Obamacare

15,000 Obamacare Enrollments Disappeared; Payment Still an Issue

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Healthcare.gov
U.S. Government

Healthcare.gov may now working better-ish, in that users aren't regularly hitting a wall or pulling up code salad, but the Obama administration still seems to have a low threshold for invoking the word "fixed." According to the Department of Health and Human Services, information that went in the front end, from people applying for health coverage, didn't necessarily make it to the companies who are supposed to provide that coverage. Although that's getting better. Of course.

Says an HHS announcement conveniently released on Saturday:

As the technical improvements to HealthCare.gov continue making a difference to consumers using the website, our attention remains on addressing issues with the more "back end" parts of the system, including the creation and accuracy of 834 transaction forms.  These transaction forms are processed by health plans when consumers choose a product in the Marketplace, and our priority is working to make sure that every 834 form – past and present – is accurate, and that consumers are able to successfully enroll in the coverage of their choice. …

Our analysis indicates that between October 1st and December 5th, the number of consumers for whom 834s were not produced was fewer than 15,000.  But as the graph shows, since the beginning of December, missing 834s as a percentage of total enrollments has been close to zero.  These significant improvements are due to the technical fixes put in place by the end of November.

So, a fair number of people who diligently banged on the system to get their Obamacare plans were shouting into the void, never to be heard.

Glad to hear that their efforts in self-sacrifice won't be demanded on an ongoing basis.

Unfortunately, another thing that's not making it through the system is money. People may be "enrolling" in coverage, but that doesn't mean they've closed the deal by paying premiums for what they'll receive. Charles Ornstein of ProPublica quotes industry executives saying that only five to 15 percent of those who have made it through the sign-up process have actually paid a bill and truly enrolled.

[A]mid the rush to enroll as many people as possible by the Dec. 23 deadline, there's a huge caveat that isn't getting much public attention: In order for coverage to take effect on Jan. 1, enrollees must pay their first month's premium on time. (The deadline varies somewhat by state and by insurer.)

That's slow going, according to consultants and some insurers, raising the prospect that actual enrollment will be far lower than the figures HHS is releasing.

"There is also a lot of worrying going on over people making payments," industry consultant Robert Laszewski wrote in an email. "One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date."

Another consultant Kip Piper, agreed. "So far I'm hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month's premium and therefore truly enrolled," he wrote me.

Which may explain why the feds are leaning on insurers to provide coverage even to those who haven't cut a check. New rules to be published in the Federal Register (PDF) are very clear on when coverage must begin—and in asking for "flexibility" of insurers in terms of receiving payment.

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  1. Has enough time passed for the low payment ratio to matter at all? I have never in my life paid for health insurance, so is it typically an up-front payment scheme or paid in arrears?

    1. insurance and rent are paid in advance. taxes and interest are paid in arrears.

      1. taxes and interest are paid in arrears.

        The IRS and the parasites in the legislatures figured out that was a non-starter years ago. Try paying your federal income tax in arrears and see how that goes for you.

        1. everyone pays taxes in arrears meaning after, not late.

          1. Have you figured out how to avoid both withholding and quarterly estimated taxes?

            1. withholding and quarterly payments are made in arrears of (after) the taxable event.

              1. Huh? I can’t possibly know the tax consequence of, for instance, my January 15 paycheck until Dec. 31 of that year. The consequence may be $0 if I earn very little in the rest of the year, or it may be quite large if I earn a lot. It may also vary depending on other expenses, actions, etc. I have yet to make. Yet I have to pay a standard amount based on tables published by the IRS in advance of figuring out what my liability will actually be.

                1. I done trying to explain linear time.

                  1. So, in your world, if I pay an amount in advance of knowing how much is due, that’s actually a payment in arrears. Got it.

                    1. quarterly payments are made after the quarter. What part of that is complicated? For the typical non-self employed person, taxes are taken out as you earn and they comprise an estimate of what your final bill will be.

                      Your tax return reconciles what was taken out vs what you actually owe, at which point some of what was taken is either returned to you interest-free or you owe an additional payment.

                2. You don’t have to pay your taxes before you are allowed to work to collect your pay. So you don’t pay taxes in advance. That only leaves arrears.

                  1) work
                  2) collect pay
                  3) pay taxes (which may be withheld from the pay)

                  1. But your taxes are not finally due until April 15 of the following year. Which means that the amounts you pay during the year are payments in advance.

                    Using the concepts of in arrears and in advance are obviously a bit awkward with taxes, because unlike insurance or cable tv, taxes aren’t payment for services rendered or to be rendered.

                    1. Taxes are due in April. You are required by law to make an interest-free loan to the federal government before you taxes are actually due.

                    2. “Which means that the amounts you pay during the year are payments in advance.”

                      No.
                      The withholding is done in advance of the final due date, but is in arears of the taxable event.
                      Your work is the taxable event. You are paid at the end of X period for that work. Taxes are withheld at that time.

                    3. The withholding is done in advance of the final due date, but is in arears of the taxable event.

                      Huzzah!

                    4. In comparison, one of my co-workers in Singapore bought a new car. He was required to pay a $10K tax to get a permit to then go buy a car.

                      In that case, the tax is paid in advance of the taxable event (the purchase of a car).

          2. everyone pays taxes in arrears meaning after, not late.

            Actually, to quote the IRS, “The United States income tax is a pay-as-you-go tax, which means that tax must be paid as you earn or receive your income during the year”. Try paying your 2013 tax obligation in its entirety in April of 2014 or skip a few 1040-ESs and let me know how that works out for you.

            1. Try paying your 2013 tax obligation in its entirety in April of 2014

              If you 2012 tax obligation was $0 this isnt a problem at all.

              IIRC, there is no penalty if you owe less than $500 on April 15th OR your withholding for the year was at least equal to the previous years obligation.

              Ive had this come up myself in years with large capital gains. I owed over $1k one year but wasnt penalized because enough had been withheld for the year.

      2. To sum it up, then, those who are browsing mostly aren’t buying; those who are buying mostly aren’t getting; and those who are getting mostly aren’t paying.

        Ah, delectable.

  2. On the plus side, when the IRS fines them for it, the penalty will be less than a C-note.

    1. IT’S NOT A PENALTY, IT’S A TAX.

      Sort of…

      1. Sometimes, in the deepest recesses of my consciousness( a dark and foreboding place indeed), a thought begins to take shape that Roberts concocted the Penaltax because he envisioned this catastrophe. I know it can’t be true, but the irony…

        1. I have had these thoughts as well.

          1. From the Roberts’ opinion: “It is not our job to protect the people from the consequences of their political choices.”

            You knew what you wanted and now you deserve to get it, good and hard.

            1. Mencken FTW.

      2. “IT’S NOT A PENALTY, IT’S A TAX.”

        I’m unhappy with changing words to reflect politicos’ desires.
        It’s a goddam FINE!

    2. On the plus side, when the IRS fines them for it, the penalty will be less than a C-note.

      This year it’s $95 or 1% of your income, whichever is greater. Assuming they don’t delay that part as well.

  3. You’ll just have to get sick (or hurt) to find out if you have coverage.

    SURPRISE!

    1. Not a surprise to those with eyes.

    2. Well, we need to find out what’s in it!

  4. the Obama administration still seems to have a low threshold for invoking the word “fixed.”

    Not at all, J.D. The meaning here is that of having one’s pet “fixed.”

  5. Here’s a question which has not even occurred to me previously:

    Does your mandatory signup on o-care.gov require online and/or automatic payments? Because that would be awesome. What could possibly go wrong?

    1. I saw something where several thousand accounts had been “accidentally” debited.

      Ah, it is Washington State, so a state-run exchange.

  6. we should expect some enrollment slippage come the payment due date.

    Huh.

    1. “Pay? Where is my free stuff?!!”

  7. Charles Ornstein of ProPublica quotes industry executives saying that only five to 15 percent of those who have made it through the sign-up process have actually paid a bill and truly enrolled.

    Just a doggone minute, Chucko — Those aren’t *official* percentages, so just BACK OFF!

    1. only five to 15 percent of those who have made it through the sign-up process have actually paid a bill and truly enrolled.

      The remaining 85-95% are still waiting to find out if it’s free. When they find out that they really have to pay, they will scatter for cover like roaches.

      1. Some of them. Others will see the price and realize what a horrible bargain it is and rationally choose to risk not having insurance. The only way buying it makes sense is if you have some kind of ongoing and expensive condition.

        The death spiral is pretty much inevitable now.

        1. “The only way buying it makes sense is if you have some kind of ongoing and expensive condition” AND can’t manage to get better/cheaper insurance somewhere else like through an employer, medicare, etc.

        2. Others will see the price and realize what a horrible bargain it is and rationally choose to risk not having insurance

          That’s what I meant when I said they will scatter, scatter as in opting to not pay, in effect having no insurance.

          The Dems will not let go of this thing until many of them have went down with the sinking ship. Then will begin the inevitable shrieking of ‘we have to do something!’. Something, of course, being single payer. By then, the effect of this upon government trust will be so bad, that single payer will be more of a longshot than the Texans winning the SB in 2014.

          1. There are going to be millions more people without insurance in October of 2014 than there was before Obamacare. That fact is going to be devastating to the Democrats. Even the lowest information voter knows they sold this thing as a way to get more people health insurance. When the program turns out to do just the opposite, no amount of lying is going to save them. And telling people that they are just too stupid to understand how bad their old health insurance was is not going to help.

            1. Maybe then, I can get my high deductible plan back. The company, I worked for paid for it. I just put in what I wanted in my HSA, and had a 7000 deductible.

            2. Until a majority of people realize that government is not the solution to everything, indeed in most cases, is the worst possible choice for problem solving, the nation will continue on a downhill slide into economic oblivion.

              Government needs to go back to a manageable size and to their original intentions, a military, police(peacekeepers, not militarized revenue collectors), roads and bridges. Until that happens, it will continue to get worse.

            3. It’s a double-whammy following the penaltax in April. $95 ent going to break anyone, but enough people look forward to their returns that chipping away at it will not go over well among precisely the voting bloc Dems need.

              1. Yeah, but its 95 or 1% which ever is higher, and goes up to 2 1/2. I believe. So, going my income of 32K a year would be about 300 dollars first year, and 750 the next.

                So, is the percentage apply to Gross or Adjusted Gross?

            4. “There are going to be millions more people without insurance in October of 2014 than there was before Obamacare. That fact is going to be devastating to the Democrats.”…

              My only question here is ‘how will the public know this?’
              If we are to rely on honesty from the government, well…
              And who else is going to have the data?

              1. My only question here is ‘how will the public know this?’

                Even the stupid party will be smart enough to point this out. And even the state run media will have to admit it as fact. The media tact will be that the number of people with health insurance isn’t really that important anyway and not nearly as bad as all of the “success stories” are good.

                It won’t work.

                1. “Even the stupid party will be smart enough to point this out”

                  You’re right; there remains some level of competition and it will get ‘competed’ out in to the open.

              2. Insurance companies who are being bled to death because they don’t have the tons of new healthy young customers they were promised but do have the expenses of tons of sick old people to pay for.

            5. I don’t know if there will be millions more without any kind of insurance, they may be able to make up for the cancellations with medicaid enrollments.

              But there will be many fewer people with *private* health insurance. Almost certainly on Jan 1, and likely next October.

              Also, my bet is that at least 2/3 of the people who enroll in private health insurance this year will be people whose previous coverage was canceled. Most of whom will not be at all happy about it. And there will be no net increase in insurance coverage, outside of medicaid.
              So at best all the law did was rearrange costs in the individual market, causing healthier people to drop out, forcing others to pay more, and giving the benefit to people with pre-existing consitions.

          2. By then, the effect of this upon government trust will be so bad, that single payer will be more of a longshot than the Texans winning the SB in 2014.

            The one silver lining in the Obamacare fuck-up is the massive amount of mistrust of and animosity toward government it will create in the public. Team Blue will try to spin it, but they won’t succeed except with the prog dipshits who never would have left the reservation anyway.

            1. Libertarians have been saying this sort of thing about every outrage that comes about, and while I do think Americans generally are less reactively naive about power, the effective response remains voting in the other wing of the establishment party. Democrats are in for a thrashing next November, but I worry about what reforms Republicans will devise.

              1. You forgot the scare quotes around “reform”, heh heh.

              2. Valid point about the Republicans, but Obamacare is different in that it will affect almost everyone. People who aren’t hit by this will know others who are. This is big.

              3. I agree the Democrats are in for a thrashing but I could see nearly as many Republicans losing their seats, especially in the House because lets face it, the Republican Base ain’t exactly happy with the Party.

                It would not shock me at all to see the Repubs pick up a dozen or more seats in the house while another dozen of their senior members including Speaker Boehner get primaried.

  8. OT, the tolerance of liberals and their love for the poor and less fortunate, on full display here:

    Liberal love and tolerance

    “Why is this ugly piece of junk here?” demanded area activist Gretchen Berger, referring to the rusted RV that has been stationed at Riverside Drive and 74th Street.

    “If you want a gated community, you should live in Creedmoor [Psychiatric Center],” he said. “Otherwise-liberal West Siders have very serious middle-class scruples about what should or should not be in their neighborhood.”

    1. Mac: I’ll tell you who. New poor. Ever since the recession hit, waves of new people are suddenly broke. These people have no idea how to live without money. They’re what’s called “new poor”. We’re “old poor”.
      Dennis: They could stand to learn a lesson or two from us because we would never take our homelessness and shove it down everybody’s face.
      Charlie: Have some class, if you’re gonna be poor.

  9. In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year — mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law’s passage.

    http://www.thedenverchannel.co…..poll-finds

    Blaming this all on the insurance companies is not working out so well.

    1. Have we reached Peak Schadenfreude yet? No, we have not! BWAHAHAHAHA!

  10. And it is only going to get worse

    Insurers said they had found many discrepancies and errors and that the government was overstating the improvements in HealthCare.gov.
    In some cases, they said, the federal government reported that the home address for a new policyholder was outside an insurer’s service area. In other cases, a child was listed as the main subscriber?the person responsible for paying premiums?and parents were listed as dependents.

    In some cases, children were enrolled in a policy by the federal government and parents were left off, or vice versa. In other cases, the government botched up the members of a family: A child or spouse was listed two or three times in the same application in late November. Such errors can have financial implications, increasing the amount of premiums that a family is required to pay.

    While some of the problems were discovered in the last few days, insurers said that they had previously reported many of the errors to the “help desk” at the Centers for Medicare and Medicaid Services, and that the problems remained unresolved.

    Federal officials, insurers and health care providers said they were concerned about confusion and possible chaos in the early days of January, when people try to use the new insurance coverage they believe they have.

    http://www.cnbc.com/id/101273467

    1. It only looks like it will get worse because this administration isn’t splainin and sellin it well enough to the people yet. A few more celebrities or sports teams talking about how great it is should work, and everything will be perfect.

      You see, it’s not about how good or bad your situation is, it’s all about how well your betters can make you feel about your situation that counts.

      Aren’t you better off being dirt poor if you can feel good about saving even one poor chillun? It shouldn’t matter if they can’t find this one saved chillun, the dirty faced, shoeless, little orphan peasant is out there somewhere waiting to be found…

      1. Sorry, that orphan was scooped up by jesse’s Adorphan operation. He is for lease, long term or short.

  11. So HHS wants the insurers to let people wait to see if they need to go to the doctor, and then if they do, pay their first premium. And if they don’t, they can just not pay the premium and instead pay the $95 penalty. What insurance company would be dumb enough to do that? It’s pretty much guaranteed bankruptcy.

    1. and that’s why insurance is paid in advance. it doesn’t work if paid in arrears. single payer gets around this by making health care a government service paid in arrears by taxes with the downside being health care becomes a shitty government service.

      1. …”health care becomes a shitty government service.”

        Cheap, I’m told, and worth it!
        (not sure about the cheap either)

  12. Who needs Viagra? All the Schadenfreude associated with this train wreck is giving me a constant boner.

    Thanks, Obamacare!

  13. It only looks like it will get worse because this administration isn’t splainin and sellin it well enough to the people yet. A few more celebrities or sports teams talking about how great it is should work, and everything will be perfect.

    NEEDZ MOAR SLUTZ

    1. We had best hope Lobster Girl doesn’t turn to the Dark Side.

  14. http://www.burlingtoncountytim…..4681d.html

    Meanwhile the IRS continues to put volunteer fire departments in jeopardy.

    “It would be just devastating to our budget,” Burlington Township Fire Director John Stewart said Friday. “Right now, we have three full-time employees and 90 qualified volunteers. I don’t know what we would do.”

    Pemberton Township Fire Chief Craig Augustoni said informal estimates were that the mandate might cost the municipality an additional $2 million to insure its volunteers.

    “That, or pay a fine of $2,000 per worker,” Augustoni said?

    This really makes you wonder just how dysfunctional the White House is right now. How hard would it be for the IRS to just exempt volunteer fire departments? It is within their power and even if it isn’t no one would sue of care. Yet, they haven’t done it and might actually go ahead and kill all of them. That is going from incompetence to insanity. How can they let this linger? It seems that no one is in charge or aware enough to realize the problem much less fix it.

    1. How hard would it be for the IRS to just exempt volunteer fire departments?

      Impossible, since ACA is The Law Of The Land.

      /sarc

    2. Maybe, they are aware. The Left talking heads have been screaming single payer of late, so maybe this is their goal. I know it is stupid, but we are talking about Progressives.

      1. But they have waived a lot of other stuff. It is not like they are committed to following the law when it is not to their advantage.

        1. Yes, you are correct, John. I wonder how much the Fire Departments pay into the DNC coffers since 70% are volunteer probably not as much as the Unions, Corps.

          1. That is a good point. Maybe they do mean to do it as a payoff to the public employee unions. That is politically very stupid. People love their volunteer fire departments. The resulting backlash over that is going to be a lot more harmful than one forgone payoff to the unions.

            1. When have Progs thought of future consequences. 🙂

            2. This hasn’t come up at my dept. but i’m on the city’s workers comp coverage. but i’m fairly certain all the volunteers have employer sponsored coverage. but we’re basically an add on to the city staff, not like these other places.

    3. Why have volunteer fire fighters, when you can force municipalities to pay unionized fire fighters?

  15. What is a logical outcome to this mess? I think it will look like Medicare: automatic deductions from one’s paycheck for health insurance, insurance companies placated by being given “cost plus small profit” monopolies in designated localities. Over time, political pressure will widen the gap between health insurance tax payments and the actual costs – at which time the printing presses will be turned up even more. Deficits will soar, a living wage will
    be $250,000 per year (temporarily), “death panels” will cull out the
    elderly and unfit to save money.

    1. think it will look like Medicare: automatic deductions from one’s paycheck for health insurance, insurance companies placated by being given “cost plus small profit” monopolies in designated localities.

      I don’t think that can be done. The states own such things.

      The end result of this mess is going to be a repeal of all of the mandates and a return to state control of the insurance market. People view these policies as what they are “Obamacare mandated policies” and they hate them. So first thing to go is going to be the policies themselves.

    2. This still overlooks the fact that the government lacks the power to compel doctors to accept payments from the government mandated insurer and not many (if any) doctors in private practice are going to be willing to be reliant on the payment system of a single government mandated payer.

      They may get single payer in this country but that will just create a bifrucated medical system where the rich go to private (offshore if necessary) clinics and have Concierge doctors on call and the Poor and middle class get the VA.

  16. quarterly payments are made after the quarter. What part of that is complicated?

    Have you ever actually read the instructions for estimated tax payments?

    1. I make them. And they are a total pain in the ass to figure out. And every year despite my best efforts to get as close to the proper amount as possible, I end up getting a tax return.

  17. “One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date.”

    Another consultant Kip Piper, agreed. “So far I’m hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month’s premium and therefore truly enrolled,” he wrote me.

    Which may explain why the feds are leaning on insurers to provide coverage even to those who haven’t cut a check.

    Why wouldn’t an insurance company that has a fiduciary responsibility to its shareholders extend coverage to a group of people, knowing that up to 95% of them might not ever pay any premiums, in order to cover up for screwups by the federal government, thereby resulting in predictable massive losses by said insurer?

    The fuck?

    1. I recently hit my knees and thanked the Almighty that my company does not do health insurance…

      shareholder suits, ahoy!

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