Obamacare's Federal Exchanges are Failing at Every Level



The technical troubles with Obamacare's exchanges are bad enough that even supporters are turning critical. The Washington Post's Ezra Klein, a longtime champion of the health law, has declared the launch so far a "failure" and a "disaster." Former White House press secretary Robert Gibbs is asking whether anyone will be fired over the botched rollout. 

But here's the thing: The serious problems that have gotten the most attention so far may only be the beginning of the headaches for the exchanges.

Right now, the most visible problems are concentrated on the user end, in the registration and enrollment process. Lots of people still can't create accounts in the federal exchange system at all. Others get error messages or hang-ups within the application process. It seems pretty clear that, roughly two weeks after launch, most potential users are effectively locked out of the federal exchange system—and most of those who aren't actually locked out aren't able to complete the transaction process.

But as I wrote last week, there also appear to be serious back end problems as well. On Friday, insurance consultant Robert Laszewski noted that the enrollment system is sending lots of junk information through to insurers.

Here is one example from a carrier–and I have received numerous reports from many other carriers with exactly the same problem. One carrier exec told me that yesterday they got 7 transactions for 1 person—4 enrollments and 3 cancelations. 

For some reason the system is enrolling, unenrolling, enrolling again, and so forth the same person. This has been going on for a few days for many of the enrollments being sent to the health plans. It has got on to the point that the health plans worry some of these very few enrollments really don't exist. 

The reconciliation system, that reconciles enrollment between the feds and the health plans, is not working and hasn't even been tested yet.

A separate Washington Post article seems to confirm Laszewski's diagnosis. The Post says that Cigna, which is selling health insurance through the federal exchange system in four states, has "seen 'multiple enrollments' from the same customer on the same day." Another Blue Cross Blue Shield plan told the Post it had also seen the error. The enrollment data error is further complicated by the fact that the applications lack a crucial detail: a time stamp. 

And then there's the subsidy calculator that is at the core of the exchange system. The exchanges are not only supposed to allow individuals to compare the sticker prices for insurance available in their area, they are also supposed to allow people to see, in real time, if they qualify for a subsidy—and how much that subsidy is worth.

But even before the exchanges opened for enrollment there were reports that the subsidy calculator was not working correctly. That still seems to be the case. Cigna is so uncertain about the subsidy calculator in the federal exchange that it has issued an official warning to brokers not to attempt to enroll anyone who might qualify for subsidies until November, according to the Post. Cigna isn't alone in its worries either. Jonathan Gruber, an influential Massachusetts Institute of Technology health policy wonk who helped design Romneycare and consulted on the federal health care overhaul, tells Politico that he expects that problems with the subsidy calculator could well last into next year. That's a long time for key functionality to remain broken. 

So two weeks in, here's where we're at: Many and perhaps most users can't even get into the federal exchange system. Those who can are often stymied by errors, and can't trust that any subsidized insurance prices they see will be accurate. And then, even if they do manage to get all the way through the system, their applications may not transmit properly to the insurers from whom they are trying to purchase insurance. In short, nothing works. It's a failure at every level.

The administration says it's working on fixes. But the clock is ticking.


Obama administration officials are downplaying problems, and framing current troubles as a rocky start that won't necessarily doom a six-month enrollment project. Open enrollment, they note, doesn't actually end until March 31 of 2014.

But in order for Obamacare to have any chance of success, the exchanges will need to be functional long before then. In order for coverage to start on January 1, individuals will have to complete applications by December 15. And in order to avoid the law's penalty for remaining uninsured, they'll have to be enrolled by February 15 of next year—not the end of March.

In other words, the administration doesn't really have six months to fix problems with the exchanges. Political pressure will build well before the end of March. If there isn't significant progress in a fairly short period of time, I suspect we'll start to see a lot more supporters begin to question the law, or at least start to wonder aloud about what to do with a health care overhaul that simply doesn't work. 

NEXT: Obama Delays Meeting With Congressional Leaders, Al-Libi Arrives in the US, Rouhani Calls For Academic Freedom: P.M. Links

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  1. Don’t worry, if these people don’t sign up Judge Roberts says we can still fine them, oops I mean tax them for failure to sign up.

    1. Roberts will go down in infamy as the person who single handedly destroyed this country. He may be the most evil person alive.

      1. Roberts will go down in infamy as the person who single handedly

        I don’t know anything about his evilness, but exactly how is a 5-4 vote single handed?

        1. It isn’t so much that he voted that Obamacare was constitutional – if he just sided with the liberal block, then while being a disappointment, could be accepted for its legal arguments. It was the way he contorted a legal reasoning that makes him evil. He pretty much single-handedly invented new law and reasoning.

          1. “He pretty much single-handedly invented new law and reasoning.”

            He declared a law no one passed to be constitutional.

            1. Exactly, another activist judge. Of course his ruling just brought up another lawsuit in that all new taxes need to originate in the House and the bill orginated in the Senate. Let’s see what he does when his own interpretation used to pass it was a violation of the constitution.

          2. Would anyone like to make an argument for how it isn’t a tax? There seemed to be universal agreement that it was before Roberts’ decision.

            The fact that nothing functionally changed about the law seems to support the decision.

            I’d be just as happy if he had pretended it wasn’t a tax (the Constitutionality of our social engineering through the tax system aside), but I can’t fault his logic.

            1. How about that everyone involved in passing it spent every waking moment arguing that it wasn’t a tax? How about the text of the bill, which very specifically call it a “penalty” several times, but never a tax?

              “Universal agreement” doesn’t include the president and his entire party apparently, who spent the entire time the thing was being debated and quite some time after its passage arguing that it isn’t a tax. The first people to say it was were the administration’s lawyers. I’m sorry, but you shouldn’t get to pass something screaming that it’s not a tax but a penalty, not describe it as a tax in the bill anywhere, and defend it for months, including in court, as a penalty, not a tax, then reverse yourself in court saying it’s a tax. If I was running a brothel with a big sign out front saying “prostitutes for hire inside, any sex acts acceptable” and went on television to promote my brothel, describing it as such while denying it was an escort service, then tried to argue in court that it was an escort service, I’d be laughed out of the courtroom. There’s no difference here.

              1. So your entire argument is that them lying repeatedly for years makes their lies true?

        2. He flipped his vote. He had originally intended to vote to overturn it, and then chickened out.

          1. He found out he wouldn’t be on the Washington party “A-List” if he overturned it.

          2. I’m surprised that there has been no speculation that he was blackmailed. Remember, the NSA was watching him, too.

      2. He’s just a collaborator.

  2. “Former White House press secretary Robert Gibbs is asking whether anyone will be fired over the botched rollout.”

    The is going to be too widespread of a fuck-up to be able to plausibly blame on a handful of scapegoats. Unless Gibbs means Obama should be fired for it.

    1. Sebilius is the head of the department. It should fall on her shoulders.

      People have lost their government jobs for less under this administration and others.

    2. Are they admitting to “liking to fire people” now too? Next they’ll replace whoever is fired from a binder full of women.

      I mean, fuck Mitt Romney and all, but I find hypocrisy deliscious.

  3. It would almost be beautiful, if I didn’t have to pay for it.

    1. No freaking doubt. I literally was up all night the night before they rolled this out. To me, this is end game for statists. Who would’ve guessed they’d be too incompetent to see this through to actual completion? And they could have so easily said, “Hey, we’re putting this off another year, because of those rascally Republicans and because we totally care about you people.” So it would have been a sales pitch for the elections, too. These morons couldn’t find their butts with both hands.

  4. How long before they cite the ACA’s failure as a reason to go to single payer which is what they wanted all along? Oh, it already happened.



    1. Right, since central planning failed on a small scale (a website), it must work on a much larger scale (the entire health care system).

      1. But the experience of so many countries in the 20th century proved that single-payer is the optimum way to provide food, housing, clothing, transportation, education, entertainment, and all manufactured goods! Why wouldn’t a giant, centralized system be the best way to provide health care as well?

    2. Eventually, but first they’ll blame the failures on Republicans not cooperating, and obliquely on the shutdown.

      Heck, a ton of ill-informed people probably already believe that all the website problems are due to the shutdown.

      1. Any system that relies on the cooperation of unwilling participants is fatally flawed.

    3. From Mme. Goodman

      “The for-profit health-insurance industry in the United States is profoundly inefficient and costly, and a sane and sustainable alternative exists?single-payer, otherwise known as expanded and improved Medicare for all.”

      So much FAIL in just a single sentence fragment.

      1. Yeah. I just got off my “profoundly innefficient” insurance provider’s website after making several updates, paying my premium, checking a claim, claiming a bonus, and reading messages. Everything worked fine, as usual.

        1. it’s all the competition and choice stuff that makes it inefficient. You might buy a policy that’s good for you but doesn’t serve the greater good for all.

    4. Democracy now? More like lunacy now.

    5. That would be the government answer, when government fails throw more money and regulations at it and steal more freedom from the individual at the same time.

  5. That headline is going to cost you and Megan at least one, maybe two cocktail party invites.

  6. so basically it doesn’t work at all and is just a shitty lead generation website.

    1. A $600 million lead generation website.

      Seriously. The parts that work I could build for you over the weekend for $10.

      But my multi-page application form wouldn’t be as clunky, off-putting, and outdated looking.

      1. The $600M wasn’t for web development.

        1. If you actually go all the way through to the spending tracker, it’s all IT development work.

          They may be trying to parse out what’s front end and what’s back end, but that doesn’t impress me.

          That’s what we’re actually talking about: that since the back end doesn’t work, all we got for our $600 million is the front end, and the front end is a typical government cludge, with a worse application interface than any third-rate mortgage broker website.

          1. I once had a student turn in a final project for a class that didn’t work.
            Basically, he had written really awesome C++ software to run some sort of audio processing system. Only, the problem was, the class was entitled “Microcontrollers” and he could never get his awesome C++ code to compile and run on a microcontroller. So his final project consisted entirely of a button you could push to turn the volume on and off. That was the only thing that worked.

            Yet her thought he should get an A anyway, because, hey, look at his awesome fucking C++ code!

            1. So … did she end up getting a C+?

              1. lol. No. We tried to give him a B, but then he took it to the Dean and appealed for a better grade.

                This kid was the most arrogant S.O.B. I ever taught. He was definitely a good C++ developer, but he thought he was super-hot shit because he once sold an iPhone app.

          2. Let me clarify: The web development part why it was $600M.

            The complexity and the costs are in 1) planning out the project beforehand, 2) integrating it with the insurer’s existing systems, and 3) making sure it’s adequately tested and supported. Those factors are increased since this was a retarded complicated government project with profound ambiguity, missed deadlines and Pollyanna timelines, untiered implementation, and the big dumb plan written by congressmen and 24 year old poli sci majors.

            The $600M was to make all that possible. This is a welfare project for bureaucrats that may accidentally produce a website.

            1. Me and 4 buddies, working for 3 years in my garage could have done it and we’d have only asked for 10% of that.

        2. The $600M wasn’t for web development.

          Constituent/Donor services then?

    2. Computers are racist

    3. The leads are weak.

      1. They won’t waste the Glengarry leads on people who aren’t closers.

  7. I’ve been up all night signing up various commentators at HnR I don’t like for platinum coverage including NSA colonoscopy with free radio tracking device.


    Apparently the Terms of Service include a warning that you have “no reasonable expectation of privacy” in invisible font.

    But if you put lemon juice on it you find out your spleen is now property of the Social Security Administration.

  8. So here we are. Millions of people are going to be penaltaxed for not having insurance even though the exchanges were never up and running. That is going to go over well. And make no mistake, these things are never going to function properly. I am not an IT guy. But I have been the legal adviser to IT projects and know a bit about the subject. The IT guys on here please correct me if I am wrong. But everything I have read leads me to believe there is no way to fix these exchanges. The basic concept of connecting that many databases and collecting and checking that much data for so many different sources provided by so many different users is essentially undoable. The entire concept and design seems totally impracticable.

    1. I wonder if something like the following conversation happened:

      It guys: “Mr. President, a project like this has literally never been accemplished and is likely impossible, especially given the monetary and time constraints we have.”

      Obama: “What does any of that have to do with me and my credibility? I need these things up and running on time.”

      1. “It guys” should be “IT guys.”

      2. I think somebody made up a PowerPoint showing an Exchange customer using 15 minutes to save 15% on their health insurance, and the Light Bringer said, “Make it so!” and not one of his band of lackeys had the balls to tell him he was overreaching.

        Nobody was there to say, “Maybe we should walk before we run?” Nobody.

        1. This is why the guy is so dangerous. He has no concept of any practical limits to his ambitions, and surrounds himself with people who also are unaware of any such limits.

      3. and the IT guys just said, sure we can do that, just give us a boatload of money, and we’ll call you when its done. (while taking the cash up front).

      4. I figured it would be more like this.

        Obama: What, nobody told me there was a problem. I had no idea. I was out playing golf and posing for pictures at the Skeet shooting range. Where’s Biden, he’ll fix this? Need to put a bell on that guy.

    2. What’s insane to me is that they even beat their heads against the problem of trying to make it do these things in real time.

      As they point out, they had a 6 month enrollment window. If they had built a site that just took application data, and then the backend checks were performed on a batch basis using different systems at night, they could have easily saved about $500 million. And it would WORK – or at least have a better chance of working.

      These motherfuckers destroyed this project because they wanted it to be the last word in database and web functionality. But their actual project needs only required 1996 database and 2002 web technology. They were just too stupid to see that.

      1. I don’t think they even had a concept of what they wanted to do beyond “hey lets make a cool website where everyone can get insurance instantly”.

      2. Insurance companies, like the one I work for, already do all of this stuff. Yeah, it’s a bitch – especially integration – but it’s all been done before. The only possible explanation is incompetence, which makes me wonder whether they outsourced everything to legitimate developers, or used gov-drones.

        1. It is worse than that. They outsourced it to cronies. The whole contract was a giant rip off given to the politically connected.

        2. But is it really doable? Here’s the flowchart I regularly post. Look that the federal and state areas. That’s at least 55 pre-existing government databases that need to talk to each other, securely, following HIPAA laws. Far, far simpler IT projects have failed miserably (e.g. the FBI’s Virtual Case File, and the California DMV project).

          1. Good point, I may have to amend my comment below.

            But I could get the doable parts working.

            1. Then again, no.

              I could do it based on the conditions I gave below. Part of what I would have to throw away would be the 55 different databases and the HIPPA laws.

              1. But the government databases are critical to calculating subsidies. Without them, no accurate prices on any policies.

                1. But the complicated part is making it real time.

                  If after completing the application, users got a message saying, “We will now interface with 55 government databases. You will receive an email from us with your coverage options within two business days!” that would be very straightforward.

                2. I’ve seen you post this thing several times, and you ought to continue. The first time I saw it, it was obvious that the integration was not going to happen. Just plain NOT.
                  The systems were never designed to work together and in order to make them do so, several would just simply require replacement.
                  Hey, IRS! We’re going to give you a whole new back office by, oh, 1/1/14!

          2. My “go to” for showing just how doomed projects like this are is DIMHRS (Defense Integrated Military Human Resources System). It was a project in the DoD to get all the services onto one system for personnel and pay. 10 years and a billion dollars later it was “cancelled”. In reality it was renamed to IPPS (Integrated Personnel and Pay System).

            Right now the initial fielding of the IPSS-A (Army) is being sent out of the field. It is only fielding one product, and the initial testing was missing about 95% of a Soldier’s information. It is not scheduled to become and actual document of record until FY 2015.

            20 years and over a billion dollars and it has produced a single report, poorly.

      3. They are smarter than the market. They can do anything better than private industry…in fact they could make more in the private sector but choose not to.

        On FB, I had to read two academics discuss if the income tax should be 75% or maybe a little lower, and agree that all the money should go to education.

        These people have no clue. They think that they naturally could be a billionaire but they took the other road.

        1. So…had this discussion with someone the other day. He told me that it would take me “500 years to gain his level of economic insight”. I blame their elitist sentiment. They truly think anyone with an ivy league degree is the smartest guy in the room, so they all pretend they have the same level of education so that they have credibility. To their shock, most libertarians don’t feel education denotes intelligence. I see a similarity in the way people would claim to be related to royalty in previous generations and Americans consistently thought it was meaningless. I worked for a high level University. I know how stupid many of their graduates actually are.

    3. I have worked on integration with our software and third-party software several times, and it is always a bitch, even on a small scale.

      I don’t like to use the word “impossible”, but I think these exchanges would definitely qualify as “no where near worth the effort it would take to accomplish”. The reconciliation is definitely the tip of the iceberg. There is no way that can be cleaned up without a person going through each record and correcting them one at a time.

      1. The problem I see is linking all of those systems and verifying so much. It gives me a headache to think about it.

      2. There is no way that can be cleaned up without a person going through each record and correcting them one at a time.

        JERBZ created or saved!!!! /Krugabe

      3. I don’t like to use the word “impossible”, but I think these exchanges would definitely qualify as “no where near worth the effort it would take to accomplish”.

        This is my opinion as well. Trying to reconcile & integrate data from that many out of date guvment systems/data bases with other 3rd party system in real time is just not worth the effort. Like fluffy said above, if you take application data and then off peak hours process them to then email/deliver applications to consumers it might be possible, but probably still not worth the effort.

        If was a beneficiary of the $600 mil. cronyism, my first order of business would be to try and purchase all or pieces of some of the existing private systems and then work from there to integrate with all the other madness in non-real time.

        Web technology is great, I really love it. But real time processing/integration coming from a web interface is still very limited. A lot of the critical steps in the software I work on is in fact handled away from the “web” in queues processed by task compiled for maximum efficiency.

        1. More Americans are born every day than the ACA could possibly handle, given its current infrastructure.
          Not only that, but think of how many DEAD Americans’ health care you will be paying for as the years pass.

          1. If only Palin had allowed them to implement the Death Panels, this could have been avoided.

          2. Pretty much. What was the estimate, 20-40 million without health insurance? So, at this rate, they’ll be able to get insurance in, let me see… exactly how many thousands of years optimistically…

        2. FAFSA I believe makes you come back later to complete your student aid form once they have the data from the IRS…they should have used that as a model.

      4. ” I think these exchanges would definitely qualify as ‘no where near worth the effort it would take to accomplish’.”

        You know what? We need a word that encapsulates this concept. It would come in handy in so many places, most (but not all) of them governmental.

    4. It’s certainly impossible when you delay design and implementation until after the election so that Republicans won’t say mean things about you.

    5. If they were willing to throw what they have done so far away, I could probably have them working sites by the end of the year.

      But I wouldnt touch anything already done.

    6. It’s not an impossible project it’s simply a poorly designed architecture.

      Apparently that architecture was chosen for political rather than technical reasons and that is your point of failure. There are several ways they could have put this together that would have had a good chance of success but most of those would have been politically embarrassing had they worked so they chose what they thought was the lesser evil.

    7. I have insurance. My policy just isn’t “approved” by the government – you need maternity care and such not something I could use without a uterus. So, I’m still subject to the penalty, which is still CHEAPER than the options on the exchange in my state.

      1. but then you as a male would be getting lower cost coverage than a woman, and that’s just not fair!

    8. True, any IT guy would tell you that it is impractical and even if done it would be very brittle. But there is no shortage of yahoos that could convince someone like President Stompyfoot that they could do it.

  9. The Post says that Cigna, which is selling health insurance through the federal exchange system in four states, has “seen ‘multiple enrollments’ from the same customer on the same day.”

    perhaps they are different Ben Dovers.

    1. I wonder how many are hackers trying to steal personnel information?

      Seems like a good place to try, a screwed up computer system with lots of personnel info on soon to be millions of people.

      1. And not just hackers. The Drudge headline at the moment is the outstanding arrest warrant for an Obamacare navigator.

        1. Rosilyn Wells ? the Director of Outreach and Enrollment for the Heartland Community Health-care Center (HCHC) ? is “the only full-time Affordable Care Act navigator in Lawrence,”

          Top. (Wo)Men.

    2. This Turd Ferguson seems to require a lot of proctology insurance, and Heywood Jablome keeps asking if STD treatments are fully covered.

  10. I don’t know how you could even bring this up at a point where the U.S. is on the brink of defaulting on it’s debt!

  11. …has “seen ‘multiple enrollments’ from the same customer on the same day.”

    What I’m hearing then is that we’ve found a herd of unicorns. That’s right, folks, there have been enrollments!

    Listen, there are two reasons Obama water carriers are talking about how the rollout was a colossal pooch screw. One, it’s obvious. There’s no hiding it. Second, it’s a nice distraction from the economic havoc Obamacare will undeniably wreak and the health care industry devastation it will most assuredly cause. The web component difficulties will be fixed or worked around eventually. The slow but steady decline of health care in the United States will continue underreported for years.

  12. They may be failing at every level but you can still count on the main stream media to keep spinning it otherwise.

  13. How long will it be before the wacko left tries to blame this on BOOOOSH! too?

  14. The only thing schocking about all this is taht WaPo is even reporting on the foul-ups, unless you think that Jeff Bezos is teeing up political support for the Government to subcontract the website out to Amazon.

    1. Even Obama bootlicking journalists can only a ignore a huge story for so long. They don’t want to be in the Baghdad Bob position of denying that the Americans are in Baghdad while M-1 tanks roll past in the background.

      1. We will see…

    2. Isn’t Bezos libertarianish?

  15. Call me when one of his butt-lickers says the idea was a bad one, not just the execution.

  16. The failure of the “exchanges” overshadows the larger point that basically everyone will have to pay twice what the current market rate is, and the government will refund people for the doubling. In other words, it’s a huge pass-through to the insurance industry who will now cover (as long as it profits them) the previously uninsureable because the tax payers are subsidizing it.
    The reason they didn’t provide cross-state purchases is because the insurance companies don’t want you to have real competition.
    The sign-up crap is just the tip of the iceberg of this collectivist ponzi scheme.
    They would have been better of imposing another entitlement tax outright and extended medicare or medicaid to people who had pre-existing conditions.

    1. the government will refund people for the doubling

      Unless, of course, you earn a princely 400% of the federal poverty level, but then again you already knew this because it was explained to you by your Philippino manservant.

      1. Right. Then it’s just straight-up sodomizing. “You’re rich. You can afford to pay for other people’s health insurance.”

        I am seriously contemplating taking steps to prepare for an economic disaster. After riots, earthquakes and hurricanes, I think it should be doable.

    2. The thing that drives me crazy is the lack of competition on the exchanges with only 3 or 4 insurers in each state participating. The insurers don’t want competition across state lines because many of them act as regional cartels.

      If we actually wanted cheap insurance for all we’d have a catastrophic plan option offered across state lines.

  17. It sounds like Obamacare’s server squirrels are even more cantankerous than Reason’s. That makes me wonder: what happens if someone tries to sign up for Obamacare at 3PM?

    1. I think your phone rings, and a ghostly voice tells you the number of days left in the Obama administration.

    2. It will attempt to enroll them eight different times instead of just four.

  18. The Federal Government does not have the IT expertise to pull this off. In fact, as an IT Professional, I’m not sure that anyone could pull it off. IT contracting companies are understaffed and overworked as it is.

    The big problem is you have people who are pretty much computer illiterate making promises that these systems will work a certain way when they have no clue whether it’s even possible.

    Plus, I can’t imagine who in their right mind would set the thing to simply start up full speed on day one. This should have been rolled out slowly over months, with hundreds if not thousands of designated testers to make sure the site was working properly.

    1. …”with hundreds if not thousands of designated testers to make sure the site was working properly.”

      “The Amateur Barack Obama in the White House”
      http://www.amazon.com/s/ref=nb…..ywords=the amateur barack obama in the white house&sprefix=the+amateur,stripbooks,293

  19. To me the funniest part of all is that the Bronze plans only cover 60% of costs.

    So 40% is on you.

    And here’s the thing: if I went and got medical care with absolutely no insurance, and they sent me the bill, and I called them on the phone and said, “Guess what? I gots no moneys. But I’ll give you 40 cents on the dollar to call it square,” the billing people would say, “Oh, well. OK. You got yourself a deal.”

    So if you’re male and under 45 you’re paying the premium to protect the system from the threat that in the unlikely scenario that you consume any health care this year, you might free ride on 60% of the bill…that the hospitals wouldn’t expect to collect anyway, in a direct negotiation.

    1. Or you could just declare bankruptcy and walk away from it all. I am not seeing how insurance that only covered 60% of your costs would be worth it at anything but the cheapest price, especially if you don’t have any kind of pre-existing condition. Remember, unless you are already sick, there is a non zero chance that you will have no medical costs this year. So the value of that 60% needs to be discounted by the likelihood you will ever need it paid. And by the time you do that, the premium is going to have to be pretty low to justify buying the insurance.

      1. It covers 60% of *expected costs*. Which means in most cases a high deductible plan, thus covering 0% of your costs (other than insurer negotiated “discounts,” which don’t get counted as coverage but can be significant) under, say, $6000 a year (which is most years for healthy people), but covering 90% past that point.

        1. And then having an annual max beyond which 100% of covered. That’s how sane (catastrophic) plans get 60% of expected costs covered.

      2. I mean, yeah, technically a plan could also satisfy that with a $0 deductible and 60% coverage from the first dollar. That would work too.

        It would be stupid as all hell, but some idiots think that that’s how insurance should work.

        1. That’s essentially traditional medicare, except its 80% after a couple hundred dollar deductible.

        2. I’m pretty sure that’s what they actually mean. As I understand it, deductibles are limited to $2000/year for an individual.

          My understanding of the bronze plan is $2,000 deductible and then 60% of costs thereafter.

          1. No, that’s not what I’ve seen from looking at the exchanges, or from reporters who are logging in to compare the plans (including the McSudermans.)

          2. Most of the Bronze qualifying plans have fairly highly deductibles. The 60% is on expected costs. The higher the deductible, the higher the percentage covered after you meet it to get 60%.

          3. I was over at one of the liberal think tank sites and the way I understood the Bronze (cheap) plan was a $2000 deductible, then insurance paid 60% up until $6300 out of pocket PER PERSON then 100% after that. 0% in the 1st $2000, 60% of the next $7167, then 100%

    2. 60% of expected costs. If you end up with bad luck and have something really expensive, almost all plans as offered cover a lot more than 60%.

      A catastrophic plan with a high deductible covers, for someone in good health, approximately 0% of the cost 80-90% of the time, but the rare times when something bad happens, covers 80-90% of the costs (with higher percentage covered the worse it is). It ends up being 60% of expected cost, but that’s okay; what you want is catastrophic coverage.

      The “X% of expected costs” is a pretty stupid metric, but it’s the one that the Democrats wanted, since they (and voters) don’t understand that insurance is about catastrophe, not about covering average every day costs.

      1. Thank you for that explanation.

        That makes it even worse than I thought.

      2. The “X% of expected costs” is the actuarial value, which isn’t stupid for some purposes and in particular for pricing. It’s actually the main way that insurance companies price plans. It is stupid when used as a tool for consumers to rate different plans against one another.

        1. Right. I have no fucking clue what 60% of expected costs are because I have no idea what my costs are going to be.

          What I want to know is IF something happens, what is it going to cost me?

          And 60% of “expected costs” sounds like really shitty coverage from that perspective.

          1. Right, it sounds shitty. In reality, basically every high deductible plus HSA plan is going to be Bronze or maybe at best Silver, even though it could be a great plan from a consumer’s perspective.

            It’s dumb to put a $5k deductible, 90% coverage past that, $10k max out of pocket plan in the same category as a $0 deductible, 60% coverage of everything, no max out of pocket plan, but that’s what this Bronze rating system does.

            The former is insurance; the latter is a discount card.

        2. You’re absolutely right. It’s exactly correct with regards to pricing and the job the actuaries do. It’s just stupid as the consumer facing metric.

          There’s a big difference for consumers between 60% of everything, $0 deductible, no out of pocket limit, a catastrophic plan with a $6k deductible that covers 90% after that, with an annual out of pocket limit paid by the consumer, and a “mini-med” plan that covers 100% of coverage for cheap things, but doesn’t cover expensive things at all.

          But there are ways to squeeze all of those approaches into the 60% Bronze level.

    3. what Fluffy said. you’d be amazed how much doctors will discount for cash today as opposed to a labor intensive partial payment from an insurance company who knows when. oddly enough doctors think $1 today is worth more than $3 that gets reduced to $2 and costs them another $1 to get 3 months from now.

      when you get down to it, the bronze plan is like a coupon from a dentist, if you were dumb enough to pay for the coupon.

      1. Most catastrophic plans with HSAs, even if really good, are going to end up being Bronze or at best Silver, even if fantastic plans. That’s because that high deductible means that they don’t cover a lot of “expected costs.” That’s why they have low premiums.

        But that’s okay, since what you should care about is the big unexpected expenses. There’s little point in paying $1200 extra per year in premiums to get $1200 extra in first dollar coverage for completely expected events.

        1. The Pennsylvania site is good at answering questions, but so far has no prices or sign up info – it’s just FAQs. They did say that you need to consider the total cost – premiums plus deductibles plus copay.

          If I were designing the site I’ d have several columns of levels of medical bills ($0, $5k, $10k, $25k) and a row for each plan, with the cell values being how much total cost (premium plus deductible plus copay) a person would be responsible for each year in those situations.

  20. I wonder if all those repeated enrollments will be counted separately when the administration releases the first set of numbers. I wish that was a joke but I could see it happening.

  21. Former White House press secretary Robert Gibbs is asking whether anyone will be fired over the botched rollout.

    That Gibbs must’ve turned into one of those crazy racist Teabaggers!

    With Barry, to ignominy! Forward, ho!

  22. What isn’t Obamacare making more complicated and much more expensive?

  23. The Obamacare fiasco should remind everyone how well those 5 million green jobs Obama promised have worked out.

  24. Is there anything that screams federalism louder than this exchange fiasco? The feds totally blew it, purposefully or not, some states aren’t hacking it and other states are managing. It just proves the best way to find a solution is let the states do the experimenting.

    For the record, I hope the model state for their enrollment success, Kentucky, goes bankrupt on the medicaid expansion.

  25. Open enrollment, they note, doesn’t actually end until March 31 of 2014.

    I predict open enrollment will be extended until March 31 of *2015*.

    1. By executive order, no doubt.

      And thereafter, indefinitely.

      We can’t have people with pre-existing conditions being denied their right to healthcare merely because they missed the enrollment period, after all.

      What kind of people do you think we are?

  26. …they got 7 transactions for 1 person – 4 enrollments and 3 cancelations.

    Ladies and gentlemen, we have one successful enrollment!

  27. Has anyone followed up with Chad Henderson to see if he actually purchased a policy? I’m curious to see how long he sticks to paying $175/month for insurance.

    1. Exactly.

      I’m a healthy 49 yr old male who smokes.

      I have a catastrophic plan bought as an individual.

      No maternity coverage.
      No mental health coverage.
      No “first dollar” preventative coverage.
      A $7 million lifetime limit.
      A $5K deductible.

      My premium is less than $120/mo.

      1. When I was a 30 yr old smoker, I had a similar plan (all of the above except no “lifetime limit” and the deductible was $3K)

        My premium then was $25.12/mo.

  28. My question is once the deadline hits, will the government still levy taxes and fines for people who don’t enroll even though it’s clearly their fault people can’t register? I can totally see fines going out.

  29. he Washington Post’s Ezra Klein, a longtime champion of the health law, has declared the launch so far a “failure” and a “disaster.”

    Hey, Palin’s Buttplug. I’ve got a job for you: Someone over at wonkblog is thinking something bad. Better get on that.

  30. I have tried to sign up for Obamacare since day 1.
    I am carefully documenting my attempts — even my daily calls to the toll-free exchange number — in hopes of attempting to join the class-action lawsuit that will eventually arise.
    Second-year law student, FTW!

    1. Do you mean the class action suit against the insurers, or against Ted Cruz?

      1. If Obama and his IRS attempt to fine me for not buying a state-mandated service, I will not pay it. And I will join the lawsuit challenging that fine.

      2. So either way, bitches, I’m getting some money out of you. Either my health care costs, or the damages from the lawsuit I joined.
        Eat it, fuckers.

  31. Just to be safe, I’m going to sign up for 400 policies, and pay the premium on one of them randomly every year. If I get sick, I’ll take a trip to Mexico and pay cash.


  32. Don’t worry folks, I’m sure they had the good programmers work on the security bits. Its fine….no worries.

    1. ‘Don’t worry folks, I’m sure they had the *foxes* work on the security bits *for the hens*. Its fine….no worries.’

  33. Yeah, yeah, yeah but Kathleen Sebelius is smokin’ hot.

    1. Someone should Photoshop her into an Obamacare dominatrix outfit. “This GILF has a mandate for you slaves! Do what I say, or suffer the penaltax!”

  34. These folks only know how to tell people what to do. Delivering an actual product is beyond their capabilities.

  35. “Political pressure will build well before the end of March. If there isn’t significant progress in a fairly short period of time, I suspect we’ll start to see a lot more supporters begin to question the law, or at least start to wonder aloud about what to do with a health care overhaul that simply doesn’t work.”

    It was never meant to work. Most of the criticisms about the law and its implications are true, despite what the Democrats and the media are saying. The law DOES provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved and free health care for illegal immigrants, among others.

    The Bill will intentionally force private insurance companies out of business, and put everyone into a government run system. All decisions about personal health care will ultimately be made by federal bureaucrats who will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled by the government.

    If obamacare passes, welcome to the New Amerika. Under this man, we are almost there.

    1. Can’t wait for a CR or Debt Limit crisis to shutter ERs, Hospitals, or reimbursement from the Feds to score some “political points” and “make it hurt”.

  36. The dirty little secret that is still awaiting enrollees is the out-of-pocket annual deductible. Those “millions” who will benefit from subsidized premiums will undoubtedly suffer “sticker shock” when they calculate that they need an additional $500 per month before they get a dime reimbursed on their expenditures.

  37. “Former White House press secretary Robert Gibbs is asking whether anyone will be fired over the botched rollout.”

    Let’s start with those that voted this into law.

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