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ObamaCare Clusterfuck: ObamaCare will take three years to settle down, says new IA insurance commissioner

I'd hate for the processing of paying for health care to be boring! Desmoines Register:

The soft-spoken former life insurance company executive expects the turmoil to last a while. Eventually, he said, people will adjust to the new realities of the health insurance market and won’t face unpredictable costs or changes in coverage. “But I think that’s at least three years out,” he said at his Des Moines office. “I think it’s probably going to be a few years before the market can really digest what’s happening. There’s just a lot of unknowns right now.”

But nobody knows anything:

Estimates vary wildly about how many people will use the exchange to buy insurance. “We just don’t know enough about the consumer behavior. We know there are roughly 250,000 Iowans who don’t have employer-based insurance today that could qualify for some level of tax credit on the exchange. But I can’t tell you what their purchasing decisions are going to be,” Gerhart said.

One big factor could be the complicated application process. A draft version of the federal application is 15 pages [26, unless they've changed it], which Gerhart termed “a little absurd.” Once those applications are filled out, people would face the prospect of sorting through competing insurance plans on the exchange.

The insurance division will assist with trying to educate Iowans about how they would sign up. The national program also calls for independent groups to provide specially trained “navigators” to help citizens figure out the process and choose the right insurance plans for their families. The state is still setting rules navigators will have to follow, but Gerhart is confident some groups will want to participate.

“We’ll have navigators, I just don’t know who it’ll be yet,” he said. “They could be unions. They could be community groups — Kiwanis could be one, or a PTA could be one.” He added that federal officials probably will oversee that part of the system, including about 30 hours of training for each navigator.

The federal government is providing $600,000 to hire navigators, and Gerhart’s office will encourage Iowans to use their services or ask an insurance agent for help. “I don’t know too many people who have actually sat down and gone through their health policies and picked the right plan,” he said. “Most people get it through their employer, or an agent or an adviser of some kind, so I think we’ve got a lot of work to do around that.”

So, if I have this straight, nobody knows how to buy insurance online. If user experience design work has been done, it must have been done on prototypes, since none of the real systems are ready. So the health exchanges could end up being Insanely Great, or like Windows 8. Nobody knows. The people who are to train consumers citizens how to buy insurance online have not been selected. From the OH experience, it's not clear who is to pay them, or whether there will be enough of them. Oh, and the target population who is supposed to benefit from ObamaCare tends to have less experience than average with computers, and (being poor) may not even be computer owners.

NOTE Will the "navigators" have fiduciary responsibility? I doubt it. It would be nice to know, though, what regulatory regime they come under.


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beowulf's picture
Submitted by beowulf on

Eventually, he said, people will adjust to the new realities of the health insurance market and won’t face unpredictable costs or changes in coverage. “But I think that’s at least three years out,” he said at his Des Moines office.

OK this is the sort of thing that is going to make House Democrats panic, seeing as they face election every two years.

Submitted by lambert on

Indeed. I wish I had a metric for the amount of propaganda needed to convert the reality of a three years at best success (being generous) into the perception of a two years of success.

Like Bernays Unit or something.

beowulf's picture
Submitted by beowulf on

If I was going to give the Administration one piece of advice to keep Obamacare from crashing and burning on takeoff: Build in a software glitch such that EVERYONE who applies for coverage accidentally gets the full tax credit for premiums.

Sure its going to blow up up the budget deficit, but people who worry about budget deficits with a trillion dollar output gap are pinheads anyway. Conservatives are going to call it a budget buster no matter what happens, you'll never get their support. On the other hand, the Admin has yet to but WILL will lose the rest of the country once it becomes evident that Obamacare doesn't do much of anything to make insurance affordable. Only way to keep that from happening is to by unilaterally accidentally supersizing premium support eligibility. Or they can just wait for the Republican House and Senate to take a stab at "fixing" Obamacare after their 2014 midterm blowout. Idiots.

Rainbow Girl's picture
Submitted by Rainbow Girl on

But it assumes that Obama (and the Democrats) would pounce on any opportunity to get on the Republicans' nerves. This opportunity, however, would incidentally help Americans -- at least as far as Obama personally is concerned, I think that he would rather give up the fees for his first two years of speaking engagements (after 2016) than have any hand in doing something (even accidentally) humane. Even if it meant getting under the GOP' skin (and creating great headlines for the Other Right Wing press) for a month or two.

Rainbow Girl's picture
Submitted by Rainbow Girl on

" Eventually ... people will adjust to the new realities of the health insurance market."

Statements like this are why no elected or appointed public official should be allowed to legislate or pontificate about the appropriate health care system for this country. Being so totally immune from the effects of their own dirty deals with insurance and pharma companies renders them incapable of being worthy stewards on this fundamental issue.

Rainbow Girl's picture
Submitted by Rainbow Girl on

Adding. And the same goes for insurance executives -- no matter how well-intentioned -- who participate mightily in influencing political decisions about citizens' medical well being and, unfortunately, have an inherent conflict of interest (in the disfavor of citizen-patients).

Rainbow Girl's picture
Submitted by Rainbow Girl on

"Will the "navigators" have fiduciary responsibility?"

Best ACA joke of the last 60 minutes!

NOTE. The one fiduciary responsibility they will have is to their employer -- the vendor to whom HHS/CMS will outsource the particular state Navigational Ed program and who will be paid for performance based on how many "screen clicks" the temp ($9.00/hr) "navigators" make every day on an exchange screen.

nihil obstet's picture
Submitted by nihil obstet on

Being a pessimist, I thought that Obamacare would at best entrench the current system and at worst be the right-wing nose in the tent to privatizing Medicare. However, I overestimated the energy that interested parties, like insurance companies and medical industries, would put into slathering a patina of "It works" over the mess. This is going to be a massive fail beyond even my imaginings.

It takes a lot of expertise to run even a moderately complex program, much less one based on a 1200 page bill. And it's already a moving target, with changes in procedures and deadlines being announced. It will be even more of one as businesses lobby Congress to fix this or that portion of the law to give themselves more profit. And it's so complex the Congresscritturs can argue that each little portion is just to tweak some little requirement that was having unintended consequences.

While we talk about the problems that the poor will have, remember that it's not just the poor -- over 20 million Americans pay tax preparers to prepare the 1040EZ form, which is one page and has 10 blanks to fill in. No decisions to make based on analysis of the medical marketplace or anything like that -- just 10 blanks. And we think that many Americans are going to successfully fill in a 26 page form?

In terms of pressure on Congress, I think this may generate more than we've seen on any other subject. The foreclosure crisis, unemployment, all those issues are unacceptably painful, but directly affect a minority, and most don't have any idea about what government can do. But the insurance purchase mandate affects everybody, and the "affordable" label isn't one many people will agree with. So now you have to figure out this 26 page application form, pay a lot of money for cruddy insurance, and it's all RUN by government? Oh, and if you move from one state to another, you have to start over.

So you've got this mandated process in which government can't figure out how to do it, private companies can't figure out how to do it, and people can't figure out how to do it. I've gotten very hopeful that it will all collapse.

Submitted by lambert on

It's the downwardly mobile middle class who will have problems! Could be true...

Aeryl's picture
Submitted by Aeryl on

Yeah, the only poor people I know who pay H&R Block to file their 1040 EZ, is people who are wanting a refund anticipation loan, and H&R will deduct their payment from the loan.

Aeryl's picture
Submitted by Aeryl on

To clarify, they want the RAL, cuz they need the money NOW NOW NOW, unable to wait the two weeks efiling online will get you.

quixote's picture
Submitted by quixote on

"over 20 million Americans pay tax preparers to prepare the 1040EZ form, which is one page and has 10 blanks to fill in"

This. I'd put in in bold and all caps, but I don't want to be rude.

The ACA is toast. It'll be toast long before it's "settled in" if that takes three years. You should start a pool in the sidebar, Lambert. One box for whether it'll be repealed, and another for if so, when.