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Murphy Versus Obama

January 2nd, 2014 - 8:50 pm

HHS Secretary Kathleen Sebelius has made much of the claim that 2 million people have enrolled, in some form or other, in the Obamacare program. She has hailed it as a success and declares the worst of its rocky rollout is over. But data from 17 states — the only data that is publicaly available — suggests that only half of enrollees have actually paid a premium. For this reason some providers, like Health Tennessee are extending the payment deadline to January 10 to allow the paperwork to catch up with the expectations.

The uncertainty over who’s paid — or even who’s enrolled — is now having practical repercussions as people with heightened expectations come face to face with database air gaps and monetary reality. The Daily Mail describes how people who think they have enrolled in Obamacare are finding that nobody knows anything about it.

Hospital staff in Northern Virginia are turning away sick people on a frigid Thursday morning because they can’t determine whether their Obamacare insurance plans are in effect. …

She was leaving the building without getting a needed chest x-ray.

‘The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the x-ray,’ Galvez said, her young daughter in tow. ‘It’s not fair – you know, I signed up last week like I was supposed to.’

The x-ray’s cost, she was told, would likely be more than $500. …

It’s unlikely that a valid insurance card would have changed Galvez’ fortunes, however.

Her Carefirst plan, identified on the Obamacare website as BlueChoice Plus Bronze, carries a $5,500 per-person deductible for 2014 – an amount she would have to pay out-of-pocket before her coverage would apply to medical expenses. …

A similar situation frustrated Mary, an African-American woman small businesswoman … ‘I had chest pains last night, and they took me in the emergency room,’ Mary said. ‘They told me they were going to admit me, but when I told them I hadn’t heard from my insurance company since I signed up, they changed their tune.’ … a nurse advised her that her bill would go up by at least $3,000 if she were admitted for a day, and her doctor told her the decision was up to her.

If Mary didn’t have a heart condition before she entered the hospital she probably has one now. Many people, especially the poor are susceptible to misunderstanding the fine print. Perhaps there was something a “navigator” hadn’t told her. Other supporters of Obamacare are making similarly rude discoveries.

The 41 employees of Extreme Dodge in Jackson, Mich., are very familiar with trade-ins, but this year they’re learning about trade-offs as they come face to face with the new realities of health care. A few workers say they’re getting a great deal, but most have a severe case of sticker shock.

“I feel like I’ve been taken to the cleaners,” said Neal Campbell, a salesman.

Glitches of the sort being experienced in the Northern Virginia hospitals may eventually be fixed. But the money woes of the middle class cannot. Arithmetic dictates that Obamacare will need new sources of money to keep it going. According to Heritage the taxes soon slated to hit wallets are the Individual Mandate Tax, Health Insurer Tax, Reinsurance Tax, and coming soon the Employer Mandate Tax.

By law, the employer mandate was supposed to begin in 2014, but the Obama Administration delayed enforcing it until 2015. The employer mandate forces employers with 50 or more full-time employees (defined as those working 30 hours per week) to offer government-approved health coverage or pay a penalty. The penalty varies—either $2,000 per employee after the first 30 workers, or $3,000 per employee receiving subsidized coverage in the exchange, whichever is less.

There’s no help for it. Expenses must equal revenues. More expenses, more revenues. Jeffrey Young writing in the Huffington Post in the late summer of 2013 described the economic assumptions of Obamacare. It hoped to get 7 million enrollees, 38% of whom must be young to break even.

The White House believes that Obamacare can connect 7 million people to health benefits next year and that 2.7 million of those must be young, healthy adults with low medical costs to offset the expenses of the older and sicker people expected to flock to the health insurance exchanges. The battle will be won or lost not in the halls of Congress, on cable news programs or through television advertisements, but block by block in communities where the need is greatest and the prospects for success the highest, the officials said.

Avik Roy at Forbes says this is the crucial number. “The most important thing CMS won’t tell us is the proportion of healthy people, as opposed to sick people, who are signing up for exchange-based coverage. If too many sick people sign up, and not enough healthy people, the average health spend per enrollee will increase, leading to higher premiums that are increasingly unaffordable for average Americans.”

The Kaiser Family Foundation also argues the demographics of Obamacare will make or break it. Without the young and middle class paying up, where will the money come from? Most insurers are operating on the assumption that they’ll be able to pay for the sick with the healthy.

In setting their premiums for 2014, each insurer had to project who they thought would enroll. Some insurers may have been optimistic, assuming proportionate enrollment of young people. Others may have been pessimistic, and set their premiums somewhat higher across-the-board as a result. Because the ACA includes a risk adjustment system that transfers funds from individual market insurers in a state with younger and healthier enrollees to those with older and sicker enrollees, what really matters for next year is the demographic composition of actual enrollment in total in each state compared to what insurers as a whole projected. In the future, the goal remains to get a proportionate mix of enrollees by age in a given state.

The data suggests the insurers will be cruelly disappointed. The healthy ain’t coming to the party. In California, one of the few states for which demographic data is available, the goal of pulling in the young invincibles is already failing.

For example, 10,387 people between the ages of 55 and 64 enrolled in Obamacare insurance in California in October, which was a whopping 34 percent of all individuals enrolled in that month. But that age group comprises just 11 percent of the state’s overall population.

In second place, 22 percent of the total number of individuals enrolled were adults between the ages of 45 and 54, who only represent 14 percent of the state’s total population.

This suggests that many of Sebelius’ 2 million enrollees have not only not paid, but are also old and infirm.  They will get a health card from Obamacare, but will they get healthcare?  The Weekly Standard notes that hospitals Obamacare contractors are already behind on their payments to the hospitals.

The contractor building the financial management system for Healthcare.gov is being blamed by a Houston hospital for delayed Medicare reimbursements that have caused the hospital to miss payrolls for weeks.

The hospital is strapped for cash not because its not making money, but because Leday says a new Medicare payment facilitator named Novitas Solutions is taking too way long to pay out Medicare claims to the hospital.

Leday says he’s owed nearly $3 million in payments from Medicare and can’t make payroll.

Ultimately healthcare means a patient getting effective treatment.  It’s not a healthcard or piece of paper saying “Obamacare”. The healthcare system is an interlocking set of markets designed to deliver that outcome. Obamacare has disrupted the old but it hasn’t replaced it with the promised upgrade.

Not only has Obamacare not yet delivered a fully functional front end, it’s backend does not seem to have been built.   The insurance companies who have signed on to it are finding themselves stuck with an army of uninsurables and avoided by the young and healthy who alone can make the risk pool viable. This creates a drought of receivables that in turn disrupts payments to providers who “can’t make payroll”.

It’s a shambles. Unless its fixed hospitals will drop out, patients will go untreated, people will lose coverage and people will go broke. Thomas Sowell asks “what kind of man would blithely disrupt the medical care of millions of Americans, and then repeatedly lie to them with glib assurances that they could keep their doctors or health insurance if they wanted to?”

Who? Why a man who thought he had the answers; who imagined every change he made would be for the better when in fact he had a half-baked system whose fundamental assumptions are now going terribly wrong.  Making things happen was always harder than promising to do it. Campaigning is one thing. Governing is another.

The present health care system is broken and needs reform. But what those who sought to fix it forgot was that while you could make things better you could also make things worse.  The devil is in the details and in the arithmetic. So far in 2014 the score stands The Devil 1: Obama 0.


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Top Rated Comments   
They've already got their game plan set for that eventuality. The evil Repubilcans fought Obama at every turn to prevent him from delivering quality free health care to hard working Americans. And unfortunately, these evil "Tea baggers" succeeded in destroying the US health care system, and are even now, literally killing sick Americans.

It doesn't need to make logical sense, any more than "we have to pass it to discover what's in ..." the ACA bill. It just needs to be pumped through the main stream press as fact, and the lemmings will vote Obama a 3rd term as President ("Constitution? What's that? FDR had 3 terms, and Obama is 3x better than FDR ...").

In your sickly heart of heart, folks, you KNOW I'm right.
32 weeks ago
32 weeks ago Link To Comment
So why would they threaten a walk-in with a $500 charge?

Because, if the situation is anything like my local Southern California hospitals, 50% to 60% of the "walk-ins" are unfunded illegal foreign nationals, yet the hospital is required by state and Federal law to treat these patients. The charges are doubled and tripled to the PAYING customers to cover the costs of the non-paying customers.

Does that mean that insurance companies, medical corporations, doctors, and staff aren't making a $bundle? Of course not, but the corrupt government policy provides cover for the $500 xray's, which are as you say, negotiated down by the insurance providers.

The whole system is has been corrupted by Federal legislation. Folks talking about tort reform or doctor fees or the cost of illegal immigrants, or any other single cause as being "the problem" miss the main point. The medical system has ALREADY been corrupted by the Federal welfare system and Federal mandates. Obamacare simply made the entire thing wholly untenable. Now, everyone loses except for the very elite who have government provided insurance or who can afford to self-insure.

The ACA is doing what Socialism has done in every society it has touched: Destruction.
32 weeks ago
32 weeks ago Link To Comment
The first critical point to note is that the initial reports of the failings at the individual level are coming from the British newspapers. Weekly Standard was beat by the Daily Mail. The American media will NOT report the problems first, and not at all if possible because it would offend the regime.

Second, now that things are in force, theoretically; people are going to start suffering the consequences of not being able to get medical care because Obamacare forced their insurance companies to cancel existing policies and has no replacements operational. There will be deaths or bad sequalae. And to the best of the state controlled media's ability the news will be suppressed.

These deaths will be on the hands of the Democrats, their allies even further to the Left, and the media that were cheerleaders for Obamacare and who would not question any aspect of it. This will be blamed on us for opposing Obamacare, but they are the ones who will be guilty of murder. Not that Leftists have any qualms about that.

Subotai Bahadur
32 weeks ago
32 weeks ago Link To Comment
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All Comments   (79)
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These numbers don't make any sense. I'm pretty sure that this is a huge exercise in misdirection. Here's why:

There are 3 steps to purchasing insurance. They are:

1) Create an account, review your options and place a plan in your shopping cart.
2) Check out and request an invoice.
3) Pay your first month's bill.

Look at the figures on enrollmaven.com. They echo the claim of a Federal exchange enrollment of 1.1 million, but note that:

"Washington Post cautions that this number includes paid enrollees as well as people who have selected a plan but have not requested an invoice or paid."

So the 1.1 million figure includes people who have created an account, put a plan in their shopping cart, and exited without pressing the button to buy a plan. They didn't buy a plan and probably never will.

Enrollmaven then provides state by state figures for the individual states in the Federal exchange. If you add all these up, you get 133756. Or about 12% of the total.

What's going on here? Since the Federal government is running the exchanges, they know how many people have created accounts and dropped a plan into their shopping cart. The states are not running the exchanges, so all they know about are the people who select "pay" to request an invoice. There have been reports that of the people who create an account on the exchanges, only 5-15% actually purchase a plan. Or in other words, 85-95% choose a plan, realize they can't afford it, and don't click the button to pay for it. These figures add up. 1.1 million people create an account and select a plan, 12% click the purchase button.

Now on to the news articles.

A 12/31 article in the Washington Examiner says:

"Later in the call, CNN's Jim Acosta asked [Centers for Medicare and Medicaid Services spokeswoman Julie] Bataille if she could at least say with confidence that a "very high percentage" of those 2.1 million had paid.

Instead of answering in the affirmative, Bataille said, “We are confident that those consumers have SELECTED A PLAN and know what the next steps are for them in terms of securing coverage.”'

http://washingtonexaminer.com/no-2.1-million-havent-enrolled-in-obamacare-plans/article/2541435

Emphasis added. The spokesperson said "selected a plan", not "requested an invoice" or "paid for a plan." This means that she is talking about the much larger "left a plan in the shopping cart" number, not the much smaller "requested an invoice" number.

Then they pull a fast one. Here it is. From the same article:

"As of Monday, however, only about half of enrollees BILLED FOR PLANS offered by more than 100 insurers in 17 states had paid their first month's premium, said Mark Waterstraat, chief strategy officer at Benaissance, a third-party billing firm that works for those insurers," the Journal reported"

Emphasis added again. What he is saying is that half of the "requested an invoice" number have paid. NOT half of the "selected a plan" number. This is a huge difference!!

The government claims 2.1 million people have "selected a plan." Ok. Take them at their word.

Somewhere in the neighborhood of 12% of those have gone so far as to request an invoice. That's 252,000. Half of those have made their first month's payment. That's 126,000.

I think that this is the secret they are trying to hide -- that the actual paid enrollment numbers are somewhere in the 125,000 range. A ghastly market failure. Yet by engaging in deliberate deception and misleading language they have convinced the media that somewhere around a million people have paid.

That's the only way everything adds up.
32 weeks ago
32 weeks ago Link To Comment
OT - Latest word form North Korea.

Kim's traitorous uncle was NOT executed by being shot.

Instead he was torn apart and eaten by a a pack of ravenous wild dogs, a process that took some 30 minutes, while his friends and family looked on.
32 weeks ago
32 weeks ago Link To Comment
Obamacare is about bankrupting and destroying the middle-class. This is only the first year, a nip at the heels so to speak, and already thousands if not millions of middle-class families have their backs to wall just to pay their tax-premiums.

What happens to those rates next year when this year's enrollment profile is discovered? Will you say health care costs skyrocketed or will you say taxes skyrocketed?

Just as the Economic Stimulus Act of 2008 has been, thanks to baseline budgeting, priced into every budget since then. So has the largest single spending bill in the nation's history: The American Recovery and Reinvestment Act of 2009.

Both of these monsters are repeatedly funded year over year and now this, taxes-as-insurance premiums. With our taxes now disguised as healthcare insurance premiums, it won't be long before the evil doctors, nurses and hospitals will be the most hated folks in the nation.

Meanwhile, back at the ranch, we can ride electric vehicles through central park.
32 weeks ago
32 weeks ago Link To Comment
Michael Moore argues that Obamacare's failures are because it is a right wing plot forced on the president, who really, deep in his heart, wants a single payers system.

"I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it."

http://www.nytimes.com/2014/01/01/opinion/moore-the-obamacare-we-deserve.html

Victory has a thousand fathers. Defeat is an orphan.
32 weeks ago
32 weeks ago Link To Comment
And when the USSR imploded the head of CPUSA said, "The problem was that they never really tried communism in the Soviet Union."
32 weeks ago
32 weeks ago Link To Comment
Robert Duval (from Open Range): "Most times a man will tell you his bad intentions if you listen, let yourself hear."

Barack Obama (before he became president): “I happen to be a proponent of single-payer, universal health care coverage.”

You just have to let yourself hear his bad intentions.
32 weeks ago
32 weeks ago Link To Comment
Obamacare was designed to fail. The dems hoped that it would fail in such a way as to force the single payer option. That means that at all points the failures are the result of the insurance companies.
The initial failures of Obamacare put the onus on the Obama admin where it properly belongs.

The big thing that the Obama admin is doing now is repositioning themselves so as to not take blame for failures. The best target is the insurance companies. The pubbies are also an ok target for the failure of obamacare but blaming the republicans doesn't advance the single payer option as well as blaming the insurance companies.

The problem the dems have is that way too many people are getting burned. Jibberish propaganda has a hard time trumping a person who's just been burned by a flim flam man. some people are ok with that. but there's a lot of people who will take it badly. even democrats.

The republicans at every point need to put the blame for Obamacare in the place where it belongs. On Obama and the congressional democrats.

The fall election writes itself. It can be played exactly like the 1994 elections. In that election Newt brought all the candidates together, tied them to one agenda and sent them each to their districts to spread the standard stump speech. vote for us as a group and we'll cut government spending and red tape.

So people voted for them as a group. They did what they said they would do. cut spending and red tape....well actually what they did was to stop spending increases so that the lower gas prices and an exploding stock market could increase revenues to federal coffers so as to balance the budget.

a balanced budget became clinton's legacy even though he fought tooth and nail to prevent it from happening and creamed newt for making it happen.

all the pubbies need to sign on to one thing. vote for us. give us big majorities in the house and senate and we'll kill obamacare.

alas the effect is this guys. a dead obamacare will cause an explosion of business activity which will jack up federal revenues while federal spending has been capped--leading to a balanced budget.

If the republicans are successful in killing obamacare Obama and the media will heap an immense amount of sh-t on them and Obama will take credit for the balanced budget.

That's just the way it works.

Maybe the pubbies will wait long enough so that enough people are burned by Obamacare so that the media sh-t storm will be ignored. hard to say what will happen there.

Right now about 20 people are getting a worse deal for every 1 person who gets a better deal. But we're only talking about 5-10 million people. The big numbers don't start until 2015. That year the people with group plans under corporate insurance --who were just given a years grace period by Obama so they wouldn't be effected before the fall 2014 elections -- these people by 20-1 margins will discover they got worse deals under obamacare. at that point it becomes the republican patriotic duty to rescind obamacare. everyone will understand why.
32 weeks ago
32 weeks ago Link To Comment
Latest word is that people who got low cost medical insurance - Medicaid - under Obamacare - are using the emergency room rather than doctor appointments 40% MORE than people who do not have insurance.

A major justification for Obamacare was to replace costly emergency room visits with doctor appointments. Another myth bites the dust.
32 weeks ago
32 weeks ago Link To Comment
Obamacare is about insurance. It's not about health care. Back in 1971 RAND examined the healthoutcomes of those in "cost sharing" insurance plans. It concluded that cost sharing reduced "inappropriate or unnecessary" medical care (overutilization), but also reduced "appropriate or needed" medical care.

Megan McArdle noted that a recent study examining 10,000 Medicaid enrollees in Oregon showed it didn't improve health outcomes nor reduce ER use. In fact it increased both ER and preventative care use. She makes a very common sense observation.

"For an economist, insurance is a financial product, health insurance as much as life or auto insurance. Auto insurance probably doesn’t improve your driving much, but it does protect your assets if you’re in an accident. It may not be what we expected Obamacare to do ... but it’s probably what we should have expected."

Obamacare is about government collecting money and buying people insurance products on a on a small, medium and large basis. Why should we think it would affect medicine? Or cost? Note that in the Daily Mail article an X-ray still costs $500 and a day's stay in the hospital hits you $3,000. Even if Obamacare works, which it still doesn't, it hasn't shifted the costs. It only guarantees the insurance companies will be paid, either through cross subsidies or taxpayer dollars through "risk corridors".

Cutting costs means tort reform, increasing the supply of doctors and medical professionals and increasing competition. It doesn't mean guaranteeing the insurance companies a market.

That might be more meaningfully achieved by removing excessive torts, increasing the supply of doctors, improving competition among health care providers, etc rather than by centralizing insurance. It's like arguing that government will reduce the cost of chewing gum if we let a Federal Agency buy it for us. It may well do, but explain why? It is not an ipso fact conclusion.

Obamacare may turn out to be a MacGuffin: “a plot device in the form of some goal, desired object, or other motivator that the protagonist pursues, often with little or no narrative explanation as to why it is considered so important.” It’s a red herring; a substitute goal.

The Left is off, like a greyhound chasing a fake rabbit, after the belief that if we get government to collect money from everyone and pay insurers we will have good, cheap healthcare. No, what it does is guarantee payments to providers. Does it do anything else?
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32 weeks ago
32 weeks ago Link To Comment
But that x-ray NEVER really costs anyone $500, that's a completely bogus list price that they throw at the insurance companies who ignore it entirely. And if you walk in off the street and offer to pay cash, I'll bet they will adjust it down to $250 or less.

Maybe Rush Limbaugh would pay $500 if he were carried unconscious into a big-city ER and billed, he brags about how he carries no medical insurance since being as rich as he is he doesn't need it. Then again, maybe his wife, accountant, or AP clerk would negotiate it down anyway.

Someone might pay $500 cash against your deductible, I suppose.

Games people play.
32 weeks ago
32 weeks ago Link To Comment
"It's not about health care."

I observed 30 years ago that there had never been a discussion on health care. No one was talking about numbers of doctors or numbers of hospital beds or private vs. govt funding for research, or why costs were going up and how to stop that trend. They were only talking about WHO PAYS. And that argument seemed to be reduced to the fact that some people get it for free so everyone should get it for free.

"It's like arguing that government will reduce the cost of chewing gum if we let a Federal Agency buy it for us."

That was the theory behind the Space Shuttle.
Advertised capability: 50 missions a year. Cost per mission : $14M and each of those used for commercial payloads would result in a net income of at least $4M and as much as $22M.

Reality: No more than 8 missions a year. Cost per mission $1.6 Billion. Net income from commercial missions: $0.

32 weeks ago
32 weeks ago Link To Comment
That what happens when people decide to elect someone and use an irrelevant qualifying parameters (like sex or skin color) doing that.
32 weeks ago
32 weeks ago Link To Comment

THE GREAT INVERSION

FWIW?

A lot of the Obama faithful are simply convinced that Obamacare is not working because of Republicans, right-wingers, Tea Party, ad nauseam.

I heard one "theory" in the gym locker room to the effect that Obamacare is actually a rehash of the Heritage Foundation's health care proposal as a counter to Hillarycare back in the 90's. WHAAAA? Seriously? Obamacare is a rehash of "Hillarycare," period.

While these kinds of beliefs may bring comic relief, they need to be watched out for. I've heard perfectly intelligent people say that if the GOP had gone along with the ACA, it wouldn't be such a mess -- and therefore it is the Republican's fault. WHAT? Folks, parse that one any way you like, but such bizarre and delusional thinking is going to infect a fair number of people.
32 weeks ago
32 weeks ago Link To Comment
" if the GOP had gone along with the ACA, it wouldn't be such a mess".

Another branch to the narrative, and assumes that freedom doesn't matter. Even if the ACA AKA "ObamaCare" had worked 100%, the lost freedom (like having your deductible and premiums set by government bureaucrats) would be tragic.
32 weeks ago
32 weeks ago Link To Comment
I heard one "theory" in the gym locker room to the effect that Obamacare is actually a rehash of the Heritage Foundation's health care proposal as a counter to Hillarycare back in the 90's.

Yes, I believe this is true. Many of the most onerous aspects of Obamacare are an attempt to make it revenue-neutral, where a pure Democratic proposal would simply suck from the general fund. By those lights figure that the mandates and the taxes are ALL directly or indirectly motivated by Republican-style budget concerns and some directly from the old Heritage proposals. They have already denied it, IIRC.

The problem with Obamacare is that it is a pack of lies from top to bottom so that no mechanisms however motivated are going to work, the truth is so expensive it cannot possible have a happy ending.

Ironically enough, if the "Republican" aspects were taken out then it might well have attracted a handfull of Republican votes, it would have worked better, and had at least a patina of bipartisan support.

32 weeks ago
32 weeks ago Link To Comment
Ironically enough, if the "Republican" aspects were taken out then it might well have attracted a handfull of Republican votes, it would have worked better, and had at least a patina of bipartisan support.

A good point that is "inverted" by leftists to mean that it is all the Republicans' fault for not saving the Democrats from themselves. :-)
32 weeks ago
32 weeks ago Link To Comment
Nah, that's too complex for them, they just mean Ted Cruz and the scary, scary Tea Party have told such horribly lies that all the poor people, the sick people, and the web servers of healthcare.gov are afraid to come out in the light and gyre and gimble in the wabe.
32 weeks ago
32 weeks ago Link To Comment
Yes, and they richly deserve what they will get. Unfortunately a substantial part of the population is taken for the ride.
32 weeks ago
32 weeks ago Link To Comment
With a figurative Niagara Falls being just two miles downstream, it might be insightful for the leadership on the conservative side to approach some of the current health insurance providers to encourage them to come out with the offer of a range of policies that ignore the restrictions of PPACA.
They could be prepared to make national advertisements of their availability should Congress be able to repeal PPACA.
In other words, have a prepared alternative to single payer should that chaos become intolerable.
32 weeks ago
32 weeks ago Link To Comment
My understanding is that it would be illegal for current health insurance providers to offer a range of policies that ignore the restrictions of PPACA. By doing so they would be breaking the law. Do you think Holder's 'Justice' dept. would prosecute? (rhetorical question)
32 weeks ago
32 weeks ago Link To Comment
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