• Tips gratefully accepted here. Thanks!:

  • Recent Comments

    riverdaughter on Calm your tits, Donny
    riverdaughter on Calm your tits, Donny
    Ivory Bill Woodpecke… on Calm your tits, Donny
    Propertius on Calm your tits, Donny
    Propertius on Calm your tits, Donny
    Beata on Wordle Playing Update
    jmac on Wordle Playing Update
    William on Wordle Playing Update
    jmac on Wordle Playing Update
    jmac on “Then They Came For Fani…
    William on “Then They Came For Fani…
    William on “Then They Came For Fani…
    Seagrl on “Then They Came For Fani…
    William on “Meet John Doe,” T…
    Propertius on “Meet John Doe,” T…
  • Categories

  • Tags

    abortion Add new tag Afghanistan Al Franken Anglachel Atrios bankers Barack Obama Bernie Sanders big pharma Bill Clinton cocktails Conflucians Say Dailykos Democratic Party Democrats Digby DNC Donald Trump Donna Brazile Economy Elizabeth Warren feminism Florida Fox News General Glenn Beck Glenn Greenwald Goldman Sachs health care Health Care Reform Hillary Clinton Howard Dean John Edwards John McCain Jon Corzine Karl Rove Matt Taibbi Media medicare Michelle Obama Michigan misogyny Mitt Romney Morning Edition Morning News Links Nancy Pelosi New Jersey news NO WE WON'T Obama Obamacare OccupyWallStreet occupy wall street Open thread Paul Krugman Politics Presidential Election 2008 PUMA racism Republicans research Sarah Palin sexism Single Payer snark Social Security Supreme Court Terry Gross Texas Tim Geithner unemployment Wall Street WikiLeaks women
  • Archives

  • History

    July 2013
    S M T W T F S
  • RSS Paul Krugman: Conscience of a Liberal

    • An error has occurred; the feed is probably down. Try again later.
  • The Confluence

    The Confluence

  • RSS Suburban Guerrilla

  • RSS Ian Welsh

    • Consequences Of Indicting Trump
      So, a New York DA has charged Trump. There’s some posturing by DeSantis, but Trump will almost certainly go to New York and surrender. This is a watershed moment, no former President has ever been charged with a crime. This is a political act. Many President have committed crimes and have not been charged. It will lead to red state DAs indicting Democratic p […]
  • Top Posts

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.

Things I learned this week and other stuff

If you're 5 and can read this sign...

If you’re 5 and can read this sign…

I went back to work full time this week after my prolonged involuntary sabbatical featuring periodic consulting work.  Here’s what I learned:

1.) Don’t park in Oakland.  Just don’t.  Fortunately, this is only temporary for the summer because I have to drop the kid off somewhere else and can’t take public transportation.  In the fall, I’m taking the bus that’s within walking distance from my house.  My brilliant plan to take public transportation will work perfectly.  Bwahahahahahahahahhhhh!**

2.) It’s easier to get up and get going at 6am than 9am.  Go figure.  I guess I really am a morning person. If I get up too late, I might as well bag the rest of the day.

3.) Don’t take the Parkway to work, especially if your route has to go through the Squirrel Hill tunnels.  Getting to work on time?  Nah-gah-happen.

4.) If you want to get to the South Side in the morning, do the counterintuitive route and go east and then north west.  Sounds bizarre but I cut a lot of time off my trip and the view of Pittsburgh in the morning as I’m flying over the bridges is spectacular. We were gobsmacked. It looks like some skyline poster from the early twentieth century and you can almost hear Rhapsody in Blue playing in the background. I need to get a dash mountable video camera.  Pittsburgh really is beautiful.  Buy real estate now because when the rest of the biotech industry decides to move here, the neighborhoods with the great views will be in high demand.  I almost feel like buying a fixer upper nearer to downtown to renovate.  (No, no, stop me before I buy again.  What am I thinking??)

5.) Another counterintuitive thing: There’s more variety and diversity in Pittsburgh than in suburban New Jersey.  What I mean to say is that the marketers haven’t really pinned down this city so there seems to be a lot of choice here where there’s virtually no choice in New Jersey.  I feel like I’ve been missing something for the past 20 years.

Last night, Brook, who is changing her look, bought something at Hot Topic and the kid running the cash register asked us where we were from.  We told her we were fugitives from New Jersey.IMG_1978

** What is with the conservatives’ hatred of public transportation and trains??  I don’t get it.  30 years ago, I got around Pittsburgh without a car because the bus system was excellent.  In the past few years, funding for the PAT bus system has been cut, as have many routes.  This is a real problem for the studdabuppas who never learned to drive and now find themselves stranded in their neighborhoods without the buses they used to rely on.  In my case, the bus will stop close to my house at 7:04am and I will have to transfer closer to town.  I used to be able to take the bus directly to my destination but someone decided that people in the east suburbs didn’t need as many buses so they cut back and changed the route.  That means more traffic gets dumped onto the Parkway and snarls local roads on the way downtown.  And this is the summer.  I can’t wait to see what it’s like in the fall when everyone is back from vacation.

One disturbing trend I’ve heard from a couple of my  40 something cousins is that they think it’s alarming when an employer has to pay benefits to new hires and I think that’s part of what’s behind the cutbacks in public transportation.  The PAT drivers are union and they get bennies.  So, if there are fewer buses and more complaints, maybe there will be more pressure on the unions to drop their demands for benefits. The public might be willing to chuck the bennies in exchange for more bus drivers who are new hires not covered by the old contracts.  Just speculation on my part as to what the politicians are thinking.  I think it’s going to be tough to convince a lot of the boomer generation though who grew up in a very union city where the buses ran great and who still think that there’s nothing wrong with benefits.

Pittsburgh could use more trains.  It’s depressing to walk through Oakmont, a lovely little town on the Allegheny not too far from me, and see the unused train tracks that run right through the center of town to downtown.  Now, that former commuter train area is a pretty landscaped park.  I’m not exactly sure why it can’t be prettily landscaped and functional but for some bizarre reason known only to the editorial columnists at the Wall Street Journal, the wealthy, powerful and Republican hate, Hate, HATE trains, even if it means that the minions can’t get to work on time with the least amount of trouble and expense.

I’m not sure I understand the reasoning behind this.  The wealthy and Republicans don’t need trains so no one can have them?  It’s perfectly ok to spend $150 million of public funds on a new sports facility because that’s what the wealthy want but not ok to spend the same amount of money on a better bus system because that’s what the not so wealthy want??  Who died and made them gods?  Where do they think they’re living? Rome?  Even Rome knew that it was a bad idea to skimp on the bread for the masses.  What’s really a bad idea is to party like there’s no tomorrow while the natives get restless and the barbarians are at the gate.

PPACA Links: 2013-07-24

Readers, this should have been Monday, but with painting and other things to do, my schedule has gotten a little out of control. –lambert

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09 Health Affairs, July 2013

In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

Countdown To The Health Insurance Marketplaces: Four Actions Essential To Success Health Affairs, 2013-07-08. Note that the administration has adopted a diametrically opposed campaign strategy.

We recommend four actions that policy makers should take to promote the success of the marketplaces, the structured exchanges where consumers will shop for health coverage under the ACA. Some of these actions can be implemented before the October 1 launch date, while others will need to be initiated now to bring about changes needed by 2015 and 2016.

  1. The marketplaces must disallow unreasonable prices from insurers.
  2. A unified national campaign should be launched to attract a broad pool of marketplace enrollees.
  3. Consumers receiving advanced premium tax credits to purchase insurance should be protected from unanticipated tax liability for the first two years of operation, so that the marketplaces attract as many people as possible.
  4. New non-profit consumer-run insurance plans (CO-OPs) sponsored by the ACA should have funding restored. This would enable more CO-OPs to enter the market in 2015 and 2016 to help hold down prices in the 26 states where they do not yet exist. In addition, the Office of Personnel Management (OPM), responsible for contracting with at least two “national plans” to enter each state to spur competition, should focus on developing networks of smaller plans to serve as national plans in 2015; this would avoid giving greater market share to dominant insurers. </li

43% Believe that US Health Care is Corrupt, 64% that Government is Run by a Few Big Interests, Media Shrug Health Care Renewal, 2013-07-10

More than one-third (43%) of [Transparency International] respondents thought that US health care is corrupt. …

For comparison, the proportions of people who thought the health care sector is corrupt were 24% in Canada, 28% in France, 48% in Germany, 47% in Japan, and 19% in the United Kingdom.

Friends with Benefits, Insureblog 2013-07-15. Walking around money.

[Among others:] The advertising firm Porter Novelli was founded by William D. Novelli, who was the CEO of AARP from 2001-2009. Catherine “Kiki” McLean is a senior partner and managing director of Porter Novelli. She is a Democratic Party operative who worked for the campaigns of Al Gore, John Kerry, and Hillary Clinton, as well as the 2008 presidential campaign of Barack Obama. McLean was hired by Porter Novelli in June of 2009. Since 2010, Porter Novelli has been awarded $49 million in HHS contracts.

Health Insurance Marketplace by State Commonwealth Fund

[Handy interactive map.]

Health Insurance Exchanges and State Decisions Health Affairs, 2013-07-18. Neutral evaluation of the state of play.

Although GAO and others have questioned exchanges’ ability to be fully operational in time for open enrollment, particularly given the compressed time frame in which exchanges and supporting infrastructure are being developed, HHS maintains that exchanges will be ready on time. Key milestones to be completed in the months before open enrollment include testing state and federal information technology systems, certifying plans, and training and certifying navigators and in-person assisters.

Are the Wheels Coming off the ACA Wagon? History Suggests Not Center on Health Insurance Reforms 2013-07-18

These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs. …. These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs.

Consumers In Most States Unlikely To See N.Y.’s 50 Percent Reduction In Premiums In Individual Market Kaiser Health News, 2013-07-19

New York’s announcement this week that insurance premiums would drop 50 percent next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the health law, but consumers in most states are unlikely to see similar savings.

That’s because only a handful have New York’s rules, which like the federal law bar insurers from rejecting people with health problems. Unlike the federal law, however, New York does not require consumers to purchase coverage, so over time, mainly older, sicker people, have purchased coverage. That drove up prices and discouraged younger, healthier people from buying policies, as did a requirement that insurers charge the same rates regardless of age or health status.

“ObamaCare” Small Ball––The Republicans Are Winning the Battle Over the Big Idea Health Care Policy and Marketplace Review 2013-07-21

It shouldn’t be a surprise that this administration, now buried in the minutia of injecting an extraordinary amount of micro management into a sixth of our economy, would think a $100 rebate for someone already paying thousands of dollars in health insurance premiums would be a major accomplishment.

GOP support grows to force shutdown over funding ObamaCare The Hill, 2013-07-22

Sen. Mike Lee (R-Utah) said he’s recruited more than a dozen Senate Republicans willing to shut down the government to prevent President Obama’s healthcare law from going into effect.

Lee said the Republicans would block a continuing resolution to fund the government beyond Sept. 30 if it includes funding for ObamaCare.

Lee acknowledged that certain parts of the law were popular, such as coverage for pre-existing conditions and children being able to stay on their parent’s coverage until they’re 26 but said that since these parts had already been implemented, Republicans weren’t looking to do away with them.

Majority of employers already in compliance with ACA mandate Health Reform Talk, 2013-07-22.

The majority of employers (56 percent) said that they are already in compliance with the employer mandate under the Patient Protection and Affordable Care Act (ACA), according to recent research from PricewaterhouseCoopers (PwC). … Overall, 72 percent of private companies said that they were prepared for the ACA’s next wave of requirements, but only 35 percent said that they were well prepared.

Phillip Caper, The end of Obamacare? Think again Bangor Daily News, 2013-07-22

Despite its serious flaws, Obamacare has benefits, some intended and others not. One major barrier to reform of our health care system has been apathy on the part of people who already have good health care coverage (“I’ve got mine”) or who have been lucky enough not to need health care (the young and healthy), and are therefore unaware of our system’s many problems. That’s about to change. Due to its requirement that as many people as possible have health insurance (the individual and employer mandates) the apathetic population is about to become dramatically reduced. Like it or not, many more people in the U.S. are about to become engaged in the health care system.

Q & A – Early Implementation of MAGI HealthLaw.org 2013-07-23

The Affordable Care Act (ACA) requires all states to implement the new income counting methodology, Modified Adjusted Gross Income (MAGI) , for applicable Medicaid eligibility categories beginning January 1, 2014. To help facilitate the transition to MAGI, CMS issued guidance allowing states to implement MAGI on October 1, 2013, coinciding with the beginning of open enrollment in the new health insurance marketplaces (exchanges). The following addresses questions and concerns regarding the early implementation of MAGI.

Q 1 . Why should a state implement MAGI early?

A. Early implementation of MAGI will simplify and streamline state Medicaid eligibility processes. During the open enrollment period from October 1 to December 31, 2013 , states must screen applicants for eligibility for insurance affordability programs using two different sets of rules – the state’s existing Medicaid rules to determine who is immediately eligible , and the new MAGI rules to identify those eligible January 1, 2014. By implementing MAGI early, states can use just one income counting methodology for all new applicants . Early implementation will also ease the transition by allowing states to operationalize new systems before the influx of new applicants expected when new coverage options become available in January 2014.

OFA embraces tea party blueprint for August push Politico 2013-07-23

OFA’s preparing a range of under-the-national-radar tactics in conjunction with heading for town halls. Rallies, distribution of fliers and district office demonstrations will be aimed at drawing the same sort of local attention that tea party groups managed four years ago, hoping to spook members of Congress worried about the 2014 midterms.

[T]he group has grown more quickly than even its leaders anticipated, raised millions of dollars and hired 26 state directors, but they’re still building support staff and volunteers out in the states. Even at the meeting on Monday night, a call from Planned Parenthood Action Fund President Cecile Richards to get involved in Arkansas revealed that none of the prospective action leaders in the room actually lived in the state (though one woman in the crowd shouted that she used to live there).

They’ll begin Aug. 4, marking the president’s birthday with a day of events organized to promote the benefits of Obamacare.

Quick Notes about Pittsburgh


Parrothead pastries at The Oakmont Bakery

There are a couple of posts in the NYTimes today that are full of praise for the economic recovery of Pittsburgh.  (Here and a Krugman post here.)  So, I thought I’d throw in my 2 cents.

First, I love it here.  People are just nicer than they are in Jersey.  And there are fewer of them.

Second, it is true that you can get higher incomes in places like Boston and San Francisco.  A lot of people who lost their good salaries in NJ due to Pharmageddon decided to try their luck in Massachusetts because that’s where all the lemming CEOs pharma companies relocated a fraction of their workforce and where there are a bunch of start up companies.  And I thought about that- for about 15 seconds.

Although the chances of finding a job up there for me is slightly greater than in NJ, job insecurity comes with it.  I heard from a lot of people who were transferred there or got a job in a start up there or were already working there and they hated it.  They were scared to death of losing their jobs, the cost of living was astronomical and the commute from the burbs to Cambridge proper is ridiculous.  It was even more ridiculous when you consider that even with their good salaries, they couldn’t afford to live close to work.  So, I crossed it off my list.  I didn’t want to drag a teenager to a place where I could lose another job and spend all my money on rent and taxes because my salary was high.  It sounded like an unreasonably risky thing to do for a job.  I have no idea what the bonus class is thinking but I think it has something to do with the status of being near Harvard and MIT.  In my humble opinion, that is not a good enough reason in the age of internet to risk your staff’s domestic security and increase its precariousness.  Precariats are under too much stress to be innovative creative types.  You can’t whip and threaten them and expect them to discover all the time.  Nah-gah-happen.

When I sat down and did the math, I figured that I could have the same standard of living in Pittsburgh, on a much more modest salary, as I would in Cambridge or NJ AND because I own my home without a mortgage, I am not in danger of losing my house if the job goes away.  I can eek out a living here as a bartender and still live reasonably well.  Fortunately, I won’t have to relearn how to pour but if I had to, it wouldn’t have been an issue.

So, I’m glad that Pittsburgh is now being held up as a model of urban renaissance because it deserves it, although it would be great if the bus capacity went back to what it was 20 years ago.

Zimmerman’s defense sounds vaguely familiar

So, I was reading about Zimmerman’s defense, since I wasn’t hanging on every word during the trial and I prefer to read than have the visual and auditory clutter of the talking heads on TV jamming my internal logic board, and I got a sudden rush of deja vu, or vuja de or something.  Here are the money quotes:

Members of the jury took notes furiously as Officer Singleton later read out Zimmerman’s hand-written statement to the court.

‘As I headed back to my vehicle the suspect emerged from the darkness and said, “You got a problem?” and I said “No” and the suspect said, “You do now”.

‘Each time I attempted to sit up the suspect slammed my head. My head felt like it was going to explode.

‘I tried to slide out from under the suspect and continued to yell “help”. As I slid, the suspect covered my mouth and nose and stopped my breathing.

‘At this point I felt the suspect reach for my now-exposed firearm and say, “you are going to die tonight motherf***er”.’

Hmmm.  I mean hummmm.  I started hearing a little song in my head.  Something about a convent girl from Mississippi who got involved with jazz and liquor:

It worked so well for Roxy Hart.


I have to present my papers tomorrow for the third or fourth time since I moved from NJ.  This time it’s for a certification that I am a natural born US citizen who is able to work in the US.  It used to be that all you needed to present was a SSN.  That’s not good enough anymore.  Can I just say that my birth certificate is getting pretty fricking ragged at this point.  And my social security card.  AND my divorce papers that show that I am legally allowed to use my original name. AND my passport, deed to my house, three utility bills, etc, etc, etc.  Where does it stop??  I have to keep a dossier ready at all times.  No, I’m not kidding. If this is what elderly and minority voters are going through, we might as well just cancel all elections from now until eternity and let Republicans run everything.  This level of identification is beyond ridiculous and is bound to hit women harder than men.

I definitely do not like the feeling I’m getting of having to carry around so much official documentation all the time.

More what’s wrong with these people, er, picture?

Screen Shot 2013-07-21 at 8.36.40 AM

So, to recap:

Leakers and whistleblowers who tell us what’s really going on in our opaque neoauthoritarian government get the full force of the law thrown at them, their lives, fortunes and futures ruined.  See, the Obama administration is doing us a favor by catching up on all the cases that were unprosecuted.

BANKERS, who have acted like relapsed gamblers anonymous attendees on a weekend binge, and who ruin the lives, fortunes and futures of billions of people across the world through their reckless, irresponsible, greedy, cheating behavior get a tap on the wrist and the equivalent of a speeding ticket in fines.

Priorities, you know.

This is what the so-called “liberal base” voted for because, well, he could have been Trayvon Martin* and apparently no other disadvantaged group in the country has ever had people telling them they couldn’t do something, especially not women, who never have anyone tell them they can’t do anything.  Except in Texas, Virginia, Ohio, the Dakotas, and pretty much everywhere in the country where it’s Ok to treat women like second class citizens and brains where jobs, money, authority and promotions are concerned.  Otherwise, you know, we could be president.  Or not, depending on whether there is a disadvantaged group represented by a male who gets there first.  Because, you know, females have it easy compared to guys.

{{rolling eyes}}

Wake me when this ridiculous fiasco of a presidency is over. Or when the Obots grow a clue.  Whichever comes first.

*Disclaimer: For the record, I am shocked and dismayed by the jury verdict for George Zimmerman. Trayvon Martin was racially profiled by Zimmerman and pre-emptively taken out before he had a chance to grow up.  That was outrageous and shameful. I blame the state of Florida for creating the law that allowed the guy to get away with murder.  But the Republicans have successfully made this country and its laws into an affirmative action program for white guys and I see absolutely no evidence that Obama has done anything in his past or recent present to change that.  A speech, which turns out to be nothing more than mental masturbation, doesn’t cut it, IMHO.  To spell it out for the Obots, Obama uses race as a distraction for his base.  He identifies with the victim and you guys forget that he’s really just a corporate ladder climbing guy who is not doing anything you want him to do as far as the war, economy, finance sector, improving the lives of the poor and disenfranchised  or anything else you find important.  He dogwhistles race, you forget about Afghanistan and unemployment.  Just because Republicans criticize Obama for his reaction to Trayvon Martin doesn’t mean they’re wrong in pointing out his hypocrisy.  They’re just focusing on different issues and their own f^&*ed up agenda.  In this case, the Republicans are not suffering from the cult of personality like the left.  They’re clear headed and smart enough to see what’s going on and are exploiting it to their own nefarious ends while the left is still infatuated and completely losing the plot.

What’s wrong with these people, er, this picture?

Screen Shot 2013-07-19 at 7.18.27 AM

Oo! Oo!  I know how to fix this!  Maybe we can take the fines from the banks like Chase, who now consider fines just protection money they have to pay so they can keep doing what they want, and use it to make Detroit solvent.  Or would we hear whining from Wall Street that it is unfaaaaair to redistribute our country’s tax dollars to the unworthy?



In another story of bad deed doing, Glaxo Smith Kline (GSK) is creating an international incident in China where it has been accused of bribing government officials and doctors with about $500 million in order to raise the price of their prescription drugs.  Note that it was probably the testosterone and amphetamine soaked sales department that came up with this brilliant idea.  Now, China is forbidding GSK’s finance director from leaving the country.  What a splendid idea!  Maybe we should send all of our misbehaving finance directors to China.  Derek Lowe has more on the story.

If I recall correctly, the GSK research site in Shanghai was also accused of some falsification of data that lead to publications being pulled from Nature.  Hey, the management in China wanted to show it could get publications in Nature so it did- by lying.  For a brief time there, the Shanghai site was probably held up as a model of research brilliance by the executive class to all of the other global, loser “centers of excellence” at GSK.  That ought to give the King of Prussia, PA site a nice warm and fuzzy feeling.  We shouldn’t be surprised by the China syndrome.  One of my Chinese colleagues told me that China wasn’t like the US in terms of business infrastructure and relatively low levels of corruption but that only time would prove to the executive class that China wasn’t ready for a world class research industry.

It’s also GSK that proposed to pay their scientists million dollar bonuses if a drug candidate goes blockbuster.  Read Derek Lowe’s post on the topic for a run down of why this is a phenomenally bad idea.

GSK, this week’s poster child.

Personal Update

Just thought you’d like to know, I got a job. I start next week. Commence the Snoopy Dance.

If I’ve done my calculations correctly, this move to Pgh was the right one from an economic standpoint. Maybe it’s too early to call it a success, since I haven’t started working yet, but I think I will like this job very much.

So, I’d like to roll the credits for those people who helped me stick it out since disaster struck in 2011, including all of you faithful Conflucians. You really get to know who your friends are and what kind of character they have when something like this happens to you. All of these people showed the highest quality:












Randy Scott

Pat and Frannie

Sister Beth

All my Aunts, Uncles and Cousins

Tikva and Dave



and last but absolutely not least and most importantly,


Thank you all. I’m going to spend the rest of the week working on my house and finding work appropriate clothes. I know they’re in a box here somewhere…

PPACA Links: 2013-07-17

Readers: Here’s the latest in a series of posts that collect what I hope are the most interesting stories of the week on the PPACA (ObamaCare). This is a huge subject to cover, so if you have additional links, please add them in comments! I’m afraid I’ve only been able to contribute this on a nominal Tuesday, since I had a very late night on Monday. –lambert

Health Reform Rule Change Will Not Stop Important Verification Judy Solomon, Off The Charts 2013-07-08

In the last several days, some media coverage has seriously misinterpreted changes to how health reform’s new health insurance marketplaces (formerly called exchanges) will verify that applicants are eligible for federal health insurance subsidies.&nbsp; The changes to verification procedures, which the Department of Health and Human Services (HHS) announced in a new rule on Friday, are really rather modest.&nbsp; All marketplaces — both state- and federally run — will still conduct important checks of applicants’ income and require applicants to provide information on any coverage that employers offer.

The changes announced Friday apply only to the 16 states (plus the District of Columbia) that will operate their own marketplaces, and the changes — which are optional for these states — are designed to make the process easier for the states to administer as they get their marketplaces up and running.&nbsp; The changes do not affect the remaining 34 states that will rely on the federally facilitated marketplace to determine eligibility for the health insurance subsidies, which will come in the form of premium tax credits.

Moreover, a rigorous income verification process remains in place in all states, including those that will operate their own marketplaces. &nbsp;All marketplaces must first check the income level that an individual reports on his or her application against a federal database that contains data on the applicant’s federal income tax returns, as well as information on his or her Social Security benefits if any.

White House scrambles to get ready for ObamaCare implementation The Hill, 2013-07-09

Earlier rules had called for each state’s exchange to independently verify information submitted by people seeking insurance, including their annual income and whether they were able to buy healthcare coverage through their employer. But the Heath and Human Services Department said in new regulations Friday [July 5] that exchanges could accept the information submitted by most applicants and double-check only a limited sample. [George Washington University professor Sara] Rosenbaum said, the exchanges are now relying solely on applicants to determine not only whether they’re eligible for employer-based coverage, but whether that coverage meets the healthcare law’s definition of affordability. “That is nothing that any mere mortal would ever know,” she said.

Lambert here: The forms are filled out under penalty of perjury. And excess subsidies can be clawed back. Surely this new rule is an accident waiting to happen?

People Who Haven’t Filed a Tax Return to Get Unverified Health Insurance Exchange Subsidies Health Care Policy and Marketplace Review, 2013-07-10

The head of the Centers for Medicare and Medicaid, Marilyn Tavenner, is out with a “Myths vs. Fact” clarification memo regarding the waiver of the employer mandate and whether the new health insurance exchanges will verify people’s incomes when calculating subsidies. What everybody is trying to figure out is why the administration has suddenly said they aren’t going to check the vast majority of applicants where the information doesn’t match and the applicant can’t explain it? … Tavenner said in her “Myth vs. Fact” memo that “there have been some mischaracterizations of these regulations,” and “she suggested we needed to do a reality check on some of the myths that have been circulating.” … I will suggest the most important thing the administration could do toward making people understand what’s going on here is to tell us exactly why they aren’t going to make an attempt to verify every applicant’s representation that doesn’t make sense. … And, since they are putting so much faith in the IRS correcting any subsidy problems later when people file their tax returns, they can also tell us what they are going to do about giving people benefits that don’t have a history of filing tax returns.

Obama, Congress shifting billions from public health initiatives to other programs Saint Louis Beacon, 2013-07-11

Unprecedented spending to prevent illness and improve public health is one key promise of the Affordable Care Act. That’s why $18 billion had been set aside for a newly created Prevention and Public Health Fund under Title IV of the law. Its goals include relying on innovative public health policies to address problems such as obesity and tobacco use. The first chunk of money taken from the fund for non-prevention purposes occurred late last year when the Obama administration and Congress agreed to use $6.2 billion from the fund for other purposes over a nine-year period. The reduction was used to offset pending cuts in Medicare payments to physicians. This year, HHS is taking another $500 million from the fund, partly to underwrite insurance exchange activities. Developments like these are raising concerns that most of this money might never get used for its intended focus on public health issues.

Final navigator rule has few concessions for brokers, agents Modern Healthcare, 2013-07-12

Navigators hired to help Americans sign up for expanded coverage under the healthcare reform law must receive at least 30 hours of training, according to a final rule on the navigator program (PDF) issued by the CMS Friday. … “We believe that up to 30 hours of training, as stated in the proposed rule, is sufficient for navigators and non-navigator assistance personnel in federally facilitated exchanges and state partnership exchanges to perform their duties and is in keeping with the number of hours of training many states require for individuals seeking licensure as an agent or broker,” the rule states. … The final rule also makes clear who cannot become navigators, assistance personnel, or counselors. “In all exchange models, entities ineligible to become navigators include health insurance issuers and their subsidiaries, issuers of stop loss insurance and their subsidiaries, associations that include members of or that lobby on behalf of the insurance industry, and entities that receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP insurance product.”

But associations such as chambers of commerce are permitted to have a non-navigator assistance program.

Agents and brokers are permitted to continue to help people individuals enroll individuals and groups with health coverage, including through an exchange, but will be compensated by insurance companies, as allowed by state laws, just as they always have.

Obamacare Delay? What Obamacare Delay? National Journal, 2013-07-12

States and health plans have begun testing some data exchange with the federal hub. But states have been testing “clean” data, meaning that every name is spelled perfectly and every Social Security number is entered correctly. Ultimately, the data hub will need to identify people and their information even with typos and errors. Still, while the public deadline is Oct. 1, HHS and its contractors will realistically have a little extra time to fix IT problems. The insurance plans won’t go live until January, leaving a cushion if parts of the system have to default to paper, or if delays arise in processing applications. Cheryl Smith, a senior practitioner at Deloitte, worked on the Utah small-business health exchange, which launched in 2009. Before the open-enrollment deadline, “I had holes in my stomach,” she says. “We got to that day and I realized, this is not really the launch.” As long as the website goes live in October and people have new insurance plans in January, the administration will have kept its key promises.

Obamacare’s missing mandate Politico, 2013-07-13

The massive coast-to-coast campaign to get people to sign up for Obamacare is light on mentions of one central element: the widely disliked individual mandate. Poll after poll has found that Americans don’t like being told they have to get insurance or face a penalty. So the groups doing outreach don’t plan to draw much attention to it. …. Kevin Counihan, CEO of the Connecticut exchange, known as Access Health CT, has plenty of experience in this area. When he was the chief marketing officer for the Massachusetts exchange, he learned it was OK – imperative, even – to talk about the mandate. “Speaking about a mandate, speaking about a law, gets attention,” he said. Yet the Connecticut exchange’s two-stage advertising push isn’t highlighting the mandate. The first wave, started a few weeks ago, is meant to inform people about new insurance options and federal subsidies. The second stage, coming in September, will highlight stories of real people.

Analysis: Obamacare struggles to meet make-or-break deadline Reuters, 2013-07-14

The White House, and federal agencies including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), must ensure that working marketplaces open for enrollment in all 50 states in less than 80 days, and are responding to mounting pressure by concentrating on three essential areas that will determine whether the most critical phase of Obamacare succeeds or fails. “The administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University professor Timothy Jost, a healthcare reform expert and advocate, told an oversight panel in the U.S. House of Representatives last week. Current and former administration officials, independent experts and business representatives say the three priorities are the creation of an online portal that will make it easy for consumers to compare insurance plans and enroll in coverage; the capacity to effectively process and deliver government subsidies that help consumers pay for the insurance; and retention of the law’s individual mandate, which requires nearly all Americans to have health insurance when Obama’s healthcare reform law comes into full force in 2014. Measures deemed less essential, such as making larger employers provide health insurance to their full-time workers next year or face fines, and requiring exchanges to verify the health insurance and income status of applicants, have already been postponed or scaled back.

“And What If We Don’t Distribute the Exchange Availability Notice?” ACA Review, 2013-07-15

We have been putting off answering this question for two reasons: (1) although employer distribution of these notices is central to the Administration’s plan for marketing the Exchanges, the ACA appears to impose no penalty for employer refusal; (2) we would like to see the Labor Department’s proposed rules to evaluate any contention that there is an applicable penalty. Such rules have been repeatedly promised but never issued, and the deadline for distributing the notice is October 1, 2013. Employers need guidance. Here’s our best guess, as of July 15, 2013. Given the money and effort about to be expended to advertise the availability of subsidized insurance through the Exchanges, most employers should assume that most employees will receive that information, regardless of employer § 218B compliance. Would you like employees to have accurate information from you, or would you prefer them to act based on unknown information obtained from an organization with adverse interests? Making this choice early, some employers already are arranging for their staffing companies, brokers and TPA’s to serve as Exchange guides for employees who choose that alternative. If you make the same choice, you’ll want to take each opportunity to be, and to appear to be, your employees’ trusted source of ACA information.

HHS: ObamaCare rollout ‘on schedule’ The Hill, 2013-07-15

The Health and Human Services (HHS) Department says the implementation of ObamaCare is “on schedule” despite a recent decision to delay the employer mandate. The Health and Human Services (HHS) Department says the implementation of ObamaCare is “on schedule” despite a recent decision to delay the employer mandate. Federal health officials released a Web video Monday titled “HHS is on schedule.” … “In less than six months, historic changes will go into effect, ensuring that all Americans have access to affordable, quality health coverage,” Monday’s video states.

Lambert here: The administration should really stop lying about “all Americans.” The first year of ObamaCare will cover 7 million, tops, and even when ObamaCare’s rollout is complete, approximately 30 million will still not be covered. And that’s before we get to what “affordable” and “quality” mean.

Obama’s Employer Health Care Delay May Goose Exchange Enrollment Bloomberg, 2013-07-15

Former Democratic Party Chairman Howard Dean said increased enrollment in the exchanges will be “an unintended effect” of the employer-coverage delay. “What this means is that if you don’t have insurance, the exchange is your default position, not the employer,” Dean, who is a medical doctor and served as Vermont’s governor from 1991 to 2003, said in a phone interview. “This will drive more people into the exchanges, and that’s good.”

Here Comes The Sunshine Act — And It’s Alright HuffPo, 2013-07-16

The Affordable Care Act (ACA), also known as Obamacare, is one of the most controversial pieces of legislation enacted in the last decade. One reason is certainly going to be evident in the next few weeks when, on August 1, the Physician Payment Sunshine Act (Sunshine Act) goes into effect. The Sunshine Act, created under Section 6002 of the ACA, is designed to highlight the dubious financial relationships enjoyed by many doctors with the manufacturers of medical devices and pharmaceuticals — such as rampant gifts, five-star dinners, trips, and money paid to physicians by drug and medical device companies for decades.

Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care Health Affairs, July 2013

We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use.

PPACA FAQ: Everything we knew is wrong.

(Cross posted at Corrente)

Lambert and I are taking our PPACA FAQ project seriously – but, it’s pretty difficult in the face of the obvious lack of commitment by the Obama Administration.

I cannot imagine the frustration suffered by the programmers implementing the inner-workings of the Health Care Exchange Marketplace — or whatever it’s supposed to be called this week. Just trying to write a PPACA FAQ post every week is a bizarre-other-worldly experience.

And it’s no wonder. The answers weren’t (publicly) available: it wasn’t until Friday July 5 (!!) that The IRS released their 600+ Final Regulations regarding a huge range of outstanding PPACA/ObamaCare issues.

But, were they privately available to ObamaCare system planners and developers?

Megan McArdle has this to say (link to Must Read Corrente post, ObamaCare Clusterfuck: How bad is it? Megan McArdle gets it right on the exchanges, with more detail):

One of two things must be true: the administration knew this was necessary long ago, but concealed it from the public and the congress in order to limit the time they had to react; or the administration is so incredibly inept that it has only just now realized that it wasn’t going to be able to handle any of the complicated bits. Either way, why would we assume that anything else they say about the systems–like, “It’ll be ready next year”–is true? Indeed, why should we assume that this is the last such revelation? (emphasis mine – kb)

Our ignorance on which isn’t a simple issue of poor reporting or lack of Congressional oversite. Here’s Kathleen Sebelius lying to Congress last April:

ObamaCare Clusterfuck: Sibelius says Federal “data hub” for exchanges is “built and paid for”

The Hill:

Sibelius said Friday that the $1.5 billion would help her department with information technology projects, including the data hub that exchanges will use to retrieve information from other state and federal agencies

“That’s really to get the IT hub, the call center, the IT up and running,” she said.

But later in the same series of questions, Sebelius said the data hub is nearly finished.

“The hub is basically built and paid for,” she said.

Except that 34 states haven’t connected to it.

As if that’s not bad enough, read this incredible bit of information at the top of The Hill’s story:

The Health and Human Services Department will meet its central ObamaCare deadline and does not need a backup plan for delays, HHS Secretary Kathleen Sebelius said Friday.

Sebelius told the House Ways and Means Committee that a federally run insurance exchange will be up and running by Oct. 1.

“No,” Sebelius said when asked whether there’s a backup plan in case that deadline slips. “We are determined and on track to meet the Oct. 1 deadline.” (emphasis mine – kb)

(Except there’s always a backup plan, isn’t there?)

I have to take a break here to say that this implementation issue is not a trivial thing. Many, many, many people are counting on it. They expect to have access to health insurance and for that health insurance to give them access to actual health care. I repeat: This is not trivial. It is not a game.

So, at the end of April, Sebelius is totally in control — everything is on schedule and there are no problems on the horizon. Bolstering that status, this post appeared in The Healthcare Marketplace and Policy Review with encouraging news about the Maryland Exchange:

Will the Affordable Care Act’s Health Insurance Exchanges Be Ready On Time? The Obama Administration’s Top Secret Enterprise

Last week, I received my weekly email update from the Maryland health insurance exchange:

Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.

This report tells us a few things.

First, the Maryland health insurance exchange is on track to launch on time and ready to serve all comers. I continue to be impressed by how well this state-run health insurance exchange is working toward implementing the Affordable Care Act (“ObamaCare”) on October 1, 2013.

Second, apparently the Federal Data Hub is up and running. While that is what the Obama administration has been telling us, it has been hard to find anyone who has actually seen it or used it.

Third, Maryland has its system ready to exchange eligibility and premium information with the health insurance plans––perhaps the biggest challenge the new exchanges, state or federal, face.

Can any of that be true? I honestly don’t know what to make of it.

Checking back at The Healthcare Marketplace and Policy Review there IS a post about the “Final Regulations” but there is no mention of the previous post about the Maryland Exchange and their ability to interact successfully with the (mythical?) Federal Data Hub.

Except for the disappointment of not addressing the mystery of the Maryland Exchange, this story is outstanding in a number of ways.  But my favorite part is when the author describes the frustration of the consumer who does not want to commit fraud:

Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With “ObamaCare’s” Federal Data Hub?

I can also imagine lots of innocent consumers getting their subsidy all bollixed up on the front-end (Do you know your likely “modified adjusted gross income” for 2014?) only to get hit with a whopper tax bill when they finally reconcile all of this on their 2014 tax return. For example, a family of four getting subsidies based upon 200% of the poverty level but ending up making 250% of the poverty level for the year, would see a retroactive liability of about $1,700 on their tax return because of subsidy overpayments.

That begs another question: What happens if subsidy recipients don’t file a tax return––as millions of Americans now don’t––for 2014?

Two of the essential things the Federal Data Hub was supposed to be able to do was to determine and report to the exchange if a person was eligible for a qualifying employer plan and to be able to feed an individual’s income history to the exchanges to help determine the amount of subsidy they would be eligible for.

As of the week of the Fourth of July, it would appear the Federal Data Hub will be doing neither of these things––or at least not doing them to the extent they can be relied upon.

That begs yet another question: Is the Federal Data Hub not working as intended?

And there we are — that question seems like as good a place to end this sordid piece as any. Frequently Asked Questions Without Answers.

TWO Notes:

1) This post would not be necessary if the massive Democratic majorities in the House and Senate had been encouraged, pushed and led by the Democratic President Obama to pass Medicare for Everyone. President Obama came into office with tremendous popularity, authority and power. With a strong commitment to truly Universal Health Care for Everyone by him, Medicare for Everyone could have been implemented with little more than his signature on the bill.

2) Lambert and I would LOVE more contributors to this project (there are multiple tasks including writing posts, a weekly Link Dump and our still in development Resource Library). Contact us through Corrente or The Confluence if you are interested in working with us.