More ACA mischief

[Joe Guy]

Or the other view is that there are so many problems that go to the very heart of the ACA, not the least of which is its unwieldy complexity and regulatory burden. This is the main reason the roll out has been a disaster in most places. Add all the dysfunction and disincentives caused by the law, as well as the complete lack of effort to control health care increases (in fact the law as designed would clearly increase health costs substantially, as is being borne out by the high cost of the new plans), and it is reasonable to say the law should be revoked in total. Then take the few good ideas that are in the law (e.g., coverage for adult children to age 26 on the parent's health plan), and rebuild a sensible law from there.

The roll out has been a disaster?

Wouldn't the best way to gauge how it will work by comparing it to RomneyCare?

I would like to see unbiased statistics that support how much the cost of health care has risen. Especially since enrollment for health plans under ACA is just beginning and won't go into effect until 1/1/2014.

[Long Run]

The roll out has been a disaster?

I too try from time to time to avoid the news since it is usually bad and badly presented, but you can't hardly turn around without seeing another example (or one hundred) of how bad things are going with Obama's signature law, that has been the highest priority for his administration, when they've had three years to get the infrastructure in place to implement it. You might say it is partisan stuff, but when one of the president's biggest supporters, Ezra Klein, writes an article "Five Thoughts on the Obamacare Disaster", and there are many other liberal commentators and politicians saying the same thing, it is kind of hard to reach any other conclusion.

[Joe Guy]

Oh now I get it.

I should believe everything I read.

[rubato]

The roll out has been going for just over two weeks. There can be no effect on actual insurance until the beginning of next year. We will see where we are at the end of December.

The only certain disaster is in the 26 states which decided to opt out of providing subsidized health care for millions of their citizens. Texas is leaving one million citizens stripped of health insurance they would otherwise have. Florida is #2 with close to 900,000.

Compared to the real-world alternatives Obama Care is a screaming success already. The Republican alternative is "let the working poor die". And we already know how that turns out.

http://money.cnn.com/2013/07/01/news/ec ... on-states/

yrs,
rubato

[Long Run]

1% success rate. Nowhere to go but up from here.

[Rick]

I know this is going to be met with a bunch of roll eyes buuutttt,

I don't see why we just don't go ahead and socialize, I can't see how it would be any more cumbersome that what is up now or any less fraud resitant or any greater a tax burden.

The human animal by far and large does not get health maintenance, the vast majority of folks are of the opinion if i ain't broke I ain't going to get fixed.

Insurance will NOT change that...

[Long Run]

Well, Rick, that was the goal all along with the ACA. Either the designers are complete morons (not the case), or they designed it to cause a lot of problems for which the only solution is single payer (as it will be too difficult and tumultuous to undo the layered coverage rules). Of course, the original strategy was that the coverage and benefit failures would come to light gradually, as more people are covered under the ACA. However, the designers of the ACA did not think they would be so incompetent at implementing the law, plus they are not prepared for the volume of unhealthy people that will flood to the Exchanges and the relative paucity of healthy people to offset that actuarial nightmare. There is a real risk that the whole thing could fail in the first year or two driven by adverse selection. So, by having an excessively incompetent government health program, they risk the entire strategy which is to have a government single-payer health care model -- the majority of America which had okay health care before will rebel against the same people responsible for the ACA failure being in charge of all health care.

[Rick]

Or in essence if the GOP would just sit by and watch the whole thing would be self pruning.

[Crackpot]

Actually the GOP were compelty agInst single payor until Obama passed thier favored option at which point they jumped on the single payor bandwagon.

[rubato]

1% success rate. Nowhere to go but up from here.

36,000 enrollments in 5 days. Multiplied by the number of people covered by each one, since many are families.


It has now been two weeks since then. We'll have to wait and see what the numbers are when more states start reporting since this was only a fraction.



Yrs,
Rubato

[rubato]

Actually the GOP were compelty agInst single payor until Obama passed thier favored option at which point they jumped on the single payor bandwagon.

To the best of my knowledge the GOP are just as vehemently against single-payer as ever.


Yrs,
Rubato

[Econoline]

To the best of my knowledge the GOP are just as vehemently against single-payer as ever.

I was just about to point that out. The difference is that before Obama embraced the individual-mandate RomneyCare-type system, that was the Republicans' favorite Big Idea for health care reform. Now not even Romney will admit that RomneyCare was a Republican idea.

I can't wait till Obama comes out in favor of breathing.

[Crackpot]

Oh you'd be surprised how many people who identify as republican or further right have voiced support for single payor since the ACA has passed. Mind you I think the "party" would still be against is but than again being against things is what defines the Republican party these days.

[rubato]

http://thinkprogress.org/health/2013/10 ... obamacare/

Ohio Will Expand Medicaid Under Obamacare, Extending Health Coverage To Nearly 300,000 Residents

By Sy Mukherjee on October 21, 2013 at 5:32 pm
Ohio Gov. John Kasich (R) has been a major proponent of Obamacare's Medicaid expansion

Ohio Gov. John Kasich (R)

CREDIT: AP Photo/Rick Osentoski

Ohio joined the list of states expanding Medicaid for Americans under 133 percent of the federal poverty line on Monday, after a special seven-member budgetary oversight panel made up of state lawmakers gave final approval to Gov. John Kasich’s (R) decision to grow the program via executive order.

Kasich had to procure approval from a special panel of seven lawmakers in order to actually spend the federal money that facilitates the expansion. That approval came on Monday in a 5-2 vote, securing Kasich a long-sought victory and setting the stage for inevitable legal challenges questioning the legality of the maneuver.

Medicaid expansion, a key provision of the Affordable Care Act, is expected to cut Ohio’s uninsurance rate by over 60 percent and extend basic health benefits to 275,000 of the poorest Ohio residents. According to the Advisory Board Company, 26 states are trying to move forward with some form of Medicaid expansion, while 22 are not, and the rest still remain undecided.
_____________________________________________

[Long Run]

Oh you'd be surprised how many people who identify as republican or further right have voiced support for single payor since the ACA has passed.

I am not sure who you are referring to. And while single payer is a rational approach in theory, in practice why would anyone think it would be better than Medicaid, Medicare, VA or what we see so far from the ACA? All of these are regarded as being far less beneficial than most decent employer provided coverages. Further, if you take away the private plans, then there is no place for the government to cost-shift reduced reimbursements for those existing plans, meaning, they're going to be even more a financial drain and have even more benefits cut.

Clearly, the Rs have done a poor job of describing what they would prefer to replace the ACA, but there are plans out there which include expansion of the HSA concept (catastrophic insurance combined with a savings account for routine care). HSAs are a major factor in the recent drop in health care inflation since they cut out a big piece of the middle man cost (insurance companies didn't have to scrutinize everyday claims for the vast majority of those insured with HSAs because the insurance company was never going to pay any amount for such insureds).

[rubato]

http://delong.typepad.com/sdj/2013/10/p ... noted.html

Fox News and the Right will stop at nothing to lie about the ACA:

Prairie Weather: Experiencing the ACA: Noted

Prairie Weather: Experiencing the ACA:

If you're genuinely interested in the experiences of others as they encounter the flawed computer system, then skip down to the comments. The system seems to work pretty damn well.

Paul Krugman reports on a Fox News campaign to make ACA look like an early failure and found that they brought in "ordinary" people to lie on camera.

...Sure enough, the businessman who claimed that Obamacare was driving up his costs, forcing him to lay off workers, only has four employees — meaning that Obamacare has no effect whatsoever on his business. The two families complaining about soaring premiums haven’t actually checked out what’s on offer, and Stern estimates that they would in fact see major savings.

You have to wonder about the mindset of people who go on national TV to complain about how they’re suffering from a program based on nothing but what they think they heard somewhere. You might also wonder about what kind of alleged news show features such people without any check on their bona fides. But then again, consider the network. ...Krugman,blog

[rubato]

Looking ahead 2-5 years there are going to be substantial problems with the ACA (unlike the temporary and trivial difficulties so far). The first one is that there are too few physicians to provide an adequate level of care for all of the formerly uninsured who will not have coverage. Mass. had to recruit English-speaking MDs who could be licensed in the US from outside the country. And Mass. is a small fraction of the size of the country as a whole. Some states, like Calif. are already trying to shift some of the added work to PAs, NPs, RNs and others.


yrs,
rubato

[Lord Jim]

I saw an interesting piece on CNN last night that did a math breakdown showing that based on the numbers that have begun the enrollment process, that even if one makes the most wildly optimistic assumptions (assuming that 100% of those who begin the application process become paying exchange members, which of course is not going to happen.) that extrapolating from the current rates will result in only four million being covered by the end of the "open enrollment" period.

This is well south of the seven million that the administration itself says it needs for the system to be solvent. (And this doesn't even address the issue of what percentage of the sign ups are the younger healthier people that are needed for the system to work.)

Yesterday Obama showcased a bunch people crowing about how much signing up for Obamacare has saved them in health insurance costs...

Those folks may be singing a very different tune by next summer, because those rates they got will start to sky rocket if the open enrollment goals aren't met.

[Long Run]

All the consultants I know are expecting the Exchange rates to increase a lot in the next few years; the current rates, which are already high (though some of that cost is due to more comprehensive coverage), are essentially teaser rates to get people into the system.

And yes, let's look at the numbers.

[
36,000 enrollments in 5 days. Multiplied by the number of people covered by each one, since many are families.

Let's go ahead and say, the average is 2 people per enrollment, though I think that is probably high. During the period of time with the highest interest in enrolling, they managed to get 7,000 enrollments per day in to cover 14,000 people. Of course, some of those people are already covered in other plans, so we aren't actually gaining 14,000 newly covered people, but let's just assume we are. There are 40 million Americans without insurance (isn't that more than the population of Australia?). There will be millions more going off of their current plans and onto the exchanges. As LJ notes, the Exchanges need about 10 million to get to viability, assuming a reasonable number of healthy people join to offset all of the high risk insureds. At 14,000 per day, that means in 100 days, or three months, there will be 1.4 million covered. At that rate, it will take nearly three years to get the 10 million covered to make the Exchanges viable. That's how bad things have gone.

But the good news is that at some point they will get the system working reasonably well so that people can get signed up without unreasonable efforts. This could be weeks, but more likely months. In the meantime, they will have missed their big chance for a major success in signing up hundreds of thousands per day who do want coverage. More unfortunate, they are missing out on healthy people who have very limited incentive to sign up and so won't spend much time at singing up. More good news is that some state run exchanges are actually doing okay, like Washington and Oregon. Oregon's success is mainly due to signing up more people on Medicaid; it turns out that when people can get free health care they are more likely to sign up than when they have to pay for it. So, for states that had a good track record on health care reform at the state level, if they started several years ago planning and working toward this day, they were able to do a pretty good job implementing at least parts of the new law.

[oldr_n_wsr]

It cost the federal government more than $300 million for outside contractors to set up the Obamacare website that has had so much trouble in its first three weeks of operation.

Most of that money has gone to six contractors that together have received more than $200 million in taxpayer funds, with the biggest single contractor receiving $88 million.

Overall, the government has spent $394 million setting up the website and the exchanges through which the public can buy health insurance, according to a report earlier this year from the General Accountability Office, a government watchdog. While not all the money went into the troubled websites, most of it did.

http://money.cnn.com/2013/10/21/technol ... contracts/

Almost half a billion dollars on a website that had three years to get completed. I know there are going to be a certain amount og glitches with any new website, but with the cost and the amount of problems, only the US government can do that. And they are going to manage our health records?

I would be very afraid to put my SSN on that website.