Questions Congress should ask Sibelius.

[Borg]

The first day's numbers are in - 6. Yes, only six people managed to make it through on the first day.

 

[Vic Sandler]

This is the 28th unfortunate day for the ACA website. The site was down all day yesterday and a good part of today, but it is up now. I still can't log in. I called the 1-800 number and they told me they can't access my information even though it was input using the 1-800 number, not the website. That is, the problems with the website are not the only problems with the program as a whole. This time I got to speak to a supervisor, but it didn't do me any good. However, I was told that my case was being upgraded and that I would be receiving a call within 48 hours from a problem solving team that presumably has more effective tools at its disposal. I was also told that the 48 hour promise was not to be taken seriously and I shouldn't get upset if it were to take until Friday before they contact me.

I posted that on Monday. Then they said I should call back to the 1-800 number if the Advanced Resolution Center didn't contact me by 9:00 pm Friday. Since they did not call me, I called the 1-800 number. Three times. The first two times my call was dropped after I said I didn't want to take the survey after the call. The third time I called I said I would take the survey and I was connected to a representative. When I was finished speaking to the representative, I hung up and did not actually take the survey. The gist of the conversation was that when they told me I would be contacted by Friday, they misspoke. They were supposed to say that it would take from 2 to 5 days. In other words, if the Center doesn't call me by 9:00 pm tomorrow, I should call the 1-800 number. The representative I spoke to also claimed that he cleared my password and I should retry the link in the e-mail they sent me. I did so, but got the same error message as before.

 

[Vic Sandler]

This is getting very old, Vic.

You're preaching to the choir with that one brother. As I said before, I am providing an accurate account of my adventures with the website. I am not struggling with the vast complexities of a website tasked with dealing with the vast complexities of the ACA. I am just trying to get a user name and password that works. As far as I'm concerned I am doing a favor for those who are interested in it. It stands to reason that if you are not interested in it, you shouldn't be reading it.

No, she didn't. She said "whatever".

I know that's what the headlines said, but the actual quote is:
"You clearly, uh," (then a small pause, followed by), "whatever."
The Secretary put both her hands in the air, briefly, then resumed.
"He is the President. He is responsible for government programs," she concluded.

That is the perfect response to a "when did you stop beating your children" type of question.

Actually, the question was whether Obama was ultimately responsible for the rollout. Sebelius was asked several times before she gave the correct answer. "When did you stop beating your children?" doesn't have a correct answer.

Watch the video in this link. There's more to it than just 'whatever'.
http://politicalticker.blogs.cnn.com/2013/10/30/frustrated-sebelius-to-questioner-whatever/

 

[edward]

you're preaching to the choir with that one brother.


I know that's what the headlines said, but the actual quote is:
"you clearly, uh," (then a small pause, followed by), "whatever."
the secretary put both her hands in the air, briefly, then resumed.
"he is the president. He is responsible for government programs," she concluded.


Actually, the question was whether obama was ultimately responsible for the rollout. Sebelius was asked several times before she gave the correct answer. "when did you stop beating your children?" doesn't have a correct answer.

Watch the video in this link. There's more to it than just 'whatever'.
http://politicalticker.blogs.cnn.com/2013/10/30/frustrated-sebelius-to-questioner-whatever/

"Whatever."

 

[SteamKing]

I hate to pile onto poor Vic's troubles, but assuming one does enroll in a plan, the pain is not necessarily over.

Depending on a number of factors, the rates you are quoted for coverage for 2014 may not be the rates you'll have to pay for 2015 and beyond. Like most everything, these rates will be subject to change in the future, once more information comes available. If you can only barely afford coverage in 2014, it might be entirely out of reach in 2015.

Another thing to consider is that hospitals have not been merely sitting on the sidelines during this process. They have some pretty smart numbers guys, too, and when they examine the features of the various metal plans, with the high deductibles and the caps on payouts, the hospitals figure they will be at risk for making up the difference in what the health plan pays for and what services the patient consumes. As a result, some hospitals may refuse to honor insurance policies purchased on the exchanges.

http://health.usnews.com/health-new...2013/10/30/top-hospitals-opt-out-of-obamacare

 

[Vic Sandler]

It is difficult for me to ask the following question without seeming to be spreading false information. Please do not read this as a description of a real situation, but rather as a question. Am I correct in the following, or am I wrong?

Consider a person is so poor that they can neither afford any kind of health insurance nor can they pay for medical services on their own. Yet they make more than the maximum to qualify for medicaid. Currently, when they get sick, they have no recourse except to go to an emergency room, because while doctors can turn them away, hospitals cannot. The money to pay for these people comes from higher prices charged to hospital patients who have insurance or who are able to pay for services themselves.

Under the ACA, these poor people would likely get a subsidy large enough so that they could get a bronze or perhaps even a silver plan for no premium cost whatever. Now, they still can't afford to see a doctor since, there is a deductible and they can no more afford it under the ACA than they currently can. They still go to the emergency room and get free services up to the deductible and then the insurance company starts paying up to the cap, and then the insurance company pays for the rest. Thus less is added onto the bills of the paying customers.

For the poor, there seems to be no difference under the ACA than the current state of affairs unless there is within the ACA some provision to pay for doctor visits which tend to be cheaper than emergency room visits. Nor does there seem to be any difference for those who have insurance since they will continue to pay through insurance premiums that are higher than they would otherwise be, just as they do now. Of course, those premiums are subsidized for many people and that is a difference under the ACA. However, you cannot say with assurance that they won't pay for the subsidy directly through increased taxes, or indirectly through other means.

Please remember that although these are stated as facts, they are really questions.

 

[SteamKing]

The situation you describe also works for individuals and couples who are not poor. Under the ACA, the subsidies have an income cap, where if you make just $1 over the max. allowed income, POOF!, there goes the entire subsidy and you are on the hook for all of the premiums. There's no sliding scale to soften the blow, just $1 over the limit and the subsidy disappears. That's why the article in sfgate.com was so startling: it advocated that if an individual or couple thought their income for the upcoming year would put them over the limit for receiving a subsidy, they should cut back on their hours or find a way to make LESS money during the year. Talk about perverse incentives.

http://www.sfgate.com/business/netw...-can-net-huge-health-care-subsidy-4891087.php

So, in the years ahead, expect to see less economic mobility as people decide not to look for a better job or upgrade their skills or education because they might make too much income to get a subsidy to buy health coverage where there are large deductibles and copays and which might not even be accepted by many hospitals or doctors.

And remember, the unsubsidized premiums and out-of-pocket outlays all come out of after tax income, so people will be required to budget differently than in the past. This means less money to spend on entertainment, fixing up the house or buying a new car is put off, maybe the kids don't get to go to college after HS (and maybe not at all), and vacations become few and far between. The ripples in the economic pool really haven't started yet, but it doesn't look like there will be any strong recoveries anytime soon, and any dip back into recession will take longer to climb out of.

 

[Vic Sandler]

The situation you describe also works for individuals and couples who are not poor.

As in my previous post, the following is my understanding. Treat it as a question, not a fact.

Currently, if you are not poor and you have no insurance and you need medical attention, you may not be responsible for the entire bill. However, they will wipe out all of your savings before they start to charge your costs to others. Health insurance is not to protect your health, it's to protect your wealth.

I don't see how this has anything to do with my previous post, since I was talking about people who have no wealth to protect.

 

[Locrian]

This adverse selection business has me perplexed. It has been said that if the young and healthy opt for the cheap penalty instead of the expensive insurance while the old and sickly buy the insurance, it will sink the entire system. But how about individual companies? Is there a plan in place in case the young choose company A and the old choose company B?

That's a good question. In a normal market, company A would become very profitable while company B would probably wind up losing money. If this situation continued for some time, company B would probably have to exit the health care insurance business unless it was able to alter its mix of policyholders. If company B raises its rates to raise more revenue, it runs the risk not only of shedding its older customers, but it would also not be as attractive for the younger customers either.

I don't think these are inaccurate descriptions of the dangers of selection, but when comparing company outlooks in the 2014 individual market there are some additional considerations.

Risk Adjustment, firstly. Under the ACA, members on individual policies have risk scores assigned to them based on demographic characteristics and claims patterns. The average risk scores for a plan are tallied and compared between companies. Companies with higher risk scores will receive payments from companies with lower risk scores. Thus having sicker members results in both higher claims and higher revenues. Whether the revenues offset the claims is something we'll find out in late 2015.

Additionally, there are two more R's to consider: Reinsurance and risk corridors. Between these three systems, individual companies can still be very much at risk, but they are much less so than they would be without them.

The reason why the system needs young, healthy members is to lower overall premiums. HHS defined an age-curve that results in the young subsidizing the old. The young will be overpaying, and the older underpaying. The three R's will help protect a single company from disaster, but it doesn't help keep rates down for the entire risk pool.

Ultimately, if you design a system that results in cross-subsidization, you had better make sure the people you're taking money from can't opt-out, or you won't have anything to give the people you're trying to give money to.

 

[Locrian]

Depending on a number of factors, the rates you are quoted for coverage for 2014 may not be the rates you'll have to pay for 2015 and beyond. Like most everything, these rates will be subject to change in the future, once more information comes available. If you can only barely afford coverage in 2014, it might be entirely out of reach in 2015.

Very true. However, keep in mind that the size of the subsidy is based on the second highest Silver metal tier plan. So as premiums go up, so will the subsidy.

Well, for those that can get it.

As a result, some hospitals may refuse to honor insurance policies purchased on the exchanges.

http://health.usnews.com/health-new...2013/10/30/top-hospitals-opt-out-of-obamacare

I think we should keep in mind this is coming from both sides, though.

For the most part, you should - both historically and in 2014 - be using in-network providers. This means that the insurance company and provider have signed a contract detailing what payment rates are and how they will be paid. Network building and monitoring is an important service that managed care organizations and insurance companies provide.

What has happened is that insurance companies and MCO's are looking for any way to reduce cost, and some companies have introduced plans that don't include the most expensive providers. You can blame the providers for "opting-out", or you can blame the insurance company for being unwilling to pay the rates the provider demands. It is also true that some providers are refusing to provide out-of-network services, but I think this is a smaller issue than the introduction of thin-network plans.

Note that the extent of this varies by state. In my state and at least one next to it, there are thin-network plans that cut out huge swaths of world-class providers. But there are also more expensive plans that include pretty much everything available.

IMHO the problem here isn't the existence of these plans - personally, I'd love to cut out the most outrageous costing providers from my policy to lower premiums. The problem, though, is that I don't think people buying these thin-network plans will realize they've done so until it's pretty late in the game.

Expect a lot of noise about this in 2014.

 

[Locrian]

Now, they still can't afford to see a doctor since, there is a deductible and they can no more afford it under the ACA than they currently can.

If your income is low enough, there are reduced cost-sharing plans available.

However, I do share some of your worries, just with more cynicism. There are ways for the poor to reduce their cost sharing, but what about everyone else? I'm surrounded by people living in $300k houses with $60k in vehicles in their driveway that don't have $3k in savings - or at least claim that $3k in deductible expenses would be unbearable.

Insurance is a financial tool. Most US citizens are have little or no understanding of personal finance. The first can only work if we fix the second.

 

[SteamKing]

The politicians who whelped this monstrosity known as the ACA appear not to understand personal finance, either. But then, they don't have to, since they made a separate deal to keep themselves and their staffs off the exchanges.

The following story illustrates how the ACA is effectively turning formerly law-abiding citizens to considering if not outright law-breaking, at least non-compliance with ill-conceived legislation, which IMO further erodes the willingness of average citizens to abide by the rule of law. This state of affairs does not bode well for the future.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_YOURE_CANCELED?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-11-02-09-44-38

 

[SteamKing]

The Secretary of HHS received a key technology document this week which should help start to resolve some of the problems with the healthcare.gov website:

 

[Locrian]

Hah, yea, I saw that, too. Funny stuff.

She looks like she's going to bite them.

 

[Locrian]

But then, they don't have to, since they made a separate deal to keep themselves and their staffs off the exchanges.

Well, let's be clear about how this worked.

The way the law functions, congress and their staff would never have been buying off the exchange if it weren't for very specific legislation that singled them out to have to - other largish, self-funded groups do not have to buy on the exchange. This exception was made to try to scare off Democrats, but the reality is that buying off the exchange doesn't hurt them any; they'd still be using taxpayer money and they'd be able to afford the platinum PPO plans (or whatever is best). Furthermore, some staff members would certainly be getting taxpayer funded subsidies to buy off the exchange, which seems pretty silly.

Having congress maintain their own self-funded plan so expenditures can be tracked - like almost every other large employer and government group out there - makes a lot more sense.

 

[SteamKing]

Legislation aside, there apparently were some specifically vague features contained in the ACA which have received an interpretation in Congress' favor by the Office of Personnel Management (OPM):

http://blogs.rollcall.com/wgdb/opm-proposes-obamacare-fix-for-congress/

All-in-all, another shabby deal just like all the exemptions granted by the Administration.

 

[Vic Sandler]

It is unfortunate that the website failed the first day.

This is the 33rd unfortunate day. The 5 day self imposed time-frame for returning my call to the Advanced Resolution Center has passed without a return call. I would call the 1-800 number as I was instructed to do, but as any good tester, I first went to try the site to see if it would allow me in. I got the gray screen of death. The site has crashed. I see no point in calling them under these conditions, so I will hold off until they recover from the crash.

(the website) has never crashed.

http://news.yahoo.com/healthcare-gov-suffers-outage-as-sebelius-testifies-that-it-s-never-crashed-181641521.html

This is getting very old, Vic.

Another day older.

"Whatever."

 

[edward]

This is the 33rd unfortunate day. The 5 day self imposed time-frame for returning my call to the Advanced Resolution Center has passed without a return call. I would call the 1-800 number as I was instructed to do, but as any good tester, I first went to try the site to see if it would allow me in. I got the gray screen of death. The site has crashed. I see no point in calling them under these conditions, so I will hold off until they recover from the crash.


http://news.yahoo.com/healthcare-gov-suffers-outage-as-sebelius-testifies-that-it-s-never-crashed-181641521.html


Another day older.

If your bicycle had a broken chain I wonder how many times a day you would keep trying to ride it?

 

[Vanadium 50]

If he gets fined for not riding a bicycle, perhaps many times.

 

[Vic Sandler]

If your bicycle had a broken chain I wonder how many times a day you would keep trying to ride it?

If the shop was charging for repairs by the hour, I'd probably pop my head in once or twice a day to see how they were doing. Wouldn't you? Your bike is working well, so you'd probably stand there laughing at me every time I walked away disappointed.

 

[Vic Sandler]

It is unfortunate that the website failed the first day.

This is the 34th unfortunate day. On Monday, when I called the 1-800 number, they said I would get a call back from the Advanced Resolution Center in 2 days but that I should wait until Friday (4 days later) 9 pm, before I call the 1-800 number back to find out why I hadn't been called. When I called back on Friday to tell them that I hadn't been called by the ARC, they said it was supposed to be 2 to 5 days and I should give them until Saturday 9 pm. This Sunday morning I called them to tell them I hadn't been called and they said it's supposed to be 2 to 5 business days and I should wait until Monday 9pm. So, irrespective of problems with the website, there is a problem with the script given to the 1-800 representatives. Also, the Advanced Resolution Center doesn't operate on the weekends even though the deadline draws nearer with each day, weekends included.

"Whatever."

This is getting very old, Vic.

Another day older. Make that two days.

 

[Vic Sandler]

If your bicycle had a broken chain I wonder how many times a day you would keep trying to ride it?

Life imitates life. My car went into the garage yesterday. The power steering doesn't work, and the battery idiot light is on. Being as it went into the shop late Saturday, they won't be able to look at it until Monday morning. They don't have any loaner cars for me. I need the car by noon on Monday. Do you think I should call Monday morning to get a sense of what's happening, or should I wait for them to call me. This is the same quandary Obama faced on Oct. 1. Obama and Sebelius both waiting for the other to call.

Here's some light entertainment to watch while Obama works on his next signature achievement, the Affordable Transportation Act.

https://www.youtube.com/watch?v=3VMSGrY-IlU

 

[edward]

Be sure to remind us that tomorrow is the 35 unfortunate day.

 

[Vic Sandler]

Be sure to remind us that tomorrow is the 35 unfortunate day.

After all this time, you've joined the nay-sayers who are rooting for the ACA to fail?

 

[SteamKing]

Obama is not dating Sebelius. She works for him. Obama is within his rights to call on his subordinates at any time day or night to find out what is happening with his 'signature' legislative achievement. That he did not do so and that his administration spokespuppets currently are busy manufacturing excuses indicates a serious lack of understanding of what the functions of the chief executive are. If you are large and in charge but you go around saying 'I didn't know about this or that problem', then you've picked the wrong people to delegate to and you are avoiding your responsibility to be current on what is going on.

OTOH, Sebelius knew that the successful launch of healthcare.gov was going to be one of the most important goals of the administration. If she didn't know about these problems, then that is her failing as the cabinet member who is now in charge of one-sixth of the US economy. It never bodes well when there is no accountability in any organization, government, military, or private, for whatever reason. If Sebelius felt she was not up to the task of running HHS, she should have resigned immediately. That Obama has not asked for her resignation shows a shocking lack of responsibility on his part.

 

[Vic Sandler]

If she didn't know about these problems, then that is her failing as the cabinet member who is now in charge of one-sixth of the US economy. It never bodes well when there is no accountability in any organization, government, military, or private, for whatever reason. If Sebelius felt she was not up to the task of running HHS, she should have resigned immediately. That Obama has not asked for her resignation shows a shocking lack of responsibility on his part.

My take is slightly different. As a result of a test done a few days before the rollout someone knew that the website couldn't handle more than a few hundred logins. The person who ran that test had an obligation to tell their superior and on up the chain of command. The first person to break that chain bears a great responsibility. That doesn't necessarily mean Sebelius herself, but that person can and should be identified and very publicly fired. Why haven't they been?

 

[SteamKing]

Sure, the minion should get the chop. But that's not the end of responsibility. People are put in charge of organizations to GET THINGS DONE. They can't simply wait for the bad news to get to them first, they must have procedures and people in place to keep them positively informed about critical developments in the functioning of their organizations.

It's like being a commander in charge of a military unit. His orders are to attack the enemy and take an objective. Now, if the attack fails because the soldiers ran away, the commander can't excuse the failure of the attack on crummy soldiers and expect to keep his job. The commander gets fired too, because it was his job in the first place to make sure his troops were properly equipped and motivated to succeed. And if the general who ordered the failed attack allows the unfortunate commander to keep his job, then the general has failed to do his duty as well.

The best run organizations don't depend on just the bottom-up flow of information: the leadership must take active steps to insure that the proper information about the functioning of the organization is reaching the top. Obviously, the larger the organization, the harder it is to do this, but it must be done, nevertheless. Sure, you can put anyone with a pulse in charge of something, but that will not guarantee good results.

Before the ACA, HHS was responsible for spending approx. one quarter of the federal budget. Next was the Social Security Administration, and third was the Dept. of Defense. With the enactment of the ACA, the office of the Secretary of the HHS by law is now in charge of making the day-to-day decisions required to administer the ACA, including making various interpretations of the law and formulating policy and regulations to carry out its provisions. The effects of the ACA are too broad and far reaching for the Secretary to simply wait passively for problems to manifest themselves.

 

[Vanadium 50]

There seem to be many cases where information that should be flowing to the President is not: the ATF scandal, the IRS scandal, the DoE Solyndra scandal, the NSA bugging our allies, and I probably missed some. This is worrysome, to be sure. As you point out, in most organizations, there would be a discussion that goes like this: "You didn't know, but you should have. And you should have told me. You're fired".

However, none of this is news. Many examples occurred during the President's 1st term, and he was reelected. So the electorate decided that despite the examples of bad management, President Obama should get a second term. That's democracy.

 

[Vic Sandler]

It is unfortunate that the website failed the first day.

Today is the 36th unfortunate day. Last night the 1-800 representative told me that I should call this morning and they would connect me directly with the Advanced Resolution Center. According to the representative I spoke with this morning the one last night "misspoke." She took down my particulars a second time, entered them into my log, and told me that she would put me on the ARC queue a second time. Now I am to wait 2 to 5 business days for them to call me. I think that the ARC should call me once, just to verify that I am on their queue, and perhaps a second time if they cannot fulfill their 5 day target so they can set a new target rather than push me onto the queue a second time. I also realize that kind of efficiency is rare in a government office.

From one point of view, the problems I am having contacting the ARC are not website problems. But there surely is a connection between the two. I think the large number of people who have problems with the website are swamping the ARC, whose job is to handle them.

I certainly have no bone to pick with the 1-800 call center representatives. They just take down information and read from their script. I am always courteous and matter of fact with them. The one I spoke to today sounded sad. Perhaps she has borne the brunt of too many other callers who she was unable to help and who were not as polite and soft spoken as I am. Because she could read the log of all my calls to the 1-800 number she knew how persistent and frustrated I am and she remarked on it and thanked me for my patience. The next time you shake your fist at some government functionary, remember that they have been all politeness to me, and me to them.

"Whatever."

This is getting very old, Vic.

Another day older.

 

[Vic Sandler]

While the individual components of the front room did undergo security testing, the system as a whole could not be tested because it was being worked on until late in the game. Tavenner testified that was the reason she had to issue a temporary certification. The decision was brought to her level because of the overall magnitude of the project, she said. She said she didn't voice the security concerns to her boss, Health and Human Services Secretary Kathleen Sebelius, or to the White House office that oversees federal agencies.

http://news.yahoo.com/health-websites-security-prompts-worries-080743026--politics.html
Why hasn't Tavenner been fired? I thought that was the whole idea of falling on your sword.