Charles Gaba's blog

For any tech geeks like me out there curious as to how the original HC.gov website mess happened, this gives you an idea of how crazy the project became...

Healthcare.gov faltered last fall in large part because it was built by a crowd of uncoordinated contractors with no one in charge of making sure all the interlocking pieces fit together.

As the White House tries to prevent a repeat catastrophe, government watchdogs are investigating why the Obamacare marketplace failed in the two months after it opened on Oct. 1, 2013. A new report (PDF) details the 60 separate government contracts, awarded to 33 companies, that contributed to building healthcare.gov. The chart above shows how much each contractor was awarded."

Of course, the Obama Administration also sent in an "Apollo 13" emergency tech wizard team to clean up the mess and salvage the project in November, and the rest is history, but it's still important to understand how the federal exchange came so close to failure in the first place...

This. Is. Awesome. News.

A little-known Obamacare tax on health insurance executives' salaries raised $72 million in new revenue last year.

For decades now, the United States has limited the corporation tax deduction for executive pay to $1 million for the company's top four employees. That deduction cap, however, excluded performance bonuses, creating a massive loophole allowing companies to pay their top employees more than $1 million without facing a higher tax burden.

Obamacare quietly changed the rules for health insurance executives. It lowered the cap to $500,000 — and, in that amount, now includes all forms of compensation. The health insurers' regulation also widens the scope of who it hits: while the general deduction cap only applies to the company's top four employees, the Obamacare rule hits any executive earnings more than $500,000.

These new limits kicked in last year. The Institute for Policy Studies ran the numbers and found that this one change resulted in the 10 largest insurers paying an additional $72 million in taxes in 2013.

Presented without comment (except for my emphasis):

INDIANAPOLIS (AP) — Indiana residents will have more than triple the number of health insurance plans to choose from when the federal insurance exchange enrollment period starts in November, according to a state official.

Indiana Department of Insurance attorney Tina Korty told a legislative panel Thursday that some insurers took a “wait-and-see” approach during the first year of the exchanges under the Affordable Care Act.

Nine companies will offer a total of 975 plans - not all will be available in every county - for Indiana residents on the federal exchange, she said. During the 2013-14 period, three companies offered 278 plans, The Times of Munster and the Post-Tribune reported.

“I think a lot of companies were waiting to see how the first year went,” Korty said. “Also were seeing some smaller providers that may offer a policy in only a few counties.”

Korty said a 5 percent average increase in exchange premiums is expected on Indiana policies.

This is flat-out wrong and should be stopped/fixed immediately:

A worrisome trend is emerging among some Californians who thought they were safe and secure under Covered California: Their plans are being canceled without consent and sometimes without notice.

...A growing number of Californians with Covered California plans are learning – sometimes through happenstance – that their plans no longer exist. Some, like Manahan, are getting shunted into Medi-Cal. Others are dropped outright.

...Covered California acknowledges that it is yanking some people off of its plans and putting them on Medi-Cal, months after they signed up or submitted income information.

We’re “in the process of manually verifying the documents provided by individuals who were conditionally eligible for obtaining health care coverage through our agency,” says Covered California spokesman James Scullary. “Through that process, some customers will receive notices indicating they are now eligible for no-cost or low-cost Medi-Cal coverage.”

Happy Labor Day Weekend, everyone!

If my calculations are correct, the total number of ACA exchange-based QHP enrollments should now be at around 9.2 million...and the number of people who have paid for their first month's premium should have finally crossed the 8 Million milestone right around...now (plus or minus a week or so).

A few days ago, news broke that Pennsylvania's Governor Tom Corbett, whose re-election numbers are in the toilet and who is desperate to get Pennsylvanians to like him, has finally agreed to the Medicaid expansion provision in the Affordable Care Act.

While "doing a single decent, human thing after a couple of years of being a jerk about it" shouldn't really count as being praiseworthy, I suppose he deserves at least a small golf clap, just as Michigan Gov. Rick Snyder and Ohio Gov. John Kasich did.

Anyway, next up to bat would appear to be Tennessee Gov. Bill Haslam:

In a move that could mean health coverage for thousands of Tennesseans, Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee's Medicaid program but did not release any new details on how it might work.

Someone just brought this piece from the right-wing Daily Caller to my attention:

Florida Obamacare Enrollment Total Plummets By A Quarter

Florida’s Obamacare enrollment is now over 220,000 lower than the Obama administration’s most recent tally, according to a report from the state insurance department. 

The Obama administration hasn’t released updated Obamacare enrollment statistics since May, when the Department of Health and Human Services put the number of Florida sign-ups at 983,775 — but the Florida Office of Insurance Regulation says that now, just 762,723 Floridians have health insurance through the exchange.

OK, stop right there. Yes, it's true that the most-recent HHS report had enrollments at 983,775, but that was as of April 19th, not "May". Minor error, I agree, but important in the context of what we're talking about there. OK, go on...

The Maryland Health Connection just issued their latest monthly enrollment report (running from 7/27 - 8/23). On the one hand, the QHP tally includes both new additions and dropped/cancelled enrollments this time around, making it useless for adding to my off-season enrollment projection chart...

Enrollment Data
As of August 23, 78,666 individuals have enrolled in qualified health plans.1

As of August 27, 2014, 355,281 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage. We have begun reporting the net changes in Medicaid enrollment. This figure takes into account that individuals lose Medicaid coverage because of changes in household, age and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of August 27, 2014 is +262,737. 

A little while ago I posted about the failed Florida "Health Choices" website, the Florida GOP response to the Affordable Care Act. Over a 6 month period, they've only managed to enroll 30 people, total. That's Three-Zero.

So, how does this compare to the cost-per-enrollee of other "failed" Obamacare exchanges?

Well, Healthcare.Gov itself, which enrolled over 5.4 million people and covers 36 states, spent $647 per enrollee.

Nevada's ACA exchange was botched by Xerox to the tune of $51 million, and enrolled 38,000, or $1,342 apiece.

Maryland spent $118 million and had enrolled 78,930 people in private plans as of the end of June. That's $1,495 per person.

File this one under "Not From The Onion":

TALLAHASSEE — Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

Six months after the launch of the state's effort, called Florida Health Choices (floridahealthchoices.net), just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services.

Huh. OK, exactly 1 day after I snarkily speculated that Cover Oregon is unlikely to release an enrollment update anytime soon due to their increasingly-ugly legal (and technical) battles with Oracle Corp., take a guess what just happened this morning...

August 25, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 340,621
Total private medical insurance enrollments through Cover Oregon: 100,013   

Oregon Health Plan enrollments through Cover Oregon: 240,608*

*OHP enrollment data is current as of August 6, 2014. An updated number will be posted soon.

Dental enrollments 
Total private dental insurance enrollments through CoverOregon 1: 20,018

Net enrollments 
Net private medical: 78,714
Net private dental: 14,299

On the one hand, the total QHP number has jumped an impressive 3,103 over a 19 day period, or 163/day, so good on them.

Sarah Kliff at Vox broke the news a few hours ago, but I just received the official press release from CMS; there seems to be some discrepancy about the total number eligible, but it's fantastic news no matter what:

Pennsylvania has apparently struck a deal with the Obama administration to expand its Medicaid program to more than 300,000 poor residents, Joan Alker at Georgetown University tweets:

Pennsylvania would be the 27th state (not including the District of Columbia) to participate in Obamacare's Medicaid expansion, and Gov. Tom Corbett would be the ninth Republican governor to sign on.

According to the CMS Dept, however, the actual number eligible in Pennsylvania could top 500,000:

FOR IMMEDIATE RELEASE Contact: CMS Media Relations

August 28, 2014
(202) 690-6145 or press@cms.hhs.gov

CMS Statement on Approval of Medicaid Expansion in Pennsylvania

I post guest entries once in a blue moon, and this one could be huge, if his conclusions are accurate (and still well worth discussion even if they aren't). Recently, both Sarah Kliff over at Vox and Margot Sanger-Katz & Kevin Quealy at the NY Times Upshot have delved into some fascinating and unexpected news regarding Medicare & Medicaid spending in the U.S. over the past few years.

Well, an ACASignups supporter named Jim Stuart (all I really know about him is that he's a retired executive and educator who attended Princeton and lives in Illinois) has gone even deeper into the weeds on this and, well, I'll let those who know more about such things than I do decide how much of a Big Deal this is.

With Jim's request/permission, I'm reposting his piece verbatim, but I'd also advise checking out his own blog.

This is an interesting overview/update about the state of the ACA's small business "SHOP" exchanges, which, by my calculations, have only enrolled around 72,000 people nationally to date (a rounding error compared to the 9,000,000 or so who've enrolled in individual QHPs so far):

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

The good news is that things should start ramping up on the SHOP side this fall:

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.

In spite of their amazingly successful manual workaround process (which has enrolled 465,000 people in either private or Medicaid coverage), Oregon's website debacle continues to fester. Even so, until recently they've ironically been one of the most reliable state exchanges when it comes to publicly posting updated enrollment data. New detailed data has been posted pretty much once a week since the crazy days of March/April on a regular basis.

That all came to a screeching halt just over 3 weeks ago; the last update out of CoverOregon was August 6th. Again, this is still much better than most other states which only publish updates monthly or not at all, but for Oregon it's been worrisome for me, since they're one of only a handful of states giving that info out at all during the off-season.

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