Economics, Health Care

What we learned about Obamacare today: Dec 3, 2013

1.) Obama spoke today on Obamacare, saying, “We’re not repealing it as long as I’m president,”  and “If I have to fight another three years to make sure this law works, then that’s what I’ll do.” See more of his remarks in the feature video. Today’s speech is part of a strategic, re-invigorated push for the health law. If you’d like to learn more, be sure to read Kaiser Health News round-up on the subject.

2.) AP reports that earlier today “the administration released a 50-state report saying that nearly 1.5 million people were found eligible for Medicaid during October. As website problems depressed sign-ups for subsidized private coverage, that safety-net program for low-income people saw a nearly 16 percent increase in states that have agreed to expand it, according to the Department of Health and Human Services.”

3.) For updates on Obamacare’s legal challenges, check out these articles: “Notre Dame again sues over Obamacare,” “Supreme Court turns down Liberty University’s challenge to the health law’s employer mandate,” “Obamacare’s next legal challenge,” and “A new wave of challenges to health law.” An excerpt from that last piece:

A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states…along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange.

At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is “rewriting his own law” by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges.

4.) Here are Sarah Kliff’s latest on Obamacare: “Three things we learned from today’s Obamacare update” (spoiler: number one is that there 1 million visitors to HealthCare.gov yesterday), “HealthCare.gov finally works – for some people,” “Can HealthCare.gov actually handle 50,000 users at a time?”, “These two paragraphs say everything about HealthCare.gov’s problems,” and “Obamacare media updates are starting to get tense.” From the last:

We don’t know how many inaccurate 834 transmissions went out…. experts tell me repeatedly that if the health law wants to have a shot at working, then the 834 transmissions need to work, too. That makes how poorly, or how well, the 834 transmissions are going a really important metric for understanding whether the health-care law is working…

5.) According to the Wall Street Journal, “The agency [CMS] running HealthCare.gov mostly kept to itself as warning signs grew about the website”:

A CMS spokeswoman…said CMS “did not anticipate the degree of problems in the system”… Some of CMS’s problems with developing the site may have stemmed from the White House’s own contracting policies… A March 2009 White House memo directed federal agencies to ensure they were conducting proper oversight and not letting contractors take on inherently governmental duties, part of a broader preference within the Obama administration for reducing the government’s reliance on outsourcing….

The problems with the arrangements emerged in March, when a White House website that tracks the status of major government technology projects labeled the project high risk. Officials attributed the downgrade to a lag in submitting information, and its status was upgraded the following month…. By July, CMS officials were growing alarmed about the project’s status, including a shortage of staff to address the ever-mounting list of problems…. But the depth of the website’s difficulties still didn’t become apparent until weeks after the Oct. 1 launch.

6.) Merrill Matthew says, “Doctors seeing Medicare patients face a 24 percent cut in reimbursements beginning January 1.  But almost no one has grasped that those cuts will hit Medicaid too—thanks to Obamacare.  Unless Congress acts, we’re likely to see a huge exodus of doctors who will not accept either Medicare or Medicaid patients.”

7.) “Obamacare’s new goal,” according to Megan McArdle, is to “stay alive until 2015”:

First, the good news: Compared with the chaos of October, the consumer experience is much better…. In early November, the site was down more than half the time; now it has greater than 90 percent uptime. A source in the know tells Bloomberg that 100,000 people signed up in November, four times the pace of October enrollment.

Now for the bad news: Although the administration says its repair team is working with “private sector velocity,” a private-sector website would still count this as a very bad performance. Any business person will tell you that every time a customer has a bad experience, you risk losing them…. Further bad news: The administration has chosen to count not how many people have actually enrolled in a plan, but how many people have put a plan in their electronic shopping cart, whether they checked out or not. Some of those people will never actually enroll in any plan. Some further number will never pay, or they will stop paying after a short period of time.

8.) Matt Labash decided to tag along with two Get Covered America workers as they went door-to-door with information on Obamacare. He chronicles the journey here.

9.) For information on insurers, take a look at this Kaiser Health News collection of articles on the subject, including “Insurers are offered assistance for losses,” and “Year-end signups crucial test for health care site.”

10.) AEI’s Jim Capretta appeared on Fox News to discuss the question, “Is HealthCare.gov the least of Obamacare’s worries?” For the video and transcript, go here. When asked if HealthCare.gov is fixed, Capretta replied:

Look, the real test of Healthcare.gov is whether or not you make the right payment for the right people to the right insurance plan. It’s very easy to fix the front end enrollment if you turn off controls on the back end. It’s very clear from multiple media reports that the system is still not accurate when it makes payments to the insurance plan. In fact, they’re doing a workaround. They’re going to actually make large lump sum payments to the insurance plan, based on self- reporting from the insurance companies instead of actual individual subsidy calculations.

When later asked if it’s true that “the cut costs that many of these new plans under Obamacare will sharply limit your access to doctors and hospitals, as much as Medicaid does today,” Capretta said:

That’s correct. Most of the plans, especially the silver plans and lower cost plans in the exchanges have very narrow networks. Some in Los Angeles don’t include the most visited commercially based hospital systems that are used by commercial insurance.

So, yes, the answer is this is going to feel a lot more like the Medicaid program with a narrow network of doctors, a narrow set of hospitals you can use. If you go outside that system, you pay a lot more…. It’s going to be difficult, frankly, through the website, the website is not good enough to figure out if your doctor is in the plan. But when you can figure it out, a lot of people will find out their doctor is not in their plan.

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