest of Fail.
TooManyJens
@Davis X. Machina: It’s been ages since I’ve seen a bang path.
Burnspbesq
@FlipYrWhig:
Medicare for all sounds like a great idea, but I think we all have better things to do than endlessly rehash the debates about what is and isn’t politically feasible.
Gene108
@Keith P.:
What else did the original plan offer versus the bronze plan or the employer plan besides the deductible?
There is more to the plan than just monthly payments and the deductible.
It might be worth going over each option in detail to see if he is getting a better or worse deal.
Gene108
@FlipYrWhig:
It is more than just stories of rationing that will kick with Medicare for all. Providers get more money from private insurers than they do from Medicare on a per patient basis.
What cut backs are providers going to make as their revenue shrinks?
Medicare for all sounds good, but the impact on the overall system is not clear because it would be such a big change.
feebog
@Gene108:
I disagree. It would not be hard at all if it was simply phased in by age over a few years. Start by lowering the age to 60, while raising the premium costs slightly for this new group. Rinse, lather, repeat until the entire population is covered.
WereBear
I swear, we can study these Tea Partiers for pathology and save a lot of money.
They are like the a$$hole older bro-types who would say, “Stop hitting yourself! Stop hitting yourself!”
Violet
@Mnemosyne: Yeah, it’s beyond ridiculous. How the hell do they not have the 2014 info when open enrollment ends in a few days? There’s simply no way to find out the info. None.
@Burnspbesq: Live in a red state with few worker protections, so I doubt there are good whistleblower laws. As for letting the CEO, etc. know, they’d probably just fire the troublemaker rather than do anything about it. I learned a long time ago that the purpose of Human Resources is to protect the company. They have no interest in helping or protecting the employees.
Belafon
@feebog: And watch when the insurance companies close up shop and abandon everyone. Or triple their rates to make a lot of money before they go out of business.
MomSense
@Keith P.:
I find it very hard to believe that he was paying $180 per month with a $1,500 deductible before he was on his employer provided plan. That does not sound right at all. More like $180 per month for a $15,000 deductible or catastrophic insurance.
$400 per month for a company plan sounds much more plausible.
I don’t think you qualify for subsidies if you refuse employer provided insurance.
BruceJ
@fuckwit: You had Token Ring?? Luuuxury!
We had to craft our data packets by hand with squid ink, then attach them to a mouse tied to the cable to carry them from computer to computer!
Patrick
It shouldn’t have been all that difficult for the MSM to figure out that this a major reason for the problems with the ACA website. But I have yet to hear that from out so called brilliant pundits within the beltway.
The sad thing is that there seem to be a surprising number of the non-1% who are either scared of change or “I got mine, s**** you” attitude. Yet, most of these folks could just be a layoff away from not having health insurance pre-ACA.
ellie
Did anyone read this? Apologies if I missed it.
Anything, to make sure people don’t have health insurance. God, I hate repukes with the red hot intensity of a thousand suns.
Mnemosyne
@feebog:
And what would the under-60 people do in the meantime?
Big R
@Keith P.: Alabama has a specific reason why premiums are climbing so much: medical underwriting. http://blog.al.com/spotnews/2013/10/in_wake_of_obamacare_why_are_s.html
Mnemosyne
@ellie:
As I said before, I would be all in favor of allowing people like that to carry cards and/or wear Medic Alert bracelets to inform everyone around them that if they are in a car accident or have a heart attack, they prefer to be left to die rather than participate in the healthcare system. Parents would not be allowed to make this choice on behalf of their children — only people over 18 could make the affirmative choice to refuse all medical care in case of an emergency.
Freedumb!
Mnemosyne
@Big R:
In the very first comment, someone caught BCBS Alabama doing exactly what I suspect a lot of companies are doing — they’re trying to upsell people who have Bronze-type plans to Gold or even Platinum-level plans and trying to claim that Obamacare made them do it.
I really hope word about these insurance company shenanigans is starting to penetrate the MSM, because it seems like ordinary people are starting to notice and complain.
jo6pac
@mai naem: I’m an old white male and believe Medi-Care for everyone in Amerika, citizen or not. I vote Green.
Gene108 says
You remove all other private plans and the corp. welfare health care system with it. This make expansion easy your are already on the list do to SS.
FlipYrWhig says:
November 7, 2013 at 3:23 pm
I agree but with the proper message through the so-called liberal media it could be done. That’s after both houses of govt. are removed from office, money is removed from elections and we start over. No more cycle-0-paths. Then I forgot there’s dod, doj, fbi, hls and every other 3 letter govt. office that needs to be closed or returned to their real jobs.
Fair Economist
@Keith P.: First of all, he should absolutely get insurance, because otherwise he’ll face medical extortion and be charged 2-3 times the price for anything beyond a flu shot. Second, the #1 reason for exchange policies being more expensive is that prior policies had too low of a lifetime cap – when you really needed them, they didn’t pay. Third, he’s getting insurance for HALF the price of his company’s group and he’s upset?
Take a look at his old policy. It’s almost guaranteed that it’s got a catch in it.
Davis X. Machina
@TooManyJens: When I was a lad the snow on the bang paths was thigh-deep. And they were uphill. In both directions. And!we!were!grateful!.
Jacel
Keith P: If you are going to qualify for subsidies, you need to go through the exchange. However, if subsidies aren’t a factor, there should be additional plans available in the state that choose not to be listed on the exchange. If I understand right, some of the nationwide drugstore chains are set up to provide information and in-store services for dealing with the new health insurance situation. One sign of this is the rather clear information and calculators provided by CVS.
https://www.cvs.com/promo/promoLandingTemplate.jsp?promoLandingId=affordable-care-act
wvng
I went on healthcare.gov on Monday to apply in the WV exchange, which is being run by the Feds in partnership with the state. I was able to go through the federal website process and complete the application with no problems at all other than having the right information available. It was nice to not have to answer any medical questions.
Much better than experiences a month ago.
I might add that I later met with a navigator to discuss plans. She was well informed and very helpful. And had stories about people who really wanted Affordable Care Act insurance but want nothing at all to do with “that Obamacare.” Wouldn’t believe they are the same thing.
Violet
@Mnemosyne:
That would be great. They could choose to pay up front for emergency services or not be served. And while they’re having their heart attack, they can call around to make sure their ER is offering them the best pricing. Along with the ambulance company. I wonder if you can switch ambulance companies on the side of the road while you’re being treated for a heart attack, if you find one that has a better price?
r€nato
completely off-topic:
heard on NPR today that the %age of Hispanics who voted Romney in 2012 was…
wait for it…
guessed it yet?
Yep. 27%.
PhoenixRising
@Keith P.:
Yeah, I doubt it. That $180 a month for the $1500 deductible had an out of pocket of ‘your house, if you actually end up using it’, and real coverage is gonna cost more.
Work him through 3 examples of things that could go sideways with his health (With that pre-existing premium I can confidently predict it’s been excellent and he’s under 40) under the old plan vs. the exchange plan.
Using each example, you should be able to show that the $200 a month is a btter deal- with the OOP limit at his deductible, which is the new federal max for both–in the unlikely event that he gets close to knocking on that deductible, the OOP limit will bail him out.
catclub
@BruceJ: “then attach them to a mouse tied to the cable”
I learned somewhere that ferrets were used to run cables in Boeing aircraft construction.
Mnemosyne
@jo6pac:
Yeah, who needs FDA or EPA? Let companies monitor their own food safety and environmental problems.
Davis X. Machina
@catclub: Cable-pulling ferrets save millennium-eve pop concert.
catclub
@Mnemosyne: The ‘rinse repeat ,’ means lower the qualifying age another 5 years the next time. et cetera, et cetera.
catclub
@PhoenixRising: “$200 a month is a btter deal”
Better? or Bitter? or Butter?
Hal
I think I’m going to have to find something other than MSNBC to watch in the mornings until end of November because I seriously just can’t with the ACA coverage anymore. What if, but if this doesn’t happen, in two months, mid term elections, Chris Christie, coulda woulda shoulda.
They have nothing more to add, and there is this absolute unwillingness to cut through the BS. Kay Bailey-Hutchison was on this morning saying “everyone” was receiving notices about changes in their insurance because of ACA. Not some people. Everyone. When the anchor and Ed Rendell corrected her she just kept going with it. Oh no, she’s talked to people. It’s as laughable as Marcia Blackburn’s’ “The it professionals I’ve talked to” nonsense.
If only Netflix already had their Defenders mini-series running I could immerse myself in that comic book goodness until after Thanksgiving.
IowaOldLady
@Hal: A claim about everyone is lunatic, since most of the people watching the show can invalidate it by their own experience. I haven’t gotten a letter, ergo, she’s blowing smoke.
I hate stupidity.
PhoenixRising
@catclub: buy me a vowel on yr full size keyboard, ya putz. you’re probably typing on ergo-corrected real keys.
kindness
NPR is driving me nuts with the whole ACA thing. For whatever reason they run two or three pieces every day about how it is failing. And this from ‘Liberal Public Radio’. And then I read the comments under the articles. No doubt that is my problem. I know better and still do it. It’s like I was at Breitbart.com almost. You know when you see all these people cheering (perceived) failure of something that if it works will really help us all. Makes me crazy. No more donations for NPR. That is all I will say.
Elizabelle
@Hal:
Stop watching MSNBC and write them to let them know why. Couldn’t hurt to contact a sponsor or two as well.
Money is the only thing that talks to those weasels.
What they’re doing with disparaging the ACA at every turn is not using the public airwaves for the public interest.
Mnemosyne
@catclub:
So if you lower the age by 5 years every year (assuming that’s humanly possible, of course), that means that 20-year-olds only have to wait 7 years for coverage? Good thing none of them will get sick or need insurance in the meantime.
fuckwit
@Davis X. Machina: why!would!you!do!that!dude
Excuse me, I have to reset my Telebit Trailblazer 9600 baud modem now.
fuckwit
@Violet: I would have signed up for that, though, with qualifying for Medicaid in January I probably will have better options now.
Davis X. Machina
@fuckwit: In the department office I keep a copy of the O’Reilly Bear Book to wave at young people, instead of a cane….
Mnemosyne
@catclub:
IOW, your very simple plan to extend Medicare to everyone is not all that simple when you start looking at the practicalities of implementing it.
Steeplejack
@Keith P.:
I call bullshit, sort of. I just went on Healthcare.gov, selected Alabama, and entered the following (required) information to drill down to the available plans: Mobile County, insurance for one person, age 49 or under. I note that your brother has to have annual income over about $46,000 (as an individual) to be ineligible for a subsidy.
I found seven plans available (all from Blue Cross/Blue Shield):
At the bottom of the food change, there is a “catastrophic” plan for $141.51 a month. “Covers less than 60% of costs.”
There is one bronze plan, $163.63 a month. “Covers 60% of costs.”
There are two silver plans, one for $202.79 and one for $215.11 a month. “Covers 70% of costs.”
There are two gold plans: $262.50 and $264.07 a month. “Covers 80% of costs.”
There is one platinum plan: $315.88 a month. “Covers 90% of costs.”
You can’t get more detailed information on the plans until you fill out a complete application. But it seems just from this that your brother is not looking very hard or is willfully ignoring some available options. The one bronze plan is well under the $200 quoted by your brother, and for only $3–15 more he could get one of the silver plans.
I suggest that you run the numbers yourself. It takes only a few minutes. Presumably you know your brother’s exact age and the county in which he lives. I picked Mobile County because it’s a fairly large one. Maybe your brother is getting radically higher quotes because he lives in Shitheel County, population 8,000. At least you would be better informed and able to ask your brother, “But what about x,” instead of just listening to his possibly ill-informed whining.
Sorry if I sound testy about this, but (a) I have been without any health insurance for several years because of a preëxisting condition, and (b) I have had several real-life conversations with people who squawked about how awful Obamacare is but who turned out to be woefully uninformed when I asked them to get specific. It’s like they want Obamacare to fail so bad that they’re willing to scuttle their own situation.
And, although the Obamacare Web site still has problems, the part where you can get a rough idea of what plans are available does work pretty well. It’s available right from the home page.
ETA: Forgot to mention that his current plan, $180 a month and $1,500 deductible, is probably a joke that the insurance agents laugh about over drinks at the annual convention.
Central Planning
@fuckwit:
Don’t forget X.25, ATM, and 100VG
Gene108
@Steeplejack:
The percent of cost covered is co-insurance, I assume, which does not translate to what the deductible is.
Keith’s bro’s issue is the deductible.
Baud
@Gene108:
I think % of cost covered refers to the actuarial value of the plan — so it includes everything (on average).
jo6pac
@Mnemosyne: Yeah, who needs FDA or EPA? Let companies monitor their own food safety and environmental problems.
I said
The departments you mention haven’t been doing their job in protecting the Amerikan public from the greed of corp. Amerika have they. There was a time not long ago corp. really tried to do the right thing because of govt. oversight but since have been taken over by corp. cycle-0-paths and installed their own in the office of govt. that at one time did protect us.
Steeplejack
@Gene108:
I didn’t say it was the deductible, or equivalent to it. I was just passing along the information that was (readily) available from the Healthcare.gov site.
My underlying point is that there is a lot of specific information available that often doesn’t jibe with the vague complaints of people’s friends, relatives or neighbors who allegedly are being brutalized by Obamacare.
Mnemosyne
@jo6pac:
Uh-huh. Sell your government is bad “anarchist” bullshit somewhere else. We’re all full up here.
ETA: Because the difference between a Republican who wants to shut down government departments he doesn’t like and you is … ?
John F
@Gene108: For some areas, providers would probably cut back on ambulance service, especially air medical transport. Air transport is critical for getting patients to trauma centers within the “golden hour”, especially in rural areas. Some medavac choppers are outfitted almost as a flying ICU so that’s better for patients as well. However,
Medicare does not reimburse these operators as well as private insurance companies. The air medevac companies operate on tight margins, so if Medicare became the single payer a lot of those services would be canceled for many communities. To summarize, private insurance helped build the air medical industry to what it is today.
Keith P.
@Steeplejack: Thanks for the info. I’ll clean it up a bit (I get along with my brother a bit too much to tell him he’s full of shit and/or whining) and email it to him. Makes me feel kind of lucky, though. I’m in Texas, which sucks for insurance, but I’ve always worked for larger companies that have good groups. Plus I have to go on Medicare in February (dialysis), so I have a fallback in case things go south, although really, I’m going to have Medicare A&B (hospitalizations and the dialysis), PLUS my employer insurance to cover pills (bypassing Part D). Dunno which pays for my transplant, but it better not be me!
Steeplejack
@Keith P.:
Again, sorry I was a little, uh, vehement, but I am on my last nerve with people who are calling the wahmbulance on Obamacare when I can find info in two minutes that solves their problem or at least refutes their bullshit. And two of them are acquaintances who think nothing of tweaking Travelocity, Kayak, etc., for hours to save an extra $20 on airfare. Puh-leeze.
Original Lee
@Violet: And this is the system that has been our norm, yet is somehow better than Obamacare. Right.
FWIW, in our plan, p h a r m a c y costs do not count towards the medical deductible. In fact, anything that is a separate piece (dental, vision, etc.) does not count toward the medical deductible.
Original Lee
@Mnemosyne: Gah. Express Scripts. I never know what I’m going to see when I open my refill bottles. They change up the generics all the time. Plus, there is one medication that I need the brand name version because I’m allergic to the dye in the generic version (so far, only made by one company). So about twice a year, I have to send back the generic and get the brand name while making lots and lots of phone calls.
Keith P.
@Steeplejack: I feel ya. I know people who are the same way about driving all over town to save $.05 per gallon gas, even after I offer to throw in a cool $5 on their fillup. My brother’s not anti-Obama or anything, but he definitely buys into anti-government propaganda hook, line, and sinker (libertarian liberal). And he works with ultra-right-wingers, so some of their bullshit seeps in on occasion. Better than my mom, at least…after 9/11, she turned from a liberal into a Michael Savage Republican (she was a converted Jew who became militantly anti-Islam)
Steeplejack
@Keith P.:
Further thought: If you are old enough to be going on Medicare soon (not Medicaid), I presume your brother could be older than 49, which could kick up the premiums from the numbers I cited.
I hope you follow up on this with him and report back here with more specifics. There is just so much free-floating bullshit out there now. I would love to know more about his current insurance. That could be another line of advice to him, if you look at it with him and determine that it is a lousy policy (which I suspect). That would possibly ease the pain of having to pay more for a good policy under Obamacare.
GHayduke (formerly lojasmo)
@Violet:
If your employer’s plan is not compliant with the ACA, it will be cancelled. IF it is compliant, you are not eligible for the exchanges.
GHayduke (formerly lojasmo)
@Keith P.:
He’s lying.