Thursday, November 6, 2014

Untangling ObamaCare Healthcare.Gov Website

Oh. what a tangled net we weave,
When we first practice to deceive.

Sir Walter Scott (1791-1832), Lochinar

Sometimes complicated things are simpler than they first appear.

Take the problems of untangling ObamaCare’s website, and its second launch, starting November 15, 2014 and lasting until February 15, 2015.

This second launch, following the first launch, October 2013 to March 31 2014, has multiple looming problems.

• The government has yet to fix the website’s back end problems that crippled its first year of open enrollment (Louise Radnosky, “More Health-Site Bugs Loom,” WSJ, November 15, 2014).

• The second enrollment launch follows in the wake of the midterm elections, in which voters showed they profoundly distrusted government competence and after which Republicans vow to replace or repeal ObamaCare. People are leery of ObamaCare because the President promised they could keep their doctor and their health plans, and this has not proven to be the case, hence the tangled net and deception metaphor.

• Replacement or repeal would pose a formidable political problem – providing a safety net for those seven to eight million, 87% of whom are receiving federal subsidies, after repeal or replacement. The numbers will probably exceed ten million after the second launch concludes. Once government gives awaY something , i.e."the free stuff," it is almost impossible to take it away.

• The Obama administration admits potential glitches lie ahead for about five million who signed up during the first health exchange . People may end up with two health plans, paying premiums on each. The government has yet to figure out what to do with those who moved during the year or who gave wrong information on their incomes or citizenship eligibility.

• Confusion and ignorance exists among the uninsured, people who purchased exchange plans last year, people who plan to buy plans this year, small businesses who want to place employees on the exchanges, and who want to switch plans to avoid high premiums and deductlbles. None of ten of the currently uninsured, which number about 11 million, are not even aware a second launch is about to begin.

The Obama administration has sought to alleviate these difficulties by automatically renewing coverage for those who do not return to the website by leaving people in their old plans. But this does not solve problems of what happens come tax time when the IRS tries to collect penalties for those who did not enroll in plans or switched plans or had improper information on income or citizenship eligibility or who moved to a new address.

It’s complicated for because there are gaps and holes in which has not yet found a way to make it less complicated. It’s complicated for health care consumers too. They must sort through a maze of options – monthly premiums, deductible and copayments, choice of doctors and hospitals, and range of benefits. A Kaiser Foundation study of the first launch found that 76% of people who tried to enroll had difficulties exploring these options.

A family physician friend of mine, Doctor Donald Copeland of Cornelius, North Carolina, explained to me why things are so difficult to consumers.

ObamaCare raises premiums and deductibles for the majority of Americans with health plans, not for all but for about 75% of health care consumers. Even for those 87% of the formerly uninsured, now with federal subsidies, have trouble affording health care.

In Doctor Copeland’s experience with hundreds of thousands of patients, people on average can afford to spend $250 to $500 a year on health care.

Anything beyond that amount, physicians and hospitals will have difficulties collecting. In our slow growth economy over the last six years, the worst recovery since World War II, the uninsured and most of the middle class, people cannot afford to pay, even with federal and state exchange subsidies.

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