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PPACA FAQ: Everything we knew is wrong.

katiebird's picture

(Cross posted at The Confluence)

Lambert and I are taking our PPACA FAQ project seriously - but, it's pretty difficult in the face of the obvious lack of commitment by the Obama Administration.

I cannot imagine the frustration suffered by the programmers implementing the inner-workings of the Health Care Exchange Marketplace -- or whatever it's supposed to be called this week. Just trying to write a PPACA FAQ post every week is a bizarre-other-worldly experience.

And it's no wonder. The answers weren't (publicly) available: it wasn't until Friday July 5 (!!) that The IRS released their 600+ Final Regulations regarding a huge range of outstanding PPACA/ObamaCare issues.

But, were they privately available to ObamaCare system planners and developers?

Megan McArdle has this to say (link to Must Read Corrente post, ObamaCare Clusterfuck: How bad is it? Megan McArdle gets it right on the exchanges, with more detail):

One of two things must be true: the administration knew this was necessary long ago, but concealed it from the public and the congress in order to limit the time they had to react; or the administration is so incredibly inept that it has only just now realized that it wasn’t going to be able to handle any of the complicated bits. Either way, why would we assume that anything else they say about the systems–like, “It’ll be ready next year”–is true? Indeed, why should we assume that this is the last such revelation? (emphasis mine - kb)

Our ignorance on which isn't a simple issue of poor reporting or lack of Congressional oversite. Here's Kathleen Sebelius lying to Congress last April:

ObamaCare Clusterfuck: Sibelius says Federal "data hub" for exchanges is "built and paid for"

The Hill:

Sibelius said Friday that the $1.5 billion would help her department with information technology projects, including the data hub that exchanges will use to retrieve information from other state and federal agencies

“That’s really to get the IT hub, the call center, the IT up and running,” she said.

But later in the same series of questions, Sebelius said the data hub is nearly finished.

“The hub is basically built and paid for,” she said.

Except that 34 states haven't connected to it.

As if that's not bad enough, read this incredible bit of information at the top of The Hill's story:

The Health and Human Services Department will meet its central ObamaCare deadline and does not need a backup plan for delays, HHS Secretary Kathleen Sebelius said Friday.

Sebelius told the House Ways and Means Committee that a federally run insurance exchange will be up and running by Oct. 1.

“No,” Sebelius said when asked whether there’s a backup plan in case that deadline slips. “We are determined and on track to meet the Oct. 1 deadline.” (emphasis mine - kb)

(Except there's always a backup plan, isn't there?)


I have to take a break here to say that this implementation issue is not a trivial thing. Many, many, many people are counting on it. They expect to have access to health insurance and for that health insurance to give them access to actual health care. I repeat: This is not trivial. It is not a game.


So, at the end of April, Sebelius is totally in control -- everything is on schedule and there are no problems on the horizon. Bolstering that status, this post appeared in The Healthcare Marketplace and Policy Review with encouraging news about the Maryland Exchange:

Will the Affordable Care Act's Health Insurance Exchanges Be Ready On Time? The Obama Administration's Top Secret Enterprise

Last week, I received my weekly email update from the Maryland health insurance exchange:

Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.

This report tells us a few things.

First, the Maryland health insurance exchange is on track to launch on time and ready to serve all comers. I continue to be impressed by how well this state-run health insurance exchange is working toward implementing the Affordable Care Act ("ObamaCare") on October 1, 2013.

Second, apparently the Federal Data Hub is up and running. While that is what the Obama administration has been telling us, it has been hard to find anyone who has actually seen it or used it.

Third, Maryland has its system ready to exchange eligibility and premium information with the health insurance plans––perhaps the biggest challenge the new exchanges, state or federal, face.

Can any of that be true? I honestly don't know what to make of it.

Checking back at The Healthcare Marketplace and Policy Review there IS a post about the "Final Regulations" but there is no mention of the previous post about the Maryland Exchange and their ability to interact successfully with the (mythical?) Federal Data Hub.

Except for the disappointment of not addressing the mystery of the Maryland Exchange, this story is outstanding in a number of ways.  But my favorite part is when the author describes the frustration of the consumer who does not want to commit fraud:

Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With "ObamaCare's" Federal Data Hub?

I can also imagine lots of innocent consumers getting their subsidy all bollixed up on the front-end (Do you know your likely “modified adjusted gross income” for 2014?) only to get hit with a whopper tax bill when they finally reconcile all of this on their 2014 tax return. For example, a family of four getting subsidies based upon 200% of the poverty level but ending up making 250% of the poverty level for the year, would see a retroactive liability of about $1,700 on their tax return because of subsidy overpayments.

That begs another question: What happens if subsidy recipients don't file a tax return––as millions of Americans now don't––for 2014?

Two of the essential things the Federal Data Hub was supposed to be able to do was to determine and report to the exchange if a person was eligible for a qualifying employer plan and to be able to feed an individual's income history to the exchanges to help determine the amount of subsidy they would be eligible for.

As of the week of the Fourth of July, it would appear the Federal Data Hub will be doing neither of these things––or at least not doing them to the extent they can be relied upon.

That begs yet another question: Is the Federal Data Hub not working as intended?

And there we are -- that question seems like as good a place to end this sordid piece as any. Frequently Asked Questions Without Answers.

TWO Notes:

1) This post would not be necessary if the massive Democratic majorities in the House and Senate had been encouraged, pushed and led by the Democratic President Obama to pass Medicare for Everyone. President Obama came into office with tremendous popularity, authority and power. With a strong commitment to truly Universal Health Care for Everyone by him, Medicare for Everyone could have been implemented with little more than his signature on the bill.

2) Lambert and I would LOVE more contributors to this project (there are multiple tasks including writing posts, a weekly Link Dump and our still in development Resource Library). Contact us through Corrente or The Confluence if you are interested in working with us.

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Alexa's picture
Submitted by Alexa on

PPACA VERY interesting, and am sorry that I won't be able to help out (after all) in the Fall. {As things stand now, I will be reduced to 10-15 hours A WEEK to "blog," which is why I'll have to go to the "Twitter" method of blogging, and quit commenting and/or writing much at all. Maybe I can offer to "Tweet" some of the links that you and Lambert, Hipp and RG think are the most salient.}

I agree with basically your entire piece. And I hate to be "the skunk at the Garden Party," but I truly believe that none of the corporatist Dem politicians will ever lead the charge for MFA.

And that includes Hillary, if she were to run for President again.

I saw a very dejected commenter hoping that she would "swoop in"--the commenters words--and save the day, putting us on the track for MFA. Needless to say, I was VERY doubtful, considering her DLC ties. But I hadn't read up on her stance on healthcare in a very long time. And this gentleman's "entreaty" made me curious.

So I "Binged." Here's the latest that I could find regarding her stance on healthcare. I will be posting a very detailed version when I cover the DLC (from another blog) in the Fall

This excerpt is from her DLC plan, "Saving the American Dream," written, I suppose, with her 2008 Presidential bid in mind.

Every family should have the opportunity to afford health insurance for their children, and the responsibility to obtain it.

Her other big policy recommendation was the same as the President's--everyone should get a college education.

Which is fine, as far as it goes--but what about those of us who've done that, and are still losing ground every day?

Hey, maybe I'm too negative. But honestly, I believe that my skepticism is based on reality. And that reality is that the Democratic Establishment as a whole, will never support MFA. (At least, not in my lifetime.)

I believe that is exactly why the mad push for the PPACA. The Dems wanted something--anything--as a placeholder, to defeat the single-payer movement.

But in the meantime, thanks for your heroic efforts to keep us informed. I do salute and support your determined push for MFA. ;-)

Alexa's picture
Submitted by Alexa on

"Cadillac Plans."

The first link exposes their wheeling and dealing with the Democrats regarding the Cadillac Plan surtax back in 2010.

The second link shows their attempts at CYA today.

Talk about cynical . . .

BTW, would you possibly know a good Twitter "hashtag" or username that would allow me to direct some of my ACA Tweets to any of the major union Twitter feeds?

I've tried to tweet them in the past, and my Tweets never showed up on their Twitter feed. Wondered if they "filter out" incoming Tweets that don't serve their purposes.