Politics Obamacare

Aceventura · Nov 21, 2013

redux said: ↑

Most Americans w/o insurance will benefit (except those low income folks in red states), most individuals who had their policy cut will benefit, and the 2/3 of Americans in group plans will benefit.
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Let's actually walk through this. A young healthy person who can not afford insurance, enrolls in a bronze plan. Before enrollment let's say they would spend about $1,000 per year on health related issues. Now with insurance what happens? Let's say they get the Bronze plan and after subsidy they spend $100/month. But, they have a $5,000 deductible. If they need to use the coverage, they are $6,200 out of pocket before insurance kicks in. The policy will have a co-pay and to figure how that plays in we need the details in the policy, but what may happen is that the maximum out of pocket will most likely be higher than the $6,200 amount. But let's assume the max out of pocket is $6,200.

For many healthy young people they will go from spending perhaps $1,000 per year to between $1,200 to $6,200 per year before getting any benefit from insurance. How many will be in which category? You do not know and you can not honestly say :most Americans w/o insurance will benefit" In fact the way insurance works is that most people can not benefit - in principle few people benefit and most people pay the net costs! There are no free rides in real insurance markets.

It is shameful.
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What is shameful is a convoluted unworkable law and the deceptive practices used to sell it. If we simply asked Americans if they would pay about $100 per year to help provide healthcare to those in need - I bet the majority would say, sure! And yes there is a tax on insurance plans that will basically cost each American about $100 per year to support medicaid increases.

redux · Nov 28, 2013

Aceventura said: ↑

Let's actually walk through this. A young healthy person who can not afford insurance, enrolls in a bronze plan. Before enrollment let's say they would spend about $1,000 per year on health related issues. Now with insurance what happens? Let's say they get the Bronze plan and after subsidy they spend $100/month. But, they have a $5,000 deductible. If they need to use the coverage, they are $6,200 out of pocket before insurance kicks in. The policy will have a co-pay and to figure how that plays in we need the details in the policy, but what may happen is that the maximum out of pocket will most likely be higher than the $6,200 amount. But let's assume the max out of pocket is $6,200.

For many healthy young people they will go from spending perhaps $1,000 per year to between $1,200 to $6,200 per year before getting any benefit from insurance. How many will be in which category? You do not know and you can not honestly say :most Americans w/o insurance will benefit" In fact the way insurance works is that most people can not benefit - in principle few people benefit and most people pay the net costs! There are no free rides in real insurance markets.
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Ace...for that $100/month, the out-of-pocket limit is $6250. Few, if any, will face financial hardship from a serious illness/accident that millions have faced in the past and all will have far greater consumer protections that any time in the past. That is a fact.

Yes, most will never see the full return of their payment of premiums....neither will I in my group plan and neither will most Americans. I wont see the full return on my premiums for property or car insurance either.....that is why it is insurance!

What is shameful is a convoluted unworkable law and the deceptive practices used to sell it. If we simply asked Americans if they would pay about $100 per year to help provide healthcare to those in need - I bet the majority would say, sure! And yes there is a tax on insurance plans that will basically cost each American about $100 per year to support medicaid increases.
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The distortions, the outright lies, the "anecdotes" that when vetted often proved to be misleading, the ideological assumptions have not proven to be supported by the facts or experiences to-date.

The extremists on the right will go to any length possible, like no other time in our history, to demagogue a law that they just cant stand, in part because it is Obama's.

It is the law...it will remain the law.

Try offering something constructive for a change.
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samcol said: ↑

have the people spoken yet? when is this going to be repealed...
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The people have spoken and they dont want the ACA repealed.

...Republicans, lacking a plausible alternative, offer nothing but obstruction. The law is being implemented. The GOP can’t fight it without, in effect, rolling back coverage and benefits. Changing the law’s details is a popular position. Repealing it isn’t.

Look at the polls. In a CBS News survey taken Oct. 1–2, a majority of Americans—51 to 43 percent—disapproved of the Affordable Care Act. Only 43 percent, however, said the law went “too far in changing the U.S. health care system.” Thirty percent said the law was about right, and 20 percent said it didn’t go far enough. The plurality supported the law or an extension of it.

In an NBC News/Wall Street Journal poll taken Oct. 7–9, 43 percent of respondents said the law was a bad idea. Only 38 percent called it a good idea. But 50 percent opposed “totally eliminating federal funding” for it, compared with 39 percent who favored cutting off funds.

Twenty-one percent of Americans in a Gallup poll conducted Oct. 12–13 said they’d like major changes to the law. Ninteen percent said they’d like minor changes. But only 29 percent said they’d like the law to be repealed entirely—less than the 32 percent who took that position three years ago, and not much more than the 24 percent who said they’d like to keep the law as it is. When Gallup pressed further, asking respondents whether the changes they had in mind would scale the law back or expand it, 40 percent of those who wanted changes (and who answered the question either way) said they preferred to expand the law.

A CNN/ORC survey taken Oct. 18–20 found that respondents opposed the law, 56 to 41 percent. But when pressed further, 12 percent—nearly a quarter of those who opposed the law—said it wasn’t liberal enough. Only 38 percent of the entire sample—less than the number who favored the law—said it was too liberal.

Now comes a second NBC/Journal poll, conducted Oct. 25–28. The numbers look grim: Forty-seven percent say Obamacare is a bad idea, up from 43 percent in early October. When they’re asked whether the law “is working well the way it is,” “needs minor modifications to improve it,” “needs a major overhaul,” or “should be totally eliminated,” only 6 percent say it’s working well as is. But among the remaining options, 38 percent of respondents say the law needs minor modifications, 28 percent say it needs a major overhaul, and only 24 percent say it should be completely eliminated.

This puts Republicans in a difficult spot. Their mantra, repeated over and over and over, is that the law must be “entirely repealed and replaced.” “One thing that all Republicans agreed on back in 2009 is that we thought Obamacare was a terrible mistake,” Senate Minority Leader Mitch McConnell reminded the public on Oct. 20. “We still think that, and we're going to do everything we can in the future to try to repeal it.” At an Oct. 29 press conference, House Speaker John Boehner agreed: “We want to repeal Obamacare and replace it with patient-centered health care.” When a reporter asked whether “Republicans would like to join in with some Democrats to change the law,” Boehner scoffed, “There is no way to fix this monstrosity.”

The polls don’t support that view. There’s a big gap between the public’s dissatisfaction and the GOP’s full-throated antagonism. Obama is filling that gap.

Obamacare polls: Americans want to reform the Affordable Care Act, not repeal it.
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Wouldnt you agree that the "people who have spoken" dont want it repealed?

Aceventura · Nov 21, 2013

redux said: ↑

Ace...for that $100/month, the out-of-pocket limit is $6250. Few, if any, will face financial hardship from a serious illness/accident that millions have faced in the past and all will have far greater consumer protections that any time in the past. That is a fact.
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You are saying most will benefit - this is not true. Obamacare maintains an insurance market - a basic understanding of insurance tell us that from the perspective of money (as opposed to valuing the mental well being of having insurance) many pay and few benefit - otherwise the market will collapse. It is misleading, a lie to suggest most will benefit financially in an insurance market!

Yes, most will never see the full return of their payment of premiums....neither will I in my group plan and neither will most Americans. I wont see the full return on my premiums for property or car insurance either.....that is why it is insurance!
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If you understand that why mislead people? Obamacare is setup to get people paying into the system to cover the costs of all the benefits you recite. You recite these benefits as if there is no cost, as if no one is paying for it, as if it is free. I repeatedly remind you that it is not free - all Obamacare does is shift the costs, some benefit at the expense of others - but Obama won't say that, why? Everything in the law is based on that.

Try offering something constructive for a change.
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I know what it is like to be on both sides of this issue, being poor and understanding business or the system. I knew a young lady who was single, pregnant, and who could not afford prenatal care, delivery cost and had no insurance. I suggested she talk to her doctor and see if he would waive or reduce his fees, the doctor reduced his fees and other costs. I suggested she talk to the hospital in advance and ask them to reduce or waive their fees, they reduced their fees. I suggested that she ask them for a payment plan that she could fit into her budget, they set up a payment plan that fit into her budget at 0%. The delivery went fine and she paid her bills without a problem.

Under Obamacare, if she gets a bronze plan with a $5,000 deductible and annual premiums of $1,200, with her insurance under obamacare the delivery would cost her more! If she goes to the doctor and ask him to reduce his fees, he can not report one thing and bill her something different, this is fraud, so she would still have her deductible. Same with the hospital. With insurance her out of pocket cost will be what they are regardless. People who have difficulty with the premiums, deductibles and copays will have an eye opener next year. It is not going to be easy for working poor. Obamacare does nothing to reduce the cost of delivering a baby!

Something constructive is, let's fix this problem! It should not cost $5,000+ to deliver a baby. Why does it cost so much? Partly due to the liability issues - tort reform could help here, a plan suggested by Republicans many times. We can do other things as well to reduce cost. Obamacare does nothing to reduce costs.

redux · Nov 28, 2013

Same old crap

Tort reform (negligible impact) and selling across state lines (btw, the ACA includes state "health care choice compacts" to satisfy the Republicans, but this is not enough for the extremists).

Both are great for the insurance industry and both suck for the consumers.
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Ace...the ACA does include grants for state demonstration projects to test and implement medical-malpractice reforms and other initiatives to deal with defensive medicine (albeit small in comparison to other features).

If the Republicans want to open that discussion again as part of a commitment to fix rather than repeal, I would suspect Obama would be open to that discussion.

Baraka_Guru · Nov 22, 2013

redux said: ↑

The people have spoken and they dont want the ACA repealed.
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It wouldn't make sense to repeal it, as it would be taking a huge step backward. I think reasonable people would rather take steps forward. I've mentioned maybe here (maybe elsewhere) that no current universal health care system is the same as it was when it got started. Canada's system started in a few provinces, then spread to other provinces before getting additional federal support. There have been changes since, and it will continue to change.

The ACA needs changing, it should be changed, and it should continue to change. Perhaps it will involve separate related legislation as well.

This popped up recently. I think Americans would do well to consider these points about the Canadian system when deciding how to move forward: 21 Ways the Canadian Health Care System is Better than Obamacare | Common Dreams

redux · Nov 23, 2013

redux · Nov 24, 2013

This is a good article on just one way the ACA is investing in lowering the high cost of health care.

The primary aim of the Affordable Care Act is to reduce the number of uninsured Americans. Even if the new federal health law accomplishes that goal, states still must grapple with the relatively high cost and low quality of U.S. health care.

Per person, the U.S. spends far more than any other country on health care—and yet it gets relatively poor results for its money. It lags behind other countries on many health measures, and according to a recent report by the U.S. Institute of Medicine, about one-third of the $2.6 trillion Americans spent on health care last year paid for unnecessary procedures and avoidable hospital admissions.

Under the current “fee-for-service” system, health care providers are paid per office visit or procedure performed. The key to cutting costs and improving quality, many experts believe, is to reward health care providers for keeping their patients healthy and keeping costs down, instead of giving them a financial incentive to provide as many services and procedures as possible.

That’s where states come in. Under an ACA program called the State Innovation Models Initiative, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont this year began testing new health care financing models. Another 19 states are in various stages of developing similar experiments.

Out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. A unit of the U.S. Department of Health and Human Services known as the Center for Medicare and Medicaid Innovation reviews applications and approves the grants.

“The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur,” said Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health care system.

Colorado, New York and Washington are next in line to test their cost-containment models. California, Connecticut, Delaware, Hawaii, Idaho, Illinois, Iowa, Maryland, Michigan, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas and Utah are using federal money to develop their models.

A common theme is connecting more people to “patient-centered medical homes” where “care coordinators” ensure they receive cancer screenings and other preventive care. For those with chronic illnesses such as diabetes, high blood pressure and heart disease, the goal is to avoid expensive hospitalizations by managing their conditions with medicine and lifestyle changes.

The experiments extend beyond doctors’ offices to hospitals, mental health centers, nursing facilities and community social services agencies. In some states, multiple health care providers have banded together into “accountable care organizations” to better coordinate care and control costs.

Some states are using ACA money to engage in other experiments. Vermont, for example, is examining whether it can save money on health care by spending more on its schools, since people who attain higher education levels tend to be healthier.

Market Power
Even though private insurers pay most of the nation’s health care expenses, states wield tremendous influence in the health care marketplace. Medicaid, the joint federal-state health care program for low-income people, accounts for about 15 percent of all U.S. health care spending. When combined with benefit plans for millions of state workers and retirees, states are among the biggest payers in the health care system. Medicare, the federal health care program for seniors, accounts for another 25 percent of spending.

Under the innovation grant program, states must convince private insurers, major employers and Medicare to join their experiments, in the hope that their combined market power will force even the most prestigious health care providers to pay attention, said Sharon Silow-Carroll, a health care consultant with Health Management Associates. In addition, standardizing quality measures and payment policies among all payers should make it easier for health care providers to comply, she said.

Following is a rundown of what each state plans to do with its ACA grant:

more: Obamacare Gives States Innovation Grants to Cut Costs, Improve Quality
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Derwood · Nov 25, 2013

samcol said: ↑

they already royally botched this law up, how hard of a sell is single payer going to be now? there's no reason for the america people to trust the government setting up our healthcare, especially now
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It's almost like opponents of the law were hoping this exact thing would happen so we'd never have single payer......

rogue49 · Nov 25, 2013

Question for the masses out there...

Are any of you experiencing raising of drug prices out there ...directly related to the ACA being enacted?

I've heard of a few policies being cancelled, because they weren't up to new standards. But that's rare in comparison to most.
But I haven't heard of med price adjustments...and that wouldn't make sense...it's not law...unless some insurance unsavory companies are unfairly leveraging the situation to maximize profits.

I think it's people irrationally relating the current spotlight of negativity from Obamacare to any increase of med prices.
Illogical...false correlation. Just because A, doesn't meant A = B.

Can anybody else confirm either way?

Aceventura · Nov 25, 2013

redux said: ↑

This is a good article on just one way the ACA is investing in lowering the high cost of health care.
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We are seeing many reports on Medicaid results being sub-par. Increasing costs for poor results is not going to result in any net benefit. There are better ways to address our healthcare problems than what we have with the ACA. What do the supporters of ACA have to say? Anything other than the PR talking points? I guess we can always attack the source without responding to the data.

As the Obamacare debacle rolls on -- looking even worse than it did a week ago, if that's possible -- there's a separate but related issue involving Medicaid expansion. And, as with Obamacare, people who oppose the expansion risk being called heartless murderers for "denying sick people care."
The thing is, though, there's a difference between care and coverage. Insurance programs, whether Obamacare or Medicaid, only provide coverage. It's doctors who provide care. But because government insurance programs -- even money-sucking ones like Medicaid, which costs $450 billion a year -- can't pay doctors enough and smother them with paperwork, doctors are hard to find. Without doctors, coverage doesn't mean much.
That's the point of How Medicaid Fails The Poor, a new book by Forbes columnist and Manhattan Institute fellow Avik Roy. Coverage isn't care, notes Roy -- and in the case of Medicaid, coverage may be worse than not being covered.
That's because extensive research indicates that Medicaid recipients actually do worse than people without any insurance at all. A University of Virginia study found that Medicaid patients hospitalized for major surgery were actually 13% more likely to die in the hospital than those without any health insurance. Likewise, the National Cancer Institute found that late-stage prostate cancer, late-stage breast cancer, and late-stage melanoma were actually much more common in Medicaid recipients than in the uninsured. And a Johns Hopkins study of patients receiving lung transplants found that Medicaid patients were 29% more likely to die within three years.
What's more, a University of Pennsylvania study (published in the journal Cancer) found that colon cancer patients with Medicaid had a higher mortality rate than uninsured patients, and a higher rate of surgical complications. And these findings hold up even when you correct for age and socioeconomic status.
Why Medicaid recipients do worse isn't entirely clear, but it's likely because the best doctors seldom accept Medicaid, leaving patients with subpar physicians. In addition, Roy opens with the story of Deamonte Driver, a seventh grader with a tooth abscess who wound up dying when it turned into a brain infection, after being shuffled from doctor to doctor for weeks. Uninsured patients probably go straight to the Emergency Room or to a free clinic, while Medicaid recipients may waste precious days, weeks, or months trying to navigate the bureaucracy.
As Roy notes, people who have complained about Medicaid problems and argued against its expansion, like Connecticut Sen. Joe Lieberman in 2009, are called the equivalent of mass murderers. But on numbers like this, it's the Medicaid-boosters who are guiltiest.
Roy observes:

While Medicaid costs too much, its principal problem is that it doesn't make Medicaid patients healthier. It's not wrong to spend a large sum of money on health care for the poor. It is wrong to waste large sums of money on health care for the poor. ... Many conservative opponents of the Affordable Care Act are concerned that the law costs too much, that it represents too much government intrusion into the lives of ordinary citizens. But the law's true weakness is that it endorses and expands the humanitarian scandal that is today's Medicaid program.
It's not surprising that a government that can't build a working health insurance website can't run a massive health insurance program so that its beneficiaries actually benefit. What's surprising is that there's been so little push back over the awful results that Medicaid has yielded. It's as if the government "health care" boosters don't really care about the well being of the poor.
It wouldn't be hard to do better, relying on free markets and individual choice to take the place of bureaucracy. As Roy writes: "Start by paying a primary-care physician $80 a month to see each patient, whether he is healthy or sick. That's what so-called concierge doctors charge, and it would give Medicaid patients what they really need: first-class primary-care physicians to manage their chronic cardiovascular and metabolic conditions." On top of that, he says, add a $2,500 a year catastrophic plan to guard against financial disaster. "The total annual cost of such a program would be $3,460 per person, 42% less than what Obamacare's Medicaid expansion costs." And hey, it might actually leave its recipients' health better off, instead of worse off.
Is this the best solution? I don't know, but it's better than doubling down on failure, which is what both Obamacare, and the accompanying Medicaid expansion, are all about. I fear, however, that an approach like Roy's won't offer sufficient opportunities for graft and patronage to appeal to politicians. Worse yet, putting people in charge of their own health care might lead to similar approaches elsewhere, something that's our political class' worst nightmare. So as appealing as Roy's prescription is, I suspect we'll continue with business as usual. Which is too bad for the country, and for poor people who get sick.
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Medicaid's awful results: Column

redux · Dec 2, 2013

The ACA includes numerous provisions (and grants to states) to improve Medicaid, including payment and delivery system reforms, cost controls and enhanced program integrity.

One example: Program Integrity

And beyond the program integrity, most states are implementing some of these other improvements incentivized by the ACA, including those (red) states that opted out of expanding Medicaid and chose to leave many of their poorest uninsured.

Example: How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services andn Supports (LTSS) Today? State Adoption of Six LTSS Options (see table I for states implementing various provisions)

These are just a few examples of the most comprehensive Medicaid reform since its passage that attempt to balance quality of care for the poor (who deserve the same quality as everyone else) and cost containment.
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Aceventura said: ↑

... Anything other than the PR talking points? I guess we can always attack the source without responding to the data.
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Now this made me laugh.

I have presented so much data, including benefits and savings already achieved for millions, and all I get in response is right wing talking points.

rogue49 · Nov 26, 2013

And here is the best reason it will succeed...money.
Insurance companies are using it as a leverage to increase the volume of their client base.
More people, more income, bigger pool.

Hey capitalism. Isn't that what the GOP wants??
Nope, not if Obama was involved...but no worries GOP'ers the insurance companies aren't advertising Obamacare.
So win-win, right?

Oh yeah, god-forbid that more people have health insurance as a reason.

And the Dems spines are wobbling...quick, someone get a broomstick up their asses to show some resolve. (friggin' wishy-washy pussies...)

It's not Obamacare, it's business
By: Kyle Cheney and Paige Winfield Cunningham - November 25, 2013

Insurance companies are ready to unleash an expensive PR blitz to get 7 million new customers once HealthCare.gov is fixed.

But don’t expect them to sell “Obamacare.”

Big insurers and the stock analysts that track them say that once the White House is sure its enrollment website is working, the companies will barrage the airwaves with messages encouraging people to join new health insurance exchanges, either by signing up directly with insurers or by giving the website another shot.

The strategy makes sense: “Obamacare” polls terribly with Americans, but the idea of affordable insurance is a hit. And for the insurance industry, the new health care law isn’t about politics — it’s business.

Already Kaiser Permanente has sent a letter to potential customers in the Washington area, touting the availability of federal subsidies and mentioning specific benefits and coverage options for “hassle-free coverage that won’t let you down.”

But the letter makes no mention of Obamacare, the Affordable Care Act or President Barack Obama. “If you need help paying for health care, you may qualify for federal financial assistance when you enroll in a plan offered in the marketplace,” it says, giving a toll-free number.

WellPoint, the largest insurer within the Blue Cross Blue Shield Association, has earmarked $150 million for “exchange-related activities” that include marketing to customers, a company spokeswoman said. The timetable for spending will depend on “the pace of overall exchange readiness — and tenor of consumer sentiment,” she said.

The health care website is supposed to be working “smoothly” for most people by this weekend, White House officials say.

The insurance companies could be critical in getting people to log on.

“They’re not necessarily unbiased. They have a lot of skin in the game. They can help convince people that it’s working,” said former Senate Majority Leader Tom Daschle, a longtime champion of national health reform who now, as an adviser at DLA Piper, has close ties to insurers.

White House ally Enroll America, which has Kaiser Permanente and Blue Shield of California on its board, says it’s preparing an early December “chase program” to re-engage people who were stymied early on by the flawed website. The “chase” will get under way only if HealthCare.gov is working by then.

“Right now, there’s about 50,000 people that we’re going to be reaching back to at the door, on the phone, by email,” said Enroll spokesman Justin Nisly. “We’ll be following back up and pushing them toward the website. Hopefully the website will be working.”

Nisly added that the effort is meant to ramp up enrollment until insurers step in and provide PR “air cover” early next year.

But they have to be confident that HealthCare.gov is really working and that people have faith that they can get on and get results other than error messages and crashes.

“What you don’t want to do is direct people to a nonworking website. That is not good business practice,” said Sheryl Skolnick, managing director of investment analysis firm CRT Capital. “I think that it’s fair to say that once it’s established that you can go from typing in the words HealthCare.gov to getting a confirming email saying ‘you’re covered’ with reasonable ease, then I think you’re going to see a huge marketing boost to get people enrolled.”

An industry ad campaign could be a wild card in the Obama administration’s effort to get the president’s health program back on track — including drawing a robust number of young, healthy people into the new market. The calamitous rollout depressed enrollment in the first months and has led some analysts to predict far fewer sign-ups than the White House is seeking.

“Even if those issues are resolved quickly, you still probably are not going to get as much enrollment,” said Matthew Borsch, vice president of Goldman Sachs, who predicted 5 million people would become covered in the first year.

Insurers did increase their advertising after the federal website launched. Sixty-three percent of the industry’s television ad spending since July occurred after the Oct. 1 start of enrollment, according to an analysis by Kantar Media. But once the severity of the website problems became evident, they pulled back, analysts say.

“We have a very different situation than we were expecting two months ago,” said Mike Killeen, marketing director for the Atlanta-based firm Lenz Marketing. “They’re pulling back and they’re not placing the media I think they planned on spending. What’s the point in doing that if you can’t even get people through the system?”

In the limited messaging that is going on, insurers are either casting themselves as more trustworthy than the government — or pretty much ignoring the Affordable Care Act and the benighted website altogether. They don’t want to scare off customers from applying to a program that has provoked so much opposition and skepticism.

Nearly all of the major insurers such as Cigna, Humana and United Healthcare are mostly ignoring the health law and its messy start. Only 18 percent of ads placed by health insurers since Oct. 1 have referenced the Affordable Care Act, according to Kantar Media.

Treating the law as radioactive, at least for now, seems to be the safer path.

“It seems pretty normal for insurers to play it safe for this first round, see how things go,” said Elizabeth Wilner, vice president of Kantar Media’s CMAG. “They didn’t know the website wasn’t going to work, so now they seem pretty prescient.”

So far, Blue Cross Blue Shield is the only major network of insurers directly referencing the federal website over the airwaves — and it’s depicting itself as an alternative to the balky site. The message is that health plans can help — even when the government is stuck. They are touting the direct enrollment option. That’s been a path for consumers all along, but the HealthCare.gov repair team is still working on making that work for people who qualify for subsidies, not just those who self-pay.

But Blue Cross’s subsidiaries have released a slew of ads that recognize the law in ways meant to reassure — and even amuse — consumers. Wellmark Blue Cross Blue Shield launched three ads last week in Iowa and South Dakota that mock HealthCare.gov’s woes. The message: The federal government might be a laughingstock, but we’re serious about getting you covered.

“Things don’t always work like they’re supposed to,” the ads say. “Good thing the government exchange isn’t the only place to buy health insurance. … Just visit Wellmark.com/simple or call today.”

“Clearly, they sat down and decided ‘we are going to reposition ourselves as the reassuring solution for people who are nervous about their health care situation,’” Wilner said.

“I think what they’re selling is simplicity, certainty, confidence,” Killeen said. “It’s such a mess right now with the site. It’s a functional mess turned into an emotional mess.”

Robert Blendon, a Harvard University health policy expert, said insurers would be wise to steer clear of the broader political debate when re-engaging consumers to enroll.

“It really should be much more a consumer education campaign: We’re open for business, it’s easy to sign up, here are the kind of choices we’re offering — no mention of what happened before,” he said. “From the insurance industry’s point of view, they’re only interested in people who can come to the exchange and buy a product. They should not be involved in the broader issue.”

Daschle said insurers would do well to highlight real people who stand to benefit from the law — “people that have no ax to grind one way or the other.” That would be a counterpoint to all the stories about people who face higher bills.

It’s still unclear when HealthCare.gov will run as smoothly as the Obama administration wants — and how the insurers perceive whatever progress is achieved by Nov. 30.

Skolnick of CRT Capital Group said it’s not a good sign if insurers don’t ramp up their marketing after Nov. 30, “since we know they’re prepared to do so.”

Killeen said insurers would act when the public truly believes HealthCare.gov is working.

“I think they’ll need to be assured not only the website is working but also that people believe the website’s working.”

Daschle said he’s “encouraged by performance reports” he’s getting on the website and that the stories about glitches will, eventually, be a memory.

© 2013 POLITICO LLC
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rogue49 · Nov 26, 2013

And as a followup...here's a great practical and level-headed perspective of how businesses should navigate the current insurance environ. (ACA and more...)

Seven Conclusions About Small-Business Health Insurance
By PAUL DOWNS - November 25, 2013, 7:00 am

In my recent posts, I have told the story of how I started to explore my options for renewing my insurance this year. It’s been my habit in writing for this blog to try to convey useful information, derived from my experience as an ordinary small-business owner, in the form of narrative episodes.

Most posts have told a story, with a beginning, a middle and — I hope — a useful conclusion. Having spent the last two weeks fully immersed in the baffling world of health insurance, I’ve decided that I need to present some information in a different way. If you need to renew your policies before Jan. 1, as I do, there is no time to waste.

Let me start with a caveat: my experience is based on my own company and its location (near Philadelphia). I am a small manufacturer, who currently offers coverage to my employees. I have an insurance agent who has been my primary point of contact with the insurance market. Because I am in Pennsylvania, a state that does not have its own exchange, I am forced to use the HealthCare.gov site. However, the local market is dominated by three large private insurers — Independence Blue Cross, Aetna, United Healthcare — that all have their own websites where business owners can shop directly.

With that in mind, I offer seven hard-earned conclusions I have reached about the new world of small-business health insurance.

1. The Affordable Care Act has fundamentally restructured the insurance market. Business owners now have a better way to shop for coverage, with more plan choices and a more uniform set of standards that make comparing options much easier. There are lots of ways to save money while also offering employees a wider range of choices. As everyone knows, the new system is a mess right now, but it is a vast improvement over our previous mess.

2. That said, none of the players in my market, including HealthCare.gov, my agent, and the private insurance companies, have figured out how to communicate the precise nature of their offerings and the best path to a decision. None of the sites I looked at is easy to understand and use. Nobody has figured out a good way to deliver pricing information. All of the quotes I got were confusing and showed only a small subset of my actual set of choices. Truth to tell, I came to a good understanding of my options only by spending hours on the phone with a vice president of sales at Independence Blue Cross who called me after my last post — and even he was baffled by many of my questions.

3. If you are currently offering coverage, and you like what your agent dropped on your desk, sign it and be done with it. You can always come back and dig into your choices next year, when the dust has settled.

4. If you are not currently offering insurance, do not start now. Your people can get it themselves on the exchange. (Or not, and they can pay the penalty.)

4a. That said, I cannot comment on state-run exchanges. I have not heard anything bad about them, and you might well have access to one that works. In that case, you might want to give it a try.

4b. If you want to give your people one piece of advice before they try the exchange, tell them this: Don’t bother getting pricing without creating an account — because pricing varies widely with age. The quick quotes you can get without an account do not specify the age of the people used to generate the number. As a result, the price can be off by a factor of two or more in either direction (here is another take on this).

By contrast, the quotes you get after you make an account are tailored to your age and the ages of family members, and will be accurate. The wide discrepancy between these two numbers is causing a lot of disappointment. It is not clear to me why this mismatch has not been better explained, or why it was baked into the system in the first place.

5. The federal SHOP exchange for small businesses remains dysfunctional. As of Friday, the only information available in the SHOP was for sample individual plan costs, which are highly misleading as noted above. You still cannot enter your employee census online and get actual quotes for your business. This still must be done with a paper application. I mailed mine 16 days ago, on Nov. 6, and have heard nothing. My enrollment deadline is fast approaching, and the SHOP exchange has given me no path forward.

The main reason to use the SHOP exchange is if you have lower-wage employees and might qualify for the tax credits. A business owner must buy through the exchange to get the credits. As best I can tell, businesses that qualify — mine does not — are just out of luck until the SHOP exchange is truly operational.

6. For owners of businesses like my sister’s restaurant in Boston — where she currently offers insurance but only a small percentage of her employees actually buy it — I would suggest that they stop offering insurance. Their lower-paid employees will have a better set of choices on the exchange and may well qualify for federal subsidies. And if these businesses have fewer than 50 full-time employees, there will be no penalties. (I should note that my sister has not decided to do this — it’s just what I happen to think she should do.)

7. Those owners who have part-time employees they have been allowing to buy insurance in their group should probably cut them loose. These employees can buy on the exchange, and they might well qualify for substantial subsidies that will reduce their costs. Owners will need to write a uniform policy as to eligibility for part-time employees but simply making everyone who works fewer than 30 hours a week ineligible should work.

I have lots more to say — especially on the subject of plan design and pricing. The Affordable Care Act has totally transformed how this works, and I will be devoting subsequent posts in this series to my discoveries — including what I offered my employees and how much money I will save. So stay tuned.
Click to expand...

And the followup article for this...
What I Needed to Understand About Health Insurance

It all makes me feel like that scene with Robin William's Russian character on "Moscow on the Hudson",
where he was overwhelmed by the broad variety of coffee available in a US market...after he just got finished living in Russia.
"coffee...coffee...coffee" and he collapses.
Except, now with the ACA the coffee is a bit organized...rather than being in random order.

rogue49 · Dec 1, 2013

As I said to others...Time is on the ACA's side with this.
Because...they have and still are investing into performance tuning...and even now the lessons learned are being leveraged.
More knowledge about the internals and heartbeat...they are now aware.
This allows them to tweak it even more.

How Will We Know If HealthCare.gov Is Fixed?
by NPR Staff - November 30, 2013

Health care specialist Stacy Chagolla helps William Bishop compare plans at an Affordable Care Act enrollment fair in Pasadena, Calif., this month.
David McNew/Getty Images

Saturday is the day the Obama administration set as its deadline for making HealthCare.gov a "smooth experience" for most users.

A tech-savvy team of engineers, database architects and contractors has been working through the holiday to ensure the White House makes good on that promise, but judging the success of their efforts may take some time.

How will we know whether the website is fixed? NPR's health policy correspondent Julie Rovner says that partly depends on how you define "fixed." She joins Weekend Edition Saturday host Scott Simon to explain what that means.
Interview Highlights

What "fixing" HealthCare.gov means

Remember the promise is to have it working for what they call the "vast majority of users," by which the administration means 80 percent of visitors to the site.

That means 1 of every 5 people will still need to use a call center, an in-person counselor, or a paper application due to a technical problem or because his or her individual situation is too complex to be handled online. So Amazon or Orbitz this is not.

But then again, this is not buying a TV or a plane ticket, either. Many people have pointed out that spending a couple of hours buying health insurance online is still a lot faster than the old way, when you might have had a 50-page paper application and a process that literally took weeks.

How the administration has been fixing the website

There was a little show and tell earlier this week, where the White House actually showed reporters some of the 300 or so people who have been working pretty much around the clock from various centers located in the Washington, D.C., suburbs.

They've got a separate hardware team doing upgrades to increase the website's capacity, for example — they're saying it should be able to handle 800,000 separate visits per day going forward.

Then another team is working on software. They're fixing bugs and trying to make the website more user-friendly for consumers.

Will anyone be able to tell if the site is really fixed?

That's the really frustrating part. I'm not sure we will, at least not at first. We do already know it's working better than it was in October — which, frankly, was a pretty low bar to get over. The administration has all kinds of fancy metrics to show how well the website is working, but we don't have our own independent access to them.

We do know a big test is likely to come on Monday, when people who have been talking to relatives over the long holiday weekend — or who wake up and suddenly realize it's December and they want coverage in January — all try to sign on at once.

Key parts of the site that must wait

Insurance companies are getting increasingly worried. It seems that while so much effort has been going into what they call the "front end" of the site — where consumers go to compare insurance plans and sign up for coverage — some parts of the "back end" of the site — where insurance companies actually get paid — haven't even been built yet.

The administration says it will get that done before money has to begin to change hands sometime in January, but given that nothing up until this point has happened on schedule, that doesn't make insurance companies feel a whole lot better about things.

One piece of the site that will wait an entire year

Small businesses were supposed to be able to sign up online to enroll their employees through the federal website starting this month. That was already delayed from Oct. 1. Now that won't happen online until next November.

They can still compare plans online, but they'll have to use paper applications and go through an insurance broker or agent or an insurance company directly, unless they're in one of a handful of states that's got its small-business exchange up and running.

The administration has been pretty candid about this — they've said their top priority is to make the website work for consumers first, and pretty much everything else is taking a back seat.
Click to expand...

ASU2003 · Dec 1, 2013

The whole HSA thing for young people should have been put forth in a full GOP plan for younger people. But it wasn't. And the HSA's need to be regulated so the banks don't get rich off people's savings by gambling with them.

I am upset at some of the premium amounts that are being put out. And I know that there will be a big uptick in people getting treatment who couldn't before, that hopefully will be healthy in the next few years. And then the premiums should be going down if people don't have quite as much healthcare expenses. It did need to be worked out and explained a little better what the plan is though.

rogue49 · Dec 2, 2013

This is big...

High court ends Liberty University lawsuit over ObamaCare
FoxNews.com - December 02, 2013

The Supreme Court on Monday refused to hear a challenge to ObamaCare brought by a Virginia-based Christian university, ending for now one of the biggest remaining legal fights against the health care law.

The justices, in turning away the lawsuit from Liberty University and leaving in place a federal appeals court ruling dismissing it, did not comment on their decision. The decision comes less than a week after the high court agreed to hear a separate challenge from Hobby Lobby and one other company to the law's so-called contraception mandate -- the requirement on most employers to provide access to contraceptive coverage.

But Liberty University's case was more expansive. The university had mounted a major challenge to the law, going after the contraception mandate but also the requirement on employers to provide coverage.

Liberty made several arguments in challenging the portion of the health care law that requires most employers to provide health insurance to their workers or pay a fine. The 4th U.S. Circuit of Appeals in Richmond, Va., rejected those claims.

With the high court's decision, that ruling remains in place.

The Supreme Court's decision comes more than a year after it had ordered the federal appeals court to reconsider Liberty University's claims that the law violates the school's religious freedoms.

The courts are continuing to wade through numerous challenges to the Affordable Care Act, despite the major ruling in June 2012 that upheld the bulk of the law by ruling the individual mandate -- the requirement on individuals to buy health insurance -- valid.

But the issue of the contraception mandate will come before the Supreme Court, perhaps as early as March. The court last week said it would hear the challenge from Hobby Lobby and Pennsylvania company Conestoga Wood Specialties Corp.

The court is set to weigh in on the dispute over whether businesses can use religious objections to avoid a requirement in the law to cover birth control for employees.
Click to expand...

Spiritsoar · Dec 2, 2013

rogue49 said: ↑

This is big...
Click to expand...

It is. It made me aware that I should stop shopping at Hobby Lobby.

Tully Mars · Dec 3, 2013

redux said: ↑

Ace...for that $100/month, the out-of-pocket limit is $6250. Few, if any, will face financial hardship from a serious illness/accident that millions have faced in the past and all will have far greater consumer protections that any time in the past. That is a fact.

Yes, most will never see the full return of their payment of premiums....neither will I in my group plan and neither will most Americans. I wont see the full return on my premiums for property or car insurance either.....that is why it is insurance!

The distortions, the outright lies, the "anecdotes" that when vetted often proved to be misleading, the ideological assumptions have not proven to be supported by the facts or experiences to-date.

The extremists on the right will go to any length possible, like no other time in our history, to demagogue a law that they just cant stand, in part because it is Obama's.

It is the law...it will remain the law.

Try offering something constructive for a change.
--- merged: Nov 21, 2013 at 6:13 PM ---

The people have spoken and they dont want the ACA repealed.

Wouldnt you agree that the "people who have spoken" dont want it repealed?
Click to expand...

I buy auto and house insurance every year. I'm sure I've paid more than I ever got but if my house ever burns down I'll be glad I bought it.

samcol · Dec 3, 2013

No security ever built into Obamacare site: Hacker

It could take a year to secure the risk of "high exposures" of personal information on the federal Obamacare online exchange, a cybersecurity expert told CNBC on Monday.
"When you develop a website, you develop it with security in mind. And it doesn't appear to have happened this time," said David Kennedy, a so-called "white hat" hacker who tests online security by breaching websites. He testified on Capitol Hill about the flaws of HealthCare.gov last week.
"It's really hard to go back and fix the security around it because security wasn't built into it," said Kennedy, chief executive of TrustedSec. "We're talking multiple months to over a year to at least address some of the critical-to-high exposures on the website itself."
Click to expand...

healthcare.gov can't even meet the security standards set forth by amazon, facebook, and twitter, and you are putting even more sensitive information on it than these website. why would they tell anyone to sign up if it isn't secure? disgraceful...

Charlatan · Dec 3, 2013

Single payer. Seriously. Is it so hard?

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