Quotes of the day

A self-proclaimed non-partisan organization has been given a $1.1 million grant to establish a database of ObamaCare “success stories,” as the Obama administration tries to rehab the law’s image amid the rocky rollout…

The grant, which was first reported by CapitolCityProject.com, is meant to help Families USA expand the database of “real people” sharing their stories of enrolling in ObamaCare. Families USA solicits such stories on its website, asking Americans to submit their examples of how they are benefiting from the Affordable Care Act to educate others.

“The best way to do that is to tell your story, giving a real example of the status quo and the impact of change,” the website says.


In the non-descript building at the headquarters of in Maryland, about 30 to 40 members of the post-rollout “tech surge” will be working through the Thanksgiving holiday. After the site failed to work in October — engineers, database architects and contractors from different companies were pulled together to work in one room…

“On the walls you have these giant flat-panel monitors [showing] metrics of how the site’s doing. Uptime metrics, performance metrics, graphs that show how different aspects of the website are performing in real time,” Engates says…

“The definition of working well is relative to how badly it was working earlier on,” says Himanshu Sareen. He is CEO of Icreon Tech, which develops enterprise software. “It is working better, for sure. But it’s relative, right, because we started out with a system that just did not work at all.”


Days before the Obama administration’s self-imposed Nov. 30 deadline for fixing HealthCare.gov, its technology team is scrambling to build a new part of the Web site as a workaround that would enable more people to buy health insurance without relying directly on the site.

The new mechanism, EZ App, would permit people who are eligible for financial help from the government to enroll for coverage without calculating an exact subsidy amount, which has been a major stumbling block, according to government and insurance industry officials who spoke on the condition of anonymity in order to be frank. It would allow call centers, and eventually insurance companies and brokers, to help people enroll based on estimates of what their federal subsidies would be.

But insurers are uncomfortable with the add-on because they do not want to shoulder the financial liability for customers signing up for plans with a rough estimate of their final premiums, rather than a precise figure verified through the site.


The agency in charge of the troubled HealthCare.gov website said on Wednesday is it switching providers of Web hosting services, the latest change for the website at the heart of President Barack Obama’s health care reforms…

Now, CMS needs to transition its data center to HP at a time when it is just beginning to dig out from a mountain of problems with the website, which is designed to let consumers shop for health insurance required under Obama’s signature health care law.

The complexity of the switch between data center providers could be an additional challenge for the project. A CMS spokesman did not respond to questions about whether the transition would affect the website.


The application that she finished on Oct. 24 says “Status, complete.” Imler clicks on the actual application and scrolls down to an ominous looking red icon that says “Terminate Coverage.”

“So you hit the terminate button. It says you’ve chosen to end the following coverage… you then have to check ‘I have fully read and understand that I’m choosing to terminate coverage,'” she says. “Then you click terminate again, and we’ll see what happens.”

What happens is nothing. The health plan Imler signed up for is still listed in her profile. She logs out and then back in, and it looks exactly the same. She checks her e-mail for a notice of coverage termination and finds nothing there either. Imler leans back on the couch and looks surprisingly calm about the whole thing.

“I’m resigned to the fact that it doesn’t work. No matter what I do, it just doesn’t work. And this is the improved website.”


Even if HealthCare.gov is able finally to handle the flood of enrollees that officials expect in December, the administration could face a backlash from people who have enrolled but whose paperwork will not be completed by the time their coverage is supposed to take effect on January 1…

“People could wind up going to the doctor or the hospital, thinking they’re enrolled, when they may not be,” said one insurance industry official, who asked not to be identified because he did not want to comment publicly…

Consumers “will forgive some start-up issues with the ability to enroll on the website,” said Gregory Nersessian, principal with consulting firm Health Management Associates.

Nersessian said, however, that “it’s going to be far more damaging if their information and their expectation about enrollment and payment and coverage get confused because of the back end system.”


The first test comes next week with the rollout of the post-op HealthCare.gov. So fearful that it will crash under heavy use, the White House on Monday asked its health care allies (Enroll America, Families USA, and many big unions) not to launch a second enrollment campaign. Hardly encouraging

The next test comes in mid-December, when the White House expects a surge in enrollment as consumers attempt to purchase insurance that will begin Jan. 1. Before the six-month enrollment period ends, the administration anticipates two significant bulges in enrollment—one for the first coverage window (to obtain coverage by Jan. 1) and one for the final enrollment deadline of March 31. How the website and insurers handle the first surge in mid-December will explain a lot about the website’s triage and the efficacy of the insurance pricing and selection models. The White House also expects enrollment to taper off after Dec. 23 (the new enrollment deadline for Jan. 1 coverage) before it reaches a maximum peak from mid-February to the final cutoff date of March 31. For historical and comparative purposes, in the first two months of Massachusetts’ health care law, 17 percent of enrollees were 18 to 34; in the final two months of the 11-month enrollment period in Massachusetts, 39 percent of enrollees were 18 to 34. The administration expects this pattern to repeat itself under the ACA, though on the shorter, six-month timeline. Also in December, insurance companies will ramp up direct enrollment outreach to future consumers—offering them plans and then connecting to the state or federal website for assistance with subsidies for premiums and coverage offered. December will be an acid test for HealthCare.gov 2.0 and the new, ad hoc recruitment of enrollees by insurance companies. The verdicts, while not conclusive, will be instructive.

All this will serve as the backdrop for Obama’s State of the Union address, which will unquestionably be the State of Obamacare address.


One morning, I decide to see the net-cinching end of Enroll America’s efforts by sitting in on an enrollment session that they cosponsor with two contracted Navigator groups, who help people in person sign up on the Obamacare insurance exchange. In a computer lab at Miami Dade College, a roomful of nearly 100 uninsured or underinsured citizens, with the help of 19 or so Navigators, take the daunting plunge into HealthCare.gov…

To give the CliffsNotes version of the three-hour session, it went a little like this: The woman beside me, named Jenny, a naturalized citizen from Ecuador, spent two and a half hours trying to crunch through the system before it finally returned her to the first page, then locked her out. She never even saw the prices. When Blade had her call the phone support hotline, they told her she’d need to wait three weeks to find out the status of her application. The same happened to her colleague, Sue, sitting next to her. They both need insurance now, because the endocrinologist they work for had to cancel theirs because it didn’t meet Obamacare requirements. They’re hoping not only that they can get insurance, but also that they can keep their jobs, since Jenny, who does billing for the doctor, says Obamacare is completely convoluting how, if at all, they’ll be able to collect money from patients.

Two men sitting behind me get to a price list, though one wigs out because of the high premiums and leaves. The other finds a relatively cheap plan, but the deductible is so high, for his family of four, that he says, “I can’t touch this.” And he leaves, too. The two people on the other side of Jenny and Sue, whom I never even meet, leave after about 30 minutes. Blade suggests it’s probably because of “sticker shock,” if they even got that far. A recurring problem, he says, in his line of work.

All told, even with all the hand-holding Navigators, I’m assured by members of the two Navigator groups who worked the session that of the 100 or so prospects in attendance, exactly none walked out with a completed enrollment.


Since the launch of the Affordable Care Act’s health insurance exchanges on Oct. 1, frequent glitches and long waits have dominated the news coverage. But these reports—while frustrating the Obama administration and delighting its opponents—distract from a far more important question: Are consumers doomed to make poor choices about health plans? Maybe our brains just aren’t wired to use a site like HealthCare.gov, whether it works or not

One recent study found that Medicaid-eligible individuals in California with multiple plan options were significantly less likely to enroll than those with just one option. Another study found that Medicare Part-D beneficiaries with more choices are less likely to identify low-cost, high-value plans. These individuals placed more weight on premiums than out-of-pocket costs, and ended up paying extra. This tendency to overvalue salient features like premiums at the expense of other aspects of the plans might be particularly relevant for exchange enrollees, given the media’s obsession with exchange premium rates in recent months…

While understanding a plan’s cost-sharing structure is crucial for making good decisions, it is also the skill with which people are most likely to struggle. A recent study by the Commonwealth Fund found that people had great difficulty understanding and manipulating terms like coinsurance, allowed amount, deductibles and annual limits—leading to “deep-seated confusion and lack of confidence with respect to health plan cost-sharing.” Even health-literate participants had trouble estimating their total out-of-pocket spending, and often selected plans not in their best interest. This is particularly concerning for those enrolling in the exchanges, many of whom have long been uninsured and have low levels of health literacy.


Over the last several years the Republican party has proved inept at making a coherent, sustained argument either for conservative principles or against the perils of modern liberalism. They haven’t even been capable of making effective arguments against the single most consequential—and unpopular!—piece of legislation in a generation: Obamacare. I don’t want to name names, but the most important Republican figure of the last four years didn’t even want to talk about Obamacare during the 2012 election.

Yet now that we actually have Obamacare in action, conservatism is no longer at the mercy of the Republican party. Because Americans now get to see first hand. And the argument makes itself.

This argument isn’t just about the duplicity and hubris of Barack Obama. It’s not even limited to the competence and trustworthiness of the Democratic party. It’s about the civil compact, the nature of government, and the perfectibility of the kingdom of man.

Reagan himself couldn’t have made a better case for conservative ideas than Obamacare is making daily. So, just for one day, let’s be thankful for it.



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