Tuesday, October 29, 2013

I read Robert Laszewski (without realizing who I'm reading for a while)

Somehow - I have no idea how - I ended up reading Robert Laszewski’s blog, Health Care Policy and Marketplace Review. The particular post I was directed to is entitled “The Commitment to Fix Obamacare’s Computer Systems by December 1 - Because It Can Be Done By Then or Because Is Has To Be Done By Then?” The point embedded in the title is a good one, I think: it’s awfully convenient that the date promised is the date needed to be sure people can actually get insurance as of January 1. The whole post - in fact all the posts there than I read - are worthy reading in full but there were a couple of other points I want to comment on. One has to do with delaying the individual mandate:

Some Senators, Democrats as well as Republicans, are talking about passing legislation to defer the individual mandate for as much as a year because of the computer problems. That makes some sense given the problems consumers are having. But will that legislation also appropriate money for the insurance companies that would be required to cover the sick while the healthy sit it out for a year?

I’ve said before that I don’t think delaying the mandate (really, I think, the fine/tax) will make a big difference in how many health people sign up. That is, I’m not convinced anyone would sign up simply to avoid the fine/tax. I think the problems with the rollout make it even less likely the young invincibles would sign up anyhow. I’m in the minority apparently. Peter Suderman, for example, shares Laszewski’s concerns.

Laszewski’s other point consists of two suggestions for the new ObamaCare Czar’s to-do list. One is to get the 834 transactions (the backroom transmission to insurers) cleaned up before anything else is fixed. As he points out, if system is fixed enough so that lots of people can sign up but that information doesn’t get to the insurers cleanly, there is going to be quite a mess.

His second suggestion is:

Focus on the private exchanges and health insurance companies with their own websites that still cannot connect to healthcare.gov for things like subsidy calculations. The companies have been begging for this capability from the beginning. If it had been done, they could now be serving as an effective work-around giving consumers an efficient means to get signed-up. This should have been Plan B in the first place in case the Obamacare site did not work.

I’m not quite sure what he’s saying here. Is he simply referring to giving insurance companies help telling their customers what subsidies they can get; or is he advocating letting people do the whole sign-up process with their insurance company, removing any need for anyone to ever use the ObamaCare website/exchanges? If the latter, I agree; if the former then, yes, that would reduce the anxiety for people who are looking at big premium changes and can’t figure out if they’re going to be subsidized. (Although there are free-standing subsidy calculators available on the Internet - here and here, for example. These aren’t official numbers but they are both from reputable sources so would presumably at least be in the ball park.)

The “Commitment” post went up at Laszewski’s site a few days ago. Today he posted “Mr. President: I like My Health Insurance and I Would Really Like to Keep It - Can You Help Me Out Here?”. He talks about the excellence of his current plan and reports receiving a letter telling him he cannot keep it “because my plan isn’t good enough under Obamacare rules.” The new plans he can buy have worse coverage than his current plan. And to cap it all off:

And, wait all you people telling me rate shock does not exist, it far more restricted plan costs 66% more than our current monthly premium. Mr. Rate Shock got rate shocked––and benefit shocked to boot.

Odd. This seems not to back up the claim that all of us who are losing our current insurance have sub-standard crap or the claim that if we are going to have to pay more it’s worth it because we’ll be getting more.*

Laszewski has also done a couple of interviews with Ezra Klein. In one of them, dated October 23, he makes this point:

But they have to get the backroom fixed before they open the front door. If they open the front door before that back room is fixed, you’ll have a catastrophe. People are going to be signing up and seeing their banks accounts debited multiple times, or their insurance won’t come through. The White House is meeting with insurance industry executives today, and I can tell you what they’re talking about. They say you need to get this fixed, because you’re setting us up for a real fall with our customers. They’re not going to blame Kathleen Sebelius if they walk into their doctor’s office and the doctor doesn’t know who they are. They’ll blame the insurance company. And I’m sure what the insurers are telling the White House today is we will not let you put us in that position.

I suspect the White House doesn’t care what the insurers are saying. I’ve always believed that one of the worst features of ObamaCare and yet one that has great benefit for its supporters is the involvement of the insurance companies. Large corporations, especially large insurance corporations, make great scapegoats.



* I want to say, for the record, that even if both these claims were true they would still not be valid arguments for making me buy what someone else thinks I should. I get to decide what is and is not sub-standard for me. I get to buy sub-standard crap if I really want to. I get to decide I’m willing to live with less rather than paying more. I get to go without if nothing I can buy suits me. My money, my health, my decision.

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