The unofficial Obamacare thread...

Just making shit up as they go along...


HHS: We Lack 'Statutory Authority' to Extend Deadline to Sign Up for Obamacare
5:07 PM, MAR 11, 2014 • BY JOHN MCCORMACK

On a conference call with reporters Tuesday afternoon, officials at the Department of Health and Human Services insisted that March 31 is the firm deadline to sign up for Obamacare. "We have no plans to extend the open enrollment period," HHS official Julie Bataille said. "In fact, we don't actually have the statutory authority to extend the open enrollment period in 2014."

A reporter followed up, asking why the administration could delay many other parts of the law but not this one. Michael Hash, who directs the Office of Health Reform at HHS, replied that the law states that the HHS secretary must set the open enrollment dates by June 2012, which Secretary Sebelius did. "Once that 2014 open enrollment period has been set, they are set permanently," Hash said. He did not explain why the administration has the authority to ignore other statutory deadlines to implement the employer mandate or cancel private health insurance plans not eligible for "grandfathering."



Obama administration will allow more time to enroll in health care on federal marketplace

By Amy Goldstein, Published: March 25

The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.

Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension.

Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth. :chuckles:

The rules, which will apply to the federal exchanges operating in three dozen states, will essentially create a large loophole even as White House officials have repeatedly said that the March 31 deadline was firm.

The right can’t admit that Obamacare is working

On Thursday, I stated the obvious: HHS Secretary Kathleen Sebelius's resignation was timed to follow news of Obamacare's surprising success signing up 7.5 million people for private insurance.

Conventional wisdom was that Sebelius would resign back in October or November, when Healthcare.gov was a mess and the White House needed a scapegoat. Like many others, I thought Sebelius — and a few others — should be fired.

But for better or worse, President Obama doesn't like to fire people amidst crises, even if the crises are partly their fault. And so Sebelius's resignation, coming on the heels of a rush of good news for Obamacare, is evidence that the White House considers the Obamacare crisis is over. With 7.5 million people (and rising!) signed up for the insurance exchanges and 3.5 million people (and rising!) signed up for Medicaid the law is likely here to stay — which means the White House can finally exhale, and begin changing the team that runs it.

This blindingly obvious analysis made a lot of Obamacare critics very, very angry. Sen. Ted Cruz, for instance, took the column on in a speech in New Hampshire:

If you listen to Democrats, if you listen to the media - although, I repeat myself - they will tell you there is no hope. They will tell you we cannot turn this around. They will tell you you cannot stop Obamacare. They will tell you that Kathleen Sebelius resigning is a result of Obamacare's success. Well if that's true, then I hope every Democrat will follow her path and resign, as well!

Republicans used to talk about Bush Derangement Syndrome. Washington Post columnist Charles Krauthammer defined it as "the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency — nay — the very existence of George W. Bush." Republicans like Krauthammer understood that BDS helped the Bush administration in two ways: it fired up their supporters and it distracted liberals from more modest, but effective, critiques.

TODAY, THE RIGHT STRUGGLES WITH OBAMACARE DERANGEMENT SYNDROME

Today, the right struggles with Obamacare Derangement Syndrome: the acute inability to see Obamacare as anything but a catastrophic failure that the American people will soon reject. For those suffering from ODS, all bad Obamacare news is good news, and all good Obamacare news is spin. In this world, delays of minor provisions in the law prove that the entire structure is collapsing, while surges of millions of people enrolling in insurance don't prove anything at all.

ODS has kept Republicans from updating their mental model of how Obamacare is doing. To them, the law's disastrous rollout proved that it was doomed. The fact that it recovered beyond anyone's expectations — literally, not a single analyst or policymaker I spoke to in December thought it credible that the exchanges would sign up 7 million by April, much less 7.5 million — hasn't made much of an impression.

Today, Republicans are thrilled by Sebelius's resignation: It means that the Obama administration needs to get her successor, OMB Director Sylvia Matthews Burwell, confirmed by the Senate. And that's an opportunity for Republicans to relitigate the many failures of Obamacare.

SO LONG AS TED CRUZ IS PROMISING OBAMACARE CAN BE STOPPED, NO REPUBLICAN CAN OUTLINE A PLAN TO TWEAK IT

But it's coming at a moment when Obamacare's successes are getting tougher and tougher to deny. The law signed up more than 7.5 million people in the exchanges, more than 3.5 million people in Medicaid, and it led millions more to get health care through their employers or directly through insurers. Premiums are lower than the Congressional Budget Office predicted when the law passed, and insurers are already thinking about how to compete for applicants in 2015. The White House has a much better story to tell than anyone — including me — thought possible in December.

There are still many good critiques to make of Obamacare. But Republicans don't want to critique Obamacare. They want to stop it. Repeal it. They want to make it the hill big-government liberalism dies upon. And those in the party who know better continue to be cowed by those in the party who don't. So long as Ted Cruz is going to New Hampshire promising that Obamacare can be stopped, no Republican can step before the faithful and outline a plan for how it can be tweaked.

The irony of this is that Obamacare's successes are, in many cases, conservatism's successes. The individual mandate is a conservative idea — and it's working. Liberals were skeptical that private insurers would compete on price even absent a public option — but they are. High-deductible health plans are a longtime conservative solution for health costs — and Obamacare is spreading them far and wide. But conservatives can't take credit for any of this, much less build on it.

For the White House, the new hearings present an opportunity. Public opinion always lags a bit behind policy reality. Obamacare, weirdly, became more popular in its disastrous first weeks. But then its numbers plummeted as people realized Healthcare.gov really was a disaster. Now that Obamacare is recovered the White House needs to somehow get that message out to the public — and even to liberals. That's a tough job. Obamacare's unexpectedly impressive enrollment numbers aren't getting nearly as much coverage as its early disasters.

THE IRONY IS THAT OBAMACARE'S SUCCESSES ARE IN MANY CASES CONSERVATISM'S SUCCESSES

The other problem for the White House is that many think Obamacare is basically working despite the Obama administration's best efforts. The roll-out really was a disaster, the law remains unpopular, and estimations of the Obama administration's competence are still low. The public would gladly flock to a political party that had a real plan for improving Obamacare, and a serious claim to being able to manage it more professionally. Luckily for the Obama administration, ODS ensures Republicans are still far, far away from being that party.

http://www.vox.com/2014/4/14/5613094/obamacare-derangement-syndrome

I prefer a state-ran single payer system. Vermont has plans to slowly institute it.

1 Payer (each individual state). No more medicaid, no more medicare (for those in said state). No federal government overreach. No more burden on employers to offer health care.

How would it be funded? Sales tax, income tax, taxes on things that are detrimental to health and increase hospitalizations. Legalize weed and tax it.

Everyone is covered. It doesn't have to be "free". I'd like it to be setup like a typical insurance plan, however, one with no deductible (like the Obamacare plans). 80/20 with X amount max out of pocket per individual and per family. $1500/$3000, for example.

Everyone in the state has the same medical plan and can visit any hospital in the state, any doctor in the state, etc. If someone gets sick out of state, set it up with x amount max out of pocket for "out of network" sites. $5000/$10000, for example. Also, people could buy supplemental insurance to help with any out of state medical expenses.

Kyrieville said:

I prefer a state-ran single payer system. Vermont has plans to slowly institute it.

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Interesting... Why do you say it should be at the state and not federal level? One of the primary savings found in national exchanges is the risk pool is larger (nationwide). By having 50 different systems, you dramatically increase the amount of overhead and increase costs. What is the advantage?

Kyrieville said:

1 Payer (each individual state). No more medicaid, no more medicare (for those in said state). No federal government overreach. No more burden on employers to offer health care.

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All good, but I don't understand how national compulsory enrollment across all 50 states is not the functional equivalent of federal government overreach. The "overreach" is the mandate, not the existence of the federal system itself. If there is no mandate, then the program will be far less effective. And without a mandate, you can forget absorbing Medicare.

So the "federal government overreach" line just strikes me as odd. If it's a state-wide mandate, that's a stopgap solution in a status quo where there is no universal health care system. If all 50 states had a single-payer system, that would be an effective mandate; so again, why bother with having 50 discrete and independent systems instead of 1?

Kyrieville said:

How would it be funded? Sales tax, income tax, taxes on things that are detrimental to health and increase hospitalizations.

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There is a better way to do this.

Nationalizing health care insurance and coverage removes the employer mandate. Therefore, instead of paying your employer for your health insurance, this same amount of money is collected in the form of taxation (for single-payer).

My preferred approach, is actually a multi-payer system, where the money actually does go to private insurance companies, but it is collected in a tax/withholding-like fashion.

Kyrieville said:

Legalize weed and tax it.

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Kyrieville said:

Everyone is covered. It doesn't have to be "free".

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Nothing is "free." Many conservatives just throw that term around to make people who are poor seem lazy.

Kyrieville said:

I'd like it to be setup like a typical insurance plan, however, one with no deductible (like the Obamacare plans). 80/20 with X amount max out of pocket per individual and per family. $1500/$3000, for example.

Everyone in the state has the same medical plan and can visit any hospital in the state, any doctor in the state, etc. If someone gets sick out of state, set it up with x amount max out of pocket for "out of network" sites. $5000/$10000, for example. Also, people could buy supplemental insurance to help with any out of state medical expenses.

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Again, why the unnecessary overhead of state-level organization for a national program?

gourimoko said:

Nothing is "free." Many conservatives just throw that term around to make people who are poor seem lazy.

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That's why I put free in quotations. My point being that, to prevent moral hazard, it should be setup like an insurance plan with copays and such.

gourimoko said:

Again, why the unnecessary overhead of state-level organization for a national program?

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I think the state can manage it more efficiently than the federal government can. It's much easier to monitor fraud and locate and improve areas of weakness in the program. Also, it is my personal opinion that a single payer system is the way to go, and the federal government is not going in that direction. Rather than sit back and wait for it to get done on the federal level, maybe the state should follow Vermont's lead and pass their own single payer plan. They mandated private insurance and the policies are pretty bad, imo. Huge deductibles that are unaffordable for most middle class people who bought the plans.

I think with a pool of 11 million+ members, the state will have enough purchasing power to negotiate low drug costs and other medical services. They can even work with other states that go the single payer route and combine their purchasing power in negotiations.

gourimoko said:

My preferred approach, is actually a multi-payer system, where the money actually does go to private insurance companies, but it is collected in a tax/withholding-like fashion.

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I am not a fan of public money going to private companies. Too many opportunities for corruption (see private prisons, defense contracting, etc...). I am fine with using existing insurance companies as plan servicers (like with the student loan servicers).

Kyrieville said:

That's why I put free in quotations. My point being that, to prevent moral hazard, it should be setup like an insurance plan with copays and such.

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Oh I know, I was just commenting on it..

Kyrieville said:

I think the state can manage it more efficiently than the federal government can.

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But this is counterfactual to historical and statistical data. The CBO went over these numbers in detail in 1994, 2003, and 2009. It is not more efficient to run state-wide programs rather than a larger but singular federal program. Simply put, having 50 departments running with different standards and laws and overhead creates a tremendous burden on the population that need not exist.

Kyrieville said:

It's much easier to monitor fraud and locate and improve areas of weakness in the program.

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Again, this does not play out in practice. States like Alabama, Mississippi, Louisiana, Arkansas, many many others routinely fall behind with social safety net standards even though they are by far the poorest states in the Union. Many of these states have constitutional restrictions that would simply prevent them from making fundamental changes like a single-payer system including Balanced Budget Amendments that would prohibit the necessary deficit spending to roll out such a program with limited tax revenue.

It's just very very hard to do, and almost impossible to maintain, on a universally state-wide level.

But this isn't to say that Vermont shouldn't enact a single-payer system; however, it's to say that once you have 50 such systems, the overhead becomes absurdly high.

Kyrieville said:

Also, it is my personal opinion that a single payer system is the way to go, and the federal government is not going in that direction. Rather than sit back and wait for it to get done on the federal level, maybe the state should follow Vermont's lead and pass their own single payer plan.

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Totally 100% agree with you here. The states should take the lead, but once enough of them have the system it really should be transitioned into a national program.

Kyrieville said:

They mandated private insurance and the policies are pretty bad, imo. Huge deductibles that are unaffordable for most middle class people who bought the plans.

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This was no different than what most people had already. Basically non-policies. The Obamacare policies are improvements for most people, while there are edge-cases that have seen increased premiums.

Kyrieville said:

I think with a pool of 11 million+ members, the state will have enough purchasing power to negotiate low drug costs and other medical services.

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While the State of Ohio could certainly improve against the national average, many states like Mississippi simply couldn't. Also, with the actual graded national proposals like the Medicare-For-All program, the entire United States economy would save over $1T in costs. The system would go from being dramatically regressive to dramatically progressive, almost overnight.

While I support what you're saying, take whatever action can lead to incremental change; we should not advocate the stopgap over the complete solution.

Kyrieville said:

They can even work with other states that go the single payer route and combine their purchasing power in negotiations.

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That would not be easy without forming a corporate entity as it may violate the federal system and structure of government. It would almost certainly require Congressional action.

Kyrieville said:

I am not a fan of public money going to private companies. Too many opportunities for corruption (see private prisons, defense contracting, etc...). I am fine with using existing insurance companies as plan servicers (like with the student loan servicers).

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There's plenty of corruption (more) in the government. Having the money flow into private companies allows Americans to have a choice in their health care providers. I think that's very important. It maintains competition, which fosters innovation, and keeps standards high.

While I support single-payer over the present system; I do think it has it's flaws. One of which is the forced purchase of a monolithic federal provider program, rather than having a choice in which provider you think offers the best service. That's why I'm for a multi-payer system that maintains a strongly government-regulated but mostly privately-owned health insurance system.

Max article posting in 3...2...1....

Good News on Obamacare, Just in Time for Democrats


Today the nonpartisan Congressional Budget Office released its latest Obamacare report card (pdf), and for supporters of the law, the news is good: CBO now projects that over 10 years the law will cover more people—25 million, up from 24 million—and cost a lot less—$104 billion less—than it had previously forecast.

This comes on the heels of the other recent bit of good news, that the law has exceeded its enrollment target of 7 million people. Last week, outgoing HHS Secretary Kathleen Sebelius told Congress that 7.5 million people had signed up during the open enrollment period, which was supposed to end on the last day of March. Since the Obama administration decided to grant anyone who’d begun the signup process before the March 31 deadline an extension until April 15 to complete their enrollment, the final number could approach 8 million people.

As the chart below from the CBO report shows, this is not the first time that the Affordable Care Act’s cost estimates have fallen:

What accounts for the drop? One big factor is that insurance premiums wound up being about 15 percent lower than CBO had originally estimated. That, in turn, means government subsidies to help people pay for insurance coverage have been less costly—about $300 less per person, CBO estimates.
This is propitious news for Democrats because, due to Sebelius’s impending departure, they’re about to get dragged into relitigating Obamacare. Republicans are planning to use the confirmation hearings for Sylvia Mathews Burwell, who has been nominated to succeed Sebelius, to beat up on the law (some more). The fact that its cost projections keep falling will make that a little harder.

http://mobile.businessweek.com/arti...news-on-obamacare-just-when-democrats-need-it

tedginnjr said:

The right can’t admit that Obamacare is working

On Thursday, I stated the obvious: HHS Secretary Kathleen Sebelius's resignation was timed to follow news of Obamacare's surprising success signing up 7.5 million people for private insurance.

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Working? :chuckles:

Two questions that you will not get the answer to about that 7.5M number - How many of those people were uninsured that had never bought insurance before and how many are actually paying their premiums? This was all about the uninsured, right? A significant portion of the 7.5M-8M that the administration is bragging about are people that got kicked off of their plans Obama promised them they could keep...they were forced to buy Obamacare. Also, creating an account to explore your options is what they consider "signing up" and all you had to do to get counted in that number. After you signed up, you could have said "Fuck this, i'm never making a single payment for this shit", you still get counted in that 8M number they are bragging about.

If this was working I wouldn't be getting a letter from my doctor saying he's being forced to retire. My wife wouldn't be getting a letter from her specialist that he's closing his doors. For every success story, i'll bet there are 9 people that lost the insurance they were promised they could keep, lost their doctor they were promised they wouldn't lose or are paying more more than they were before. This was supposed to be about the 45M uninsured...bottom line is that 10% of them have chosen to "sign up" for it. To call this thing anything other than a catastrophe is ridiculous. To type the words that Obamacare is working is a bold faced lie.

Maximus said:

Working? :chuckles:

Two questions that you will not get the answer to about that 7.5M number - How many of those people were uninsured that had never bought insurance before and how many are actually paying their premiums? This was all about the uninsured, right? A significant portion of the 7.5M-8M that the administration is bragging about are people that got kicked off of their plans Obama promised them they could keep...they were forced to buy Obamacare. Also, creating an account to explore your options is what they consider "signing up" and all you had to do to get counted in that number. After you signed up, you could have said "Fuck this, i'm never making a single payment for this shit", you still get counted in that 8M number they are bragging about.

If this was working I wouldn't be getting a letter from my doctor saying he's being forced to retire. My wife wouldn't be getting a letter from her specialist that he's closing his doors. For every success story, i'll bet there are 9 people that lost the insurance they were promised they could keep, lost their doctor they were promised they wouldn't lose or are paying more more than they were before. This was supposed to be about the 45M uninsured...bottom line is that 10% of them have chosen to "sign up" for it. To call this thing anything other than a catastrophe is ridiculous. To type the words that Obamacare is working is a bold faced lie.

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While you're wondering where the 7.5 million number comes from, I'll be wondering where this number comes from.

How many of those nine had an insurance plan that provided them with ridiculously poor coverage or provided nothing more than borderline negligent coverage that still left them screwed in case they ended up with anything serious?

I'm pretty against republicans as a general life philosophy, but I work in a hospital and I see obamacare NOT working every day. It sucks.

I don't want to go back to the old system but this one isn't what I would call a solution.

I guess that's the big issue. The old system sucks. The new system sucks less but still isn't ideal.

Ohdang said:

I'm pretty against republicans as a general life philosophy, but I work in a hospital and I see obamacare NOT working every day. It sucks.

I don't want to go back to the old system but this one isn't what I would call a solution.

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What are you seeing happening, on the ground, so to speak?

Well I work in the lab so this is mostly all coming from that perspective.

I see patients declining lab tests due to fear of their deductible. My deductible tripled over the past few years, and my health insurance through the hospital is pretty damned good. I'm sure regular people are worse off in that regard.

A lot of illnesses and diseases can be treated better/more cost effectively if they're caught early but less is being done to catch it early due to the amount of money it costs patients out of pocket. A lot of that cost stems from us not being reimbursed for things that we should and used to be reimbursed for; now we eat some of that cost and pass some of that cost along to the patients. As a result people are avoiding treatment more often which is more expensive in the long run.

We are also very understaffed across the board from lab to respiratory to nurses etc. In the lab this means longer delays for specimen collection from the respiratory techs and the nurses, and combined with less manpower means longer turnaround time for results which means prolonged hospital stays and more cost, which we inevitably eat a lot of.

The plan, I think anyway, was to force us to cut expenses and operate leaner to stay profitable by cutting the amount we are reimbursed for. In reality we've gotten anorexic not lean, and our quality of care has suffered instead of our efficiency rising. What they didn't account for is that we were really fucking efficient already and didn't have much in the way of fat to cut, and that doctors know better than them what tests and procedures should be ordered and therefore reimbursed for by Medicare/Medicaid/insurance. They are now telling us that this test or that operation was not the correct thing to do and we have to eat the cost due to our "mistake." Sometimes it's not possible to diagnose and treat a disease on the first attempt. If it was that easy everyone would do it.

Are you using a plan on the exchange or still using your old plan?