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ACA Running Thread

Wrangor said:
So 7 million by the end of March was the goal? Eesh. No way we get there (or even get close). How are the numbers shaping out for young people signing up? After the sheer numbers that seems to be an important implementation detail. Are we getting the milk cows in the system?
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I always thought the 7 million was way too low FWIW. We have nearly 50 million uninsured after all. And please don't blame the lack of Medicaid expansion. In states where Medicaid wasn't expanded, the commercial projections should be HIGHER as they dropped subsidy eligibility from 138% of the FPL to 100%.

The #s coming in are worrisome. I think you are seeing it skew older and sicker nationally. HHS reported this and I know many insurers priced for a different age spread. Will be interesting to see how this shakes out by May 1st. I sit in on a call with HHS each week about their outreach and they are pushing hard to get young folks enrolled. Their tactics are well, lets say not exactly cutting edge. Magic Johnson? Zo? Getting Moms to harass their sons? Sigh.

In hindsight, a weak mandate and a really bad launch coupled with high OOP costs are tough to overcome. I cant imagine the fallout if they increased the penalty.
 
DeacinBama said:
SS computers are going down for maintenance. SS is used for identification verification purposes under the ACA.

I'm not sure if this is routine maintenance done by SS the second Saturday of every month, for example, and the ACA people just never put two and two together. Or it could be a great example of how the left hand rarely knows what the right hand is doing with the federal government. Either way, the timing absolutely sucks.
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Its happened to us. Sometime our systems go down on big deadline days. We finally had to give IT no fly zone days. Anyway, just one more rookie goof.
 
WFU71 said:
http://www.usatoday.com/story/opinion/2014/02/12/obamacare-appeals-website-healthcaregov-editorials-debates/5436305/

"Nearly four years after the Affordable Care Act was signed into law, you'd think most of the kinks would have been worked out. And, of course, you'd be completely wrong.

True, the website that could sign up only six customers on Oct. 1, the day it debuted, is working better. The administration said Wednesday that 1.9 million people have signed up in the federal marketplace. But vital parts of the portal still haven't even been built. One critical omission is the part that processes the appeals of people who end up with the wrong health insurance coverage or no coverage at all.

The good news is that this affects only about 22,000 people, or a little more than 1% of those who signed up on the federal website.

The bad news is that for those people, the fact that they're part of a relatively small minority only increases the likelihood that they'll endure longer delays while the system's many other problems get attention.

The Washington Post tells the story of a 27-year-old woman in West Virginia who found a policy on the exchange that cost $100 a month more than she was entitled to with a deductible that was $4,000 too high. When she sought advice from a call center, she was told to sign up and appeal later. Without an effective appeals process, she was stuck paying the high premium and waiting for bills for emergency surgery that could overwhelm her $22,000 annual salary.

For her, Obamacare is inflicting the kind of financial pain it was supposed to prevent.

After the flaw was exposed, the administration belatedly sprang into action. It now promises that the problem will be fixed "soon," and caseworkers are reaching out to try to help people.

Making big changes in health care, which accounts for 17% of the economy, was never going to be easy. The system's complexity guarantees years of fine tuning. But that does not explain why the program's administrators failed to address predictable problems, such as the immediate need for an appeals process, or the website's weakness, or the need for reliable connections to insurers..."
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I can tell you from firsthand experience that there is just a huge mess out there. Rules get changes every day. The openly change an rechange rules. They issue contradictory guidance. Its just the wild west with one of the bigger issues is that the site doesn't support what the law says it should. And the call center itself gives flat out wrong information.

Im very worried some carriers are going to drop out. Its that bad...
 
DeacMan said:
The primary data all comes from HHS. Not sure why who writes about the data matters. The math is the same.
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All scientific data related to climate change is the same then regardless of the author? The math is the same. LOL
 
CHDeac said:
I can tell you from firsthand experience that there is just a huge mess out there. Rules get changes every day. The openly change an rechange rules. They issue contradictory guidance. Its just the wild west with one of the bigger issues is that the site doesn't support what the law says it should. And the call center itself gives flat out wrong information.

Im very worried some carriers are going to drop out. Its that bad...
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What would be the affect on the participants/users and the carriers?
 
CHDeac said:
In hindsight, a weak mandate and a really bad launch coupled with high OOP costs are tough to overcome. I cant imagine the fallout if they increased the penalty.
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Why weren't the penalties higher from day one? Politics?

Using very high penalties to effectively force people to sign up seems like the only right play for this system. You still get the IT issues, but at least there'd be a critical mass of demand to enroll and avoid adverse selection...
 
09deaconX said:
Why weren't the penalties higher from day one? Politics?

Using very high penalties to effectively force people to sign up seems like the only right play for this system. You still get the IT issues, but at least there'd be a critical mass of demand to enroll and avoid adverse selection...
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Because ACA was sold (and still is being sold) as SO good for everyone that once people learn about it that they will be clamoring to join the program. You can't enforce some huge penalty if people don't sign up and at the same time try to convince them that they are going to love it.

"You are going to love ACA, but just to make sure you love it we are going to fine the heck out of you if you decide not to join."
 
I think it was politics. So many better ways to deal wit this. I woudl have done a penalty PLUS a surcharge for every month you didnt buy. It just drives anti-selection.
 
WFU71 said:
http://thehill.com/blogs/healthwatch/health-reform-implementation/198296-before-o-care-debacle-sebelius-made-many-trips-to-white-house

"The documents reveal that Sebelius met with or attended calls and events with Obama at least 18 times between Oct. 27, 2012, and Oct. 6, 2013, including at least seven instances in which the two were scheduled to discuss the new healthcare law, according to the secretary’s draft schedules."
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C'mon now, the President didn't know about this article...
 
http://www.politico.com/story/2014/02/obamacare-newly-insured-103645.html?hp=l2

"The ACA originally allocated $30 million to support the programs, and the Department of Health and Human Services doled out an additional $30 million in August 2012. But most of this money is gone, even though 15 states with Republican governors never applied for funding in the first place. There seems to be little chance of more funding any time soon."
 
http://online.wsj.com/news/articles/SB10001424052702303491404579391740095244018

"The law's true impact will play out over years. It will depend in part on whether backers overcome serious early setbacks, including crippling glitches in the new online insurance marketplaces and many states' rejection of the Medicaid expansion. But another obstacle the law faces is pushback from some consumers and industry over the higher costs, complex rules and mandatory requirements it imposes."
 
One thing the liberalgencia on this board never really note is just how fucking regressive this law will be in terms of the mandatory costs it imposes upon people. Once you are out of subsidy land (and the vast majority of Americans are not in it), you pay the same general freight regardless of your stature in life.
 
DeacMan said:
One thing the liberalgencia on this board never really note is just how fucking regressive this law will be in terms of the mandatory costs it imposes upon people. Once you are out of subsidy land (and the vast majority of Americans are not in it), you pay the same general freight regardless of your stature in life.
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Per KFF, In North Carolina,

21% are below 100% of the FPL (and are SOL)
50% are between 100-400% of FPL and APTC eligible
29% are over 400% and thus generally not eligible

But I do think the law can be very hard on the working poor. Its can be a tax (1% of income or $95 in 2014) but if you buy, the amounts of premium still could be substantial even with the APTCs. Thats a hard conversation too.
 
CHDeac said:
Per KFF, In North Carolina,

21% are below 100% of the FPL (and are SOL)
50% are between 100-400% of FPL and APTC eligible
29% are over 400% and thus generally not eligible

But I do think the law can be very hard on the working poor. Its can be a tax (1% of income or $95 in 2014) but if you buy, the amounts of premium still could be substantial even with the APTCs. Thats a hard conversation too.
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Good data. Thanks.
 
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