Trying to Make Sense of the Covered California Numbers

I've read a number of reports in recent days gushing over the progress Covered California is making leading the nation in signing up people for Obamacare.

But, I am having trouble understanding how the numbers should make anyone gush with enthusiasm.

"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.

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.

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.

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

How Many People Have Signed Up For Health Insurance on the Federal Health Insurance Exchanges?

Based upon my survey of a large number of health plans accounting for substantial market share in the 36 states the federal insurance exchange is operating in, not more than about 5,000 individuals and families (about 10,000 people in total) signed-up for health insurance in the 36 states run by the Obama administration through Monday.

It is not uncommon for a major health insurer with a large market share to report less than 100 enrollments in the first week.

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.

Why the Federal Health Insurance Exchange and So Many State Exchanges Are Not Working

We may be getting a better idea why the federal exchange and so many state exchanges aren't working.

An article in Saturday's Baltimore Sun, regarding Maryland's problems, provides insight I have not seen elsewhere:

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.

Benefit Shock? Consumers Will Be Surrpised By What They Find on the New "Obamacare" Health Insurance Exchanges

Will we have rate shock?

It looks to me like consumers will have a choice when they get to look at the health plans available on the new "Obamacare" health insurance exchanges––rate shock or benefit shock.

While there has been lots of focus on the issue of rate shock, I will suggest that just as big an issue may well be benefit shock—that consumers will look at what they will be getting for their premium payments and that they will be surprised at what their out-of-pocket costs will be and before they get anything.

The following chart was prepared by Covered California, the state-run California exchange. This chart does not include specific California plan premiums. What it does show is the net of subsidy cost a single person would pay at the various income points for the second lowest cost Silver plan, as well as the deductibles and co-pays they can expect to see from the standard Silver plan.

So If the Maryland Health Insurance Rates Are So Cheap Why Did I Get This Postcard From Maryland Blue Cross?

That's what I wondered when I got this postcard; presumably sent to lots of people who live in Maryland:

In it, (click on card to enlarge) Maryland Blue Cross is telling me that; "I am invited to obtain a [health] plan right now with rates that may be significantly lower than reform-compliant plans [their emphasis]."

Are they suggesting there is rate shock coming?

I was surprised to get this card because the Maryland Health Insurance Exchange recently issued a report that said they would have among the lowest health insurance rates in the country once "Obamacare" goes live on October 1:

People Who Haven't Filed a Tax Return to Get Unverified Health Insurance Exchange Subsidies

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.

I noted a couple of things in her memo.

Her memo indicates that the exchanges will request additional income information from a "random sampling" of people when, among other things, "an individual does not have a tax return on file and attests to an income significantly below current wage data."

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

Come October millions of people will be applying for tens of billions of dollars in federal health insurance premium subsidies on the honor system.

On the Friday after the Fourth of July––when the administration apparently hoped no one would be paying attention––the Obama administration dropped 606 pages of regulations. Buried inside was the news that that insurance exchanges can ignore any personal income information they get from the Federal Data Hub during 2014 if it conflicts with "attestations" made by individuals.

Will the Affordable Care Act's ("ObamaCare") Federal Health Insurance Exchanges Be Ready On Time? Finally the Facts!

After months of speculation on just where the Obama administration is toward the development of the new health insurance exchanges, the Government Accountability Office (GAO) has issued a 48-page report complete with timelines and a detailed report on just where the Obama administration is––or at least was last month.

The key summary: