Shoot For the Moon
Sarah Kliff, formerly of the Washington Post, dissects the failure of Obamacare in Massachusetts. In article titled "How Massachusetts screwed up Obamacare" she describes how they "shot for the moon" and missed. The irony was the Massachusetts seemed to have all the elements of success. It had the RomneyCare system; it was a blue state; it is one of the information technology centers of America.
Massachusetts pioneered universal health care in 2006. Under then-Governor Mitt Romney, it was the first state to guarantee access to insurance — and drove its uninsured rate down to just 4 percent.
Which makes it baffling that Massachusetts did arguably the worst of any state in implementing Obamacare. Like a handful of ardent Obamacare supporters in other states, Massachusetts officials tried to pull off an ambitious launch — and failed badly.
Yet it did so badly that the Commonwealth is junking the site, essentially scuttling the ship. Kliff does not blame Obamacare -- for how could that be defective? -- instead she blames the incompetence of the Bay Staters, theorizing that the existing system simply got in the way of the more perfect one.
Massachusetts needed to toss out the paper applications it had used for years. This turned out to be more difficult than it sounds.
"In some ways it's harder to rehab your house when you're still living it," Jon Kingsdale, the Connector's first executive director, says. ...
After pioneering universal coverage in 2006, Massachusetts was quick to embrace the Affordable Care Act. It was among the seven states that the Obama administration awarded an "early innovator" grant, to develop models for the new, all-digital marketplace that other states could replicate.
Massachusetts' wanted to build a more complex marketplace than other states were attempting. For example: the state's health reform law gives residents more generous subsidies to buy health insurance than the federal law. So officials decided the state should keep paying more, using its own state funding. That meant Massachusetts was layering on another level of financing — and another level of complexity.
"We shot for the moon, and we missed," M.I.T. health economist Jon Gruber, who is a member of the Health Connector's board of directors, says.
There were three agencies working on the launching the new exchange: MassHealth (the state Medicaid program), the Connector, and Massachusetts Medical School. One audit report from December 2012, which showed the project already behind schedule, cited "inefficient communication" between those three agencies as one reason for the delays.
"There wasn't a single point of management," Gruber says. "It was poorly set up and it was this horrible combination where the contractor would get different orders, and would do none of them."
And the result was fiasco.
"Screens were disappearing, information wasn't there, people thought they had submitted an application but it actually hadn't gone through," says Amy Whitcomb Slemmer, who runs the consumer group Massachusetts Health Care for All. ...
"If you were applying for unsubsidized coverage, it was error-prone but you could get through," says Iselin. "If you were applying for subsidized coverage, all you could do is enter your application. Aside from the intake, we had no exchange website."
Kliff unfavorably compares the Massachusetts site to Healthcare.gov which was 'largely fixed by December'. But that's not correct. It isn't fixed. As yesterday's post noted, Healthcare.gov's backend is largely imaginary. In fact Amy Goldstein and Sandhya Somashekhar of the Washington Post say it's handing out money uncontrollably, like a broken ATM machine.
The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.
The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show. …
the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.
Like a cash machine that has no idea how much a customer actually has in its account, the Federal government is handing out tax money in subsidies to people who declared a lower income on their Obamacare application than on their tax return. And the Obamacare site is powerless to detect it.
The inability to make certain the government is paying correct subsidies is a legacy of computer troubles that crippled last fall’s launch of HealthCare.gov and the initial months of the first sign-up period for insurance under the Affordable Care Act. Federal officials and contractors raced to correct most of the technical problems hindering consumers’ ability to choose a health plan. But behind the scenes, important aspects of the Web site remain defective — or simply unfinished.
All those broken State Health sites running for shelter to Healthcare.gov are going to migrate their data into a bucket without a bottom. The administration is going to impose a $250,000 fine on anyone who lies on an Obamacare application. The fine will be reduced to $25,000 with a good explanation for an honest mistake. But as the Blaze points out, some Obamacare Navigators have been advising applicants to lie.
The Urban League of Greater Dallas has reportedly fired one person and suspended three others after an undercover video from James O’Keefe’s Project Veritas caught Obamacare “navigators” advising a potential applicant to “lie”and provide false information to get a lower premium and more subsidies.
Where did it fail? Kliff suggests that Obamacare's failure in the Bay State is largely a failure of implementation. But maybe it is mostly a consequence of a bad design. Obamacare is 2,000 page monstrosity whose complexity defies implementation. It's a one size fits all system designed to "fundamentally transform" 1/6th of the US economy. What could go wrong?
Practically anything. The problem with all-or-nothing undertakings is if they fail, they fail completely. The Krell Machine goes haywire and the Forbidden Planet explodes. Obama should have known this, but chose bet to everything on the venture. Kliff seems to think Obamacare will sail serenely on. But perhaps the only difference between Healthcare.gov and the Massachusetts Connector is that Healthcare.gov hasn't run out of money yet. When it does then, as in the movie, you have to be at least 100 million miles away to survive the blast when the Krell furnaces overload.
Recently, a think tank close to the president has called for a Czar to take over the program. "Obama supporters call for ObamaCare czar to avoid another rollout disaster".
The White House acknowledged Saturday being open to a proposal for President Obama to appoint a chief executive to oversee the Affordable Care Act -- an ObamaCare czar -- following the Department of Health and Human Services handling last year’s disastrous rollout.
The idea is being proposed by a group of healthcare experts that wants a new chief executive officer to oversee the ObamaCare online health-insurance exchange and to ensure the overall program is ready before the next open-enrollment period, which begins in six months. ...
The proposal was released this weekend by the Center for American Progress, founded by John Podesta who left the think tank earlier this year to become a White House senior counsel.
The idea is supposedly to take the Healthcare.gov site away from the federal government and put it in the hands of the better-suited private sector.
Coming as it does from Podesta's shop it likely represents the White House's deepest fears as if they knew they were sitting on a timebomb and had to put the requisite distance between Obama and Obamacare before it all went up.
The great virtue of the Health Care Compact concept advanced by Leo Linbeck is that it is incremental and diversified. It doesn't put every egg in one basket, and isn't founded on a single controversial, immutable piece of legislation passed without a single Republican vote. That approach alone may give it several key advantages and may hold key lessons for the Obamacare alternatives now emerging. A more subsidiary approach can only ever partially fail and since different states can experiment with different approaches, it is far more likely to strike gold than Obamacare, which is digging a hole to China in one fixed place. What Obamacare reaches when they dig deep enough should give one pause.
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