Politics Obamacare

loquitur · Nov 9, 2013

redux, there can't be data for stuff that hasn't happened yet. By definition. It's Bastiat's dilemma all over again. But when the bad stuff finally does happen, you get stuff like this: Dear Libertarians, you were right. Just received this in the mail from Humana. - Imgur

redux · Nov 16, 2013

loquitur said: ↑

redux, there can't be data for stuff that hasn't happened yet. By definition. It's Bastiat's dilemma all over again. But when the bad stuff finally does happen, you get stuff like this: Dear Libertarians, you were right. Just received this in the mail from Humana. - Imgur
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Right, but you can consider independent surveys of businesses and employee benefit managers.

And do you feel the same about the $400 million in spending to misinform the public about the ACA?
--- merged: Nov 9, 2013 4:24 PM ---
My advice to the libertarian who received the cancellation notice from Humana is not to take the replacement plan suggested by Humana in its own corporate interest, but to shop on the Exchange for numerous other options in the consumer's best interest.

redux · Nov 9, 2013

Should we take at face value the oft-cited conservative talking point that the ACA is a "job killer"? Based on what?

Or raising the minimum wage is a job killer? Or protecting LGBTs from employment discrimination (Senate passed workplace protection bill earlier this week; bill is DOA in House because it is a job killer) ? Or a small tax increase on the top 1%? Or environmental regulations?

Lindy · Nov 9, 2013

redux said: ↑

....particularly when employers offer health benefits instead of higher salary (at a much lower costs to employers as a result of 33% tax deductions in employerpayroll and income taxes)
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I don't understand this, @redux.

I'm lost here. Could you please explain it to me?
Where does this 33% tax deduction come from?

redux · Nov 16, 2013

Lindy said: ↑

I don't understand this, @redux.

I'm lost here. Could you please explain it to me?
Where does this 33% tax deduction come from?
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I can see why it was confusing.

I went off on a tangent, compounded with a typo. Employees benefit from employer sponsored health plans because the employers contribution is not treated as income....it is excluded from income for both employee income and employer payroll tax purposes. Or, a dollar paid to the employee in the form of health insurance is worth more relative to a dollar in wages. The 33% was a ballpark estimate.
--- merged: Nov 9, 2013 at 3:12 PM ---
A recent survey of large employers and health insurance:

Zero out of 512 employers plan to drop health insurance, survey says

Employers are getting closer and closer to making a very big decision: whether to continue providing health insurance to workers after the Affordable Care Act's coverage subsidies come online.

Health insurance is expensive, costing employers $15,073 on average to cover one worker and the employee's family. If companies with more than 50 workers stopped offering coverage, they would face a fine that is significantly smaller than that cost, at $2,000 per employee.

Which makes this Towers-Watson survey all the more surprising: The consulting firm polled 512 companies that employed more than 1,000 workers each.

These are companies that spend at least $5 million in health benefits annually. They were asked how likely it was that they would drop coverage in 2014 and send employers to the new health care exchanges being created to accommodate the law.

Not a single employer said that scenario was "very likely." A mere 3 percent ranked it "somewhat likely." The vast majority -- 77 percent said -- it was "not likely" that they would stop offering health insurance.

The majority plan to keep doing what they've been doing: offering employer-sponsored insurance in order to "minimize penalties" from the new law.

If it's hard to understand why employers would spend more than $15,000 on employee health benefits when they have the option of only spending $2,000 to skip health care, it might help to think in a different way. Right now, employers spend $15,000 on an employee's health benefits when they could be

spending...absolutely nothing. They offer benefits not because any law requires them to but because it serves their interests: They can remain competitive when recruiting employees and keep their workforce healthier and more productive (emphasis mine)
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Lindy · Nov 9, 2013

redux said: ↑

I can see why it was confusing.

I went off on a tangent, compounded with a typo. Employees benefit from employer sponsored health plans because the employers contribution is not treated as income....it is excluded from income for both employee income and employer payroll tax purposes. Or, a dollar paid to the employee in the form of health insurance is worth more relative to a dollar in wages. The 33% was a ballpark estimate....
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Got it. So it's a tax saving to the employee because insurance benefits are not taxable like wages.
At least not yet.
And for many workers, depending on tax bracket, it's even bigger than your ballpark.
According to my quick calculations (when including Social Security and Medicare) to a single taxpayer earning $50K, it's worth 32.1% more than a raise in pay, to a single taxpayer earning $100K, 36.6% more, and to a single earning $200K results in a savings of 40.4%
A smaller (but still significant) savings to the employer, who doesn't have to pay the 15.3% employers share of SocSec and Medicare taxes on insurance benefits like they do on wages.

cynthetiq · Nov 9, 2013

rogue49 said: ↑

From a technical point of view...this is actually quite typical for new computer processes...for BOTH corporate & government.
It's actually a running joke of a sorts...has to do with the dynamics & politics of management.
They fell for the same ol' trap.

Management and SMEs take their own sweet time getting specifications, context & business rules (or laws) that the devs need to write on.
Kind of hard to make something out of thin air without knowing what the hell they need.
Example here: Govt staffers didn't get specs to Developer contractors until just this past spring, they only had 6 months to build it.

Contractors often hire unqualified mercs to try to increase their bottom line, they don't truly invest until the end...near deadlines

Everyone focuses on features, formatting & business rules

Under the gun, cut short on time, changes to rules on the fly...they all forget to deal with Capacity planning, Optimization or Security.
Why?? Because they don't want to do that until the end...because that's one more thing, and security locks down changes.
You often get developers and testers that are ignorant of performance. (Ex. A process that results in 5 rows against 50 vs. 5 MILLION)

So in the end, at least at first...MOST entities forget all of this...including Quality Assurance testing...and again, if they do it...
they focus on features and business rules. And mgmt is ignorant of it all.

So, that's why I have a job...Companies & Govt often find themselves scrambling and skritching their heads after the fact.
Security
Optimization
Performance Tuning
Quality Assurance
Capacity Planning

And all you can say is "Duh"...You'd think they'd know better.
But it's typically a Chinese Firedrill...even at the best of the best places, even with the smartest people around.
White House, Lockheed Martin, the Mint, CACI, DHS...and so on.
I've seen it again and again...and it's even happening at the job I'm at now.

So this is not unusual...it's just drawing more attention because it is a spotlight project, under contention and the media is watching it.

They'll get it fixed, then we can move on...to the next circus.
Click to expand...

Now for me everyone thinks performance is solved by using the cloud.

I don't buy it.

rogue49 · Nov 10, 2013

cynthetiq said: ↑

Now for me everyone thinks performance is solved by using the cloud.

I don't buy it.
Click to expand...

And I'm sure you know this..."Cloud" is actually the 7/11 of computer platforms.

Suurre, they don't want to buy outright or maintain their own application...That's "hard"
but instead...they buy convenience...and pay the "convenience" prices...a continuous lease.

You play by their rules, their security, their support.
You pay monthly...and by user....and that adds up to a nice annual deposit into their bank accounts.

You can't customize beyond what they support.

Actually, the Obamacare techs just announced they went from Virtual servers, to dedicated servers.
Why???
Because in Virtual, while convenient...you have to share resources.
With dedicated servers...you get the resources focused on your needs...configured specifically for your needs.
And the software allocates and interacts with the software differently...cleaner.

You can get away with this...with small environments, but not with National or Global scale.
And that's what the Obamacare site is...National, handling millions.

It amazes me how many managers and developers don't understand or try to get away with skimping.
They fall for it every time.
You get what you pay for.
You don't use a Toyota for 18-wheeler work.

It will all be fixed soon, last I heard a few days ago, they're up to 17,000 user/hour capacity.
They'll hit their deadline for performance and bugs.

The hard part will be getting all the depts and insurance companies to play nice and work well together.
Politics takes longer than tech.

Actually, I've got an IT guarantee hanging up,
"All IT executions will take less time than decisions"
Haven't missed it yet.

redux · Nov 10, 2013

Another survey that refutes the assertion that many businesses will drop their employee's health insurance as a result of the ACA.

The survey of the International Foundation of Employee Benefit Plans found that more than two-thirds of companies definitely plan to offer health benefits to full-time workers and another 25% are very likely to continue offering benefits (combined 94%); the numbers are higher in 2013 than 2012. Only a combined 2% definitely or very likely will drop their employee coverage.

IFEBP : 2013 Employer-Sponsored Health Care: ACA's Impact

I think this data (and the previous survey posted) is probably more representative of the facts than ideological presumptions that employers will drop coverage en masse.

Aceventura · Nov 10, 2013

redux said: ↑

Another survey that refutes the assertion that many businesses will drop their employee's health insurance as a result of the ACA.
Click to expand...

Why the delay for business in Obamacare?

Why the thousands of exemptions in Obamacare and the implication for those not getting the exemptions?

Oh, and word on the street says that the administration has already cut a deal with the Unions regarding "Cadillac" plans - why would they do this?

My suggestion is that you not actually try to answer these questions, consider them rhetorical.

redux · Nov 10, 2013

This is worth a read...the cost cutting impact of the ACA:

The anger over the botched rollout of the Affordable Care Act’s federal health insurance exchange — and over the conflicting explanations about whether people can keep their coverage — has been bipartisan and well-deserved. The administration needs to make personnel and management changes to get enrollment back on track. But the focus on insurance coverage obscures other parts of the ACA that are working well, even better than expected. It is increasingly clear that the cost curve is bending, and the ACA is a significant part of the reason.

The law has two overarching goals: Cover almost everyone, and slow the growth of medical care costs. The goals are equally important. Too little coverage, and premiums in the exchanges will be unaffordable; too rapid a cost increase, and the federal government will not be able to afford the subsidies.

Even as coverage efforts are sputtering, success on the cost front is becoming more noticeable. Since 2010, the average rate of health-care cost increases has been less than half the average in the prior 40 years. The first wave of the cost slowdown emerged just after the recession and was attributed to the economic hangover. Three years later, the economy is growing, and costs show no sign of rising. Something deeper is at work.

The Affordable Care Act is a key to the underlying change. Starting in 2010, the ACA lowered the annual increases that Medicare pays to hospitals, home health agencies and private insurance plans. Together, these account for 5 percent of the post-2010 cost slowdown. Medicare payment changes always provoke fears — in this case, that private plans would flee the program and that the quality of care in hospitals would suffer. Neither of these fears has materialized, however. Enrollment in private plans is up since the ACA changes.

The law also emphasized that payments should be based on the value, not the volume, of medical care. In a value-based system, compensation is made for the patient as a whole, not for specific services provided. As a result, eliminating services that are not needed is financially rewarded. The reaction to this change has been rapid: Hospital readmissions, which used to bring in substantial dollars, are now penalized.

Unsurprisingly, the readmission rate in Medicare is down 10 percent since 2011. Similarly, hospital-acquired infections used to bring in additional dollars, but now they do not. One program to cut infections, encompassing only 333 hospitals, saved more than $9 billion. Both of these changes improve patient health even as they reduce spending.

The accountable-care movement — which aims to make providers more accountable for the cost and quality of care — has blossomed far beyond expectations. There are nearly 500 Accountable Care Organizations (ACOs) nationwide, half in Medicare. Ten percent of Medicare beneficiaries are in ACOs, and many others are in payment systems that put together all reimbursements for a procedure, such as a hip replacement or cardiac stent insertion. Leaders of medical systems routinely report that they expect, and are preparing for, a move to value-based payments.

Evaluations of recent ACO programs show quality improvements among all participating organizations and financial savings for many. This is not a surprise. The Institute of Medicine has been reporting for more than a decade that a third or more of medical spending could be eliminated while increasing patient health. The only surprise is how fast the system has moved in this direction.
...
Six states, including places as diverse as Arkansas, Massachusetts and Oregon, are using ACA-appropriated funds to help shift medical care to a higher-quality, lower-cost system . Nineteen other states are planning similar changes. And many of these states are solidly red.
...
Looking ahead, there is every reason to believe that costs will continue to grow slowly, maybe even more slowly. A study in Massachusetts showed that ACO savings increase over time as organizations move into more areas that can slow cost growth. An analysis of exchange premiums estimated that insurance costs in the exchanges are 16 percent below what was forecast two years ago; the lower costs were attributed to competition from new entrants in the market.

If cost growth continues at its low pace, the cumulative savings to the federal government would be more than $750 billion over the next decade. Such savings are likely to dwarf anything that comes out of Congress this year.

Many Americans are rightly upset with the Obama administration’s rocky rollout of the insurance exchange. Failing at such a major project is inexcusable. But if the early indications are any guide, we should be pleased with how the new health law is affecting what we pay for care. If the Web site is fixed and enrollment can catch up to expectations, the ACA could yet become a major policy success.

The health-care law’s success story: Slowing down medical costs - The Washington Post
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rogue49 · Nov 11, 2013

So basically, the new trend is...if you're opposed, then it should ALL die, even if it means harm to ALL.

And in the unending media of ACA site issues they are focused on.
Media and people are not focused on another tech glitch of a 30 billion dollar contract for our new navy ships. - LINK
But Nooo...this doesn't get paid attention to.

In the end, media and people focus on what they want...what is the hype, what they love, what they hate.
Everything else, falls by the wayside...for good or ill.

Even those in the media are noting the difficulty with keeping up and what gets focused on.
With twitter and other instant...the news cycle is not even just 24/7...but minute by minute.
Everything is Attention Deficit Disorder...no attention span.
Most gets passed by on the highway.

They'll figure out Obamacare...and I'd LOVE to hear the opposition's alternative solution, other than just die.
And when they fix it...as they have fixed many other programs.

We'll be on to the next flavor of hate for the second.

See myself? I don't expect perfection.
I expect reasonableness. (but I don't hope for it)
I hope for forethought. (but I don't expect it)

rogue49 · Nov 12, 2013

BTW...the insured actually enrolled, not just searching...is under 100,000

Now, considering it went from just the tens...to this, in a month...is not too bad.
The momentum will gain.

And it would be likely more if it weren't for the bad press.

I wish people and the media would wallow in reality and realistic expectations, instead of instantaneous gratification.
Reporters and pundits are the worst for this...as is their line of questioning.

I'm not going to judge until we get to the Spring.
There's going to be a ton of mess to sort out between then.

Of course, the media will likely be onto the latest crisis "du jour" by then...and not paying attention, whether good OR ill.

rogue49 · Nov 12, 2013

Here's a good summary for reasons for the issues that are occuring.

Immediate lessons from health-care reform
By Lawrence Summers, Published: November 10
Lawrence Summers is a professor and past president at Harvard. He was Treasury secretary from 1999 to 2001 and economic adviser to President Obama from 2009 through 2010.

As President Obama has recognized, his administration’s failure to deliver a functioning Web site that Americans can use to enroll in Obamacare represents an inexcusable error. The Affordable Care Act, which legislates near-universal health insurance, was passed after more than a century of failed efforts to achieve this progressive dream in this country. It is tragic to be falling short on the mundane task of enrolling Americans in health-care exchanges. Even if the goal of getting the health-insurance exchanges working by Nov. 30 is achieved — and objective observers cannot regard this as a certainty — a shadow has been cast on the federal government’s competence.

What can be learned from this episode? It is too soon to know with confidence, but some preliminary judgments are possible.

The dismal track record of the implementation of large-scale information technology initiatives even in rigorous and focused corporate environments points up their difficulty. Unexpected obstacles arise, deadlines are missed and budgets are overrun. Maximizing the prospect of success requires providing for slack in the schedule and the budget, structuring projects with clear accountabilities and frequent checkpoints, and assigning oversight responsibility to people with extensive information technology experience rather than general managers who have programmatic commitments.

Success also requires some trusting but more verifying. A homeowner who hires a general contractor to build an addition, discusses the project and then goes away for six months probably would be unhappy with the result. The same is true for public managers who hire contractors to perform essential tasks but fail to rigorously oversee every step.

Another requisite for success is steadiness and realism in the face of difficulty. Once a project gets off track, there is an overwhelming temptation for everyone involved to circle the wagons and promise rapid repair so as to hold critics at bay. Yet the right response to failure is to surface problems as rapidly as possible and to move more deliberately and carefully — not more quickly. In football, the best teams stick to their playbooks even when they fall behind. When one has fallen behind on a project, it is important to mobilize new resources and management but not to overpromise with respect to how soon and how good a fix is possible. One instance of over-optimism will ultimately be forgotten or forgiven. Repeated over-optimism should not and will not be excused.

These are old truths that those responsible for implementing Obamacare should have heeded. Yet fairness requires recognizing the equally important, and in some ways more fundamental, factor behind the problems implementing Obamacare: the systematic effort of the president’s opponents to delegitimize and undermine the project.

Large-scale information technology projects in the private sector are hard enough without an organized constituency for failure. It is no exaggeration to say that the failure of Obamacare has been the prophecy and the hope of many of those responsible for funding implementation of the Affordable Care Act, confirming the appointments of those who will do the job and overseeing the results. They have been eager to seize on any problems and highlight any controversial judgments. All serve to create an environment in which failure becomes the expectation.

It is disingenuous for those who stood ready to turn any regulatory detail into an attack ad to profess outrage when guidance was not provided during an election campaign. It is hypocritical for those who held up confirmations of key officials with responsibility for managing federal health-care programs and whose behavior deterred many people from coming into government to lash out at the incompetence of government management. And it is indefensible to refuse to appropriate money to carry out a program and then attack it for being under-resourced.

There is a line that must be respected between political opposition and conscious subversion. Everyone understands that when the country is at war, even a war a person may oppose, vigorous oversight is essential, but, in the end, there is an obligation to support American troops. In the same way, history will not judge kindly those who, having lost political debates over policy, go beyond vigorous oversight and seek to subvert enacted programs.

There is a danger here that goes far beyond delays in access to health insurance. The risk is of a vicious cycle in which poor government performance leads, on the one hand, to overly bold promises of repair and, on the other hand, to reduced funding and support for those doing the work. This generates unmet expectations and disappointment, setting off the cycle anew. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.
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The only problem, many of those who should learn the lessons aren't going to acknowledge their own complicity.

Tully Mars · Nov 12, 2013

They just stated on the news this morning that Oregon, one of the states running it's own exchange, had zero enrolls. They left out, of course, the computer system has yet to be launched, and that many like myself have requested more information on several plans and options. If it's available and I can afford it I'll buy even though I'm not required as I live in Mexico. I'm spending more time there and my insurance here will not cover me in the US. The US is one of about five countries my insurance is not valid, obviously due to medical care costs.

samcol · Nov 12, 2013

ah now we have bill clinton saying obama should uphold his promise that people should be able to keep their insurance, and the 12 or so democrats who want it postponed for a year. this thing just keeps getting uglier.

redux · Nov 12, 2013

The only issue that really matters is getting the Exchanges up and running by the end of the month. If that happens, every thing else falls in place, despite the whining. Administratively, it would be almost impossible for insurance companies to reinstate cancelled plans, despite the rhetoric. The White House can give a pass to the Senate Democrats in swing states up for re-election next year.

At best, I could see Obama proposing to extend the 400% poverty level upward so more of those folks would get subsidies.

The bottom line is many of those plans, the "junk plans" at $100/month with numerous loopholes, exclusions, coverage gaps, etc, are bad for the individual, bad for the individual's family and their financial security, bad for the individual's workplace where untreated ailments can spread to others (think not getting a flu shot), and bad for the country as a whole (think $5o billion annually in unpaid hospital bills passed on to consumers).

Baraka_Guru · Nov 12, 2013

America, what's with all the subprime lending and junk insurance plans? What else are you hiding? Sheesh.

redux · Nov 12, 2013

What Obama should do is tie a bill to increase the minimum wage from $7.25/hr to $10.10/hr to any bill or legislative "fix" dealing with the cancelled insurance policies and bait the Republicans.

Tully Mars · Nov 13, 2013

Baraka_Guru said: ↑

America, what's with all the subprime lending and junk insurance plans? What else are you hiding? Sheesh.
Click to expand...

The thing is most US citizens don't know. The corporations that sell and bundle this crap fund the advertising and at times own some media outlets so this stuff goes way under reported. Pick up a business magazine or watch a business channel and you'll never even see these issues mentioned.

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