Obamacare

Federal Watchdog Report Points to Trouble For Obamacare's Health Exchanges

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Whitehouse.gov

Will Obamacare's federally run health insurance exchanges be ready on time? In a report released today, the Government Accountability Office has weighed in on the question, and its answer is…maybe? But the federal watchdog can't say for sure—and federal officials will face additional challenges between now and October, when the exchanges are scheduled to open for enrollment.

Under Obamacare, each state will have its own health insurance exchange, and 34 of those exchanges will be run by the federal government. (States will assist with some of the work in 14 states.) Those exchanges are supposed to start accepting enrollees on October 1 of this year, but for the last few months reports have suggested that federal officials may be having a difficult time with the implementation effort, and in particular with the database technology that is supposed to make up the heart of the exchanges. Health and Human Services representatives have continued to insist that the exchanges will be up and ready on time, and they still do today. But the GAO's report isn't exactly confidence inspiring.

"Much progress has been made," the report says, "but much remains to be accomplished within a relatively short amount of time." Medicare officials have a timeline in place that they say will allow them to open the exchanges on schedule. But that's only if they can stick to the timeline. The agency has missed multiple deadlines so far, the GAO report says, and that could be a problem: "While the missed interim deadlines may not affect implementation, additional missed deadlines closer to the start of enrollment could do so."

Meanwhile, the federal government is still relying on states to do some of the work, but the GAO report found that "many state activities remained to be completed and some were behind schedule." Even with the contingency plans that federal health officials say they are developing, GAO concludes that it's tough to say whether the federal exchanges will be ready on time. "Whether CMS's contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined," the report says.

There's plenty that's not finished on the federal side too. Federal health officials have "many key activities remaining to be completed across the core exchange functions—eligibility and enrollment, including development and implementation of the data hub; program management; and consumer assistance." That's a lot to not have finished with just a few months to go, especially since GAO reports that federal officials are already behind schedule on some of those activities, like consumer assistance planning.

Some of the key technological features of the exchanges haven't been tested yet: Functionality intended to offer real-time verification of income, citizenship, and eligibility for insurance subsidies hasn't happened so far, and the federal government told GAO it still needs to complete additional steps in order to do so. The plan is to have those steps completed by July. But, as previously noted, sticking to deadlines has proven difficult in the past. 

In other words, there's still a lot of work to be done, and the conclusion one ought to draw from the GAO report is that it's not entirely clear that federal officials can complete it all on time.

Nor is the GAO the only organization reporting that government officials setting up exchanges have a rocky road ahead of them. The Robert Wood Johnson Foundation published a report this month looking at exchange implementation efforts in three states: Alabama, Virginia, and Michigan. And it too found a variety of struggles with the process.

One of the concerns the RWJF report raises is that state and federal officials are having trouble communicating and coordinating effectively. "Discussions with state staff in all three states made it clear that the actual structure of operations and functioning of the communications and interactions between states and [federal health officials] are evolving but are not yet clear on numerous levels, leading to significant frustration at the state level," the report says.

The RWJF report also notes struggles to make the technology work as intended, saying that "the challenge that has weighed most heavily on all states since the earliest discussions over exchange development has been IT system construction and integration with existing programs." Michigan and Virginia intend to work with the federal government to operate their exchanges, but staff in both states "continue to be concerned with the details of how information will be exchanged between the state departments of insurance and the federal exchanges." Even in Alabama, where the federal government has essentially taken charge of the whole exchange operation, state officials say they expect to have some interaction—but according to the report, "they do not seem to have any sense of what that interaction will look like." Officials in Alabama additionally expressed frustration at having been assigned six different federal case officers since exchange planning began, meaning they have no consistent contact or information.

Now, even with all this, my guess is still that most and probably all of the exchanges will be open in some form on October 1, perhaps with somewhat limited technical capabilities, and almost certainly with a variety of noticeable glitches and headaches for both users and government officials. Still, these reports do not bode well for the successful implementation of the law's key vehicle for the expansion of health coverage, and they suggest the scale of the administrative complexity involved in enacting the law's coverage schemes.

NEXT: G-8 Leaders: Apple, Others Should Feel Bad About Minimizing Tax Burdens

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  1. Alt-text: Cluck-cluck-cluck!

    1. Alt-text: No Mr. Bond, I expect you to die!

    2. Alt-text: Evacuate? In our moment of triumph? I think you overestimate their chances.

      1. She does look a lot like that guy.

        1. She really does.

          Can’t think of a better person to run this program, the ultimate terror of Obama’a domestic agenda.

          1. Dude, stop insulting Peter Cushing by comparing him to that harridan.

            1. That just shows how good an actor he is.

      2. Solid.

      3. Grand Moff Tarkin?* Nicely done!

        *Leia refers to him as Governor because that was his current job during Episode IV.

        1. I just figured Grand Moff is an honorific Sith title like Darth, his actual duties being governor of the Outer Rim territories and chief executive officer of the Death Star.

          1. Grand Moff was just the term the Galactic Empire used for what we call Governor of an Oversector, or a specially-designated sector of the Universe. They were strategic locations, such as where the Death Star (Ver. 1) was being constructed or Coruscant or the Rishii Maze, where the clone army was being grown and replenished.

  2. So it appears that it will be time to use some of that slush fund cash to make an ad buy or two. Blame “obstructionist elements”!

  3. Oh, and that is pure alt-test WINNING!

    1. See what happens when you put up good alt-text? We are reasonable people. We don’t have to be all stick.

  4. Let’s be fair–it takes a lot of time and resources to design carousels that both levitate and blow up 30 year-olds.

    1. If it takes long enough that I am already 30 by the time it gets implemented, do I get grandfathered in?

      1. You’ll have to go live in Washington DC.

      2. Well, as sloopy notes, the only exemption is for the ruling class.

        1. Hmmm… I may prefer to just leave the US’ jurisdiction than to live in DC.

          You know where the US doesn’t have jurisdiction?

            1. Correct. Plus the Moon has certain… strategic characteristics.

              1. It’s a major problem for Earth governments when independent groups begin operating permanently in space. They have, ahem, the high ground.

                1. As I mentioned in the AM Links, probably too late to be seen, I don’t like giving up the high ground.

                2. Something. Something. Just to be sure…

                  1. What’s great about being a military power in space with enemies on Earth is that you don’t need a nuke.

                  2. Nah, I’m keep those for myself. However, I do have some trash that needs disposal.

                    1. When you need the trash taken out, call Mass Drivers.

                    2. I do tend to have a lot of tungsten lying around.

                    3. What the fuck is up with your boy, Aaron Hernandez? Is Tebow gonna start at TE if he gets locked up for murder?

                    4. 1) Don’t know. Seems very suspicious, but there haven’t been enough details to know yet.

                      2) No, he is not starting over Fells and Hoo-man, let alone Ballard and Gronk.

                    5. Gronk is gonna be ready to play in 9 weeks? That seems optimistic.

                    6. The season is 12 weeks away, which is also the expected timeframe for the back surgery.

                    7. Oh, I had my weeks screwed up. That’s still optimistic for a full recovery to game speed and health.

                    8. It does assume there are no setbacks (e.g. infections), but weeks 6-12 are for getting back in shape, so it’s not like there is no time for that.

                    9. Oh, I see. I thought it was a bit worse than all that.

                    10. Yeah, this back thing shouldn’t be an issue. Unless something drastic happens, the worst case would be coming of PUP after week 6, but probably ready for week 1.

                    11. So you’re saying that he should probably not give Aaron Hernandez and shit while he’s rehabbing?

                    12. That might be a good start.

                    13. That’s still optimistic for a full recovery to game speed and health.

                      But Gronk at 80% is still worth putting on the field (assuming this doesn’t increase the risk of further injury).

                    14. Don’t be absurd. Brady gets injured, and Tebow wills them to a win. Then the impossible happens.

                    15. Dude, stop. You’re gonna give more than one person on here a heart attack.

                    16. I am not sure if I would like Tebow getting the Pats a win or not.

                    17. A miracle is in the works, and the Patriots are the vehicle.

                    18. That’ll be two miracles, by the way. One more and the Pope can start the beatification process. That should make any Patriots fan proud to be a part of it.

                    19. Exactly. I always thought the team and its coach were tools of Satan, but God moves in mysterious ways. I believe Tebow will also restore constitutional government and usher in an era of peace among the various NCAA schools.

                    20. I believe Tebow will also restore constitutional government and usher in an era of peace among the various NCAA schools.

                      Aaaaaaaaaand we have our third miracle. Get a dude with a big-ass hat over here to confirm them.

                    21. Brady gets injured, and Tebow wills them to a win.

                      At least some Big U QB from FL will finally live up to their college rep.

                    22. I hate to admit it, but that only applies to UF and FSU. Miami has provided it. Probably the top of that heap is Jim Kelly.

                    23. Jim Kelly? That loser? He couldn’t even beat the Giants.

                      /s

                    24. Great defense usually crushes great offense. The lack of great defense in the NFL today is one reason totally one-dimensional teams have enjoyed some success.

                      Kelly was pretty danged good. I’d say Kosar and even Testerverde had decent careers. Much better than anyone from UF or FSU, for sure.

  5. If she were to put her hand to her face and remove a mask, revealing a bare skull with eyes, I’m not sure that I’d even flinch.

    1. I’m giving you a choice: either put on these glasses or start eatin’ that trash can.

      1. Not this year.

      2. Never seen it. I wonder if it’s on Netflix.

        1. It is!
          http://movies.netflix.com/WiMo…..cale=en-US
          I’ll have to check it out. Looks good.

        2. Never seen it.

          It’s like I don’t even know you anymore.

          1. I didn’t watch much horror until my wife got me into it. So I’ve got a bit of catching up to do.

            1. It’s not really a horror movie.

              1. It’s not really a horror movie.

                John Carpenter. Close enough.

            2. You really need to go watch The Thing and The Fog and…just go watch a bunch of John Carpenter movies.

              1. I can’t think of a John Carpenter movie that I didn’t like.

                1. The new vampires movie?

            1. CONSUME!

          1. The more I read the preview on that link, the more I think I may actually have seen it. 1988 was a long time ago. Still, it’s going into the Instant Queue when I get home.

            1. 1988 was a long time ago.

              Let me put it this way: I may or may not have been born when this movie came out.

              1. I started high school that year.

                1. Lol I finished High School the year before, I think this means I need to tell Auric to get off my lawn or something

              2. Checked the exact release date, I was.

  6. “The Robert Wood Johnson Foundation”

    Robert’s Wooden Johnson? [sopohmoric giggling]

    1. “Woody Johnson”
      huh huh huh huh uh huh

  7. Officials in Alabama additionally expressed frustration at having been assigned six different federal case officers since exchange planning began, meaning they have no consistent contact or information.

    It sounds like each new case officer spends a few months figuring out what needs to be done then says “This is impossible. Fuck if I’m going to go down with it.” and then moves on to something else.

  8. Holman Jenkins at the WSJ had a great piece about Obamacare this morning, explaining basically why young people aren’t going to buy Obamacare.

    excerpt-

    a key point that Supreme Court Justice Samuel Alito managed to convey in many fewer words during last year’s Supreme Court argument on ObamaCare.

    Mr. Alito pointed out that young, healthy adults today spend an average of $854 a year on health care. ObamaCare would require them to buy insurance policies expected to cost roughly $5,800. The law, then, isn’t just asking them to pay for “the services that they are going to consume,” he continued. “The mandate is forcing these people to provide a huge subsidy to the insurance companies . . . to subsidize services that will be received by somebody else.”

    Since he puts it that way, why would they sign up for ObamaCare, especially since the alleged penalties will be negligible and likely unenforced?

    If you find any 20 or 30 somethings that don’t bother to get insurance now (even though they could probably afford it) but intend to buy insurance now because HEY, IT’S THE LAW NOW! please give them my number as I have many bridges for sale.

    1. The analysis seems questionable to me. Comparing the price of the insurance to the average amount of care you consume seems like it misses (what should be) the whole point of insurance – risk mitigation. It’s not just to subsidize someone else, it’s to subsidize whichever unlucky schmuck gets run over by a bus, which could turn out to be you. I’m sure he could point out that the 20-30 crowd ALSO doesn’t seem to attach much value to mitigating that risk, which I suspect is true, but that’s not the analysis he offered.

      What’s behind the assertion that the penalties will be “likely unenforced”? (Honest question, I really don’t know whether that’s accepted wisdom at this point and if so, why. It seems counter-intuitive on the face of it.)

      1. What’s behind the assertion that the penalties will be “likely unenforced”? (Honest question, I really don’t know whether that’s accepted wisdom at this point and if so, why. It seems counter-intuitive on the face of it.)

        It could be a reference to how the current tax code is handled. People get away with small time tax evasion all the time because they stay under the IRS’s radar. The penalty for not having insurance is really small, particularly in the first few years of implementation. We have no reason to believe that the IRS will be more zealous in going after people who avoid that “tax” than it is in going after other small time evaders.

        1. Well, Obama can just “not instruct” them to go after conservatives who don’t have insurance.

        2. Thanks. I thought that might be how to interpret the remark, but I wasn’t sure.

          Given that… I dunno. I think it depends on how it’s really implemented. If it’s “if you don’t have qualifying insurance, check this box and we’ll add the penaltax to your bill” (similar to the “use tax” on out of state purchases on state tax forms), then yes, I could see wide non-compliance. But if it’s “write in your insurance company code here and your policy number here, otherwise pay this amount”, then I can imagine the fear of getting caught being a LOT higher. Not 100% of course, but non-trivial compliance and collection.

          1. It’ll be the latter. The IRS, after all, is an independent government agency that is designed to collect the tax revenues people are obligated to pay under the social contract they signed.

            Enforcement, on the other hand, might just end up a little bit higher in states like, say, Texas and Arizona than it is in places like New York and California. It’ll be a coincidence or rogue employee that causes the uneven scrutiny, but bet your ass it happens.

            1. That is no doubt what they think. But the non compliance will be so widespread they won’t be able to do anything about it.

              Here is the funny and ironic thing. The tax system works because Americans are honest. If Americans as a group decided to stop paying or massively cheating, the whole system would fall apart. Not even the IRS could prosecute enough people to deter the rest once you hit a tipping point. Well, once people cheat on one thing it is a very short leap to start cheating on everything. If they are not lucky, Obamacare may bring down the whole tax system.

              1. But the non compliance will be so widespread they won’t be able to do anything about it.

                No it won’t. They force every insurance company to have a carrier code and policy/group code. If the numbers don’t match, the return is immediately recalculated with the Penaltax added onto the net return. If the filer made a mistake they will have to go to the IRS and correct it to get the money back.

                It’s basically what they do for dependents and their SSN’s having to match up with ones on file.

                1. So what about the people who say “I tried to get Obamacare but the exchange wasn’t set up yet and I didn’t have options available”?

                  Do they get penalized?

                  1. No Tman they will not. No one will ever be penalized. The whole thing is going to collapse of its own weight.

                  2. Do they get penalized?

                    That depends on what their cross-referenced database with the Tea Partiers and NSA says their political persuasions are, duh!

                2. They force every insurance company to have a carrier code and policy/group code.

                  And when I just put a good carrier and group code down they will know that I am lying how? What they think is they will be able to cross reference with the insurance companies. But that is going to be a disaster. It is impossible to keep a current list of every policy holder in the US. Thousands of people will be left off. Thousands more will have insurance but on the wrong list.

                  That system will never work and will never be implemented. IF they ever try to do so, millions of people will erroneously be assessed the tax, which will never be allowed to happen.

                  You give these people way too much credit. They can’t stop people from collecting homeless people’s SS numbers and filing returns to collect the earned income tax credit. There is no way in hell they will ever be able to properly cross reference the insurance policy of every tax payer in America.

                  1. And when I just put a good carrier and group code down they will know that I am lying how?

                    They you better include the disclosure form the insurance company will have to send everyone at the end of the year along with your W-2’s. The compliance costs the insurance companies will incur to mail these out will be passed on to the policyholders.

                    You have to think like a devious shitweasel to figure out how it will work, John. I’m probably more qualified to do so.

                    1. They you better include the disclosure form the insurance company will have to send everyone at the end of the year along with your W-2’s.

                      That won’t work. The disclosure forms won’t be current. People won’t get them on time or get the wrong ones. It is not like a W-2. It has to be current not reflective of something that happened during the year.

                      You don’t have to think like a devious shitweasel. You have to think like an incompetent bureaucrat. You just telling me yesterday how government employees are all worthless. Now today you are telling me they are going to construct this fool proof system that no one will be able to avoid.

                      Here is the reality. The bill is a complete disaster. They have no idea how to implement it and they never will. It is just going to fuck everything up. But it is never going to be implemented as designed. No one will ever pay a dime of the penaltax. The exchanges will either never stand up or if they are will have few if any members and will quickly go broke.

                      This is not going to be some nightmare out of Orwell. It is going to be a surreal, comic tragic train wreck out of Kafka.

                    2. You don’t have to think like a devious shitweasel. You have to think like an incompetent bureaucrat. You just telling me yesterday how government employees are all worthless. Now today you are telling me they are going to construct this fool proof system that no one will be able to avoid.

                      It can be both. They can be both incompetent (and I never said “all” by the way) and smart enough to devise a plan whereby people are forced to report things the way they want them reported to make collecting revenue easier for themselves.

                      And I never said the system would work. In fact, it would result in the government erroneously collecting money into the billions every year through improper filing of forms, accidental typos and myriad other things that will simply default the return to the government getting paid. It’ll fall on the individual to apply for a correction, walk it through the bureaucratic nightmare until resolution and ensure it doesn’t happen again. This, in fact, is added evidence to my claim that pubsec workers are lazy. All of the responsibilities lie with the taxpayers and the IRS reaps the rewards, often in error.

                      I’ve been hammered by the IRS a couple of times. They were in the wrong on both occasions and in one I was repaid…after three years of diligently challenging them. In the other and more expensive situation, they refused to adjust their mistake over a series of 7 years until I just gave up…after they reaudited it and I was shown to be correct.

      2. Comparing the price of the insurance to the average amount of care you consume seems like it misses (what should be) the whole point of insurance – risk mitigation.

        This may be true, but many of the currently uninsured are CHOOSING VOLUNTARILY not to mitigate said risk by budgeting their income elsewhere.

        I’m sure he could point out that the 20-30 crowd ALSO doesn’t seem to attach much value to mitigating that risk,

        That is exactly what he offered. He said that Obamacare is forcing people to spend exponentially more money mitigating the risk, which increases the amount of money they end up spending on health care. The point is, many of these people are choosing not to buy insurance -despite the fact that it may end up saving them money if they get sick or injured- even though they could probably afford it. Obamacare is no longer giving them that option.

        What’s behind the assertion that the penalties will be “likely unenforced”?

        Since they don’t even have the system ready to run the exchanges, nor a way of determining if those who are eligible for Obamacare are truly choosing not to buy it or if they are just not able to due to the failure of system to be up and running, there is no way to fairly “penalize” anyone either through direct charges or withholding or tax refunds.

        The underlying message is that the government is simply not even remotely capable of running a health insurance for the whole nation effectively or efficiently.

        1. And don’t forget what a politically sensitive issue the penalties are. It seems a bit far fetched that the government is going to go out and aggressively collect penalties from people who are too poor to buy insurance from exchanges that in all likelihood won’t even exist.

          The whole thing is going to completely fall apart. No one will use the exchanges which cause them to either not be set up at all or fall apart if they are set up and so many people will be out of compliance it will be impossible to ever enforce the penalties. Meanwhile, both sides of Congress will have every reason to ensure the penalty is never collected. Democrats will want to avoid it because they won’t want to be held responsible for penalizing the uninsured and Republicans don’t want the bill at all.

  9. Listen:

    It’s not about being ready. It’s about sending a message.

  10. She really wishes that pen was a cigarette.

    1. She certainly doesn’t wish it was a cock.

    2. So does Barry, the dirty smoker.

      1. Well, the cock wish is back in play then.

        /Reggie Love

    3. That Servo’s set to kill!

  11. Why doesn’t Cuntzilla call up the NSA? Those fuckers know databases.

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