Is the Drug Industry an Existential Threat to the Private Health Insurance Business?

At a time when many Democrats are calling for a single-payer health insurance system, are the drug companies inadvertently driving the system on a course to that end?

Consider this.

"If You Like Your Doctor You Will Be Able to Keep Your Doctor. Period"

I think you can guess who said that.

Actually, here is what the President said at the American Medical Association Meeting in July, 2009––and likely lots more times:

"No matter how we reform health care, we will keep this promise: If you like your doctor, you will keep your doctor. Period. If you like your health care plan, your will keep your health plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what's broken and build on what works."

We have all heard this repeated many times before in recent weeks. But with the front-page story in the Washington Post this morning, "Health Insurers Limit Choices to Keep Costs Down," it's as if somebody rang a new bell this time focused on the "you will keep your doctor" part.

Small Group Health Insurance "Cancellations"––The Next Shoe to Drop But a More Complicated One

Obamacare is impacting the small group insurance market in many of the same ways as the individual health insurance market. While employers with less than 50 workers don't have to provide coverage, if they do they are required to comply with the same essential benefit mandates, age rating changes, and pre-existing condition reforms the individual market faces.

That means essentially all small group policies cannot continue as they are––they have to be discontinued.

The Obamacare Rollout: The Administration Needs a Plan B––Now!

It is now becoming clear that the Obama administration will not have Health.care.gov fixed by December 1 so hundreds of thousands, or perhaps millions, of people will be able to smoothly enroll by January 1.

Why do I say that? Look at this from the administration spokesperson's daily Healthcare.gov progress report on Friday:

Essentially what is happening is people [those working on the fixes] are going through the entire process. As we have fixed certain pieces of functionality, like the account creation process, we're seeing volume go further down the application. We're identifying new issues that we need to be in a position to troubleshoot.

Does that sound like the kind of report you would expect if they were on track to fix this in less than three weeks? Their biggest problem is that they admittedly don't know what they don't know.

The Obamacare Rollout––Week Five

Enrollments continue to trickle in. Health plans, with the kind of market share that would have to sign-up 100,000 to 200,000 people for the administration to hit its goal of 7 million people, are generally reporting they have enrolled only about 100 - 200 people over the first 35 days via Healthcare.gov.

"Substandard Plans" Offered by "Bad Apple Insurers"––Does the Obama Administration Understand How the Health Insurance Market Works?

Yesterday, the President said in Boston that the millions of people who are getting cancellation letters ending their coverage in the individual health insurance market are being saved from "substandard plans" that were sold to them by "bad apple insurers."

I guess these would be the same insurers his staff invited to the White House last week. In their statement following that meeting, the White House said they were "committed to working in partnership with the insurers" toward implementation of the Affordable Care Act.

So, this is how he treats his "partners."

Are health insurance plans in the individual market substandard?

Not the overwhelming bulk of them.

How do I know that?

Mr. President: I like My Health Insurance and I Would Really Like to Keep It––Can You Help Me Out Here?

How many times have I talked on this Blog about rate shock, the millions of people who would be getting cancellation letters from their current health plan, and the problem of people having to put up with more narrow networks?

And, how many times have those predictions been met by push back and spin: Today's policies are just junk and people will be better off finding lower cost health insurance under Obamacare.

The Commitment to Fix Obamacare's Computer Systems By December 1––Because It Can Be Done By Then or Because It Has To Be Done By Then?

The good news is that it appears the adults are finally in charge of healthcare.gov.

This week, the administration put a seasoned and trusted manager in charge of getting the Obamacare computer system working––Jeff Zients.

He quickly announced a methodical approach to the problem and that he had appointed one contractor to coordinate the daily work. Zients also appeared to be pretty open and honest about what's really going on.

All things that should have happened in the first place.

Just What Is an 834 Transaction? Why Is It Holding Up Obamacare? How Long Will This Take to Fix?

You have probably already heard that Obamacare has as many backroom problems as problems with the front end consumer web enrollment portal.

Insurance companies participating in the new health insurance exchanges are receiving detailed enrollment information for each of the very few people who have successfully enrolled through the 36 federally run health insurance exchanges.

But the problem is that this enrollment is coming from the government with a very high rate of errors––way beyond anything they can handle manually once the real enrollment volume comes in.

"Healthcare.gov is in de facto shutdown"

Read my conversation with Ezra Klein today on the Washington Post WONKBLOG

The Obamacare Federal Health Insurance Exchanges––Week Three Status Report

I will be happy to have the Obama Administration do these status reports anytime they would like to takeover from me.

If I were in the White House spinning, I could report to you that enrollment in states run by the federal exchanges jumped 50% in the last few days.

Health plans that might have told me last week that they had enrolled 400 people since October 1 are now telling me they had a "surge" in enrollment in recent days and are up to 600 people. I guess that takes us up to a trickle and a half.

Still, small health plans are generally reporting they have received dozens of enrollments and large health plans are no higher than in the hundreds.

Should the Administration Shut the Obamacare Computer System Down? That Depends Upon What's Going On Behind the Curtain

My sense is that the biggest reason Obamacare is now in trouble is because of the top-secret way in which the administration has handled the rollout. If they had developed the computer system in a transparent way, the marketplace would have told them long ago this would not work.

No one outside the inner circle at the Department of Health and Human Services has any idea what's really going on behind the Wizard's curtain. Hasn't for months. Doesn't now.

For Those of You Who Yesterday Didn't Believe My Federal Exchange Enrollment Estimates and Reports of Backroom Problems...

You need to see today's Wall Street Journal front-page story, "Health Website Woes Widen as Insurers Get Wrong Data."

Here's an excerpt:

After realizing that some applications listed up to three spouses in a single family, Blue Cross & Blue Shield of Nebraska, which has about 50 health-law enrollees, had to "stop those enrollments from going through the automated process," said Matt Leonard, the insurer's sales manager. "It takes an automated process and turns it into a manual process," he said.

The biggest health plan in Nebraska has 50 enrollees so far? A state with about 300,000 uninsured.

Week Two of the Obamacare Federal Health Insurance Exchange Rollout––No Improvement

There was no progress for the new federal health insurance exchange's information technology and enrollment challenges in its second week.

At the end of week two of the Obamacare launch, health plans were generally seeing no more enrollments per day then they saw in the first week.

As troubling, the backroom issues plaguing the connection between health insurers and the federal government had not been resolved and there is no indication from the feds when they will have these things cleared up.

My sense is that the feds, based upon the number of enrollments they have sent to the insurance companies, enrolled about 10,000 people in the first week (about 5,000 single and family contracts) and another 10,000 people in the second week in the 36 states using the federal exchange.

Washington Post columnist Ezra Klein and I spoke about the Obamacare rollout yesterday afternoon.

Here is his column from today's Washington Post:

‘Obamacare is a bit like the astronaut on top of the rocket’

By Ezra Klein, Published: October 15 at 12:38 pm

Ezra Klein: You wrote about how the problems on the back-end of the insurance portals, in the way they communicate with the systems of actual insurers, might be as bad or worse than the front-end traffic problems. What are you worried about, exactly?

Bob Laszewski: What I’m worried about is that when people go to their doctor in January they may walk in, and the doctor and hospital won’t find them in the insurer’s computer system or their bank account won’t be appropriately debited or they’ll be signed up for the wrong plan. I’m worried about all these things. Now, we have a few weeks to get this straightened out. But only a few weeks.

EK: Tell me what you’re hearing from the insurance industry that has you concerned.
Read the Rest at the Washington Post

What Health Insurance Company Information Technology Executives Were Saying About the Obamacare Exchanges Last February

Were there signs the Obama administration was headed for trouble getting the insurance exchanges ready for October 1, 2014?

Last March, I did a post reviewing a survey of health insurance industry information technology executives' opinions on how well the Obama administration was doing toward launching the exchanges.

The federal health insurance exchange problems that have so far been obvious have been all front-end issues--being able to get the Obamacare's consumer portal to work.

What is concerning about this March survey is that it also identified big concerns the insurance industry had, and still has, over the critically important backroom transactions yet to come.

The Affordable Health Care Act's Launch On October 1st––So How Did it Go?

Unavoidably, that will be the big question come Tuesday.

But there will be much more to it than that.

A 180-Day Open Enrollment––Not a One-Day Open Enrollment
What happens on the first day, for good or bad, will constitute only a tiny percentage of the open enrollment period. Consumers will likely visit the new websites many times before they make any decisions, and that is exactly as it should be.

"ObamaCare" Small Ball––The Republicans Are Winning the Battle Over the Big Idea

Last week the President waded directly into the national debate over "ObamaCare" by calling a big media event in the East Room of the White House to talk about the $100 rebates a small percentage of potentially eligible people are getting under the new health law.

Senate Republican Leader Mitch McConnell countered, "If you’re a family in Covington facing a $2,100 premium increase under ObamaCare, then, really, what would you rather have: a check for $100 or so, or a way to avoid the $2,100 premium increase in the first place?”

NPR's Julie Rovner had a story on Friday––"White House Muddles Obamacare Messaging Again"––that caught my eye.

She drew a distinction between how the administration has been going about unsuccessfully selling the new health law and the way the Republicans have been more successfully attacking it:

Implementation of the Affordable Care Act––More Evidence That Rate Shock is Coming

The Society of Actuaries is out with another estimate of health insurance rate increases as a result of implementation of the Affordable Care Act ("Obamacare").

While there is a great deal of difference between states, they are estimating an average increase of 31.5% on account of the new underwriting reform and benefit expansion requirements of the health law:

More Predictions of Rate Shock Because of the New Health Law

Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act ("Obamacare").

Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.