Whats in a number Part 2

What’s in the enrollment numbers that are starting to circulate:

Politico has good news and bad news:

Bad news:

40,000 to 50,000 people have enrolled in private health care plans using HealthCare.gov — a range far short of White House hopes, according to new numbers reported by the Wall Street Journal Monday.

That figure does not include people who signed up using state exchanges. Avalere Healthcare, a consulting firm, estimated Monday that about 49,000 people had successful enrolled in insurance in 12 of the 15 states running their own insurance exchange. The largest state exchange, California, has not released numbers.

This is bad news.  The exchanges were projected to sign up and collect either checks or credit card information from half a million covered lives in this time span.  The reporting is a bit unclear if there are roughly 90,000 to  100,000 covered lives or 100,000 contracts between the state and federal marketplaces.  If it is 100,000 contracts that would be 200,000 or so covered lives as a rough guesstimate.  The exchanges are behind pace.  However, when compared to Massachusetts at a comparable period and then adjusting for the compressed time frame, the Exchanges are ahead of Massachusetts’s pace even with the techical problems.  The question is will the fixes that have been going into play be good enough to deal with the highly probable surge of people who are looking for January 1st coverage right and want to buy right after Thanksgiving.

Good news:

Those figures don’t include enrollments in Medicaid, which have vastly outpaced the number of sign-ups in the marketplace in states like Kentucky and Washington, which have released early figures. A separate Avalere report on 10 of the states expanding Medicaid found that 444,000 have signed up for Medicaid.

 This means people who need healthcare are getting it in some states in some situations.  Ideally it would be an all-state statement, but fuck you Chief Justice Roberts et al.






90 replies
  1. 1
    srv says:

    Everyone is going to wait until their geek kid is home for Thanksgiving or Xmas to do the intertube driving.

    And I’ll hazard the website isn’t ready for a Black Friday event.

  2. 2
    kc says:

    40,000 to 50,000 people have enrolled in private health care plans using HealthCare.gov — a range far short of White House hopes

    Kinda hard to enroll when the system won’t let you.

  3. 3
    Richard Mayhew says:

    @srv: From what my company is seeing, things are working much more smoothly on the back end in the past few weeks — the 834s are acting like typical 834s now.

  4. 4
    MomSense says:

    My understanding is that most people enrolled at the end of open enrollment in Mass when they first rolled out their health care exchange.

  5. 5
    Patricia Kayden says:

    I’ll wait until next March to panic about these low numbers. It’s still good to know that thousands have signed up for Obamacare — many of whom probably couldn’t get good insurance without it.

  6. 6
    MikeJ says:

    Washington had 10k sign up in the first week, and there were another 10k with everything done except money changing hands.

    http://seattletimes.com/html/l.....rsxml.html

  7. 7
    Chyron HR says:

    @Richard Mayhew:

    From what my company is seeing, things are working much more smoothly on the back end in the past few weeks

    That’s what she said!

    the 834s are acting like typical 834s now.

    Yes, that is… that is also what she said. I guess?

  8. 8
    piratedan says:

    every night, during Wheel of Fortune time (hey, the wife likes the puzzle solving), the Americans For Prosperity ad shows up, lambasting the current Congresscritter and playing the scare game on the ACA. The program doesn’t work, so don’t use it, apply pressure to your Congresscritter instead yada yada yada….. every night and at various times during the day, I’ve seen it on The Weather Channel, The Game Show Network and it peturbs me that there is actual money into paying the voiceover actors, the director in making the spot and maintaining a web site all for the sake of fucking over the poors. Damn I hate Republicans.

  9. 9
    Chris T. says:

    As I understand things, to be counted as “enrolled” in these statistics, an insurance company has to have actually collected a payment from someone. Which means you’re saying 40k-to-50k people have actually already paid for something they won’t receive until January, that doesn’t require them to ante-up until mid-December.

    That seems pretty good to me. I usually try to send my bill payments in about a week or two before they’re due…

  10. 10
    Fuzzy says:

    Most people, like me, are waiting until the bugs are gone and we can see the participating MDs and hospitals in each plan. Here in CA the insurance companies are not disclosing the info yet because they may cannot guarantee the providers how many will sign up which determines the pricing. Most doctor groups and hospitals will not commit until they know the number of patients and what they will be paid for procedures. The insurance industry is dragging it’s feet hoping to not leave money on the table.

  11. 11
    Craig says:

    @piratedan: Very high stakes poker, betting that a broken web site can’t be fixed. I think they’ll lose that bet, and in fact, they’re doing more good than harm for Obabmacare in the long run, keeping people away from the site while it improves reliability and capacity. Fifty thousand so far probably becomes a half million or more by Thanksgiving, so “the site doesn’t work” starts to lose credibility as a line of attack. “Go to the site, right now, and tell your Senators about your experience,” would be far more damaging.

  12. 12

    @MikeJ: Yeah, it’s the money changing hands part that leaves me wondering about this. Reminds me of the ‘shipped’ vs ‘sold’ shenanigans that companies engage in to spin their sales.

    Is the 50K number people who have paid with another xxx who have signed up but could cancel? I know at least two people who has signed up with a 50/50 chance of canceling (deciding to leave their job). It’s not unreasonable to exclude the people that have ‘reserved’ their spot, but it’s also misleading to not include that number as a separate item given the conclusions people will draw from that figure.

    All told I know at least half a dozen people now that have signed up (I don’t know if any have paid yet). That’s a suspiciously high hit rate for only 50K national signups (.016%). I don’t know that many people (37,500 proportionately).

  13. 13
    Bill Arnold says:

    @srv:

    Everyone is going to wait until their geek kid is home for Thanksgiving or Xmas to do the intertube driving.

    That is a good point. I expect to play with the NY State site with my stepson Thanksgiving.
    (I’m the geek, but the general point is valid.)

  14. 14
    Yatsuno says:

    @kc: The call centre is working just fine, as are enrollment counselors. Or are you stuck on the website issues? Way to embrace right-wing framing there.

  15. 15

    @Chyron HR: Dear Penthouse Forum, I never thought I’d be writing you, but I just had the best 834 of my life and needed to tell you all about it…

  16. 16

    I don’ t mean to whine but I’ve been waiting for weeks and finally am on but can’t do pricing using different groups. As a web programmer with a lot of experience this UI is pretty disappointing and not easy to use. I want more than anyone for this whole process to work and work well not just for my sake but for all those people who’ve been without insurance. I’m just frustrated and venting. Feel free to ignore me.

  17. 17
    cckids says:

    Well, as a consumer who will be getting insurance (yay!) through the exchanges (in Nevada) my spouse & I are still working through the process. There are lots of plans & each one has lots of details. We have actual lives as well, and, frankly, are taking our time with it. We’ll be enrolled in time to have the coverage kick in in January.

    I have to think there are lots out there like us; even if you want to devote several hours to going through the sign-up process (and, seriously, what a PITA that is), and the details & comparing of plans, your eyes glaze over after a while. And, its football season. :)

    So, breathe, everybody. I’m quite sure this is going to work. It is very far from perfect, but what we had before was untenable. Progress marches on.

  18. 18
    sparrow says:

    @srv: ding ding ding! I will be signing my stealth-wingnut mother up for socialized medicine around Christmas. Just in time, cuz dad is retiring in February.

  19. 19
    Ronnie Pudding says:

    Good news for Medicaid sign-ups? If we end up with lots of Medicaid signups and few young people, won’t that kill costs for next year?

    My concern is it may be a couple years before they either (a) realize they need insurance or (b) start feeling the tax penalties. But by then, what will happen to the Plan costs?

  20. 20

    I’m guessing that the numbers will look a lot better once California is included. We have what seems to be a functional web site that’s actually been up since well before October 1.

  21. 21
    Mnemosyne says:

    @Ms. D. Ranged in AZ:

    I don’ t mean to whine but I’ve been waiting for weeks and finally am on but can’t do pricing using different groups.

    I’m not sure what you mean. Are you trying to compare different medical groups, or are you trying to group your various family members in different ways? Either way, you might be able to get faster answers by calling the helpline (1-800-318-2596) and talking to an actual human.

  22. 22
    Richard Mayhew says:

    @👾 Martin: It is 50,000 people on Healthcare.gov who have selected a plan and have sent in either a check or entered their credit card information online AND the selected insurance company has put the money for the January premium into the insurance company’s bank account.

  23. 23
    mk3872 says:

    Wait a second! 50k people signed-up for insurance on a website that I’ve been told for a month doesn’t work, is a joke, a disgrace, a DISASTER !?!

    Then just how did these people sign-up online??

  24. 24
    Gypsy Howell says:

    Well, everyone above me has pretty much said what Im about to say, but I’ll chime in anyway because every time I read these stories, I shake my head, wondering if even ONE reporter can think his way through to the obvious answer. Which is:

    OF COURSE the Medicaid-eligible people are signing up right away – there’s only one plan. What’s to even think about? Either you’re eligible or you aren’t.

    For the rest of us, there are many many plans and options to consider, and none of them go into effect until Jan 1. I’m giving myself until Dec 1 or so to think about which one I want, finish my research, etc, and THEN I’ll sign up. Same with my daughter in NYS, except in her case, we’re also waiting to see if perhaps she lands a job that has benefits in the next couple of months. If not, we’ll sign her up on the NYS exchange in mid-December. We’ve already shopped out her options.

    Honest to god, is there NO ONE in the media that can figure this out? Have none of them EVER friggin shopped around for anything? Or is it just willful stupidity? Never mind, I know the answer.

    And did the administration actually think, even if the website HAD been working, that people would rush to sign up as soon as they got on the website for something that doesn’t even kick in until Jan 1? Isn’t that the whole reason they gave us 3 months to do it?

    I’m so sick of this moronic story already.

  25. 25
    Craig says:

    @Yatsuno:

    The call centre is working just fine, as are enrollment counselors. Or are you stuck on the website issues? Way to embrace right-wing framing there.

    I spent 30 minutes on the phone trying to enroll and the tech support person basically gave up and said “It won’t allow me to continue.”

    There’s nothing right-wing about discussing your difficulties with the site. You’re just trying to stifle criticism. People like you are the reason why I will never join a political party ever again. Unless I show the requisite ideological purity, my motives will always be suspect.

  26. 26
    cmorenc says:

    @Craig:

    “Go to the site, right now, and tell your Senators about your experience,” would be far more damaging.

    This is an angle that Fox FalseNews is pounding over and over and over…daily parading several people with purported nightmare Obama-care stories about how they’ve forced to lose insurance, buy far more expensive policies, new humongous bugs from Mars found in Obamacare website infrastructure and software, the rent’s too dam high..rant rant rant rant…

  27. 27
    Yatsuno says:

    @Craig:

    People like you are the reason why I will never join a political party ever again. Unless I so the requisite idealogical purity, my motives will always be suspect

    Noted, your concern has been. And maybe it’s not such a smart idea to embrace right-wing framing as a default setting.

    Oh and get over yourself. I’m not a Democrat.

  28. 28
    MikeJ says:

    Washington House Democrats: One month of Obamacare: 140,000 have signed-up for health care

    According to the Puget Sound Business Journal, almost 49,000 people have enrolled since the beginning of October. Furthermore, “Another 52,000 applications, which would provide coverage to another 91,000 people, have been completed and are awaiting payments… That brings the total to 140,000 people who have now sought coverage through the exchange.”

    (ETA: this is the Washington exchange, not the national.)

  29. 29
    kc says:

    @Yatsuno:

    Way to embrace right-wing framing there.

    Way to embrace truthiness. It’s not right-wing framing, it’s a fact, and I’m far from being a right-winger.

  30. 30
    Keith G says:

    In my part of the world, the outreach to those living in poverty (808,000 souls by fed def) is just beginning. Another 400,000 are surviving just north of the fed definition. These are the folks who I supervise in my profession. Most of them are at a loss about what actually is going on.

    I pay my bills as a pastry chef. If I have any spare time at work, I buttonhole the staff and ask them if they have signed up. None have as yet. I go on to figure out what their level of ability is to do this on their own. Then I try to get them started and/or get them to a place where fellow humans can guide them.

    This is not an easy process for the ones who need it most and they are not being well served. Their enrollment numbers will be low I am afraid.

  31. 31
    The Red Pen says:

    @Fuzzy:

    Most people, like me, are waiting until the bugs are gone and we can see the participating MDs and hospitals in each plan. Here in CA the insurance companies are not disclosing the info yet because they may cannot guarantee the providers how many will sign up which determines the pricing.

    How can you start selling a plan when you haven’t locked in the requisite provider network? How can you price a plan until the fee schedule is finalized?

    This claim doesn’t sound right to me.

  32. 32
    The Red Pen says:

    @Chyron HR:

    the 834s are acting like typical 834s now.

    Yes, that is… that is also what she said. I guess?

    I think that’s a reference to this Lovecraftian horror.

    There is a reason why — in this world of XML and JSON — it’s a fucking pain in the ass to deal with medical insurance process and that reason is called EDI X12.

  33. 33
    Violet says:

    @cckids:

    Well, as a consumer who will be getting insurance (yay!) through the exchanges (in Nevada) my spouse & I are still working through the process. There are lots of plans & each one has lots of details. We have actual lives as well, and, frankly, are taking our time with it.

    As someone who is lucky enough to have employer-provided health insurance, I know where you’re coming from. Spent the better part of last week sorting through the differences in a mere two plans. I can’t imagine how challenging it would be to do it for multiple plans.

    I only spent a week because the time allowed was limited by the employer and the choice had to be made by last week. If I’d been allowed a few months, I’m sure I would have taken most of that time, if not all of it.

  34. 34
    Keith G says:

    @Craig:

    There’s nothing right-wing about discussing your difficulties with the site. You’re just trying to stifle criticism. People like you are the reason why I will never join a political party ever again. Unless I show the requisite ideological purity, my motives will always be suspect.

    Sadly, you are more correct than not in this assertion. It’s a shame, since there is no need for some to lash out as if in panic. The fact that there has been some expected as well as some unnecessary inefficiencies does not mean that the whole effort is tits up. Humans blunder.

  35. 35
    Mnemosyne says:

    @Keith G:

    In states where our governors accepted the Medicare expansion, we have these people called “healthcare navigators” who are going around to small businesses and local groups to help people figure out what their options are.

    Your state, Texas, decided to block healthcare navigators from doing their work. So when you’re spreading that blame, don’t forget that a huge part of the problem in Texas is that your governor and legislators have decided that Texans don’t need healthcare and are doing everything possible to prevent your co-workers from finding out what their options are.

    I realize you think that Obama should be personally handling all of the phone calls to Healthcare.gov, but citizens of states that decided to actively block healthcare reform have a whole fuckton of work to do if you want to improve things in your state. Get a move on.

  36. 36
    Yatsuno says:

    @Keith G: Your governour isn’t helping matters either, with restricting enrollment counselors and refusing Medicaid. Texas is going to lag behind on this until there’s some sort of sea change in the government in Austin. That will probably take some time and maybe a few hospitals closing. Otherwise I don’t know.

    @kc: I might be overly sensitive since I’m tired as hell, but the fact is the website functionality is improving. This criticism is becoming no longer valid.

  37. 37
    Mnemosyne says:

    @Yatsuno:

    I’m still waiting for people to figure out that the majority of the complaints are coming from states that refused to set up exchanges and refused to expand Medicare. Hmm, funny how having your state government block you from obtaining healthcare makes it more difficult to obtain healthcare.

    @Craig:

    So what state are you in? California? New York? Or are you in one of the states that refused to set up their own exchanges and dumped it all on the federal government?

    I’m pretty sure I know the answer, but I’ll be curious to see if I get one.

  38. 38
    MattR says:

    This is just the latest angle that the Chicken Little media is trying to exploit. Are we really surpirsed that people are taking some time to weight their options when making complicated decisions about their health care? Or if they have made a decision about their plan, is it supposed to be shocking that they are waiting to make their first payment for as long as they can?

  39. 39
    scav says:

    @Yatsuno: Hey, but if professional attention-seekers can channel the 30s-50s as “conventional” current attitudes toward marriage, etc, amateurs can channel old tech issues as “current” bombshells and shrapnel of DOOMDOOMDOOM. So long as attention is garnered, it’s all good.

  40. 40
    kc says:

    @Yatsuno:

    Well, I hope so. I tried fairly recently and it wouldn’t even let me create an account. I’ll be trying again shortly; we’ll see how it goes. If I can’t get it done via the website, I’ll try the 800 number, but that means a considerable wait time. I can do it, but it’s not practical for a lot of people.

    Also, to you and Mnemo, yeah, I do live in one of those red states with a lousy governor, but I didn’t vote for any of these assholes.

  41. 41
    kc says:

    @scav:

    Pointing an actual fact makes me an “attention seeker?”

    Why do you have be an asshole? Why can’t you just acknowledge that there’s a real problem with the enrollment process? I honestly don’t see how it helps you, Obama, or the ACA to act like there’s not an issue here.

  42. 42
    SectionH says:

    @cckids: @Violet:

    We’re like cckids: sooooo happy to have insurance coverage in sight after 2.5+ years without (won’t go into the $30K in bills from Mr S’s car wreck a month after Cobra fraudulently dumped us).

    We’ve been on the CA site, and are discussing (ahhem) the various plans. Haven’t looked at Kentucky yet; Mr S is still a legal resident there, so we could end up with 2 single plans in different states. Of course we’re going to enroll and pay before the end of the year, but there is a deal of study to be done first, and sometimes digesting information is useful.

  43. 43
    Gretchen says:

    A better metric would be how many people set up an account. I did so, for my son. Then I had to nag him for a paystub so I could figure out what his subsidy would be. Then I got to my choices, and there were about 20: bronze, silver,gold, etc. I looked at it and thought I’ll figure it out later. It’s still early November. We will, absolutely, positively, buy a plan on the exchange,but we haven’t yet. There are a lot of choices, it doesn’t kick in until the end of the year, and we’ve got more pressing things to do.
    I’m disturbed by the way the press is going about it thought. Every day there’s another story of someone who’s going to be paying thousands of dollars more for the plan their insurance company offered them after cancelling their current one. Have they scoped out what’s available on the exchanges? Why, no, they’re sure there’s nothing good there. I even have a friend, mid-50’s, high blood pressure, no employer insurance, worrying about what she’s going to do next year. Have you looked at the exchange? Why, no, she heard it didn’t work. This is, plain and simple, sabotage. Convince people the website doesn’t work,so they don’t look and sign up,so it can be declared a disaster. I can’t count the number of articles I’ve read about people complaining about losing their insurance who didn’t check the exchanges before complaining.

  44. 44
    Gypsy Howell says:

    @Mnemosyne:
    I’m in a republican governed — if you can call it that — state, and interestingly, just today I got an email from my auto & homeowners insurance agency, with a section targeted to small employers titled “Why are you in the lealth care business anyway?” touting the advantages of the new ACA provisions:

    I wish had a dollar for every time a business owner asked me “How did I get in to the health care business anyway?” Most small business owners got into the health care business in order to attract and retain valuable employees. Providing health insurance was attractive because it was a benefit that an employer could provide that would be 100% tax free to the employee. The business owner got a tax deduction for the premiums paid and they did not have to pay FICA taxes. A huge benefit to employees was that these group plans were “Guaranteed Issue” meaning that even those with serious medical problems could still be added to your existing plan. People who bought insurance on the individual market faced preexisting condition exclusions and very high premiums that did not cover as much as group plans. In January 2014, all this changes; Individual health insurane plans will all be guaranteed issue, they will all have the “10 Essential Benefits” mandated by health reform and there may even be a way to get the same tax benefits as a group plan. Also, some of your employees may be eligible for tax credits if they buy coverage on the new Health Care Marketplace. Individuals will be able to choose form a variety of options giving them more choices than an employer would be able to provide with group insurance. It’s important to remember that there is no “government plan” and marketplace plans are all offered by private insurance carriers. There are many options to choose from. So “why are you in the health care business?” Good question. At XXX Insurance Agency, we are prepared to help you find the answer. If you decide to get out of the health insurance business we can make it seamless and pain free for you and your employees. We can help them determine if they are eligible for a subsidy and assist them in choosing the right plan for themselves and their families. We are certified to work with you on the Health Care Marketplace or in the traditional carrier market. If you have less than 100 employees there is no additional charge to you for using our services. To learn more, schedule your free health care consultation today.

    Pretty encouraging, I thought!
    So, all is not lost even in the redneckistan states.

  45. 45
    Mnemosyne says:

    @kc:

    Also, to you and Mnemo, yeah, I do live in one of those red states with a lousy governor, but I didn’t vote for any of these assholes.

    The point is, it’s those assholes you didn’t vote for who are fucking you over right now, not the assholes in Washington DC. I understand being upset that things aren’t working right, but you should be directing at least some of your ire at the assholes who deliberately decided to try and prevent you from getting health insurance rather than the ones in DC who are doing their best to get insurance to you.

    Metaphorically, your drunken neighbor set your house on fire and you’re screaming at the firefighters for not putting it out fast enough. Save some of your anger for the asshole who set it on fire in the first place.

  46. 46
    Keith G says:

    @Mnemosyne:

    I realize you think that Obama should be personally handling all of the phone calls to Healthcare.gov,

    I do not think that way, nor have I ever indicated such in any way…so please take this in the proper spirit when I break my long held protocol and say..Please go fuck yourself you disingenuous twit.

    Yes some very (quite literally) poor souls are in dire straits. No matter who their governor is, they are US citizens and our neighbors and their problems reflect on us, our society, and it’s leadership.

    More. Can. Be. Done

    Also please note that my initial comment was just to say that the numbers will go up. They are artificially low because the marketing from all levels (local, state, and federal) has been inadequate.

  47. 47
    JohnK says:

    @Yatsuno: The complaints will probably continue for weeks or more,long after the website is fully functional. Especially if we are saying the web site should me mostly functional by the end of November. This isn’t a criticism of anything other than human nature. Imagine the complaints if the web site over promises and under delivers again.

  48. 48
    scav says:

    @kc: Don’t see that Yutsey or I ever said there weren’t problems, just didn’t accept the framing of inevitable DOOMDOOMDOOM ‘n’ disaster that is passing for the conventional blah blah.

  49. 49
    The Red Pen says:

    @Craig:

    Unless I show the requisite ideological purity, my motives will always be suspect.

    Oh, I’m definitely putting you on my suspect list.

    No, scratch that. You are so suspect that I am making a list just for you. I’m calling it “Craig’s List.”

    Hey, that’s catchy.

  50. 50

    @Mnemosyne: I was trying to compare buying an individual plan for my son and myself versus us buying a plan together. I already called the number and they said there were still technical problems with the site. The only advice they could give me was to log out and log back in to try again. I did so and still no gravy.

  51. 51
    Mnemosyne says:

    @Keith G:

    Yes some very (quite literally) poor souls are in dire straits. No matter who their governor is, they are US citizens and our neighbors and their problems reflect on us, our society, and it’s leadership.

    So the fact that your state’s governor personally decided to fuck those people over is the fault of the national leadership of the US and not the fault of your state’s governor?

    I’m willing to help people but, Jaysus, you really need to admit that right now you have a problem that is not, in fact, the fault of the politicians in Washington DC. It is the fault of the politicians in your home state, who made an affirmative, deliberate choice to screw you and your coworkers. Until the citizens of your state get pissed off and demand to know why your state government is happy to let people die of preventable diseases, the only thing the national government is going to be able to do is try to patch things up along the edges.

    Your state has a huge sucking chest wound at the center of it. Obamacare can apply a band-aid to it, but the citizens of Texas are going to have to do the actual work to fix the chest wound. There’s only so much that can be done from the top down.

  52. 52
    pseudonymous in nc says:

    I just got off the phone with a Healthcare.gov support person, chasing up some eligibility confirmation steps. It was a much better and more productive support conversation than most I’ve had with private companies.

    I’d still prefer it to be a lot easier — there are certain things in applications that you should be able to go back and fix, and users should be informed that not providing certain “optional” information during an application leads to a messier follow-up.

  53. 53
    Mnemosyne says:

    @Ms. D. Ranged in AZ:

    Fun! I think someone was saying last week that you may not have to include your boyfriend’s income in your “household” income since you’re not married, but you may have to re-check that with HHS.

    ETA: Also, apparently you will have more problems with the website if you have certain privacy modes turned on (no cookies, AdBlock, etc.) So you may want to try turning off all of your security stuff and trying again.

  54. 54

    @Keith G:

    More. Can. Be. Done

    Of course, but your fellow state citizens disagree, and believe less should be done. Not only are your state officials working to undermine what gets done, but your state is sending federal officials to do the same. And residents of your state are dumping money into efforts to actively dissuade people from participating.

    I’m not blaming you for any of that, but the reasons why so many of the problems you note can be found by looking at your neighbors, not by looking at the White House or HHS. They can not pretend that Texas doesn’t exist, that those votes in Congress aren’t valid.

  55. 55
    TriassicSands says:

    It’s good that people eligible for Medicaid are getting health care coverage, but for the PPACA to work, it is necessary that many, many young, healthy people sign up, too. Right now their numbers are apparently lagging badly.

    I still foresee a possible serious problem with the use of Medicaid as the means for greatly expanding health care coverage. In many areas it is difficult to impossible for Medicaid patients to get appointments with specialists (who like patients who pay them more money). Greatly increasing Medicaid enrollment without somehow improving access to specialists looks like a train wreck waiting to happen. Right wing politicians who claim that having Medicaid is worse than having no coverage are simply liars, but Medicaid’s low re9mbursement rates are not popular with doctors — in the case of hospitals, even lower payments are better than no payments, so they may welcome Medicaid.

    There is already a problem (at least in Washington State) with Medicaid patients going to the ER too often for issues that would be better addressed by doctors in private practice or clinics. State officials claim this is because of the reluctance or refusal of so many doctors to accept Medicaid patients and their lower reimbursement rates. I see no reason why this problem wouldn’t be nationwide. The PPACA failed to address this problem adequately (if at all).

  56. 56

    @Mnemosyne:

    Save some of your anger for the asshole who set it on fire in the first place.

    Hear, hear! I’ve been screaming this from the rooftops here in AZ. Gov. Sewer-face in AZ expanded Medicaid at the very last moment and thank goodness. She’d pushed thousands of childless mentally ill adults off the rolls in 2011. They can now get back on Medicaid, IF they’re still alive. My ex bro in law was one of those people. Paranoid schizophrenic and totally reliant on Medicaid and SSID. I shudder to think of how hard it has been for those folks over the last couple of years. Republican governors don’t govern–they just sabotage and disrupt.

  57. 57
    voncey says:

    @Ronnie Pudding: Good news for Medicaid sign-ups? If we end up with lots of Medicaid signups and few young people, won’t that kill costs for next year?

    Medicaid is for the poor, not the old. And since it’s a government program it shouldn’t impact the prices on the exchanges.

  58. 58
    fuckwit says:

    where’s the surprise? people like me who can’t afford private insurance are rushing to medicaid. this is a good thing, unless you’d prefer we died instead.

  59. 59
    Belafon says:

    @voncey: The poor and the old overlap. Something like 1/4 of the people on Medicaid also receive medicare. And they consume 40% of medicaid spending. A lot of that is nursing home care.

  60. 60

    @voncey:

    If we end up with lots of Medicaid signups and few young people, won’t that kill costs for next year?

    A lot of people are poor because they’re in poor health. They’re expensive to treat. Putting them in Medicaid is overall not a bad place to put them. Income and health have correlated strongly for a long time.

  61. 61
    MomSense says:

    @TriassicSands:

    I think that huge increases in Medicaid and lagging numbers of newly insured young people and newly insured of all ages was factored into the financial projections. ETA that this is expected in the first year.

  62. 62
    MomSense says:

    @TriassicSands:

    I think that hospitals/providers negotiated this with the Obama administration because the reimbursements even at Medicaid rates with so many more people are a big improvement over the current problem of uncompensated care – that is the people that receive services but can’t pay for them.

    I also think that if providers don’t accept Medicaid patients they can’t be participating providers in Medicare and Exchange plans.

  63. 63
    aimai says:

    @cckids: I think this is an important point. This is a huge, high ticket, scary item for people–whether you are used to buying in surance or not. I wouldn’t ever make up my mind until right before I had to–thats what a deadline is for–I totally don’t get what model of people they had in their minds if they thought people were going to “one click” it like they do on Amazon when they decide to purchase an “item” like a book or a toaster. Do people not remember how much struggle it was to deal with the formularies on Medicare Part B? And you just know people are going to bitch and moan about how “everyone waited until the last minute” to purchase when that should have been built into the model.

  64. 64

    @Mnemosyne: Okay, will try the cookies, ad block stuff next. Thanks!

  65. 65
    Richard Mayhew says:

    @Chyron HR: wow — I was not expected a “that’s what she said..” riff on this one :)

  66. 66
    Richard Mayhew says:

    @MomSense: not true — PAR status in Exchange is independent of PAR status in Medicaid and Medicare.

  67. 67
    Gene108 says:

    @Keith G:

    Unfortunately there many powerful people in this country, who believe that because there are a few correctable blunders the whole endeavor had gone “tits up” and should be entirely scrapped.

    Every story of inconvenience in applying on-line seems to carry 1000x times more weight than the kid with pre existing conditions getting treatment, so every statement here or anywhere, seems to me, to just add another bit of ammo for those who want this to fail.

  68. 68
    Anya says:

    Isn’t it way too early to panic or to talk about the failure of the success of the program? The launch was just less than two month ago. Also, too, the ACA had nothing but bad publicity. Right now people don’t know much about the law and they’re confused. Give it time!!!

    I blame the culture of instant gratification.

  69. 69
    Hal says:

    Young healthy people are not going to sign up until the last minute. Anyone freaking out should really read the history of the Massachusetts healthcare law as that took awhile to catch on as well. As did Medicare.

    Right now the media needs a story. I was complaining about this the other day. Watch MSNBC and all you’ll if are if, but, what if, coulda woulda shoulda. Gotta fill 24 hours of news somehow. Hey, how’s that Benghazi story coming along?

  70. 70
    kc says:

    From Richard’s post:

    This is bad news. The exchanges were projected to sign up and collect either checks or credit card information from half a million covered lives in this time span

    Anyone care to yell at Richard for adopting “right wing framing?”

  71. 71
    Chyron HR says:

    @kc:

    Anyone care to yell at Richard for adopting “right wing framing?”

    Nope, as far as I can tell absolutely nobody said anything like that about Richard. So I guess that proves that people aren’t automatically dismissing any negative comments, and that if they do argue with someone it’s being done in good faith because they legitimately disagree with that person’s post.

    Oh, whoops. That wasn’t at all the point you were hoping to make, was it? My bad!

  72. 72
    Fluke bucket says:

    Said to hell with the website and mailed it in via the USPS today

  73. 73
    kc says:

    @Mnemosyne:

    Metaphorically, your drunken neighbor set your house on fire and you’re screaming at the firefighters for not putting it out fast enough. Save some of your anger for the asshole who set it on fire in the first place

    .

    I’m not screaming at anyone, metaphorically or otherwise. I just pointed out, quite accurately, that there are website problems and I myself was unable to set up an account.

    As a two-time Obama voter, permit me to suggest it’s not a useful strategy to go batshit every time someone accurately identifies a (potentially huge) problem with your pet policy.

    Also, I’m not entirely sure that I’d even want my state government involved in setting up its own site, since those dumbasses allowed the SS numbers and bank account numbers of every taxpayer in the state to be stolen recently.

  74. 74
    MomSense says:

    @Richard Mayhew:

    I very well could be wrong, but I thought that the carrot is that Medicaid reimbursements will be increased to Medicare levels and the stick falls under the civil rights section and says providers who contract with insurers, providers, that accept any federal funding including grants, Tricare, Medicare, etc would have to opt out completely and not just with particular exchange policies or Medicaid patients.

  75. 75
    Mnemosyne says:

    @kc:

    I’m not screaming at anyone, metaphorically or otherwise. I just pointed out, quite accurately, that there are website problems and I myself was unable to set up an account.

    Several people, including myself, have provided you with multiple ideas for fixing your website problems, including turning off security blocks and logging in with a different (new) email address. Have you even attempted a single one of the fixes that people have helpfully provided to you? So far, evidence seems to be that you just keep whining about the same shit over and over again without actually trying to help yourself.

    As a two-time Obama voter, permit me to suggest it’s not a useful strategy to go batshit every time someone accurately identifies a (potentially huge) problem with your pet policy.

    Difficulty logging into a website is a huge problem with PPACA as a policy? Really? It’s not just a technical glitch, it proves that as a policy healthcare reform was a bad idea?

    Also, I’m not entirely sure that I’d even want my state government involved in setting up its own site, since those dumbasses allowed the SS numbers and bank account numbers of every taxpayer in the state to be stolen recently.

    Unfortunately, that’s the system of government that we have. If you don’t like that the states are in charge of things like health insurance, re-write the Constitution.

    Big Daddy Obama is not going to fix the problems with your state government. The only people who can fix it are the people of your state. Get to work or stop whining.

  76. 76
    kc says:

    @Mnemosyne:

    Why are you so angry?

  77. 77
    kc says:

    @Mnemosyne:

    Difficulty logging into a website is a huge problem with PPACA as a policy?

    Sorry if my wording confused you. Perhaps I should have said it makes a big problem with implementing the policy. If it’s hard for people to enroll, and the policy requires that large numbers enroll in order for the policy to succeed, then that’s a problem. See what I mean?

  78. 78
    Mnemosyne says:

    @kc:

    Why are you so angry?

    Because I’m sick of people whining about problems with the website but not taking any of the multiple suggestions that people have made for getting around those problems. If you have tried every single one of the suggestions that have been made and you’re still having problems, then I apologize. But right now, you’re coming across as the guy who complains that he can’t find a job but never even bothered to log onto Monster.com even though six people told him how to do it.

  79. 79
    gelfling545 says:

    @Ronnie Pudding: A lot of the medicaid sign ups are young people. They don’t yet have sufficient income or their parents do not have insurance for them to remain on until 26.

  80. 80
    gelfling545 says:

    @Gretchen: I think, too, that there is a fair number of people who have never had to make actual choices about health insurance & are really puzzled about what is the right choice & need some time to mull it over & get advice. I also suspect that there are some who hesitate to enroll, even if they want/need the insurance, because they expect the Republicans to pull some shady stuff that will make the whole thing disappear.

  81. 81
    gelfling545 says:

    @Mnemosyne: I’ve also heard that using IE works best.

  82. 82
    agrippa says:

    Am I supposed to panic now?
    No.

    Start ups – of just about anything – are not dead sold perfect right away.

    And, these are big decisions being made by people who may have never had to make such decisions. They will procrastinate and dither and worry. They will do a lot of talking with relatives and friends about this plan or another.

    All that will take time.

  83. 83
    Mnemosyne says:

    @gelfling545:

    I’ve suspected for a while that a lot of the people complaining about their crap policy being canceled have never actually had decent insurance. They’ve always been making do with crap policies, so they have no idea what good insurance is supposed to look like or how much it costs or what it covers. All they know is, they were finally able to find something calling itself “insurance” that doesn’t break the bank and now it’s being taken away.

  84. 84
    TriassicSands says:

    @MomSense:
    I also think that if providers don’t accept Medicaid patients they can’t be participating providers in Medicare and Exchange plans.

    I am virtually certain that isn’t true. I live in a rural area of western Washington State in a town in which 40% of the residents are eligible for Medicare. I know for a fact that local doctors who accept Medicare also refuse to see Medicaid patients. It’s not hard to imagine how the Roberts’ court would rule if this became the subject of a lawsuit.

  85. 85
    mclaren says:

    However, when compared to Massachusetts at a comparable period and then adjusting for the compressed time frame, the Exchanges are ahead of Massachusetts’s pace even with the techical problems. The question is will the fixes that have been going into play be good enough to deal with the highly probable surge of people who are looking for January 1st coverage right and want to buy right after Thanksgiving.

    No, that’s not the question. That’s not the question at all.

    The real question is: Will the ACA go the way of the Massachusetts failed non-reform “reform,” with costs skyrocketing out of control to the point where the Massaschusetts state legislature is contemplating slapping price controls on all state medical services?

    The heat keeps getting turned up on Massachusetts hospitals and health insurers as rising health care prices eat deeper into the budgets of working families, small businesses, and governments.

    While other states will start insuring more residents this fall under the US health care overhaul, Massachusetts — which expanded health insurance access through its 2006 law — has moved past enrollment to grapple with an even more intractable health care problem: exorbitant costs.

    State lawmakers passed a cost containment law in 2012 that attempts to limit medical expense increases to the Massachusetts economic growth rate, projected at 3.6 percent this year. The success of efforts to reach that target can’t be gauged until 2014, but pressure already is mounting on doctors, hospitals, and insurers to get prices and premiums under control.

    Source: “No easy answers for containing health care costs,” The Boston Globe, 22 September 2013.

    Also see “Danger ahead? Massachusetts health costs are rising – fast” by Sarah Kliff at Ezra Klein’s wonkblog, 9 February 2013.

    Health-insurance deductibles in Massachusetts surged by more than 40 percent between 2009 and 2011, a period when health benefits were reduced by 5 percent and premiums rose by nearly 10 percent, according to a new state report on market trends.

    At a briefing, Center for Health Information and Analysis Executive Director Aron Boros said premiums are outpacing inflation and state officials “see the quality of the benefit declining.” He said, “This is the paying-more, getting-less headline. We see this throughout every group in the market.”

    Source: “Study: Mass. health-care costs rise as benefits fall,” Sentinel & Enterprise News, 15 August 2013.

    This is what happens when Obama the corporate lapdog advocates and successfully fights to pass a federal law forcing everyone to buy unaffordable private for-profit insurance whose premiums are guaranteed to rise limitlessly forever, with no cost controls on the underlying medical services.

    We now return you to the regularly schedule Swift-boating of anyone who dares criticize Obamacare as not just unwise, but doomed and unworkable, as opposed to nationalized single-payer health care — which is not just politically possible but the only eventual conclusion of this miserable screwed-up process once the ACA crashes and burns.

  86. 86
    mclaren says:

    @kc:

    Asking Mnemosyne why he’s so angry is like asking Karl Rove why he’s such a liar. If you were a corporate whore forced to tell astroturf lies on web forums like this one in return for paltry cash payments from the Kock brothers in a failed and futile effort to discredit genuine progressive reform, you’d be angry too.

    You’d be disgusted with yourself, enraged that you have to stoop so low to pay your rent, appalled when you look in the mirror every morning, and sick of the same old routine of screaming insults and using Swift-boat-style smears against any progressive who advocates a better world.

    Poor Mnemosyne. It’s just getting too hard to look at yourself in the mirror, isn’t it?

  87. 87
    mclaren says:

    @Mnemosyne:

    I’ve suspected for a while that a lot of the people complaining about their crap policy being canceled have never actually had decent insurance. They’ve always been making do with crap policies, so they have no idea what good insurance is supposed to look like or how much it costs or what it covers. All they know is, they were finally able to find something calling itself “insurance” that doesn’t break the bank and now it’s being taken away.

    In the post-legal laissez-faire anything-goes Roberts Supreme Court America of 2013, there is no such thing as “good insurance.” There’s just insurance you haven’t needed to use yet and which as a result hasn’t been cancelled or hasn’t refused payment for your treatment or hasn’t used the fine print to refuse to pay.

    We need to eliminate health insurance. Health care is basic human right. The idea that people should have to pay some for-profit company in order to live is a protection racket, pure and simple. It’s obscene.

    We need to get rid of the health care protection racket, pronto. The ACA, like the Massachusetts non-reform “reform” it’s based on, is already collapsing under the irreconcilable contradition of limitless greed in a free health care market where anyone can charge anything they like for services, and the reality of declining economic growth where families and individuals can’t afford endlessly increasing health insurance premiums. Time to admit the reality and go to Plan B — which Massaschusetts is already on a fast track toward. Government cost controls, end the for-profit horseshit, cover everyone, nationalize it. It’s only a matter of time before it happens anyway. The only real question here is how many sick people will suffer and die in the meantime.

  88. 88
    Another Holocene Human says:

    @SectionH: Ooo, you got fraudulently dumped by COBRA too?

    It happened to me in Massachusetts. At least they were a little bit scared of the AG and returned all the premiums promptly but, yergh. That they would do that at all (and given what they were being paid!) just scared me to no end.

    I do. not. trust. insurance companies. Ever.

  89. 89
    Another Holocene Human says:

    @mclaren: McLaren, you are such a fucken idiot. For someone who gets misgendered all the time, it’s pretty fucking rich that you have missed the fact that prolific poster Mnemosyne is a cis-woman, a fact she makes exactly no fucking secret of. In fact, if you were new to the blog and literally only read her posts on other threads today.

    But fuck people and their little quirks–they’re just rhetorical points in your monomania, right, McLaren?

    Also it’s fucking rich when you rant and rave given that Massachusetts has had near universal coverage mandated for years and years. Lot of big talk for someone who doesn’t have to live with the consequences of conservative governance every day.

  90. 90
    Another Holocene Human says:

    @gelfling545:

    I also suspect that there are some who hesitate to enroll, even if they want/need the insurance, because they expect the Republicans to pull some shady stuff that will make the whole thing disappear.

    Ding ding ding. Especially if their own Congresscrittur was in the suicide squad.

    I asked about ACA and some folks that lived in the rural part of Yoho’s district didn’t want to do anything to prepare for the fall because it would be best to wait and see if the whole thing really happens or just blows over.

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