Obamacare

Obamacare's Troubles are Only Beginning

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Whitehouse.gov

Right now, most of the problems with Obamacare's online insurance exchanges are with the signup process, particularly in the 36 exchanges being run by the federal government. But there are deeper, more fundamental problems looming even if the surface web-accessibility problems are largely fixed. 

For example: Just because someone has completed the online enrollment process doesn't mean that they've actually gotten coverage. Reports indicate that many of the applications that are making it through the system don't actually have enough data for insurers to process the enrollee. Here's Bloomberg News:

[Insurance companies] are receiving electronic files that can't open or have so much missing information on new enrollees they're unusable, [industry] consultants said.

Some insurers have been forced to fix entries by hand, said Bob Laszewski, an insurance-industry consultant based in Arlington, Virginia.

"If we don't see substantial improvement by the end of this week, then I would throw up the yellow flag," said Dan Schuyler, a consultant advising states and insurers on the exchanges. "If we don't see it in the next two to three weeks, it's time for red flags. The concern is some people could get to Jan. 1, and not have coverage."

A report from CNBC over the weekend suggests that for some insurers, just about every application coming through the federal exchange system is insufficient for complete processing:

As few as 1 in 100 applications on the federal exchange contains enough information to enroll the applicant in a plan, several insurance industry sources told CNBC on Friday. Some of the problems involve how the exchange's software collects and verifies an applicant's data.

"It is extraordinary that these systems weren't ready," said Sumit Nijhawan, CEO of Infogix, which handles data integrity issues for major insurers including WellPoint and Cigna, as well as multiple Blue Cross Blue Shield affiliates.

Experts said that if Healthcare.gov's success rate doesn't improve within the next month or so, federal officials could face a situation in January in which relatively large numbers of people believe they have coverage starting that month, but whose enrollment applications are have not been processed.

"It could be public relations nightmare," said Nijhawan. Insurers have told his company that just "1 in 100" enrollment applicants being sent from the federal marketplace have provided sufficient, verified information.

What happens when insurers don't have enough information to finish processing an application? They have to follow up with the indidivudal and get the extra information, somehow. That means that the supposedly simply process of signing up online will actually require an additional follow-up step. And it probably means that some people who believed they had signed up for coverage will find out next year that their application didn't go through. So even after today's technical glitches are more or less resolved, it's possible that there are additional problems waiting down the line, some of which we might not even really find out about until next year. 

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  1. It is extraordinary that these systems weren’t ready,” said Sumit Nijhawan, CEO of Infogix, which handles data integrity issues for major insurers including WellPoint and Cigna, as well as multiple Blue Cross Blue Shield affiliates.

    umm, yeah I left my shocked face in my other pants. who could have predicted this to be a clusterfuck?

    1. My wife and I just learned that we’re not going to be able keep our doctors or health care plan in 2014. President Obama promised us. So, I mean, I’m kind of flabbergasted.

      I’m left to conclude that the president of the most powerful nation in the world… Is scum-sucking, fuck-bag, dick-licking, shitter fuck. Did I mention his wife’s butt could block the five lanes of the 405?

      My goodness. Honesty and civility are defunct concepts in Obama’s America.

  2. it’s possible that there are additional problems waiting down the line, some of which we might not even really find out about until next year.

    Yes, those additional problems are largely economic and fall into the realm of “unintended consequences, moral hazard” and others.

  3. Experts said that if Healthcare.gov’s success rate doesn’t improve within the next month or so, federal officials could face a situation in January in which relatively large numbers of people believe they have coverage starting that month, but whose enrollment applications are have not been processed.

    “It could be public relations nightmare,” said Nijhawan. Insurers have told his company that just “1 in 100” enrollment applicants being sent from the federal marketplace have provided sufficient, verified information.

    Memo from the IRS: “Fuck you, pay me!”

    1. Millions of people are going to see the penaltax taken out of their refunds even thought they think they have coverage via these exchanges. They are going to fuck so many people.

      1. Also, note that it is 1% of taxsble income or $95, whichever is bigger. So even your $22000/year is going to be out something like $125 year one.

        1. Sorry, not your [John’s salary], I left out “$11/hr state worker” to get $22000/year

        2. I’m not a mathematician, but I’m pretty sure that 1% of 22,000 is $220 – not $95 or even $125.

          1. Taxable income. The individual deduction is roughly $10000, so someone who earns $22000 and qualifies for no other deductions has a $12000 taxable income.

            1. Are you sure that it’s taxable and not AGI?

              I haven’t actually seen it specified either way – so I assume it’s yet another detail that they didn’t think abou.

            2. The individual deduction is roughly $10000

              What? No, it’s like $5900. But next year it’ll be $6100.

      2. All the more reason to structure your tax payments so that you owe a little at the end of the year.

      3. Is the penaltax being directly verified by the IRS? I thought that was one of the steps that was being left out for future implementation?

        1. Yeah, that “feature” isn’t working yet. Neither is the income verification for subsidies.

          1. And the reason for this was that it was too difficult to integrate with the IRS databases, so they left that part out. Which means that all these screwups over the past few days are them playing on “Easy” mode.

            To the point of the article, I’ll compare the glitches with an NFL team spending a #1 draft pick on someone who isn’t ready for their first training camp due to an injury. It will generate a lot of “tsk-tsk” press. But if they end up in the Hall of Fame, noone will remember that they missed two weeks of training camp their rookie year.

            These IT issues aren’t the real problem, the fact that congress is trying to delicately balance incentives and penalties to simulate a free-market equilibrium via the legislative process is the problem.

        2. You’ll notice the Roberts Court didn’t say that the IRS couldn’t use failure to pay the penaltax (or present proof of exemption) as a reason to audit people to see what else they might not have paid.

      4. Millions of people are going to see the penaltax taken out of their refunds even thought they think they have coverage via these exchanges.

        Not to mention the people who actually have to go the emergency room with, say, a broken leg or something, thinking they have coverage only to be told “Nope, sorry, you don’t have insurance. Here’s your bill.”

        “But I signed up online!”

        “Not according to our records, sorry.”

      5. Consider the people who CURRENTLY have high-deductible plans that don’t qualify to avoid the penalty. When happens when the IRS fucks up and forgets that those plans are supposed to be grandfathered in?

        1. Those plans do not exist anymore.

          1. Obama waived the maximum annual deductible rule. Other than preventative care, most of the ACA compliant plans have $5k to $10k annual deductibles – meaning the people who can’t afford insurance without a subsidy will need $5k paid by them before the insurance pays the first $. After that, there still may be a 30% copay. Guaranteed issue = assume worst possible case.

  4. Gee. people don’t know how to fill out their forms properly. Who could have seen that coming. These clowns literally are not competent to run a lemonade stand. The exchanges are a monument to just how stupid progs are and how badly they will fuck up anything they touch.

    1. I’ve been thinking. This insanely complicated and doubtlessly self-contracting law, coupled with the difficulties of complying. . .well, it benefits our profession. All those poor law students, looking for jobs, they should turn into ACA compliance experts.

      1. I am sure there are already K Street firms that are all over this.

        1. Lawyers and consultants win yet again!

      2. I just graduated law school, and someone recommended exactly that. I don’t want to be a parasite, however.

        1. You’ll be a very helpful parasite. Besides, you could secretly work to kill the law.

        2. BuSab is our only hope. Join the government and work to undermine it.

        3. You’re not a parasite. Your helping the host deal with the parasite.

          1. Good points, maybe I can gut it from within.

      3. You’re right. It’s a jobs program for paper pushers. Think of the stimulus!

  5. How will they coordinate the subsidies and billing. Are those eligible for a subsidy paying the government or the insurer directly? How will they confirm subsidy level? Sounds like a continued clusterfark.

    1. Unlike the IRS question I asked above, I am fairly sure that the verification of eligibility for subsidies has been postponed and currently operates on the honor system.

      And, of course, if you ask a Progressive, nobody would intentionally rip off the government, because Government is just all of us, working together.

      1. Like every government program, it will totally fuck honest people and greatly benefit crooks.

        1. I wonder how much our country is held together by people who simply have the integrity to do the honorable thing ? Because sometimes even I start to feel like I’m a sucker for working every day for my daily bread, paying my bills on time. I mean how bad could it be to become one of the Walmart pajama people ? Just give up my honor and any sense of self-worth…that’s worth a free meal ticket, right ?

          1. The government can do a great job of taking care of you if you’re OK with living in poverty. If you want to do a better you’ll have to work for it and hope the government doesn’t take it all away to help keep more people living poverty doing nothing.

    2. The government will pay the subsidy to the insurance company who will deduct it from your bill. However, the amount of the subsidy is based on your guess of your income based in 2014.

      Everyone doing their 2014 taxes in Spring 2015 who took a subsidy will reconcile their tax credit. If you had a really good year or you deliberately low balled your income estimate, come April 15, 2015 you have an unexpected tax bill in theory up to about $10,000 to pay back the tax credit you were not entitled to.

    1. Where we’re going, we don’t need doctors.

      In other Gov IT news – NSA can spy on us but they fuck up building shit. [rub your nipples as you read this]
      http://techcrunch.com/2013/10/…..xplosions/

    2. Anyone who currently purchases insurance in the individual market as opposed to group insurance should be freaking the fark out about now. Most of them will see their benefits and premiums change, but the worst change will probably be in doctor availability. The networks are significantly more limited with few specialist or high-end hospitals.

      1. A lot of doctors around here have already went concierge.

      2. My current policy is now illegal and if I want to get anything else I’ll have to get something that costs more than twice as much, but comes with a luxurious doubling of my deductible and increases to the out of pocket cap. I don’t know if I’m just going to go without for a while or try to figure out something with my SO’s insurance, but I’d have to wait for the enrollment period, I guess.

  6. The fallout from this is definitely going to be when everyone who has to get insurance from the exchanges, finds out how expensive it is, when most of them thought they were getting free or really affordable health care. Sure, it’s affordable if you are a member of Congress getting a 70% subsidy. Otherwise, I doubt that most people are going to be jumping with joy.

  7. in April 2013 an NSA spokesperson said, “Many unfounded allegations have been made about the planned activities of the Utah Data Center, ? one of the biggest misconceptions about NSA is that we are unlawfully listening in on, or reading emails of, US citizens. This is simply not the case.”

    Hahahahahahahahaha Hahahhahahahahahahaha HHHAHAHAHAHAHAHAHAHAHA Hahahahhahahahahahaha ………………(deep cleansing breath)……..hahahahahahahahaha hahHAHAHAHAHAhahahahahahaha ……….Hahgahahahahahaha. Bwahahahahahahahahahahaha!

    HAHAhAHAHAHAHAHAHAHA….fuck you Tony…….Hahahahahahahahahahahahahahahaha!

    Whew!

  8. What’s true for individuals is also true for nations, even the most powerful nation on earth.

    Guess who said this, concerning the debt limit debate?

    1. Sounds like something some TEABAGGING RETHUGLICAN KOCHSUCKER would say. /DEEEEERRRRRRRPPPPPPPP

  9. “If we don’t see substantial improvement by the end of this week, then I would throw up the yellow flag,” said Dan Schuyler, a consultant advising states and insurers on the exchanges. “If we don’t see it in the next two to three weeks, it’s time for red flags.

    Might as well skip to the end and throw up the white flag now champ.

  10. I havn’t looked at the exchanges, so I’m not too familiar with what they ask you to fill out, but do they ask for past health status data, or are the insurers expecting it?

    The ACA supporters have been telling people they don’t have to enter any information about their health, and my suspicion is that is incorrect, and insurers are still expecting to know at least some health information. I wouldn’t be surprised if the missing information was information on the customer’s health history, and the reason that 99% of aplicant’s forms are not filled out is because the ACA advisors have been telling people not ot enter it, because the insurer has to cover pre-existing conditions.

    1. I was able to get fairly far into the application process, basically right to the point where I would pick a plan.

      At no point do they request any health info. The only thing they ask is if you have used tobacco products X number of times per week in the last 6 months. They basically can only set the prices based upon:

      -Coverage offered
      -Age
      -Tobacco use
      -Area in which you reside

      So yeah. No health questions.

    2. The key thing is you don’t need to go to healthcare.gov if you plan on asking for the subsidy. If your income is over 400% of the poverty level or you don’t want the insurance company prepaid your tax credit, just go to the web site of insurers that will offer individual coverage in 2014 – Aetna, Cigna, blue cross, golden rule (united healthcare) and ask for a quote. All they will ask is age, zip code and if you smoke. Nothing else (including gender) is involved and they are required to write a policy for 2014 (guaranteed issue). That’s the entire process. No health questions, no credit checks. They may require you to pay for January 2014 with the application, then Bill you monthly after that.

      You MUST do this during open enrollment. If you wait until June 2014 thinking you’ll wait until you’re sick, you can’t get covered until January 2015 and be prepared to be raped by the hospital if you have any assets

      1. Typo – you only need healthcare.gov IF you want the subsidy. Even that may not be true – I’ve heard insurers can apply for the subsidy without going through the Obamacare web site.

  11. I spoke to a person at Cigna about health insurance yesterday and what subsidiaries I qualify for. He said he would have to get back to me because insurance companies wouldn’t get anything from the government to do that until November 1st.

  12. And it probably means that some people who believed they had signed up for coverage will find out next year that their application didn’t go through.

    This is trivial bullshit.

    What matters is the fact that this is going to drive all the good doctors out, and it’s going to gut the US health care system. In the end we won’t be able to get anything that a GP can’t provide (if that), at any price. Because there won’t be any other doctor left.

    But let’s worry about websites, it’s a much smaller head ache.

  13. Here is the truth. The healthcare.gov website is not broken because if capacity. It’s broken for the 36 states because they have nothing to sell.

    OPM was required to qualify two “multi state” insurers for the Federal Exchange before October 1st. They failed. They did get BC/BS to agree on September 30, but they are not ready.

    In NC for example, the only other Exchange company is Coventry One. The took my name and said they don’t have plans or prices yet and won’t for a couple weeks.

    Knowing that BC/BS is the only possible choice, I called 800-F1UCKYO (that’s the real number) and was told the best they could do was give me quotes in 3 to 4 weeks – BY POSTAL MAIL.

    There is no cheese at the end of the maze

  14. If they work at all the kinks, which is going to take forever, the only people that are going to sign up are those in search of subsidies. Or, perhaps some really sick people. Obama himself has admitted that young healthy people are needed to balance the risk pool but none of these people are going to bother. They probably thought ObamaCare meant they were just going to get something for free.

  15. I’m new to libertarian thinking and I’m curious why libertarians oppose single payer healthcare. The current system is the number one cause of bankrupty in the US, isn’t even in the top 5 compared to other countries for major metrics such as infant mortality, and is driving healthcare related entitlements up to astronomical levels because of its a la cart allocation of healthcare based on dollars vs need. And even though the current system is supposed to be market oriented it isn’t -there’s no price transparency, so nobody can get a quote for the price of knee, etc…

    How is the current system any better than a single payer system? How can libertarians defend the current system when it has caused such large cost increases in healthcare that projected spending on entitlements are ballooning? Its ditto for private colleges.

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