What do the Obamacare exchange websites do?
The exchanges are online marketplace where millions of Americans who don't receive health insurance from their employers will be able to purchase coverage. The system is designed to work like any other e-commerce site. Users can compare health insurance plans, choose the one that best meets their needs, and order it online.
How has it gone?
Not great. The system was overwhelmed with traffic on its first day. Since then, the site has become somewhat more responsive, but it is still plagued with problems.
Who is in charge of the system?
Responsibility for the system is shared between the federal government and some states. The Affordable Care Act gave states the option to run their own exchanges or to leave that job to the federal government. Only 14 states and the District of Columbia opted to operate their own exchange. The other 36 states opted to let the federal government do some or all of the work of setting up the exchange for their consumers. (In other words the Republican governors refused to cooperate so that all of the responsibility for the implementation of the ACA fell on the Federal government, and DHHS, which then allowed them to point out the problems during implementation and use that as an example of why the new law will not work. And don;t think for an instant they did not know this would be the outcome.)
That means the bulk of the Obamacare implementation has fallen to the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. As its name suggests, this agency has traditionally administered key aspects of the Medicare and Medicaid programs. The Affordable Care Act gave it a new role administering the exchanges that form the heart of Obamacare.
Even in states that have opted to run their own exchanges, CMS has played an important role. CMS has supervised states' implementation of their exchanges and provided them with access to federal data needed to run the system.
Private companies sell things online all the time. Why is the government having such a hard time setting up an online health insurance marketplace?
If the exchanges were just insurance marketplaces, getting them to work might have been a lot easier. Much of the complexity comes from the fact that the exchanges are used to administer the complex system of subsidies the Affordable Care Act provides to low-income consumers. Figuring out whether a customer is eligible for a subsidy, and if so how much, requires data from a lot of federal and state agencies. Here's a chart from Xerox that illustrates the complexity of the system:
The exchanges are only open to American citizens and documented immigrants. To verify an applicant's citizenship and immigration status, an exchange must first verify a customer's identity with the Social Security Administration, and then check her immigration status with the Department of Homeland Security.
The exchanges must also check to make sure applicants are not already enrolled in another government health insurance program, which would make them ineligible for Obamacare. That means retrieving data from the Veterans Health Administration, the Department of Defense, the Office of Personnel Management, and the Peace Corps. It also means checking with a state's Medicaid and Children's Health Insurance Program agencies to see if an applicant is already enrolled in one of those programs.
Finally, once a customer purchases health insurance, the exchange must provide her information to the insurance company she has chosen. Insurance companies across the country have been scrambling to integrate their own computer systems with the exchanges.
I think that should be helpful in explaining exactly what went wrong, and why.
The article goes on to explain what is being done to solve these issues as well as predicting problems that the system may face in the future.
The thing is that ALL bureaucracies face difficulties, and clearly this one will be no different, what sets it apart is that EVERY hurdle, both big and small, is being mined for political points and will be used in attempts to undermine right up until it provides no more ammunition.
However in the meantime, health care becomes more and more affordable, and the people who listen to these assholes become fewer and fewer in number.
I was able to get in this weekend and get registered. I have employer health insurance, but am concerned because they want to move to a high deductible plan. With those plans, the employee pays every dime up front until the deductible is met. Instead of a modest co-pay for an office visit, the patient pays the entire bill and the entire bill for any labs, x-rays, etc.
ReplyDeleteThe HD plans only work if you have money in the bank to pay the bills or a big enough paycheck to cover the bills.
Yes, you can use a pre-tax HSA for these costs, but again, if the employer does not put any money in the HSA, and the employee can no more afford to put money in the HSA than they can afford the medical expenses, they are screwed.
So I do plan to see what might be out there even though I would not get subsidies if I turn down the employer plan.
Of course, I might have been able to do this earlier, except that my lazy, incompetent, teabagger governor decided to not bother with a site that would only be accessed by this state's residents instead of the entire country trying to get on board.
I recently was able to get signed up and Registered for eligibility on healthcare.gov, but have yet to make a decision on which plan to buy.
ReplyDeleteI am currently researching the options, and pricing levels and may wait a while longer to make sure that the system will be ready to enroll me in a plan, and actually begin coverage on Jan 1.
Those of you who are eligible (don't already have insurance) here's what I recommend:
1) be very careful when creating your username and password on the healthcare.gov site to WRITE DOWN your username and password EXACTLY how you signed up. The username and password ARE case sensitive.
There is currently a glitch in their system that is supposed to help you if you forget it. If you get "locked out" like many have, just choose a different email account, or create one, and use that to attempt another sign in.
DON"T FORGET your login and password, as the agents they have on the phones can't help you to reset it, like many other sites can.
2) Right after you register for an account, they will send you an email to whatever address you used to sign up. You MUST open your email, and click on the link in the correct email they sent to verify your account. You don't have much time to do that, so don't delay.
3) Once your account is verified, you then need about 15 minutes to answer a lot of questions on age, address, racial background, marital status, children, etc. I would recommend you don't leave off in the middle of all that, because until you actually finish that entire section, and get to the part where they want your electronic "signature", you are not REGISTERED.
Registering on the site will ensure that you are actually eligible, and all the subsidies that may apply will be ready when you choose a plan.
4)You will have to provide an estimate or best guess on your projected tax year 2014 income.
They give you an 800 number to call in if your income or status changes during the time you're covered, so make a note of that. They gave me 1-855-889-4325, but that may not apply to everyone, depending on what state you live in.
Write down whatever 8xx number they give you and save it for later reference
5) Try to set aside the time to do all this late at night or on a weekend when less people may be using the site.
If you first try to sign up and you get their "wait a while" screen, I would delay attempting to sign up til a few hours or a day or two later.
That's it for now, and I'll report back if I have any more recommendations.
It is going to be the first time I've had any insurance in 4 years, and quite a relief to know I'm covered in case of catastrophic problems!
Take care my friends.
In honor of the weirdo's in this country who take extreme umbrage at the idea of forcing the market to provide access to affordable health care policies. . .I bring back a ril "Merican who pisses in the eye of socialized medicine.
ReplyDeleteThomas Haden Church, Jake Szymanski, Kat Bardot, Live Funny or Die - Gus Porter gets mauled by a bear, but he won't let the socialist Canadian health care fix him up, so he'll hike back to America.
http://www.funnyordie.com/videos/618fb6cbf2/gus-porter-american-legend-with-thomas-haden-church
Our experience with Obamacare
ReplyDeletehttp://mwolske.wordpress.com/2013/09/26/our-experience-with-obamacare/
Thank You for sharing. I wish your son and family well. I have three in College, and just this portion alone, has lessened my empty nest anxiety and given me peace of mind.
Delete... Using mainly the marketplace clout of Medicare and some seed money, the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programs like Medicare), these systemic reforms potentially touch every patient, every taxpayer.
ReplyDelete“This is the 90 percent of the story that doesn’t make the headlines,” said Sam Glick, who follows health care reform for the Oliver Wyman consulting firm.
Since the Affordable Care Act was signed three years ago, more than 370 innovative medical practices, called accountable care organizations, have sprung up across the country, with 150 more in the works. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries — exactly the opposite of what doctors have traditionally been paid to do. The more money the organization saves, the more money its participating providers share. And the best way to save costs (which is, happily, also the best way to keep patients alive) is to catch problems before they explode into emergencies.
Thus the accountable care organizations have become the Silicon Valley of preventive care, laboratories of invention driven by the entrepreneurial energy of start-ups.
http://www.nytimes.com/2013/10/14/opinion/keller-obamacare-the-rest-of-the-story.html?_r=2&
Obamacare Struggles Even Worse In States That Resisted It
ReplyDeletehttp://www.huffingtonpost.com/2013/10/14/obamacare-states_n_4086910.html
Once the stories started rolling in, it really brought home to me how many young people’s lives have been profoundly altered and affected by sudden illness/accidents. Some didn’t have insurance for one reason or another and are still digging themselves out of the hole.
ReplyDeletehttp://theobamadiary.com/2013/10/14/the-need-for-obamacare/
At the beginning of 2014, there may be millions of full-time workers who transition to part-time status.
ReplyDeleteThe surge in part-timers is expected for two reasons. First, many believe the Affordable Care Act, commonly called the ACA or Obamacare, has resulted in companies cutting employee hours to get around providing health care to employees working more than 30 hours a week.
Under the health-care reform, companies with at least 50 employees are required to provide medical coverage to full-time workers (those working more than 30 hours per week) or face fines that start at $2,000 per worker not covered.
Second, the ACA will enable part-timers to have access to medical benefits that rival those of full-timers, giving them greater freedom to choose part-time work.
The perk that is usually offered only to full-time employees — affordable health care — will now be offered to part-time employees. As a result, millions of workers who are working full-time may choose to work part-time instead, University of Chicago economics professor Casey Mulligan said in a recent paper published with the National Bureau of Economic Research.
Workers who choose to reduce their own hours may end up faring better financially by paying lower premiums offered to part-timers through government exchanges rather than working a few more hours and purchasing health care through an employer, said Mulligan.
"Moving from full-time employment to part-time employment will trigger generous assistance with health premiums and out-of-pocket expenses that can offset much of the income lost due to reduced work hours," said Mulligan. Under the health-care reform, the cost of insurance will be subsidized depending on your income.
http://www.businessinsider.com/workers-are-opting-for-part-time-positions-2013-10
It's a lot of fluid information that has to be cross checked between private businesses and a few government agencies. I'd have been shocked if there were no glitches at all. My experience took five tries, actually four, but I needed to compare a few plans against what my employer and my husband's offer. I had a stellar experience with a navigator, she was well prepared and gave us the risk vs benefit of a few plans, answered all our questions and made it worth the wait.
ReplyDeleteI'm one of those who felt "Single Payer" should have been the way to go, and that hasn't changed. Once this gets rolling, and people's lives and health care are affected for the better, I think a lot more people will be thrilled with the ACA.