Interviews with current and former Obama administration officials and specialists involved in the project, as well as a review of hundreds of pages of government and contractor documents, offer new details into how tensions between the government and its contractors, questionable decisions and weak leadership within the Medicare agency turned the rollout of the president’s signature program into a major humiliation…
CGI and other contractors complained of endlessly shifting requirements and a government decision-making process so cumbersome that it took weeks to resolve elementary questions, such as determining whether users should be required to provide Social Security numbers. Some CGI software engineers ultimately walked out, saying it was impossible to produce good work under such conditions.
“Cut corners, make date,” said one specialist…
Mr. Chao seemed to colleagues to be at his wit’s end. One evening last summer, he called Wallace Fung, who retired in 2008 as the Medicare agency’s chief technology officer. Mr. Fung said in an interview that he told Mr. Chao to greatly simplify the site’s functions. “Henry, this is not going to work. You cannot build this kind of system overnight,” Mr. Fung said he told him.
“I know,” Mr. Chao answered, according to Mr. Fung. “But I cannot talk them out of it.”
During the past two months, it has become evident that no single reason explains why HealthCare.gov, a top administration priority, was not ready 3 1/2 years after President Obama signed a sprawling law designed to reshape the U.S. health-care system. Work to build the online marketplace was hindered, in part, by White House micromanagement and political sensitivities that delayed policy and regulatory decisions, fierce Republican opposition to the law, and the fact that no one at the CMS or elsewhere at Department of Health and Human Services, of which the agency is a part, had the job of managing the project full time.
But the documents and interviews make clear that CGI, by far the most central of about four dozen companies with contracts to help build the exchange, made repeated missteps. The government’s contract with CGI was $197 million as of August…
The Obama administration has set a Nov. 30 deadline — next Saturday — by which officials have promised that HealthCare.gov will work smoothly for about four out of five consumers who attempt to use it to sign up for health plans. Even now, the official familiar with the project said, CGI’s work on the repairs is not always going well; roughly one-third to half the new computer code the company is writing cannot be used because it is revealing flaws when it is fully examined by a group of outside testers, including some insurance companies.
For concision and precision in describing Barack Obama’s suddenly ambivalent relationship with his singular — actually, his single — achievement, the laurels go to Rep. Steve Scalise (R-La.).
After Obama’s semi-demi-apology for millions of canceled insurance policies — an intended and predictable consequence of his crusade to liberate Americans from their childish choices of “substandard” policies sold by “bad apple” insurers — Scalise said Obama is like someone who burns down your house. Then shows up with an empty water bucket. Then lectures you about how defective the house was.
What is now inexplicably called Obama’s “fix” for the chaos he has created is surreal. He gives you permission to reoccupy your house — if you can get someone to rebuild it — but for only another year…
The New York Times reports that last March Henry Chao of the Centers for Medicare and Medicaid Services, which superintended creation of the HealthCare.gov Web site, told a conference that he had worries: “Let’s just make sure it’s not a third-world experience.” When such an embarrassing experience occurred, Obama responded like a ruler of a banana republic unfettered by constitutionalism and the rule of law. Although no president has even a line-item veto power (which 44 governors have), this president asserts the power to revise the language of laws by “enforcement discretion,” and suggests no limiting principle.
Meanwhile, the federal government is giving consumers even more time, allowing them an extra week in December to sign up for coverage to begin Jan. 1. The previous Dec. 15 deadline has been pushed back to Dec. 23, said Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, the federal agency overseeing HealthCare.gov. She said that the date was changed in consultation with insurers and that the administration was confident carriers would have enough time to process applications.
But industry officials raised concerns that the shortened period would not be enough time to complete the many tasks required after someone hits “submit” on an application and before a benefit card arrives in the mail.
“It makes it more challenging to process enrollments in time for coverage to begin on January 1,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.
Insurers are worried that a flood of new applications at the last minute, combined with the inaccurate enrollment data they are receiving from HealthCare.gov, will leave them scrambling to verify information and receive payment.
Sweeping differences in health care exchange pricing among states and counties is leading to sticker shock for some middle-class consumers and others who aren’t eligible for subsidies under the Affordable Care Act.
The average prices for the most popular plans are twice as high in the most expensive states as those with the lowest average prices, according to a USA TODAY analysis of data for 34 states using the federal health insurance exchange…
The premiums for bronze-level plans are generally the least expensive, but “the deductibles are simply not affordable,” says Laura Stack, a former financial analyst looking for full-time work and using her 401k to pay for health insurance. “Many will not be able to afford the per person deductibles before insurance begins to pay. What are you really paying for?”…
Insurance brokers and “navigators” helping people apply for insurance say there are shockingly high prices for some consumers who aren’t eligible for subsidies. Without much competition in some states and because they know so little about their new customers, insurers may have priced higher than they would have otherwise.
Many doctors are disturbed that they’ll be paid less – often a lot less – to care for the millions of patients who are projected to buy coverage through the health law’s new insurance marketplaces.
Some have complained to medical associations – including those in Texas, California, Georgia, Connecticut and New York – saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, perhaps making it harder for consumers to get the care they need.
“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington…
Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.
Another unintended consequence of this is that these narrow network plans are almost certain to become the lowest cost plans in the exchange. Remember, the federal health insurance subsidies are tied to the second lowest-cost Silver plan. Which health plan is offering that second lowest-cost Silver plan? Likely one of these narrow network plans. As a result, if you want a wider network plan, any cost difference for that plan becomes the responsibility of the consumer.
People who might be accustomed to broader networks found in employer health plans will have to either buy-up to better plans or may find their choices limited on the exchange.
Should we now regulate the health plans and force them to give everybody access to any provider they want? We could do that.
And, we could also have another rate shock debate.
Yes, there is a penalty for failing to purchase insurance — starting at $95 or 1 percent of income the first year and rising sharply thereafter. But the designers of Obamacare went out of their way to prohibit the IRS from using its usual array of civil and criminal processes (fines, liens, etc.) to confiscate it. The government may only collect the penalty by deducting it from tax refunds — meaning people who prudently structure their tax withholding so that no refund accumulates can avoid paying with impunity.
Obviously, it would be far less expensive for young people — who are already disproportionately strained by Obama’s no-growth, high-unemployment economy — to opt for a penalty they are not actually required to pay than to purchase prohibitively costly coverage. After all, under Obamacare, they can wait until they are sick to buy “insurance.” That is, Obamacare’s architects consciously created the incentive to destroy the program’s own insurance exchanges.
By the time that problem erupts, private insurance will already be gutted. Coverage requirements will already be dictated by government, as will pricing, with a subsidy structure that builds in progressive wealth redistribution. And doctors will already be beholden to government for patient access, treatment options, record-keeping requirements, and payment. That is, much of the single-payer infrastructure will be in place.
The manufactured financial crisis will be portrayed as a demonstration that exchanges based on the assumption that individuals will take responsibility for their own “private” insurance arrangements do not work. It will be time to solve the crisis by a seamless transition — there’s that word again — to a fully socialized health-care system, now overtly controlled by the government. “Free” health care for everyone — with all the substandard treatment, absurd wait times, and rationing that entails — will be supported by a few “tweaks” to our progressive tax system . . . no more unwieldy, unpredictable premium payments.
What, then, are the lessons that Americans and supporters of Obamacare can learn from Australia’s experience? The most obvious is that no piece is legislation is permanent, but must be sustained politically. If it is passed over the opposition of a rival party, and if that party comes into power, it can always repeal it or simply make it impossible to implement. The only way to ensure that the legislation will survive a change in the party in power is if the legislation becomes thoroughly popular. If it can’t be fully implemented—which is what happened to the original Medibank legislation—it will be vulnerable to a challenge.
From all appearances, the Obama administration seemed to believe that the mere act of getting the Affordable Care Act through Congress would ensure its survival and popularity. But now it faces the very real possibility that the Republicans, campaigning on the failure of Obamacare and flagging recovery, would win back the Senate in 2014, and be in a position to force the administration to accept changes in the Affordable Care Act that will weaken the program. Obama has already embraced modifications to the act—allowing insurance companies to bypass the exchanges and their regulations—that will hurt it. And if Republicans were to win the White House and Congress in 2016, they could simply repeal the Affordable Care Act…
Some leftwing critics of Obamacare have suggested that the administration should have fought to expand Medicare to all ages rather than to build the program upon the existing structure of hospitals, employer-based insurance, and private insurance. In theory, Americans would have been better off if the Obama administration had been able to win support for a system like the Australian. But the Australian system was erected atop a medical system that was far simpler than what America now enjoys, or suffers from, and could be done with a minimum of dislocation. For the Obama administration to have installed its version of Australian Medicare, it would have had to blow up and replace the existing system. That would have been impossible politically, and would have also entailed different kinds of complex challenges—for instance, the abandonment of the employer-based system. The real alternative in 2009-2010 would not have been more radical but less radical, incremental changes to the existing healthcare infrastructure.