Tuesday, April 21, 2015

$1 billion in Federal Tax Dollars and a One Star Rating on Yelp––Quite an Expose––Behind the Scenes at Covered California

What a difference a year makes.

Last year the California Obamacare insurance exchange, Covered California, was touted as the poster child for the Obamacare launch. Supporters said it worked well, enrolled lots of people, and was off to the kind of start that proved how successful Obamacare could be.

But after the second open enrollment new sign-ups have hit a wall, customer renewal rates are among the worst in the country, and consumer complaints are growing:
In a March 2013 post on this blog, I pointed out that Covered California was, at that time, getting $930 million in federal government money, including $250 million for marketing, to build and launch its services. Almost all of the other states building an exchange got less than a third of California's budget. Also by comparison, I pointed out that the privately funded national web insurance broker Esurance.com received a total of $40 million in the late 1990s to launch its insurance website enrollment business.

So, what's really been going on behind the scenes at Covered California?

Former CBS News Emmy winning investigative journalist, Sharyl Attkisson, has a two part expose, "Incompetence, Mismanagement Plague California's Obamacare Insurance Exchange" and "Insider's Detail Culture of Secrecy at California's Obamacare Exchange" on The Daily Signal, that fills in the details behind all of the high expense, poor consumer service, and now dismal enrollment results.

Among her findings:
  • Shortly after the October 2013 launch, Covered California's systems ran into trouble that took months to fix and cost another $155 million putting the total federal investment in Covered California at $1.06 billion.
  • Last fall, Covered California hoped to increase enrollment by 500,000 in the recent second open enrollment. But only an additional 7,098 selected a plan for 2015.
  • Only 65% of Covered California's 2014 customers reenrolled for 2015. The rest dropped off the rolls.
  • One leading Covered California insurance agent is quoted as saying, "I've got one family...their Covered California account shows three different effective dates." Attkisson goes on to quote him, "I've found out a woman's plan had been terminated, but they couldn't tell me why...I know their [Covered California's] enrollment numbers aren't right. They're marketing themselves [to generate] fees." Attkisson concluded, "[The agent's] once cheerful blog has turned into a consumer chronicle of Covered California's tribulations."
But in California, the spin continues. From Attkisson's report:
"New enrollment for 2015 coverage is strong and has brought in consumers who our marketing and outreach targeted,' said Covered California Executive Director Peter Lee, overlooking the fact that his organization's retention of last year's customers was among the lowest in the country."
Now, I want to reiterate something: $1 billion for a website and insurance marketing organization––and a one-star rating. Folks, you also need to see those Yelp reviews.

Attkisson's two part Series on Covered California:
Incompetence, Mismanagement Plague California's Obamacare Insurance Exchange 

Insider's Detail Culture of Secrecy at California's Obamacare Exchange

Thursday, April 2, 2015

Wisconsin Governor Scott Walker's Medicaid Policy––and Now His Position Not to Save Insurance Subsidies if the Supreme Court Strikes Them Down––Says a Lot About How He Would Govern as President

Speaking to a conservative group in Wisconsin this week, presumptive presidential candidate Scott Walker said he would not move to establish a state exchange in order to preserve the Obamacare federal insurance exchange subsidies if the Supreme Court strikes them down in an expected June ruling:
We're going to push back. The President of the United States––they've got to come up with a solution...They're going to try to put pressure on us but we need to put the pressure right back on them.
The 186,000 Wisconsin residents now getting subsidized health insurance from Wisconsin's federally run exchange would lose their premium support if and when the Supreme Court strikes down the Obamacare subsidies.

This isn't the first time Walker has tried to clearly establish himself as the candidate with the strongest conservative credentials––and biggest opponent to Obamacare.

In 2013, Walker refused to expand Medicaid in Wisconsin under Obamacare and instead came up with a plan of his own.

About Walker's Medicaid alternative, the Milwaukee Journal Sentinel––which has supported his candidacy for governor––wrote in a recent editorial:
For the governor, it was about a conservative standing firm against Obamacare. But for taxpayers, it was about losing the chance to save up to $345 million over the next two years...

Walker's decision cost taxpayers more than $100 million in the current two-year budget. An estimated 84,700 more people could have been covered under BadgerCare [Medicaid] had he taken the additional federal money.

And, for what? To make a political statement. Wrong. Wrong. Wrong.
Two years later just how well has Walker's Medicaid alternative done? See my op-ed in Forbes here.

Thursday, March 26, 2015

Headline: "Exchanges Struggle to Enroll Consumers As Income Increases" It's Because of the Obamacare Dichotomy

Here is an excerpt from a post on this blog from June 21, 2014:
Kaiser Family Foundation Survey Finds Most People Who Bought Health Insurance on the Exchanges Are Happy With It

This week the administration reported that 76% of those who received a subsidy paid less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies––46% are paying $50 or less.

It would appear from this data that it is the lowest income people who are most often signing up for coverage. They are the ones who get the biggest premium subsidies as well as the reductions in their deductibles and co-pays.

So, the Kaiser Family Foundation has found that these people who are having their premiums and deductibles disproportionately subsidized are happy with their coverage. Hardly a surprise. If you paid for most of my insurance and cut my deductibles from the standard levels I'd be pretty happy too.
My sense has always been that Obamacare appeals to people very differently depending on their incomes. I will call it the Obamacare dichotomy: Poorer people get by far the lowest premiums and deductibles from Obamacare and working class/middle class/wealthier people, who pay very high premiums for high deductible plans, get relatively very little from it.

Why do most people express dissatisfaction with Obamacare in most of the polls? Why did Obamacare fare so badly in the last election? It seems to me that all of this has to do with who benefits and who does not.

This week consulting firm Avalere found the same enrollment breakdown I pointed to last June between the poor and the middle class after analyzing the most recent enrollment reports from the government:

Wednesday, March 25, 2015

The New York Times: Has Obamacare Enrollment Stalled?

Readers of this blog know that I have made a number of points about Obamacare in recent months:
  • The number of people signing up for Obamacare is well below the level necessary to make the rates stable over the long-term––the longstanding insurance industry standard calls for getting 75% of an eligible group in order to have enough healthy people in the pool to pay the costs of the sick people. I have reported to you that less than half of the subsidy eligible have signed up so far.
  • The Obama administration's enrollment estimates, that they now use to celebrate their 2015 enrollment results, were low ball estimates that aren't close to the kind of enrollment they need to make the program both politically and financially sustainable.
  • Obamacare's overall enrollment is coming up way short of original projections and has slowed down considerably in the most recent second open enrollment.
In the face of these comments you have likely noted any number of press reports in the past weeks pointing out just how well Obamacare has been doing.

But now none other than the New York Times has picked up the same themes I have been talking about for months.

Thursday, March 5, 2015

The Obamacare Supreme Court Subsidy Challenge––Surprising Comments From Anthony Kennedy and Maybe a Way Out for John Roberts

The Supreme Court heard oral arguments yesterday in the King v. Burwell case that would throw out the Obamacare subsidies for millions of people now receiving them in the federally run health insurance exchanges.

It sure sounded like perennial swing vote Justice Anthony Kennedy is ready to save the subsidies and Obamacare given his comments suggesting a finding for the plaintiffs would end up coercing the states into building an insurance exchange––something that would present Kennedy with a "serious constitutional problem."

But I was also struck by this line in a Washington Post article about the oral arguments: "More than the other justices, Kennedy is the one most likely to think out loud during oral arguments, trying out various theories and posing quandaries for lawyers."

Translated: It ain't over til it's over.

At one point, conservative Justice Samuel Alito asked if perhaps the Court could delay the effect of a ruling ending the subsidies thereby giving the Congress and the states time to remedy the fallout.

Monday, March 2, 2015

Republicans: "We Have a Plan For Fixing Health Care" If the Supreme Court Eliminates Subsidies in as Many as 37 States––It Won't Be So Simple

Key Senate Republican committee chairman Orrin Hatch (UT), John Barrasso (WY), and Lamar Alexander (TN) have an op-ed in the Washington Post today saying they have a plan if millions of Americans lose their Obamacare subsidies this summer.

First, I have no idea how the Court will rule, likely in late June. While it is hard for me to see Chief Justice John Roberts voting to strike a major blow to the new health law now when he had that same chance three years ago and didn't, no one can predict what is going to happen this time.

But if the Court does throw the subsidies out in late June, it will mean that the Obamacare insurance subsidies would no longer be available to millions in as many as 37 federally-run states come August 1.

Realizing just what chaos this would cause, these three senators wrote:
First and most important: We would provide financial assistance to help Americans keep the coverage they picked for a transitional period. It would be unfair to allow families to lose their coverage, particularly in the middle of the year.
They provided no more detail except to say that they have had discussions with House and Senate colleagues and that there is "a great deal of fconsensus on how to proceed."

I don't doubt their intentions, but it would be nowhere so easy.

Wednesday, February 18, 2015

Obamacare is "Working a Little Better Than We Expected"––Judge for Yourself

Here is what President Obama said in a recent video, "The Affordable Care Act is working. It's working a little better than we expected."

On Tuesday, the administration announced that 11.4 million people signed up for Obamacare in the second open enrollment.

That number is higher than the number that will ultimately pay for their coverage and complete the enrollment. Even after they complete signing up the stragglers, it is more likely the paid for number will be about 10.5 million based upon a number of conversations I have had with carriers.

But let's assume they end up with as many as 11 million people. Would that exceed expectations?

Here is what the Congressional Budget Office projected in May of 2013:

Tuesday, February 10, 2015

A Detailed Analysis of the Republican Alternative to Obamacare

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

Republicans will now argue they have a better health insurance reform plan and that Obamacare should be repealed and replaced by it––particularly if the Supreme Court plunges the new health law into chaos by throwing the subsidies out in 37 states.

They will have an uphill battle. Not because these Republicans don't have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.

My sense is that voters will end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can't we take the best from both sides?

If Democrats would just admit Obamacare needs some pretty big fixes, and Republicans would be willing to work on making those fixes by putting some of these good ideas on the table, the American people would be a lot better off.

In fact, I am hopeful that this is eventually what will happen once Obamacare's failings become even more clear (particularly the real premium costs) and both sides come to understand that neither will have a unilateral political upper hand.

See my recent op-ed on how to fix Obamacare here.

Let's take an in-depth look at the Republican alternative, "The Patient Choice, Affordability, Responsibility, and Empowerment Act." 

It's key provisions include:

Wednesday, January 14, 2015

Rethink "Repeal and Replace" and Consumer Friendly Obamacare Fixes - Two Op-Eds in USA Today

I have no doubt Republicans will insist on proposing their own complex plan to reform the health insurance system that will include repealing and replacing Obamacare.

But I think it is going to get them into more political trouble than it's worth.

Here's the first of my two of op-eds in Thursday's USA Today: Rethink "Repeal and Replace"

Of course that begs a question, Just what should we do to make health insurance reform politically and financially viable?

Proposals the Republicans are now considering will have no chance of getting by a Presidential veto––even if they can muster 60 votes in the Senate––so long as Obama is President. Even if the Supreme Court takes away insurance subsidies in the state exchanges I doubt this President and this Congress can agree on anything.

But in 2017, it will be a different matter. I really do expect the new President, Democratic or Republican, as well as the new Congress, will be anxious to move on past this long and tedious health care debate to other important issues.

Whoever wins the 2017 elections, I have no doubt the consensus will be that health insurance reform will need lots of reforming. And, the only way that will happen is when one political party is able to bring lots of members of the other party on board.

Democrats might think Obamacare will survive intact. It won't. Five years later it has failed to garner the support they thought it would.

Republicans might think they can do a unilateral conservative health insurance reform in 2017––just like the Democrats rammed their version through in 2010. They won't. The country has had enough of that.

So, what would fundamental changes look like that could gain bipartisan support, be politically attractive, and financially sustainable?

Here is my second op-ed in Thursday's USA Today: Consumer-Friendly Obamacare Fixes

Recent Post: Republicans Considering Proposing High-Risk Pools––Health Insurance Ghettos

Tuesday, January 6, 2015

Will Tax Season Be Obamacare's Next Big Challenge? Is There Really an Individual Mandate?

Will tax-filing season be the next reason for consumers to complain about the new health law? Come tax time, will the Obama administration really enforce the individual health insurance mandate?

The IRS is out with a 21-page publication––Publication 5187––describing what taxpayers need to know about Obamacare in order to file their 2014 taxes.

Monday, January 5, 2015

The Single-Payer Health Insurance Failure in Vermont

For 25 years I've been saying that I wished a little state like Vermont would implement a single-payer Canadian-style health insurance system––"Medicare For All." My argument has always been that such a small and limited experiment would give us the opportunity to see the ideological arguments for such a system play out in the face of fiscal reality and the stakeholders fighting it out in the political arena over who would get the money. The rest of the country would be able to learn a lot from it.

Monday, December 29, 2014

The Letter You Never Want to Get on Christmas Eve

I was reading the December 18th issue of Inside Health Insurance Exchanges and came across an article entitled, "New Kids on the Block Come Out Swinging; Co-Ops Lower Rates for Many Health Plans."

The gist of the article had to do with the success a number of Obamacare insurance co-ops have had in charging lower rates and getting lots of market share by "[underpricing] more established players inside and outside of the public insurance exchanges."

The article went on to point out that some traditional competitors are beginning to complain that the co-ops have unfair advantages.

This quote from the CEO of CoOpportunity––the market leading Iowa and Nebraska Obamacare funded co-op that enrolled 120,000 people in 2014––stood out:
For Blues plans and other carriers "with deep reserves, booming stock prices and market entrenchment to plead for relief from these nimble, undercapitalized start-ups is ludicrous and insulting," counters CoOpportunity Health CEO Cliff Gold. He says his company has been successful in attracting customers in two states despite not having the lowest cost products anywhere in Iowa or the most populous part of Nebraska. "At the end of the day, in the long term, success is determined by a company's ability to create value for customers, he tells HEX. "That critical but elusive combination of price, product features, provider network, and customer service is what separates competitors."
Here's the letter that Mr. Gold received a week later on Christmas Eve:

Thursday, November 13, 2014

How Many People Have Enrolled So Far in Obamacare's Second Open Enrollment?

Undoubtedly I will hear that question many times in the coming weeks.

The answer is that this enrollment process is so screwed up we will have no earthly idea how many new people have enrolled and how many 2014 enrollees remained on the program until at least April 2015.

Let me try to illustrate.

Monday, November 10, 2014

Is the Administration Low-Balling Their 2015 Obamacare Enrollment Estimate?

Well, with an estimate of only 9 million to 9.9 million, apparently they are. But I will suggest the focus should not be on anybody's estimate for 2015 but rather on how many people need to enroll in Obamacare to make it sustainable.

Friday, November 7, 2014

Supreme Court Takes the Obamacare Subsidy Case--Justices Will Rule Before July 1

In a Wow moment, the Supreme Court announced Friday that they will take one of the four pending "Halbig" cases––specifically King v. Burwell.

The issue is over whether the new health law actually authorizes the payment of premium subsidies in the 37 states that will rely upon the federal government to run their exchange in 2015.

This effort is being made on a number of fronts but has been generally know as the "Halbig" challenge. I guess we will now call it the King challenge.

If the Supreme Court eventually affirms this challenge, anyone receiving a health insurance subsidy in the 37 states run by the feds would immediately lose it. Given that the bulk of those currently getting subsides are at the lower income range for those subsidy eligible, most would likely drop their Obamacare insurance unless they were so sick it made sense for them to beg, borrow, or steal the money they would need to continue making premium payments.

Wednesday, November 5, 2014

Obamacare: Death By a Thousand Votes?

We didn't see a Republican tide on election night.

We saw a Republican tsunami.

A year after Obamacare went into effect and Democrats said people would come to support it voters gave one Republican candidate after another, who made Obamacare a big part of each of their campaigns, one victory after another.

So, how will the Republicans use their convincing result on Obamacare?

Friday, October 31, 2014

Health Insurers "Expect at Least 20% Growth" From 2015 Enrollment

That was the lead in a Reuters story this morning saying, "health plans expect at least 20% growth in customers and in some states anticipate more than a doubling in sign-ups" from the 2015 Obamacare open-enrollment.

Well they better do a hell of a lot better than that!

Sunday, October 19, 2014

Figures Don't Lie But Liars Figure––Will There Be Some Obamacare Rate Shock in 2015?

Hanging around actuaries as long as I have one of the old sayings I picked up was, "Figures don't lie, but liars figure."

I have read one story after another this summer and fall about the modest Obamacare rates increases––or decreases––for 2015.

On this blog you have also seen me write about the complex way the 2015 Obamacare rates will hit people particularly because of the impact the changes in the so called second lowest cost Silver plan will have on so many people's final subsidy. You have also seen me write about the fact that we really won't know what Obamacare costs people until the now unlimited Obamacare reinsurance program stops subsidizing insurance rates in 2017.

Recently, the Kaiser Family Foundation provided a report pointing out that the cost of the benchmark Silver Plan would fall 0.8% in sixteen cities they researched:

Monday, October 13, 2014

Wednesday, October 8, 2014

The Most Transparent Administration Puts a Gag Order on HealthCare.gov Testing

With the second Obamacare open-enrollment beginning on November 15th, the enrollment system's testing begins with insurance companies this week.

Of course, last year the enrollment system testing was a real mess resulting in a humiliating Obamacare launch for the administration.

Up until now I wasn't expecting any major problems with HealthCare.gov's consumer enrollment system given all of the lessons learned and the new people running things.

But apparently, the administration is pretty worried about what could happen.

Avoid having to check back. Subscribe to Health Care Policy and Marketplace Review and receive an email each time we post.

Blog Archive