Tag Archives: Obamacare fails

Obamacare’s enemies are still math and reality

Unable to Meet the Deductible or the Doctor – NYTimes.com.

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

“To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.”

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

While high-deductible plans cover most of the costs of severe illnesses and lengthy hospital stays, protecting against catastrophic debt, those plans may compel people to forgo routine care that could prevent bigger, longer-term health issues, according to experts and research.

“They will cause some people to not get care they should get,” Katherine Hempstead, who directs research on health insurance coverage at the Robert Wood Johnson Foundation, said of high-deductible marketplace plans. “Unfortunately, the people who are attracted to the lower premiums tend to be the ones who are going to have the most trouble coming up with all the cost-sharing if in fact they want to use their health insurance.”


This is a real problem. Many members of the middle class, and certainly lower class are living pay check to pay check and adding the cost of coverage to their monthly bills is stressful to their financing. THEN, add the cost of meeting the deductibles and their lifestyle “breaks”.

My brother recently broke his arm and has no insurance. He may qualify for Medicaid or he may not. If he doesn’t, even if he received a subsidy, most likely he could not consistently pay his premiums and certainly would have significant issues meeting a deductible. I don’t know the solution. Most of my Boulder friends would say “Single Payer.”  Me, I’m for price discovery and getting insurance out of day to day medical expenses. Also, an inexpensive accident plan would have solved my brother’s problem, assuming he could consistently pay that premium.

For example, Ms. Wanderlich needs a brain scan. How much would it cost if she could shop around? I have no idea. Heck, it may cost $300 or it may cost $3000.  An internet search shows the cost of a CT brain scan lies between $825 and $4800. Let’s say that everyone who really needed a brain scan actually got one. If there was price discovery, perhaps the cost would be lower due to higher utilization of the equipment.

Also, the public needs to shop around for these services. Even if they have insurance, it should become common place to shop around.

Another family experience. Many years ago my wife needed an MRI. We were within $500 – $800 dollars of meeting our deductible, then there was 100% coverage. We found a cost of $850 or so, but the facility was an hours drive away. In Boulder, we found a price of $1200 and the facility was 15 minutes away. Since our exposure was $800 either way, we selected the more expensive facility. If circumstances had been different, that is the money was coming out of our pocket, we would have driven an hour.

There are no easy answers, but Government bureaucracy and incompetence, which is very much on display these days, are not part of the solution.


A big h/t to Michael Smith at the Facebook page, Fans of Best of the Web today for the title of this post.


Vermont fires creator of its ‘unacceptable,’ glitchy ObamaCare site

What month is this? Oh yea, August and open enrollment starts in a little over 3 months. Vermont fires creator of its ‘unacceptable,’ glitchy ObamaCare site | Fox News.

An estimated 14,000 Vermonters are tied up in “change of circumstance” glitches with Vermont Health Connect. Since CGI launched the site this past October, health officials have received a steady stream of complaints from people unable to make adjustments to plans online.

Chief of Health Care Reform Lawrence Miller explained CGI’s firing in a statement to press.

“For many, Vermont Health Connect works as it should. For others, the system is still failing them and causing deep frustration. That is unacceptable to me, and we will explore every option and take every step to make this system work for all Vermonters,” he said. “Today’s changes are steps in that direction and more can be expected in the coming weeks.”

The Colorado Exchange, Connect for Health Colorado, uses the same contractor as Vermont, Massachusetts, healthcare.gov and Hawaii, CGI. CGI has now been terminated from Vermont, Massachusetts and healthcare.gov.

If I had to say…. being able to change coverage in the middle of a policy period is a Qualifying Life Event and I don’t believe changes have gone all that smoothly in Colorado either. They do seem to have initial sign ups under control if you can do the Medicaid dance.  Uugh.



Sick Kids Denied Specialty Care Due to Obamacare in Washington

I thought the old plans were the “junk” plans. Sick Kids Denied Specialty Care Due to Obamacare in Washington | The Weekly Standard.

“Administrators at Seattle Children’s today said they predicted this would happen, and it’s even worse than they expected,” says the local news anchor. “Patients being denied specialty treatment at the hospital by insurance providers on the Washington health benefits exchange. Children’s filed request on behalf of 125 of their patients. Of those, they say they got only 20 responses, eight of which were denials. Dr. Sandy Melzer says all this comes after reassurances of certain unique specialty cases would still be covered.”

I must admit this is not something I anticipated. Also, who ARE the insurance providers on the Washington State insurance exchange?


How federal cronies built — and botched — Healthcare.gov

How federal cronies built — and botched — Healthcare.gov | E government – InfoWorld.

“All but one of of the 47 contractors who won contracts to carry out work on the Affordable Care Act worked for the government prior to its passage,” the report reads. Some of the names ought to be familiar: Northrop Grumman, General Dynamics, Deloitte, and Booz Allen Hamilton, all of whom assumed different roles and worked on different aspects of the project.

As familiar as those names might be, especially to those who follow Beltway lobbying practices, few of them would be as commonly associated with large-scale IT projects as, say, Google, Amazon.com, or Dell would be — especially when it came to building the public-facing components of the system.

What a waste of taxpayer money healthcare.gov has been to date. Amateur hour extraordinaire.

I’m hopeful in a few weeks we can look back on this and it’s water under the bridge. Color me doubtful.

New readers, do a blog search on the phrase “prediction chaos”.


Bare Bones Health Plans Expected To Survive Health Law

Bare Bones Health Plans Expected To Survive Health Law – Kaiser Health News.

Proposed and final rules issued this spring surprised many by failing to bar large employers from offering insurance policies that could exclude benefits such as hospitalization.

Offering bare-bones policies may result in some fines, but that expense could be less than the cost of offering traditional medical coverage.

For large employers, “the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it’s got to be more robust than a dental plan or a vision plan,” said Ed Fensholt, a senior vice president at insurance broker Lockton Companies. “We had customers looking at offering some relatively inexpensive and skimpy plan designs to satisfy the individual mandate at modest cost.”

It appears that Obamacare could give large employers an advantage over small employers when it comes to healthcare costs?

The bare-bones plans cannot be offered to small businesses with fewer than 50 workers, or to individuals buying coverage through new online marketplaces that open for enrollment Oct. 1. But benefit experts expect some larger firms that buy outside the marketplaces or that self-insure to consider them.

The Obama administration says that workers offered such coverage may qualify to shop in the marketplaces and to buy subsidized plans.

The game of Obamacare chess continues.


Fraud Alert: Another Obamacare “Never Mind”

Obamacare’s Invitation to Fraud | National Review Online.

In 2014, applicants can more or less be deemed eligible for subsidies in the state-run exchanges if they say they are eligible. If it has no external sources of information regarding what insurance employers offer, the rule states, “the exchange may accept the applicant’s attestation regarding enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an employer-sponsored plan for the benefit year for which coverage is requested without further verification.” In fact, the exchanges are not only released from the obligation to verify whether applicants are eligible for employer coverage, they are also released from the obligation to confirm applicants’ statements regarding their household incomes before providing them with what is supposed to be an income-based benefit.

So let’s summarize. The applicant can….

  1. Self declare they are eligible
  2. Report their family income as they determine to receive a subsidy

An invitation for fraud.

Inquiring minds want to know:

  • I’m confused, exactly how long have has development work been ongoing? Remember, Obamacare was passed March 21st, 2010.
  • Was there a lack of appreciation of the size of the job?
  • Was there a political reason to remain silent regarding the magnitude of the job and the inability to meet goals in the prescribed timeframe?


Amateur hour

You can’t make this stuff up


Will young invincibles help Obamacare avoid ‘death spiral’?

Will Young People Jeopardize the Success of Obamacare? | Wall St. Cheat Sheet.

Of the 7 million people the Obama administration expects to enroll for coverage in 2014, officials say 2.7 million need to be young adults. (emphasis added)

The danger is the goal isn’t met? From the New Republic’s Jonathan Cohn?

“Health insurance needs lots of healthy people to sign up for coverage. Their premiums cover the big bills for the relatively small number of sick people. So if the exchanges don’t enroll enough young, healthy people, insurers will have to raise everyone’s premiums. In the worst case, this could create what actuaries call a ‘death spiral’: Rising premiums prompt people to drop out, causing premiums to increase even more.”

Obamacare needs young people that receive either no subsidy or a very small one for them to actually serve the purpose of providing a healthy rate base. It’s certainly an open question how enthusiastically these young invincibles will be to sign up for relatively high priced plans. I suspect most of them believe they are going to receive “free” coverage. Won’t they be surprised?


Young invincibles have the power to “kill” Obamacare

How to kill Obamacare without even trying | The Daily Caller.

A young invincible speaks…

In a refreshingly honest appraisal, Emanuel admits that Obamacare will virtually self-destruct if my demographic doesn’t come to its senses. The program depends on the full participation of the American citizenry. Every testosterone-soaked Young Invincible who doesn’t sign up for Obamacare will cause prices to increase. The increased prices will drive other citizens away. In the end, Obamacare will serve only the very poor (who pay subsidized rates), the very sick (who are expensive to care for) and the very old. (adverse selection – Ed)

The apparent solution is to put the young invincibles on a guilt trip Continue reading Young invincibles have the power to “kill” Obamacare


Obamacare: This is going to hurt

Flash-forward to spring 2013: As we prepare for Obamacare’s primary elements to kick in on Jan. 1, the vast chasm between the president’s claims and unfolding reality produces a constant stream of ominous headlines.

via Obamacare: This is going to hurt | UTSanDiego.com. You can’t make this stuff up. The administration has had over 3 years to get the system “ready to go” and we’re ending up with broken promise after broken promise and one missed deadline follows another.

In the very best scenario the implementation of Obamacare will be painful and chaotic.


Implementation isn’t what’s wrong with Obamacare

Say it ain’t so.

Among those flaws are the spike in insurance costs, the impact on the debt (not stripped of the unworkable CLASS Act that was designed to offset Obamacare costs), the shift to part-time work (and, the Los Angeles Times reports, reduction in part-time hours), the slow rate of new job creation and the uncertainty related to employers dumping their own insurance. That doesn’t include the impact Medicaid expansion is having on state budgets, the new tax for upper income taxpayers, the medical device tax (which Senate Democrats want to repeal), the cuts in Medicare advantage and the infringement on religious faith via the HHS mandate on birth control and abortion-inducing drugs.

Nothing to see here, move along.


Followup on Opthamologist walk out of Obamacare talk

Kris Held MD tweets:  Drs are literally walking out of this talk on implementing, complying with Obamacare. We are men and women of the mind, not mindless drones.

Stuart Varney of Fox Business News follows up with Dr. Held:


Kris Held MD tweets: Drs are literally walking out of this talk on implementing, complying with Obamacare. We are men and women of the mind, not mindless drones.

Stuart Varney of Fox Business News follows up:


Money is taken away from the seniors, taken away from procedures they need like treatment for their macular degeneration, their cataract surgery and funneled to other parts parts of the law. And so I believe that it’s going to result in the rationing of care, the denial of care based on a patient’s age, based on their disabilities.



An item totaling 0.01 percent of the budget proves that Obamacare won’t work.

Obama’s Damaging Admission | National Review Online.

The president’s Patient Protection and Affordable Care Act cuts Medicaid’s DSH payments, beginning with a $360 million cut in 2014. The theory went like this: When the PPACA begins reducing the number of uninsured, hospitals won’t need those subsidies. In his budget, however, President Obama proposes to increase Medicaid DSH payments by $360 million in 2014, effectively rescinding next year’s cut. This deceptively small item has far-reaching significance. With this proposal, President Obama has admitted that:

As they say… read the whole thing!


Not time for Obamacare obituary

Obamacare Has Its Problems, But It’s Basically On Track | Mother Jones.

I don’t expect the implementation of Obamacare to go smoothly. It’s big, it’s complex, it’s underfunded, and Republicans desperately want it to fail. This makes problems inevitable. Nevertheless, pouncing on every reported hitch as a harbinger of doom is taking schadenfreude too far. HHS has consistently claimed that they’ll be ready to go by October 1. Maybe that’s overoptimistic. But although it will probably take several years for Obamacare’s uptake rate to reach its goal, I’ll bet that by this time next year it will be up and running and basically doing its job. It’s a little early to be writing its obituary. (emphasis added – Ed)

Kevin Drum’s outlook may well be correct. Color me skeptical on the exchanges all being ready by October 1st date.