PPACA Links: 2013-06-24
Readers: Here's the next of a series of Monday posts that will collect what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! --lambert
Obamacare starts in 99 days. These 99 things need to happen before then Washington Post 06-24-2013. "60. All those call center agents will need to undergo training on the Affordable Care Act. This is important: When Part D launched, about one-third of seniors got an inaccurate or incomplete answer from the new call center."
10 to watch on ObamaCare rollout The Hill 2013-06-23. Debbie Curtis (Deputy Policy Director, District of Columbia Health Benefit Exchange); Andy Allison (Arkansas Medicaid Director); Anne Filipic (Enroll America President); Anton Gunn (Director of External Services, Health and Human Services Department); Timothy Jost (Professor of Law, Washington and Lee University School of Law); Denis McDonough (White House Chief of Staff); Peter Lee (Executive Director, California Health Benefit Exchange); Sandy Praeger (Kansas Insurance Commissioner); Jon Kingsdale (Executive Director, Wakely Consulting Group); Teresa Miller (Acting Director, Insurance Programs Group, Center for Consumer Information and Insurance Oversight).
NFL's help sought in promoting Obama health plan as outreach begins Reuters 2013-06-24. "The Obama administration is seeking the help of major U.S. sports organizations, including the National Football League, to persuade young and healthy Americans to sign up for medical insurance coverage later this year, officials said on Monday. .... The campaign is expected to target 2.7 million younger consumers between the ages of 18 to 35, mostly male and non-white, whose participation in new online health insurance exchanges is vital to the success of President Barack Obama's 2010 healthcare reform law."
Time Is Running Short for Big 'Obamacare' Push National Journal 2013-06-23. "Making the sell for Obamacare will be a particularly tough challenge for the national organizations. States are all approaching the exchanges differently; some are working in partnership with the federal government, some are going it alone, and others are letting the federal government run the show. Not all states are expanding their Medicaid programs, which will leave certain low-income adults without any affordable health insurance options. Different groups have different concerns about the law, and different insurance needs. The Obama administration may be well-positioned to find and target these groups—micro-targeting is something it was renowned for during the latest presidential campaign—but getting people to sign up for insurance could prove much more complicated than getting out the vote."
Health group launches major ObamaCare enrollment drive The Hill 2013-06-18. "A group with ties to the White House is beginning a massive grassroots effort this week to promote enrollment under President Obama’s healthcare law. ... [Enroll America President Anne Filipic said] the enrollment drive will aim to "create almost an echo chamber" of information about enrollment. ... Many of the young, healthy people the administration most wants to enroll live in a small handful of states, and the outreach effort aims to appeal to them through targeting reminiscent of Obama's 2012 reelection campaign."
Insight - It takes an army: Tens of thousands of workers roll out Obamacare Reuters 2013-06-21. "From the chief actuary at the California health insurance exchange that President Barack Obama's healthcare reform law established to the legions of call center staffers who will help people trying to buy insurance through such state exchanges, the number of people working to implement "Obamacare" has reached the tens of thousands, a Reuters analysis has found. The number of such workers, obtained through documents and interviews with officials, consultants and contractors, could be significant enough to produce a modest, if temporary, boost to employment across several industries. What is clear is that relatively few of the Obamacare-related jobs are in healthcare, at least so far. The sector added an average of 24,000 jobs per month over the last year, the Bureau of Labor Statistics reported this month. Helping the uninsured buy coverage is expected to bring millions more paying patients to doctors, clinics and hospitals starting in 2014, but most providers have adopted a wait-and-see attitude on staffing."
Government begins education blitz for uninsured USA Today 2013-06-24. "Starting Monday, visitors to healthcare.gov [1-800-318-2596, 24/7] will be asked questions about their age, sex, disability status and income. How they answer could provide them with detailed information, such as: "• Whether a participant is eligible for help paying for insurance. • What would be covered if a woman becomes pregnant. • What plans are available with benefits that fit a person's needs. • Whether insurance would come through a federal or state exchange. • How small businesses can use the exchanges for insurance for their employees. The site also contains features that allow visitors to sign up for Internet updates or instant chats with a call-center operator to answer questions."
Who’s preparing state for ‘Obamacare’?: Lots of groups, businesses, and the gov’t The Montana Standard 2013-06-23. "[Tom Jacobson, executive director of Rural Dynamics Inc of Rural Dynamics says] Montana stands to benefit from the marketplaces because it has a lot of lower-wage workers who should be eligible for substantial subsidies to buy health coverage. “I really think we need to get the public talking about this,” he says. “But people don’t want to talk about things that they don’t understand. We have to get them to understand the ins, the outs, the options. We need to have neighbors talking across the fence about what type of policy they bought on the (marketplace), rather than debating whether Obamacare is good for the country.”
An Obamacare PR Launch Gets a Correction The Atlantic 2013-06-24. "The Social Security Administration set one recipient's teeth on edge when it emailed him the wrong link to learn about the new insurance marketplace. According to the source code, someone made a very basic error in processing the original link, probably just cutting and pasting the wrong thing in the wrong place. This is a common form of error. But with expectations and nerves about joining the new exchanges running as high as they are right now, every little thing counts. And is being counted."
Implementing Health Reform: A GAO Progress Report On The Exchanges Health Affairs Blog 2013-06-20. "Third, although the [GAO] reports do not directly discuss this, the Obama administration damaged its own cause by suspending rulemaking activity in the months leading up to the 2012 election. Apparently the administration concluded that it could not risk alienating voters by pushing ahead with ACA implementation during the heart of a reelection campaign, but several months of valuable time were lost as rulemaking languished in the fall of 2012." Excellent overview. (Here is an excellent article on rationing and market failure, also from Health Affairs Blog.)
New 'Obamacare' exchanges could miss enrollment deadline - GAO Reuters 2013-06-19. "The report by the nonpartisan Government Accountability Office (GAO) said U.S. officials have missed deadlines and remain behind schedule on key parts including those that involve consumer eligibility for federal subsidies, the certification of health plans to be sold on the exchanges and the hiring and training of special "navigators" to guide people through the enrollment process. GAO found that states have also failed to complete many of the tasks assigned for implementation and that the administration has conducted only initial testing of the computerized system that will link the exchanges with states and federal agencies including the Internal Revenue Service. A separate GAO report found that the exchanges for small businesses that are also being created under the Patient Protection and Affordable Care Act are behind schedule, with about 44 percent of the key activities targeted for completion by March 31."
Will the Affordable Care Act's ("ObamaCare") Federal Health Insurance Exchanges Be Ready On Time? Finally the Facts! Health Care Policy and Marketplace Review 2013-06-19. CMS has been outwardly optimistic but is clearly struggling to make the deadlines. While the GAO report gives us a clear sense of where CMS was as of about May, we are now essentially in the dark again. As the GAO report says, whether the exchanges will be ready or not now depends upon key dates between May and October. Why can't the administration build upon this report and keep us informed?"
Blue Cross-Blue Shield Bets Big On Obamacare Exchanges Kaiser Health News 2013-06-21. "[UnitedHealth Group and Aetna [and most other non-Blue insurers “seem to be proceeding cautiously” in the online marketplaces expected to cover to millions, said David Windley, who follows the industry for Jefferies & Co., an investment firm. Five Blues executives attended the meeting with Obama on April 12 to coordinate exchange implementation: Scott Serota, CEO of the Blue Cross and Blue Shield Association; Florida Blue CEO Patrick Geraghty; Chet Burrell, CEO of CareFirst BlueCross BlueShield, with plans in Maryland and D.C.; Patricia Hemingway Hall, CEO of Health Care Service Corp., with Blues plans in four states; and WellPoint CEO Joseph Swedish. WellPoint is the No. 2 health insurer and operates Blues plans in 14 states. [F]or health coverage sold directly to consumers -- the kind that will be offered on the exchanges — Blues have the most members in a large majority of states. Protecting that business is why Blues have little choice but to offer plans in the online marketplaces, analysts said. If they abstain, they risk losing those members. Once in the game, they need to recruit as many customers as possible to avoid signing a disproportionate share of the sick."
Contractor that handles public’s Medicare queries will do same for Affordable Care Act WaPo 2013-06-20. "The Department of Health and Human Services estimates that Vangent’s call centers will receive 42 million calls about the federal marketplaces this year, a daily average of up to 200,000; plus answer 2,400 letters and 740 e-mails, and host 500 Web chats daily. ... Neither Vangent nor HHS would provide specific requirements of the contract or a copy. Employment ads for the call centers’ “temporary customer service representatives” seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience. An HHS spokeswoman said that customer service representatives will answer questions by reading from HHS-approved scripts and provide state-specific information. However, she would not provide examples of the scripts or say whether they were tested with consumers."
ObamaCare premiums lower than expected 2013-06-19 The Hill. "A new analysis from Avalere Health says the lower-than-expected prices show that the central piece of the healthcare law — new insurance exchanges in each state — is working as intended. “In the nine states that have publicized their 2014 rates, every benchmark plan came in cheaper than estimated by the Congressional Budget Office. The CBO has said it expects the benchmark policies to cost an average of $433 per month. The actual rates filed so far range from $205 to $413 per month — even the most expensive policy is still below the budget office's estimates. Although the rates are lower than expected, they're still higher than what young, healthy people are paying now for comparable coverage. Avalere's analysis also comes with a catch: the consulting firm compared rate filings for 2014 to CBO estimates for 2016. The CBO has not publicly released an estimate for 2014, Avalere said. So, lower-than-expected premiums next year could still rise to the level the CBO predicted — or even higher — in the next two years. That's especially likely if insurers are intentionally setting their prices low in the beginning, to attract initial business, and plan to raise them once the new system is more fully engrained."
Subsidy Calculations Not As Simple As They Seem Colorado Health Insurance Insider 2013-06-17. "If you’re confused about the subsidies for health insurance starting in the exchanges in 2014, you’re probably not alone. Although the basic math is quite simple in terms of the maximum amount a family or individual will have to pay based on their income if they earn less than 400% of federal poverty level, it’s still tough to pin down specifics in terms of who will end up getting subsidies, especially for people who are right on the border of the income cut-off. For now, it appears that most subsidy calculators are using generalized national average data, estimated by the CBO. But the numbers turn out differently depending on what calculator you use. For people who are right on the brink of qualifying for a subsidy based on income, it might be worth crunching the numbers and possibly discussing your situation with a qualified financial adviser or tax planner."
The ACA's Obamacare Problem The American Prospect 2013-06-24. "But over time—and, my guess is, rather quickly—the exchanges will just be something that’s always been there. It won’t seem very government-y, after all: It’s just going to look like a web site hosting a bunch of private health-insurance plans. Most consumers will remember the name of their insurance company; far fewer will remember the trying-to-be-catchy name of the web site, and of those, only a small minority will associate it with all that fuss that people in Washington were talking about. Now, under the hood, there is all sorts of government intervention going on—all sorts of new regulations about what insurance companies can do, how they must spend their money, what products they are allowed to offer through the exchanges. But that’s all going to become invisible to consumers over time."
When insurance is too expensive no matter what PNHP 2013-06-21. "The whole point of the Affordable Care Act is to expand health insurance. But here’s the thing, even after the law has taken effect, about 30 million people -- almost all of them U.S. citizens -- still won’t be covered. Dr. Steffie Woolhandler, who co-authored a recent report about the uninsured under the new health care law in the journal Health Affairs, explains who will be out of luck....[W]ith salaries averaging $22,000 for most of them... 'Even if you are subsidized, you still have to pay thousands of dollars out of pocket and lots of low- and middle-income people won’t be able to do that,' she says. Woolhandler says many of these people work in industries that don’t offer insurance, such as agriculture, forestry, and the service sector. She says between premiums, co-pays and deductibles, health costs will easily run into the thousands."
"So, You’re Thinking About Running the 29er Strategy" Affordable Care Act Review 2013-06-17. "In response to the Affordable Care Act, many employers are considering cutting some of their employees’ hours to something less than 30 per week. ... But the 29-hour strategy might not be a cure-all: it could expose the employer to claims under Section 510 of the Employee Retirement Income Security Act of 1974. ... The prototypical Section 510 case is one in which the employer fires an employee right before the employee’s rights in a pension plan become “vested.” ... Nobody knows whether or how courts will apply Section 510 to an employer who reduces employees’ hours to avoid the § 4980H penalty. Our view from here is that Section 510 lawsuits challenging the 29-hour strategy are not likely to succeed on their merits, but the theory may be plausible enough to require some hard legal work to get to a final ruling."
Tenet To Buy Vanguard Health Amid 'Obamacare' M&A Frenzy Forbes 2013-06-24. "Tenet Healthcare (THC) is buying Vanguard Health Systems (VHS) in a deal that further consolidates the U.S. healthcare industry in the wake of the passage of the Affordable Care Act (ACA) .... Health Management Associates (HMA) had been considered a target of Tenet, however, some analysts have speculated the company’s largest shareholder Glenview Capital Management could push for a merger with Community Health Systems (CYH). Glenview, which has staked billions on investments in healthcare providers and hospitals, is a top shareholder in Tenet Healthcare with a near 10% stake, according to May 31 SEC filings. Bottom Line: Tenet’s deal for Vanguard indicates a continued sellers’ market as major healthcare industry players position for ‘Obamacare.’ Expect continued consolidation among healthcare providers and hospitals."
Weiner Wants City to Test Single-Payer Health Care New York Times 2013-06-21. "Vowing to “make New York City the single-payer laboratory in the country” if he is elected mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create a Medicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act. Of insurance companies, he said, 'Their job is to take in as much money as they can and pay out as little as they can.' The complexity and delays of private insurance processing are no accident, he added: “'They make money on the float.'"
Lambert here: Even today, I still find it astonishing is that no priority is given to getting coverage to people who actually need care, either in the marketing or the program itself. No priority whatever. Nothing could more clearly indicate that ObamaCare is not a health care program at all, but a health insurance program.
Here is the blogroll we have at Corrente for health care blogs. We check these regularly. Please add health care blogs we should read in comments, and we'll check them out.