The Great Healthcare.gov Mistake: Having An ‘Older Accountant’ Create It

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14, (AP)

President Barack Obama speaks about his signature health care law, Thursday, Nov. 14. (AP)

By Michael Doonan
Guest contributor

The Center for Medicare and Medicaid Services is the behemoth federal agency that, despite limited resources, does a pretty good job of carrying out its core mission: running programs that provide health insurance for older and poorer Americans.

Expecting that this agency can also run the federal health insurance exchanges for Obamacare, however, sets it up for trouble right from the start.

The failure to locate accountability in the appropriate hands helps explain the Website debacle and anemic early enrollment, if not the president’s early miscue that everyone would be able to keep their current health insurance.

CMS simply does not know how to regulate health insurance for individuals and small business at the state level. Case in point: The agency’s previous troubles implementing insurance reforms that were part of the Health Insurance Portability and Accountability Act of 1997 (HIPAA), which, among other things, stipulated that the federal government would step in if a state was non-compliant.

Michael Doonan (Photo: Mike Lovett)

Michael Doonan (Photo: Mike Lovett)

This was like telling your kids to clean their rooms or else you will do it for them — and in the end, national regulations turned out to be weak and ineffectual.

Turned out CMS didn’t know much about the range of health plans and insurance products in certain states. Federal officials were more scared of taking over state regulation than the states. As a result, they begged the states to comply and bent over backwards in the regulations to find any state “effort” acceptable.

With the roll out of the federally mandated health exchanges, it is déjà vu all over again. Continue reading

Dr. Tim Johnson’s ‘Truth About Obamacare:’ Is The Law Doomed?

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

“Tumultuous,” is how Dr. Timothy Johnson describes the recent roll-out of Obamacare in his latest podcast. (Click on the “play” arrow above right to listen.) And that’s not nearly strong enough, he adds. “Many people are saying Obamacare is doomed,” in the wake of all the current Website and insurance problems, he says.

Is it? Dr. Johnson, retired medical editor for ABC News and author of ”The Truth About Getting Sick in America,” discusses the outlook with his regular podcast guests: John McDonough, a professor at the Harvard School of Public Health; Dr. Gail Wilensky, a health official under the first President Bush and Larry Levitt, a senior vice president at the Kaiser Family Foundation.

The first answer to the “Is it doomed?” question comes from McDonough, who offers a clear “no.”

“I’m just dumbfounded by the media’s unbelievable hyperventilation about every small detail and the implications it has for the law as a whole and Obama’s presidency and the fate of the republic,” he says. “This is on track to open up affordable coverage for tens of millions of Americans starting Jan. 1. Once we get past Jan 1, i don’t believe there’s any retreat…and I think we will get through this difficult patch.”

Wilensky agrees that the law is not doomed, but adds:

“There is a problem, and it’s not just that people are having great difficulty accessing the Website, some of whom are at risk of losing their individually purchased insurance by the end of the December….The most serious issue is that there has been a real loss in trust in the president, and that is way more of an issue than the hiccups that have gone on with regard to the Website. When people don’t feel like they can trust what their president says, it has ramifications far greater than the Affordable Care Act. And wait until people discover the second part of the president’s pledge — ‘And if you like your doctor you can keep your doctor’ — isn’t true either, not for a lot of people. That’s the next shoe that’s going to fall.”

Listen to the full podcast above, and check out Dr. Johnson’s previous Obamacare podcasts here, here and here.


Dr. Tim Johnson’s Obamacare Podcast: The ‘Unbelievable Bumble’

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

As president, you know things are really getting bad when every humor outlet from The New Yorker’s Andy Borowitz (“Snowden Offers To Fix Healthcare.gov“) to The Onion (“New Improved Obamacare Program Released On 35 Floppy Disks“) is mocking your program’s failures.

President Obama himself expressed his frustration today over the widespread technical glitches besetting people trying to sign up for health insurance under Obamacare, saying that “nobody is madder than me,” NPR reports.

Here, in his latest podcast on health reform, Dr. Timothy Johnson, retired medical editor for ABC News, takes on what he calls “the very rocky start to the centerpiece of the Affordable Care Act: the insurance exchanges.” He and his guests discuss the technical SNAFUs that are marking the launch of the exchanges and dissect their causes. He begins with a New York Times article today that says federal health authorities simply did not have the expertise to do the job of setting up the technological infrastructure needed for Obamacare. He asks, “Question #1, are they right, these reporters? And question #2, can it be fixed?”

Listen to the podcast above to hear some answers (and to hear guest Dr. Gail Wilensky, a high health official under the first President Bush, refer to Obamacare’s technical failings as “an unbelievable bumble” — what a fun phrase, rolling so nicely off the tongue!) And here’s one useful tip: For those who have trouble on healthcare.gov, the Kaiser Family Foundation is offering a simple calculator of health insurance subsidies on its website, www.kff.org.

Readers, reactions? Please share below. And catch Dr. Johnson’s inaugural podcast here.

What Obamacare Is Really About, From One Who Knows

I hate Obamacare. That is not a political statement; it’s a journalistic one. The complex, 800-plus-page law is an explanatory nightmare, and every time I think I really understand it, my clarity slips away.

So I’m always grateful when John McDonough weighs in. A professor at the Harvard School of Public Health and author of a definitive account of the law — Inside National Health Reform — he’s a leading (and openly partisan) Obamacare expert. His new piece — Obamacare 101: Promises, Pitfalls and Predictions —  is the first in a new series run by WBUR’s opinion page, Cognoscenti. Called Policy for a Healthy America, it will look at “the challenges and opportunities facing the U.S. health care system.”

Among the future questions the series will address: Why is tackling the nation’s obesity problem so difficult? How is technology changing health care delivery? Is a single-payer system the answer?

Here’s a bit from today’s piece by John McDonough:

The biggest changes will transform people’s ability to buy health insurance. An insurance concept known as “guaranteed issue,” set to take effect on the first of the year, bans the practice of “medical underwriting” and the imposition of pre-existing conditionexclusions. The individual responsibility provision, called the individual mandate, will impose a new tax penalty on individuals who do not buy health insurance and who can afford to do so. Continue reading

No, Obamacare Doesn’t ‘Start’ Oct. 1, But Here’s What Changes

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

By Georgia Feuer
Guest contributor

“I heard the ACA is starting October 1st,” an acquaintance mentioned the other day.

I was confused. The Affordable Care Act — better known as Obamacare — is a massive law with wide-ranging effects all throughout the health-care system and many, many start dates; in fact, 65 start dates have already passed. They include the start date for letting young adults up to age 26 stay on their parents’ insurance; for progress towards closing the Medicare drug coverage gap; and for money to explore health care delivery reform through creation of the Center for Medicare and Medicaid Innovation.

So what was she referring to when she said “the ACA is starting Oct. 1st”?

When I google “Obamacare”, it becomes clear that right now, the word is synonymous with just one aspect of the health care act, the section that calls for the creation of health insurance exchanges. Oct. 1, 2013, marks the opening of these health insurance exchanges; marketplaces where John Q. Public can shop for and enroll in a health insurance plan that will provide coverage as of Jan. 1, 2014. He cannot be denied coverage and the amount that he pays for this coverage cannot be influenced by his current health status (although he can be charged more if he is a smoker).

(You may also want to check out today’s Here and Now which answers many questions about Obamacare.)

Health care consultant Georgia Feuer (Courtesy)

Health care consultant Georgia Feuer (Courtesy)

Every state will have its own exchange, which may be run by a state agency or a federal agency, but in some states, information about the exchange can be hard to come by. The reason: controversy over Obamacare is abundant, and one tactic used to derail Obamacare involves preventing people from hearing about how the law might positively affect them.

A USA Today story about Oklahoma Republicans resisting efforts to help people navigate the new exchanges also helps to explain why ignorance about aspects of the law remains so high. For example, only 49% of people polled in a recent survey knew that federal subsidies will be available to help low-income residents buy health insurance5.

Alongside the opening of the exchanges comes the option for more people to enroll in Medicaid. However, many states have not opted into the Medicaid expansion, despite evidence that the expansion is in a state’s financial best interest. One of the consequences of not expanding Medicaid is a cost gap, depicted below, that I refer to as the “Sorry, you aren’t making enough money to qualify for assistance” conundrum: Continue reading

Dr. Tim Johnson Battles Obamacare Confusion In Podcast

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

The political fight over Obamacare is heating up yet again, with House Republicans threatening a government shutdown if their efforts to defund the sweeping federal health overhaul fail. And more Obamacare rubber is about to hit the road on Oct. 1, when state health insurance exchanges — insurance shopping marketplaces, like The Connector in Massachusetts — roll out. All this against the backdrop of lingering mass confusion over what Obamacare entails; surveys find that some 40 percent of Americans aren’t even sure that the health overhaul is the law. (It is.)

So there couldn’t be a better time to pilot a new podcast on health reform, starring Dr. Timothy Johnson, long familiar to ABC viewers as a lively and trustworthy voice on medicine. He’s also the author of “The Truth About Getting Sick in America.” Listen to or download the 25-minute podcast above, and check out the start of the script below:

Hello. I’m Dr. Timothy Johnson, retired Medical Editor for ABC News and current Senior Medical Contributor for ABC. It is my privilege to moderate today’s first session in a series designed to discuss health care reform in a way that will bypass the clouds of confusion generated by politicians and partisans. In other words, we will attempt to go beyond and behind the headlines and determine what is really happening and how it will affect all of us as American health care consumers. I am delighted to welcome as our panel three longtime friends who, more importantly, are also three of the leading experts on health care reform in this country.

• Dr. John McDonough, who has a Ph.D in Public Health Policy, is currently a professor at the Harvard School of Public Health. He worked for the late Senator Edward Kennedy on the writing and passage of the Affordable Care Act – aka Obamacare – and was deeply involved in the creation of the Massachusetts health reform law in 2006 – aka Romneycare.

• Dr. Gail Wilensky, a Ph.D in Economics, has been a senior fellow at Project Hope since 1993. She has served in many capacities for Republican administrations, including as head of Medicare and Medicaid under the first President Bush. She was also Chair of the Medicare Payment Advisory Commission from 1997 to 2001.

• Dr. Drew Altman, a Ph.D in Political Science, is the founder and longtime President and CEO of the Kaiser Family Foundation, a highly regarded source of impartial information about health care reform issues. Prior to this, he served in many health care administrative positions including Head of Human Services for the state of New Jersey under Governor Tom Keane and as a Vice President of the Robert Wood Johnson foundation.

The House of Representatives has passed a bill attempting to defund Obamacare by tying it to the continuation of the government spending budget due to run out within days. Continue reading

Married To Obamacare: The Soap Opera

Obamacare is hard. It’s a great big behemoth of a health care overhaul, packed with complex changes for a complex labyrinth of a system. No normal person could be expected to stay awake through the law’s 800-plus pages. But it’s important — both as policy and because it could affect your care and your wallet.

So sometimes, we get a little desperate to explain it. And hey, who doesn’t? MIT professor Jon Gruber even turned it into a comic book. The Kaiser Family Foundation made a game-like video, and has just put out a new cartoon: “The YouToons Get Ready for Obamacare.”  We’ve tried “listicles” — 10 Things About Obamacare You May Not Know But Should — and distilling it into a 3-minute video.

But now we’re getting extra desperate because the real Obamacare countdown has begun. The Washington Post even started a 100-day countdown until millions of Americans can start enrolling in the overhaul’s health insurance expansion.

So we’re trying yet another ploy: A cheesy soap opera. Below, CommonHealth intern Sascha Garrey uses her creative powers to sneak a dozen key points you should know about Obamacare into an over-the-top melodrama. For Cliff Notes types, we’ve highlighted the points in bold and listed them at the end. And for aural learners, click on the “play” button above to hear a delicious excerpt as a radio drama, produced by WBUR’s George Hicks.

Image courtesy of Clare Bloomfield / FreeDigitalPhotos.net

Image courtesy of Clare Bloomfield / FreeDigitalPhotos.net

By Sascha Garrey
CommonHealth intern

“I didn’t need that fourth glass of wine,” Cassandra St. James grumbled to herself as she slammed off her wailing alarm. Her headache from last night’s binge was beyond splitting, making her simultaneously grouchy and grateful that, thanks to federal health reform, her health insurance plan was banned from putting annual limits on essential services –  lately, she’d been going through her prescription migraine pills like they were Skittles.

“Uggghh…I cannot face another day at work!”

Cassandra had been feeling the heat at her job lately, perhaps sparking this new interest in multiple glasses of wine per evening. Being a customer service representative at a Boston-based health insurance company during the advent of federal Health Reform was stressful to say the least. But tension at work wasn’t the only reason for Cassandra’s hangover.

Cassandra was engaged to a man she hardly knew, even though she was still heartbroken over the loss of her true love, Dr. Lance Jones. It’s been almost three years since the freak boating accident that took Dr. Jones’ life along the Cape, but his body was never found, leaving Cassandra without closure. Maybe that’s why she’d agreed to marry Chip Montebello.

To be sure, Chip had a good heart, but his health insurance situation left something to be desired. His decision to defy the state’s individual mandate left him with a greater tax burden and no health benefits.

What’s more she had financial woes coming at her in every direction. It didn’t help that the health insurance available to her through her employer was all but affordable, with over 9.5% of her income put towards her premium each month. In more desperate moods, Cassandra fantasized about having the freedom to buy insurance over the Health Connector, but that fantasy was too farfetched even for her. Massachusetts law prohibits anyone with insurance available to them through their job to seek coverage elsewhere, regardless of its affordability.

But it wouldn’t matter even if she could stray to the Connector. Ever since her so-called “big promotion” her salary was boosted to $45,960 and with her household size of one, that boost put Cassandra at 400% of the federal poverty line. With an income at that level, she wouldn’t even qualify for any of the state subsidies for purchasing insurance on the Connector, available only to those with incomes between 133 – 300% of the federal poverty line.

“And then there’s my mother,” Cassandra said under her breath as the phone rang. Continue reading

Obamacare: Mass. As ‘One Good Kid’ In Class, Gets Detention For Others’ Sins

President Obama signing the health care bill into law

President Obama signing the health care bill into law

Yes, Massachusetts health reform was the model for Obamacare, but the kicking-in of the federal health care overhaul still affects the state in a myriad of ways — some helpful, some problematic.

WBUR’s Martha Bebinger reports that the state’s largest employer group is calling on Congress to waive some requirements of the federal health care law — or exempt Massachusetts altogether. She reports:

Associated Industries of Massachusetts says there are at least a half dozen requirements in the federal Affordable Care Act that undermine the state’s seven-year-old health care reform and will hike costs for businesses. The feds gave Massachusetts a temporary waiver on a few issues, but AIM president Rick Lord says the feds should not force Massachusetts to adopt these changes at all:

“Because we’ve achieved the goals of national health care reform, and as it stands now, implementation of the ACA here in Massachusetts is actually going to disrupt some of the accomplishments that we’ve achieved.”

Lord says AIM supports the mission of the Affordable Care Act. So far, federal regulators have agreed to delay some of the changes that business leaders in Massachusetts object to, but these leaders want a permanent reprieve.

Rick Lord lays out all the problematic provisions of Obamacare for Massachusetts employers in a clear blog post here, warning that the “already burdensome cost of health insurance” will rise. But the best part is this delectable analogy:

We’re left to wonder why Massachusetts stands to be penalized for having successfully figured out health reform during the past seven years. We feel like the one good kid in the class who gets detention because everyone else is talking.

Further reading on Obamacare and Massachusetts, from Josh Archambault at the Pioneer Institute: 10 Questions About ACA/Obamacare Implementation in Massachusetts That Need to be Answered.

Readers, any additional questions?

Actuaries: ObamaCare Will Hike Claims Cost 32 Percent (But Not In Mass.)

Source: The Society of Actuaries' report, "Cost of the Future Newly Insured under the Affordable Care Act." (Posted with the society's permission.)

Source: The Society of Actuaries’ report, “Cost of the Future Newly Insured under the Affordable Care Act.” (Posted with the society’s permission.)

The Associated Press, delving courageously into actuarial data, reports here:

Insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama’s overhaul, the nation’s leading group of financial risk analysts has estimated.

That’s likely to increase premiums for at least some Americans buying individual plans. The report by the Society of Actuaries could turn into a big headache for the Obama administration at a time when many parts of the country remain skeptical about the Affordable Care Act.

…Medical claims costs are the main driver of health insurance premiums. A study by the Society of Actuaries estimates the new federal health care law will raise claims costs nationally by an average of 32 percent per person in the individual health insurance market by 2017. That’s partly due to sicker people joining the pool. The study finds wide disparities among states. The estimates assume every state will expand its Medicaid program.

Naturally, my curiosity turned provincially to Massachusetts. The full Society of Actuaries report is here, including this gorgeous infographic breaking down the data by state. I’m happy to report that New England states are looking good: Vermont and Massachusetts can expect claims costs on individual policies to decrease by over 12 percent and Rhode Island by more than 6 percent. New York can expect a whopping drop of nearly 14 percent. Compare that to poor Wisconsin and Ohio, expecting an increase of over 80 percent.

The AP piece also features some refutations from the Obama administration, including: Continue reading

Bestselling Books: Surviving, Beating, And Hating On Obamacare

President Obama signing the health care bill into law

President Obama signing the health care bill into law

Hmmm. My odd compulsion to read every single entry on The New York Times bestseller list every Sunday has turned up an interesting phenomenon in the “Advice, How-To and Miscellaneous” category.

For two weeks in a row now, I’ve noticed that the paperback list has included these two books:

“ObamaCare Survival Guide,” by Nick Tate, described as “An explanation of and arguments against the Affordable Care Act.” That was at number three in the category this week. And:

“Beating Obamacare”  by Betsy McCaughey, described as “A handbook on the healthcare law from one of its critics.”

Clearly some great marketing minds have been at work. Much of the law kicks in beginning next year, and how can you not be concerned that its 800-plus pages might be studded with new rules that affect you, your insurance premiums, your medical bills?

But clearly so many great marketing minds are having the same idea that the field (perhaps it’s even a new genre? The “Surviving Obamacare” genre?) seems to be getting a bit crowded. On Amazon.com, I see that there are even two books with the same title: Tate’s, and another called “ObamaCare Survival Guide” with the subtitle, “The Affordable Care Act and What It Means for You and Your Healthcare.” It’s described as “a more objective and less partisan easy-to-read guideline to the law than the highly advertised Nick Tate’s ObamaCare Survival Guide.”

Readers, have you checked out any of these books? We’ll order them and take a look. We’ll also be shopping around for the best “What Will Obamacare Mean To Me?” material. Suggestions welcome. Harvard Professor John McDonough, himself the author of Inside National Health Reform, recommends MIT economist Jonathan Gruber’s health reform comic book as the easiest read for the lay public, but we’d note that it’s more of an overview than a guide to the nitty-gritty details.