PPACA Links: 2013-07-30


HHS is on Schedule 2013-07-15. More walking around money for the creative class.


President Obama dives into ACA details Politico, 2013-07-18

President Barack Obama’s got a strategy for Obamacare: make the big sell by talking small.

In a speech on Thursday, Obama got deep into the specifics of the sweeping health care law, from a rule that forces insurers to send rebate checks to some consumers to the price competition in its new health insurance marketplaces— all provisions designed to save Americans money.

Trippi and other Democratic strategists say Obama did what he needed to do — he talked about the ways the health care law is already saving money for people, and how it could save them more money in the near future.

But Trippi conceded there’s probably not much Obama can say to convince young and healthy people to buy health insurance that they’ve never bought before — which is why the law’s individual mandate is so important. That piece is so unpopular, though, that Obama didn’t drop the slightest hint about it.


White House finds the funny in ‘Obamacare’ pitch to youth Reuters, 2013-07-22

A website known for viral comedy videos popular with Americans under 30 – Funny or Die – has a few ideas and is enlisting celebrities to make something that catches the attention of a key demographic the White House needs to sign up for Obamacare.

“I think you can kind of have fun with some of the misinformation that’s out there,” said Mike Farah, president of production for Funny or Die.

Farah was part of a small group of Hollywood stars and entertainers who met with senior White House officials on Monday to talk about how to use pop culture to persuade young Americans to sign up for new medical insurance coverage this fall.

Obama dropped by the meeting, which included comedian Amy Poehler [Parks and Recreation], actor Jennifer Hudson [Dreamgirls], representatives for Oprah Winfrey and Alicia Keys and others.

Funny or Die has more than 19 million unique users per month and 6.4 million Twitter followers and is already working on several videos featuring celebrities.

The government isn’t paying for the help. “If there was ever any money for Funny or Die – which there never was – I’m sure it would have been cut by the sequester long ago,” Farah quipped. …

Farah said he is not worried about any backlash.

“If Republican senators have enough time to write Funny or Die a letter telling us not to be a part of this, then we’re doing something right,” he said.

Lambert here: Farah’s pathetic insiderese jokes…. Eesh. (Also, since by implication he’s admitted his effort is partisan, should the FEC look into it?


Exchanges with Preliminary Plan Rates State Reforum (valid as of July 23; Personal Communciation).

With October’s open enrollment for exchanges drawing near, a key issue that remains is premium rates for health plans sold in the exchanges. This map tracks states that have released rate information filed by carriers interested in selling plans in health insurance exchanges in both the individual and small group markets. Unless otherwise indicated, the rates are preliminary and still subject to final approval by the exchange. …. 12 states have released exchange rates. 39 states have not.


Health Reform Polls Are Inconsistent and Confusing. Should We Still Pay Attention? California Healthline, 2013-07-24

The seemingly ambiguous and incongruous results from polls measuring reaction to the ACA brings up a valid question: Why should we pay attention to them? Ambiguity is no reason to “throw away the polls,” Julie Phelan, senior research analyst at Langer Research Associates, tells California Healthline. In fact, Phelan says the results might not be as “logically inconsistent” as they seem at first glance. Phelan’s firm conducts research for ABC and Bloomberg News, among other clients.

“If you look at the provisions that people support overwhelmingly, they’re things … with no cost,” Phelan says, adding, “If you ask, ‘Do you support allowing children to stay on their parent’s insurance plans until they’re 26,’ people will say, ‘Of course — How’s that going to hurt me?'”

[Mollyann Brodie -- senior vice president for executive operations and director of public opinion and survey research for the Kaiser Family Foundation] predicts that public opinion on the law might become more definitive once U.S. residents start viewing the law through a consumer lens. She says there are plenty of “legitimate questions” surrounding the law that have not yet been answered — such as whether the law makes health care more affordable, if people are gaining access to coverage, and whether emergency department visits are being prevented, among other things — both because partisanship has clouded people’s views of the law and many of the law’s provisions have not yet taken effect.

Lambert here: In other words, as I keep saying, people don’t know the net result of the complete ACA package. So no wonder the polling is ambiguous! Nobody knows anything!


HHS Drafts Teddy Roosevelt to Promote Obamacare Washington Wire, Online Wall Street Journal, 2013-07-24

The long-suffering presidential mascot for the Washington Nationals baseball team starred in a video promo last night with Health and Human Services Secretary Kathleen Sebelius to promote Obamacare.

The video aired before the Nationals game last night with the Pittsburgh Pirates. During the video, Teddy is seen enrolling in an insurance plan under the Affordable Care Act and calling the HHS hotline for information. Ms. Sebelius urges Americans to enroll and says, “If Teddy can do it, you can do it.”

It was “HHS Night” at the ballpark last night, where agency employees could buy special T-shirts for $16 and watch someone from the agency throw out the first pitch.


Deciphering The Health Law’s Subsidies For Premiums Kaiser Health News, 2013-07-24. Good Q&A. Here’s the last one:

Q. What’s the biggest challenge for consumers and the exchanges with these subsidies?

A: The learning curve. Over time, Americans have gotten very used to things like 401(k) accounts, IRAs, penalties for early withdrawal and the kinds of documents they need to keep. But it takes a while because there are a variety of different rules and they are complicated. Keeping records will be important – both for consumers and the new marketplaces – because consumers whose income changes during the year may find they are either owed more in tax credits, or have to pay some back.

Lambert here: Again, Obama’s claim that buying health insurance online is going to be like buying a flat-screen TV is — there’s no other word for this — an outrageous, barefaced, shameless lie.


Half of Affordable Care Act call center jobs will be part-time Contra Costa Times, 2013-07-25

Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president’s Affordable Care Act. Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits — a stinging disappointment to workers and local politicians who believed the positions would be full-time. [Karen Mitchoff], the Contra Costa County supervisor whose district includes the call center called the whole hiring process — which attracted about 7,000 applicants — a “comedy of errors.”

One recent hire, who last week learned the job would be part-time, said the new “intermittent” employees feel like they’ve been used as a political tool, and many now regret applying for the positions. “What’s really ironic is working for a call center and trying to help people get health care, but we can’t afford it ourselves,” said the worker, who asked for anonymity out of fear of losing the job. The county says it had been telling the public and supervisors all along that some positions would be full-time and some part-time. However, portions of staff reports list all 204 jobs as full-time, and a job posting said the same.

[Contra Costa Deputy County Administrator Theresa Speiker] said the 7,000 applications [for 204 positions] were “totally outside what we anticipated with the demand for these jobs. We were blown away.”

The new hires, many of whom left other full-time jobs for the call center positions, were told they were the “cream of the crop,” the recent hire said.

Orientation and training started in July, but stopped on the afternoon of July 18, when employees were told they would have private meetings about their positions, the employee said. …

The worker said no clear reasons for the change were given.

Those who became part-time were told they would have to pay full freight on their health plans, ranging from $600 to $1,200 a month for a single worker and between $1,400 to $2,900 a month for an employee with a family. That is a steep bill for employees with part-time jobs paying from $15.33 to $18.63 an hour.

Another applicant said he ditched another job offer after getting a congratulatory hiring letter from call center operators in June, only to be given the runaround in the months since.

During negotiations months ago, Service Employees International Union Local 1021, which represents the customer service agents, demanded 80 percent of health insurance premiums be paid by the county, and 20 percent be paid by the employee. SEIU did not return a call for comment.

Lambert here: You’d think the walking around money for SEIU — which did so much to destroy single payer when ObamaCare passed by funding HCAN and its shills — would actually deliver on something for the workers. Guess not.


New Health-Care Law’s Success Rests on the Young Online WSJ, 2013-07-25

Interviews here with more than two dozen single workers of modest income between 24 and 31 years old suggest that insurance plans will be a hard sell. Subsidies for 26-year-old workers range from $118 a month for someone earning under $16,000 to less than $1 a month for one earning $26,500, according to an analysis of insurance data.

For Mr. Meiffren, the cheapest available insurance plan he could buy with the subsidies would cost him $116 a month, with a $6,350 annual deductible. His subsidy would total $14 a month, based on his $25,000 annual income.

“I’m healthy, so it’s not in the budget,” Mr. Meiffren said after the lunch rush. He lost a full-time job—and his insurance—last fall. He said he moved to Portland from Los Angeles in March, looking for “a better vibe” and a lower cost of living [which would be harder to do with state-based exchanges.]

Lambert here: Again, people look at the premiums after subsidy, factor in the co-pays and the deductibles, and try to fit that figure into their budget. But nobody knows what the plans will actually cover or how, so nobody knows how the total package nets out. If the exchanges are like Expedia, it’s like buying an airline ticket for $500 without knowing the carrier (“Aeroflot? No thanks!”), the number of stops, (“Nobody expects a 36-hour layover in Helsinki!”), or the terms (“You mean I’ve got to pay for toilet paper by the sheet?”). If the exchanges are like Best Buy, it’s like spending the same $500 on flat-screen TV without knowing the brand or the specifications (“Black and white? WTF?”). In other words, the policies could be cheaper because they’re worse. A candy company will leave the price and the candy wrapper the same, and shrink the size of the bar. I would expect health insurance companies to do just the same.


Ad blitz for Obama’s health care law will cost at least $684 million AP, 2013-07-26

It will make you stronger. It will give you peace of mind and make you feel like a winner. Health insurance is what the country is talking about, so don’t be left out.

Sound like a sales pitch? Get ready for more. As President Obama’s health care law moves from theory to reality in coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.

The campaign won’t come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data The Associated Press compiled from federal and state sources.

Lambert here: More walking around money for cronies and insiders; a good product sells itself. Isn’t it too bad we’re not spending $684 million on health care?


Obamacare spurs creation of thousands of new jobs to explain law WaPo, 2013-07-26

Amid a torrent of speculation about the impact of ObamaCare on the economy, one thing seems clear: The law is spurring a raft of new jobs in call centers, IT companies and community organizations designed to help Americans understand the complex health law and navigate the new insurance marketplaces.

About 7,000 to 9,000 new customer service agents will be needed to man phones and Web chats for the marketplace, called an exchange, the federal government will run for more than half of the states, a spokesman for the Centers for Medicare and Medicaid Services said. Additional agents will be needed for exchanges run by the states themselves.

Altogether, tens of thousands of people could be hired over the next several years to set up and support the online marketplaces, according to some estimates.

Lambert here: Good jobs in the rental extraction field! Contact: rube.goldberg@whitehouse.gov. (Of course, under single payer, there could be jobs in delivering actual health care, instead of jobs in figuring out how to actually get health care.)


Distinction Bias: Misprediction and Mischoice Due to Joint Evaluation Journal of Personality and Social Psychology, 2004. (Via Health Care Economist.)

Briefly speaking, we suggest that the evaluation mode in which choices and predictions are made is often different from the evaluation mode in which experience takes place. Choices and predictions are often made in the joint evaluation (JE) mode, in which the choosers or predictors compare multiple options or scenarios. On the other hand, the actual experience typically takes place in the single evaluation or separate evaluation (SE) mode, in which experiencers face only the option or scenario they or others have chosen for them. Because of the JE/SE difference, people in JE may overpredict the experiential difference between alterna-tives in SE…. More importantly, our theory suggests that in making decisions, people are more likely to overestimate the impact of factors such as income and home size than to overestimate the impact of factors such as health and marriage. We hope that our theory can help people make better predictions and hap-pier choices.

Lambert here: The decisions about plans on the Exchange will be JE. The experience of the plan will be SE. Somebody smarter about economics than I am might be able to figure out the implications of this.


GitHub: How an Open Source Programming Tool With a Funny Name Could Help Revolutionize Medical Research The Health Care Blog, 2013-07-28

So again, you may ask, why should physicians or medical researchers care about GitHub?  Because it can have broader application beyond the software/web programming world, as shown by its use among non programmers, who are currently repurposing Github to advance collaborate in their own respective fields.  They are posting book projects and transcripts of talks on the site, to encourage conversation and collaboration. … We usually share this experience and knowledge in a piecemeal way to just a few individuals who we happen to see on a daily basis. If we could share all of this information more openly and widely with the community, we could reduce work that is menial and duplicative, which would enable us to accelerate research in much more meaningful ways.


Obamacare Canvassers Seek Out Florida’s Uninsured Kaiser Health News, 2013-07-29

Enroll America’s “Get Covered America” campaign, which canvassed neighborhoods across Florida, New Jersey, Ohio and several other states Saturday to kick off several months of outreach efforts. The group, which is funded by health insurers, hospitals, philanthropies and others, has close ties to the Obama administration. It’s trying to educate [enroll] consumers about new insurance options and drive enrollment in the new marketplaces opening this fall for coverage that takes effect in January. … Laplanche and other volunteers were given a sample script to approach people, explaining what Enroll America is and that they are not selling anything. … “Don’t get into any political conversations,” French told the nine volunteers who met outside the city’s new library.


State health exchange rates vary, but lower than expected USA Today, 2013-07-29

As state health exchanges continue to announce lower-than-expected rates for health insurance, experts say both state and regional issues play a part in how much a consumer will pay for insurance beginning in January.

The actual rates are lower than HHS, the Government Accountability Office and insurance companies expected them to be. The Society of Actuaries estimated that underlying claims costs could go up by an average of 32% by 2017.

For Americans who receive health insurance through their employees, HHS statistics show those rates are stabilizing. Those rates increased by 3% from 2011 to 2012, the lowest increase since 1996.


Watchdog requests IRS review of group that is promoting ObamaCare The Hill, 2013-07-29.

Cause of Action has asked the IRS to investigate Enroll America, a nonprofit that is encouraging people to enroll in new coverage options under the healthcare law.

Cause of Action said the organization should not have tax-exempt status because increased ObamaCare enrollment will benefit the healthcare industries that sit on Enroll America’s board.

“As Enroll America’s purpose is so closely aligned with the commercial interests of these for-profit entities, its activities thus far demonstrate that it is little more than a trade association for the healthcare industry, employing marketing tactics and its high-level access to executive branch officials as a means to increase the sale of healthcare services,” Cause of Action’s complaint states.

Lambert here: I’m linking to this in case it gets bigger. There’s no About page on the Cause of Action site, no board, no list of funders. The Executive Director was big on ACORN. Personally, I think the ObamaCare rollout is, among other things, a gigantic machine to feed walking around money to the Democratic nomenklatura, but if the Republicans limited ability to gin up of scandals since 2008 is any guide, CoA’s request will at best turn into more red meat for the base, and never break out into the mainstream. So, kayfabe.


Obamacare Spin 101: How to make premiums seem really cheap – or insanely expensive Sarah Kliff, WaPo, 2013-07-29

Maryland put out the raw data, including exactly how much it would cost adults, young and old, to purchase health coverage. There were lots of ways to understand that information. Here’s the headline that The Washington Post ran Saturday on new rates: “Maryland issues insurance rates that are among the lowest in the U.S.” That sounds like great news: When you stack up Maryland’s insurance rates against the rest of the country’s, they come in significantly lower. Part of this has to do with the structure of Maryland’s insurance market: Regulators have final approval rights on insurance rates, meaning they can tell health plans to reduce initial premium proposals. And this headline makes it seem like the process is working, and Marylanders are getting a great deal.

That was our headline. But there was also this headline, in the Baltimore Sun, that would likely leave readers with a much different impression of health costs under Obamacare: “Premiums to go up as much as 25 percent under health reform.” The Sun covered the exact same data as The Post but instead compared the new rates against the rates offered in 2013. The paper homed in on one specific rate filing, from Aetna, noting that the “highest rate increase of 25.4 percent was granted” to the national health plan.

In short, health premiums are complex. Comparisons to other information can make rates seem like a bargain-basement deal or an outrageous ask. It all depends on which health-care adventure you choose.


New Report on State Approaches to Nondiscrimination under the Affordable Care Act Center on Health Insurance Reforms, 2013-07-29

Among its many new protections, the ACA ushers in significant requirements designed to limit discriminatory benefit design. Under the ACA, insurers are prohibited from adopting benefit designs—or implementing benefit designs (such as through coverage decisions, reimbursement rates, or incentive programs)—that discriminate based on age, expected length of life, disability, medical dependency, quality of life, or other health conditions. Insurers also cannot 1) adopt benefit designs that discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation; or 2) utilize discriminatory marketing practices or benefit designs that discourage the enrollment of individuals with significant health needs. … These findings suggest that regulators face practical limitations in trying to implement new nondiscrimination requirements. Further, some regulators may not be willing to assume a much broader role in defining discriminatory benefit design without clearer federal standards. In light of such limitations, ensuring that the ACA’s nondiscrimination standards are met likely requires ongoing monitoring of consumer complaints, the development of new infrastructure such as tracking systems, and robust grievance and appeals processes. … Our findings also raise questions about whether the essential health benefits benchmark plan approach may have perpetuated the inclusion of discriminatory benefit designs in at least some states by requiring the selection of benchmark plans that were not designed to be in compliance with the ACA’s most significant reforms.


An Obamacare scorecard, Part 1 Trudy Rubin, CJR, 2013-07-29. Read it all!

[Co-op insurance companies] are gone, too. About $6 billion in federal start-up money for co-ops was supposed to spur their development as a lower-priced alternative to big insurance carriers; it was sort of a sop to the public option advocates. Twenty-four co-ops were funded even though the government had begun to reduce funding. Then came the New Year’s surprise. In final negotiations over the fiscal cliff deal, Congress killed the remaining funding for 40 more co-ops whose applications were in the pipeline. Insurers, it seems, were not keen on the new competition.

Because about 60 percent of people buying in the exchange probably will be eligible for subsidies, exchange officials needed a way to verify if they were indeed eligible; that is their income was low enough and they had no other insurance coverage. But the administration says that they have now encountered “legislative and operational barriers.” The upshot: the government will rely on the honor system* to make sure applicants for insurance are telling the truth about their income and insurance status. The government will do a check when people file their income tax returns in 2015. If income and insurance status change during the year, a family could end up with a tax liability or a tax refund, depending on the subsidy they got and whether their incomes went up or down during the year.

Lambert here: This is not quite correct. There will be income verification by credit reporting agencies, presumably on a random basishonor


An Obamacare scorecard, Part 2 Trudy Rubin, CJR 2013-07-30. Again, read it all!

The next stage of Obamacare is the one that we should watch most carefully, as exchanges set up by the law start selling insurance policies to the unininsured and granting subsidies help people pay for them—the heart of the Affordable Care Act. If people get better insurance for the buck, and decide they can afford the coverage rather than pay the tax penalty, and sign up in droves—that’s a huge hit. But it’s a complicated machine to start up and operate, and reporters need to watch closely. There are bound to be misses and mixed results. Whether they will undermine the success of the law is a big unknown. Neither the Democrats, the Republicans, or the press has a crystal ball.

Lambert here: What Katiebird and I feel is that we cannot know. The touted premium decreases — all proposals until 10/1 — mean nothing until we can calculate how the total package nets out. We need to know not just the premiums, but the co-pays, the deductibles, what is actually covered. And then many of us have complex, cobbled-together personal health systems based on a particular doctor and a particular treatment know to work. What about us? And will the Exhanges really make purchasing health insurance like buying a flat-screen TV? Of course not. This is a demented claim, yet Obama continues to sell it.

7 Responses

  1. In California I think I read that the provider networks for plans on the Exchanges are only about 36% of the size of the provider networks outside of the Exchanges.

    Another interesting number? Only 35% of doctors in the Seattle area accept Medicaid.

    This may be far-fetched, but what do you bet the docs in the provider networks on the Exchanges will be the same ones that accept Medicaid? You know…the third rate docs that have trouble getting patients so they have to accept a rate cut to get any money at all?

    Anyway, me thinks this will all be a huge mess.

  2. FDR wouldn’t have put up with this.

  3. I’ve enjoyed your “Lambert here” comments as much as I have learning how screwed up this piece of shit legislation really is. Keep it up!!!

  4. OT: Does anybody know how many of the Democrat elites called for Carlos to quit the mayoral race?

    How many cable news anchors called for him to be taken into a room and beaten ala Hillary?

    Or does Mr. Danger get a man club pass?

  5. There is absolutely no way in God’s green Earth that if I was making $2150 a month I’d fork out over $100 a month for a health plan that would require me to save over $530 monthly on an ANNUAL basis to meet the deductible to actually get any coverage from the insurance industry.

    Nope, Nope, Nope….I’d save up the 2.5% for a fine ($54 a month) and pay all my stuff out of pocket. At $200 a month I’d still have a $146 sum to roll over monthly and let’s face it if it took over 1/4 of my income($630) to have what amounts to catastrophic coverage then I’m screwed anyway might as well ante in at $54 and roll the health care dice. And I’m not even in my 20s

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