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

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:

Oregon Delays Key Element of Insurance Exchange––Good for Them!

Five years from now no one will remember if their "Obamacare" health insurance exchange launched on October 1.

The state-run Oregon health insurance exchange, Cover Oregon, recently announced it will be delaying web access to the its new "Obamacare" health insurance offerings two to four weeks later than the scheduled October 1 launch date.

"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:

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.

Administration Delays the Employer Mandate––But What About Small Employers?

The administration suddenly announced tonight that the requirement that all employers with 50 or more workers offer health insurance has been delayed until 2015.

If an employer with 50 or more workers did not provide health insurance to their full time workers in 2014, they would have been subject to a fine of $2,000 per worker. The employer would have also been subject to a $3,000 fine for each worker that went to the insurance exchanges if the employer package was not affordable.

Why did the administration delay the large employer mandate?