Obamacare and you

[Sheilbh]

Right now you've the most expensive system in the world that provides the least coverage. It's tough to see how it could get worse

[merithyn]

Right now you've the most expensive system in the world that provides the least coverage. It's tough to see how it could get worse

Just wait. We're special in how we figure those kinds of things out.

[CountDeMoney]

Lulz, a stunning success!

More than 300 Marylanders enroll in health plans in six days
By Andrea K. Walker and Meredith Cohn, The Baltimore Sun

9:38 PM EDT, October 7, 2013


Since it launched last week, the state's new health insurance exchange has been used by 326 Marylanders to enroll in plans, while thousands of others created accounts to start shopping, despite persistent technical problems.

A new report released Monday outlining the performance of Maryland Health Connection in its first six days showed steady interest from Marylanders looking for health insurance. But the report also acknowledged that the state must continue to improve the system to make it more accessible.

The website logged more than 174,000 unique visitors and more than 10,500 people telephoned its call center. About 13,500 created accounts that allow them to browse, compare and buy health plans. The initial count doesn't include paper applications, which are being processed.

"Through every channel we have had tremendous interest, and our challenge and goal is to meet that interest," said Maryland Health Secretary Dr. Joshua Sharfstein. "We are doing everything we can around the clock to improve the system so people can be successful in what they want to do."

Consumers are supposed to be able to visit Maryland Health Connection, create an individual account and browse a variety of health insurance plans before buying one, much as they would book an airline flight. The exchange was created as part of the national health reform to provide a place for Maryland's 800,000 uninsured to find health coverage.

The website crashed almost immediately after it launched Oct. 1 to begin taking applications. Technical problems inhibited people from creating accounts. Those who managed to create an account ran into frozen screens, error messages and other issues.

It's unclear how much those problems might have hindered enrollment. Officials had expected many people to window shop and buy later.

State officials warned before its start that there could be glitches with the system because it was such a complex launch. They blamed the problems on the high volume of people trying to access the exchange, but some analysts have said it appears the system wasn't built with enough capacity to handle the demand. Some suggested that requiring people to create accounts to access the exchange also might have overburdened the system.

Technicians in Maryland have since added server capacity, made technical adjustments and improved the ability for employees in the call center to help those interested in enrolling, the report said. There are plans for a software upgrade in the near future.

Improvements will continue. During upgrades, users won't be able to access certain parts of the site. The site also will be taken down every night in October between 11 p.m. and 5 a.m. to fix problems.

Because Maryland's exchange has been open for so little time, it's tough to assess how well it's doing compared with other states or even within its borders, said Brad Herring, a Johns Hopkins University health economist who has been following the health law's implementation.

"If there are 800,000 uninsured in Maryland, then these numbers, at least in terms of applications and enrollment, seem pretty low," said Herring, an associate professor of health economics at Hopkins' Bloomberg School of Public Health. "But on the other hand, it's really early and certainly there have been a lot of visitors" to the site.

Herring said most people would want to gather information at first about premiums and deductibles, think about their options and return later to sign up, so the small number of enrollees is not surprising. Consumers have several months before the policies would kick in. Consumers have until March to enroll, but they must sign up by mid-December for coverage starting Jan. 1.

Also, Maryland requires consumers to create an account before seeing specific information on policies, so many may not be ready to enter the formal process, Herring said. Some also may have been deterred from logging on or creating an account because of news of the system's glitches.

On the other hand, he said, the number of visitors to the site may be inflated by those who have insurance but are curious about the offerings, such as researchers and journalists.

Others said it's not surprising there is more interest than enrollees at this point.

"The number of website visits, calls and created accounts all demonstrate significant public interest in obtaining coverage through the Maryland Health Connection," said Karen Davenport, director of health policy at the National Women's Law Center. "Women and their families looking into coverage through this marketplace need time to sort through the wide variety of health insurance options — Maryland Health Connection offers more than 80 health and dental plans — to work out what works for their budgets and anticipated health needs."

The state is taking constant feedback from consumers as they use the site.

Sharfstein declined to talk in detail about the system's problems.

"We are tracking [problems] and knocking them off as we are able to," he said. "We are certainly aware the technical issues need to be addressed. We expect the experience for users to get substantially better as we continue to address the issues."

Exchanges across the country have dealt with similar problems as millions of people went searching for insurance under the Affordable Care Act, the landmark legislation meant to spread access to health coverage to most uninsured Americans.

Community groups in Maryland helping to enroll people have turned to paper applications until kinks in the system are worked out.

Evergreen Health, a co-op started by former Baltimore Health Commissioner Dr. Peter Beilenson, has delayed signing up people using the website until next week because of problems with the exchange.

Sharfstein said people have plenty of time to enroll and he doesn't think the problems with the system will discourage people who need coverage.

"We think that there will be plenty of opportunity as the system moves forward for people to come back to it," he said.

[garbon]

Disagree Moldy.

"Do they have health insurance" is a fairly standard question for people job-seeking.  Tossing people on exchanges will, in my estimation, decrease their supply and drive up cash compensation.

I agree.  Companies might get away with shortchanging employees on compensation by failing to balance lack of health care with increased pay to allow the employee to afford it in the current economic climate, but in the long run that will cost them their good people.

LOL, "cost them their good people"...Their "good people" will stay and fucking take what they're given, all the way up the ass.  What are they going to do?  Leave in this job market?  Maybe the Senior Associate Vice President of Human Resources or the Senior Director of IT Support - Applications, but that's about it. 

But the rest of the worker bees will take the elimination of employer contributions to healthcare plans and get tossed to the exchanges without the equivalent increase in wages, and they'll fucking eat it and smile, as usual.

I suppose my title does have a senior in it.

[sbr]

Lulz, a stunning success!

More than 300 Marylanders enroll in health plans in six days
By Andrea K. Walker and Meredith Cohn, The Baltimore Sun

9:38 PM EDT, October 7, 2013


Since it launched last week, the state's new health insurance exchange has been used by 326 Marylanders to enroll in plans, while thousands of others created accounts to start shopping, despite persistent technical problems.

A new report released Monday outlining the performance of Maryland Health Connection in its first six days showed steady interest from Marylanders looking for health insurance. But the report also acknowledged that the state must continue to improve the system to make it more accessible.

The website logged more than 174,000 unique visitors and more than 10,500 people telephoned its call center. About 13,500 created accounts that allow them to browse, compare and buy health plans. The initial count doesn't include paper applications, which are being processed.

"Through every channel we have had tremendous interest, and our challenge and goal is to meet that interest," said Maryland Health Secretary Dr. Joshua Sharfstein. "We are doing everything we can around the clock to improve the system so people can be successful in what they want to do."

Consumers are supposed to be able to visit Maryland Health Connection, create an individual account and browse a variety of health insurance plans before buying one, much as they would book an airline flight. The exchange was created as part of the national health reform to provide a place for Maryland's 800,000 uninsured to find health coverage.

The website crashed almost immediately after it launched Oct. 1 to begin taking applications. Technical problems inhibited people from creating accounts. Those who managed to create an account ran into frozen screens, error messages and other issues.

It's unclear how much those problems might have hindered enrollment. Officials had expected many people to window shop and buy later.

State officials warned before its start that there could be glitches with the system because it was such a complex launch. They blamed the problems on the high volume of people trying to access the exchange, but some analysts have said it appears the system wasn't built with enough capacity to handle the demand. Some suggested that requiring people to create accounts to access the exchange also might have overburdened the system.

Technicians in Maryland have since added server capacity, made technical adjustments and improved the ability for employees in the call center to help those interested in enrolling, the report said. There are plans for a software upgrade in the near future.

Improvements will continue. During upgrades, users won't be able to access certain parts of the site. The site also will be taken down every night in October between 11 p.m. and 5 a.m. to fix problems.

Because Maryland's exchange has been open for so little time, it's tough to assess how well it's doing compared with other states or even within its borders, said Brad Herring, a Johns Hopkins University health economist who has been following the health law's implementation.

"If there are 800,000 uninsured in Maryland, then these numbers, at least in terms of applications and enrollment, seem pretty low," said Herring, an associate professor of health economics at Hopkins' Bloomberg School of Public Health. "But on the other hand, it's really early and certainly there have been a lot of visitors" to the site.

Herring said most people would want to gather information at first about premiums and deductibles, think about their options and return later to sign up, so the small number of enrollees is not surprising. Consumers have several months before the policies would kick in. Consumers have until March to enroll, but they must sign up by mid-December for coverage starting Jan. 1.

Also, Maryland requires consumers to create an account before seeing specific information on policies, so many may not be ready to enter the formal process, Herring said. Some also may have been deterred from logging on or creating an account because of news of the system's glitches.

On the other hand, he said, the number of visitors to the site may be inflated by those who have insurance but are curious about the offerings, such as researchers and journalists.

Others said it's not surprising there is more interest than enrollees at this point.

"The number of website visits, calls and created accounts all demonstrate significant public interest in obtaining coverage through the Maryland Health Connection," said Karen Davenport, director of health policy at the National Women's Law Center. "Women and their families looking into coverage through this marketplace need time to sort through the wide variety of health insurance options — Maryland Health Connection offers more than 80 health and dental plans — to work out what works for their budgets and anticipated health needs."

The state is taking constant feedback from consumers as they use the site.

Sharfstein declined to talk in detail about the system's problems.

"We are tracking [problems] and knocking them off as we are able to," he said. "We are certainly aware the technical issues need to be addressed. We expect the experience for users to get substantially better as we continue to address the issues."

Exchanges across the country have dealt with similar problems as millions of people went searching for insurance under the Affordable Care Act, the landmark legislation meant to spread access to health coverage to most uninsured Americans.

Community groups in Maryland helping to enroll people have turned to paper applications until kinks in the system are worked out.

Evergreen Health, a co-op started by former Baltimore Health Commissioner Dr. Peter Beilenson, has delayed signing up people using the website until next week because of problems with the exchange.

Sharfstein said people have plenty of time to enroll and he doesn't think the problems with the system will discourage people who need coverage.

"We think that there will be plenty of opportunity as the system moves forward for people to come back to it," he said.

Im not sure what is lulz worthy is this.  Everyone has 2 months still until they have to do anything since nothing happens until Jan 1.  Why sign up for something that early, especially if you are strapped for cash?

[grumbler]

Disagree Moldy.

"Do they have health insurance" is a fairly standard question for people job-seeking.  Tossing people on exchanges will, in my estimation, decrease their supply and drive up cash compensation.

I agree.  Companies might get away with shortchanging employees on compensation by failing to balance lack of health care with increased pay to allow the employee to afford it in the current economic climate, but in the long run that will cost them their good people.

LOL, "cost them their good people"...Their "good people" will stay and fucking take what they're given, all the way up the ass.  What are they going to do?  Leave in this job market?  Maybe the Senior Associate Vice President of Human Resources or the Senior Director of IT Support - Applications, but that's about it. 

But the rest of the worker bees will take the elimination of employer contributions to healthcare plans and get tossed to the exchanges without the equivalent increase in wages, and they'll fucking eat it and smile, as usual.

LOL, you are just repeating what I said, with mouth foam added.

[Razgovory]

Right now you've the most expensive system in the world that provides the least coverage. It's tough to see how it could get worse

Things can always get worse.

[OttoVonBismarck]

Right now you've the most expensive system in the world that provides the least coverage. It's tough to see how it could get worse

I could easily see it getting worse before it gets better. The PPACA was good in that it created a scheme by which everyone would have access to more affordable healthcare (some individuals will still face monthly premiums on the exchanges that they might conclude are too expensive), but it does little to control the rising costs of healthcare.

The OvBCare plan would take care of the cost side. It's a well known fact we spend often times twice the per capita amount of many other OECD countries for a system that doesn't even provide universal coverage. The reasons for that are varied, but the focus on health insurance companies have always been misplaced. They are just a pass-through entity, and while their profits represent some level of inefficiency for society they are not the drivers of cost increases.

I'm not sure what the long term plan is, I can only suspect that maybe when the Democrats were unable to get single payer they felt the system they crafted would at least make it so everyone was covered and then society collectively felt it had "skin in the game" about rising health care costs, in the hope that it would force some greater change down the road. Regardless, until we make structural changes to control costs things can and very well may get much worse here. With the tax subsidy scheme you could say one benefit of the PPACA is that as things get worse it will be the government's finances that take a direct hit instead of private citizens who would be unable to afford insurance, for example (which may be the mechanism that forces a serious look at controlling medical costs.)

[grumbler]

Actually, Otto, the system the Democrats "crafted" was just the one they stole from Romneycare, with the necessary pork and corruption to get it through both chambers.

That quibble aside, i agree with you; things could get very much worse, indeed.  Health insurance companies lack both the leverage and the motivation to get serious about negotiating costs, and that's where the savings in ROTW health care mostly comes from.

[OttoVonBismarck]

They're making these decisions now, but there's no way to know how long they'll continue in that manner. The reality is that for the next 18 months to two years, a lot of things are going to change regarding employee compensation, benefits, and government intervention on both of those. Obamacare will not remain as it is, and companies will not stick to whatever high-handed ideologies they have at the moment.

Things will shake out in the wash in a way that can't be expected right now. I don't know if it will be for good or bad, but it will certainly change things dramatically.

Removing employer provided health benefits reduces total compensation, I agree with the likes of Yi, Sheilbh and DGuller that this will ultimately have an upward pressure on take home wages as over time the market for labor will eventually price that in and you'll see an expectation of higher pay in absence of the expensive healthcare benefit. But these sort of economic changes can often take many years to play out, and it's not family's like mine that suffer during the transition. It is the family's where they live paycheck to paycheck on hourly pay jobs that get munched into mash by these sort of economic shifts.

[merithyn]

There is no doubt that 90% of the problem with the American healthcare system is the cost of healthcare itself. Something will have to be done about it, though what, I have no idea. It's one of (if not THE) strongest lobbies in the country, and Congress seems perfectly happy bending over the table for them.

[crazy canuck]

Actually, Otto, the system the Democrats "crafted" was just the one they stole from Romneycare, with the necessary pork and corruption to get it through both chambers.

That quibble aside, i agree with you; things could get very much worse, indeed.  Health insurance companies lack both the leverage and the motivation to get serious about negotiating costs, and that's where the savings in ROTW health care mostly comes from.

It seems to me that is the critical weakness of Obamacare.  Insurance companies control their costs by limiting coverage and denial of coverage not by controlling the cost of health care providers.  For that to occur you would need to have a single payor system.

[Admiral Yi]

It seems to me that is the critical weakness of Obamacare.  Insurance companies control their costs by limiting coverage and denial of coverage not by controlling the cost of health care providers.  For that to occur you would need to have a single payor system.

That's not entirely true.  Insurers do negotiate discounts with providers.

One of the greatest perversities of our current system IMO; people with the least ability to pay--the uninsured--pay the highest prices.

[crazy canuck]

That's not entirely true.  Insurers do negotiate discounts with providers.

One of the greatest perversities of our current system IMO; people with the least ability to pay--the uninsured--pay the highest prices.

As to the first part of your post, not really.  Insurers generally offer coverage which allows access to health care providers who agree to insurers rates.  That is often inefficient as the insurer may not be able to attract the necessary (or appropriate) providers of that service.  ie the insurer has limited bargaining power.   That is what makes single payor systems very efficient at controlling health care costs.

As to your second point.  I agree entirely.  Which is also why a single payor system makes the most sense.

[OttoVonBismarck]

That's not entirely true.  Insurers do negotiate discounts with providers.

One of the greatest perversities of our current system IMO; people with the least ability to pay--the uninsured--pay the highest prices.

Yes, although in many cases hospitals and hospital networks are becoming so powerful that even the insurers no longer have the ability to negotiate very strong prices. The hospitals maintain a chargemaster (used to be a giant book, now it's anything from an Access DB to a DB on a mainframe etc), it has mostly insane and fictitious prices. This is where the infamous $45 for a pair of surgical gloves (bought for <$7 in 500 count boxes) and $120 for a single dose of ordinary Aspirin come from. Medicare ignores the chargemaster, instead its reimbursement rate is set based on the national average for the procedure/item. It does not care what the hospital claims its costs are. Insurers used to mostly throw out the chargemaster as well, negotiating directly to hit some sort of beneficial price. But where many hospitals have so much power in terms of demand/market share in their operating areas that now insurers are being forced to negotiate "discounts off the chargemaster" which result in much higher prices than when insurers can negotiate from a neutral position.