ObamaCare Clusterfuck: Will the exchanges be able to prevent the insurance companies from gaming actuarial value?
I'm guessing no. This review of the Missouri exchange explains why. Test-Driving The Obamacare Software:
Connecture [which built MO's exchange] isn't handling the software that qualifies you to buy under the health act or verifies your eligibility for subsidies. Other companies are taking care of those. Connecture's piece is the point-of-sale program, the one that steers you through insurance choices and closes the deal.
That is, the front end.
Proponents of the health law liken the sign-up software to Expedia or Travelocity, where travelers can book flights and hotels.
Except that airline tickets are an apples-to-apples comparison, whereas insurance policies aren't based on known quantities like a seat, food (for some definition of food), and flight from point A to point B (primarily driven by cost of fuel (and/or collusion)), but are instead based on "actuarial value," which is complex, game-able, and varies wildly by vendor, as Kaiser has shown. That's why the Expedia/Travelocity comparison really amount to disinformation, and you shouldn't take anybody seriously who uses it.
It may be more like TurboTax, escorting you through requirements and choices much more complex than whether you want a flight in the afternoon or the morning.
R-i-i-i-i-g-h-t. So -- assuming the exhanges enable applies to apples comparisons, which they do not -- I can pay TurboxTax $39.95 to figure my plan out (probably more, since ObamaCare is a lot more complex than your 1040) or more likely I can go to H&R Block and pay a couple hundred smackers to deal with a human and sleep nights. (Say, no wonder H&R Block threw some cash to Enroll America!)
And now the key paragraph. And from the software developer!
"There's all sorts of wild ways that carriers can design benefits to meet the actuarial value" required by the health law, [Christopher Neuharth, Connecture's director of user experience] said. "You have to show the total cost of ownership" [by which he means the "net premium price" — after the credits are applied].
Does anybody really believe that in an arms race between the health insurance industry actuarial value devising scams, and the software industry industry implementing new "requirements and choices," the health insurance industry won't always be a step ahead?*
And how, exactly, do new "wild ways" get detected? I'd argue that will happen only after health insurance companies deny claims, and then only after
citizens consumers complain, and then only after the states and/or the Federal government propose new rules, and then only after the health insurance industry gets the new rules watered down, and then only after firms like Connecture code up the new solution, test it, and deploy it: In other words, through a lengthy and entirely needless -- yet profitable -- process of human suffering.
It's just three months until the exchanges open, but the software isn't finished.
What could go wrong?
Connecture awaits tryouts by Minnesota, Maryland and the District of Columbia and more details on specific demographic groups expected to apply for coverage. It could tweak the software based on the responses, Neuharth said.
Well, like they say in the Navy: You can't buff a turd. ObamaCare doesn't need to be "tweaked." It needs to be abolished, and replaced by Medicare for all.
NOTE * Note that a constantly churning rules-making process is good for the governmental departments that write the rules, good for the software companies that revise the software, and good for the health insurance companies, too, since the constant churn creates new opportunities to game the system. Here again we have a rents-based self-licking ice cream cone.