By Lambert Strether of Corrente.
Today I want to take a quick look at the ObamaCare numbers, which are oddly soft for an administration so dedicated to data-gathering in its campaigns. Let’s start by asking a simple question: How much has ObamaCare reduced the number of uninsured?
The administration has always gamed the ObamaCare numbers, from the first day when they scammed us with unique visitors to the Federal website instead of actual sign-ups. Then they gave us counts of people who’d pressed Submit buttons for enrollment on the website, but hadn’t actually paid for their policies (which many did not (20%), and never mind the errors. Or whether they will continue to pay. Or have cancelled, since the system can’t remove cancellees yet). Then too, there’s the issue of how many ObamaCare enrollees already had insurance, as opposed to those who actually increased the net number of those covered. To be fair, some Democrats just… make the numbers up! Not that there’s anything wrong gaming the numbers; in fact, we expect it. Finally, however, as the March 31 deadline for 2013 signup approaches, the numbers should start to firm up, right? Not so fast. Politico:
[N]obody has a good, real-time fix on how successful the Affordable Care Act has been in reducing the ranks of the uninsured. The Obama administration hasn’t been able to say how many of the 3.3 million people who have signed up for private health insurance coverage, or of the 6.3 million who have been determined eligible for Medicaid, were actually uninsured before — and health care experts aren’t sure yet, either.
And oddly, or not, the famously tech-savvy and data-driven Obama administration never asked the question “Do you already have insurance?” where it’s most obvious to ask it: On the sign-up form.
The administration could have helped by putting a specific question on the applications for the federal health insurance exchange, and encouraging all of the state-run exchanges to do the same, that would have allowed the government to track how many people were uninsured when they signed up.
The problem is, the questions they did put on the federal applications aren’t specific enough to be reliable — which is why administration officials say they can’t answer questions yet about how much progress it has actually made on the uninsured.
The questions are worded differently on the online and paper applications, but in both cases, they just ask the customers whether they need health coverage. That’s not exactly the same as asking if they’re uninsured, because they might have a health insurance plan that’s about to end, or need new health coverage for other reasons. And it’s an optional question, so the government can’t be sure everyone is answering it.
Criminey, it’s like they didn’t want to know, isn’t it?
So, to our first question: How much has ObamaCare reduced the number of uninsured? We see that the administration has no answer. Which is all to the good, really; in the absence of actual data, we can now turn the question of whether ObamaCare is meeting its enrollment projections to public relations specialists, a field where the administration has excellent connections. Simpler, cleaner, and the outcome is guaranteed, and that’s important, when the administration’s already miserably and lethally lowballed 7 million projection has dwindled to 5 or 6 (“a helluva start”; Biden), out of an uninsured population of 48 million Americans [pause to wave pom-poms]. Anyhow, problem solved.
Let’s ask a second question: How many people has ObamaCare enrolled? That should be simple; we’ll just ask ObamaCare’s “hub” — you know, the hub Kathleen Sebelius said was “built and paid for” back in April 2013 — for that information. Well, as it turns out, that’s the back end, and the back end still isn’t finished!
Even before the HealthCare.gov launch made signing up almost impossible, the Centers for Medicare and Medicaid Services had always planned to define enrollment based on the number of people who selected a plan, a CMS official said. The official said CMS knew there would be a lag in getting more-comprehensive data from insurance companies.
That lag time, though, has grown longer as a result of HealthCare.gov‘s technical problems.
CMS is still building the computer system that automatically pays insurers and reconciles enrollment information between carriers and the government. It’s one of the back-end systems that took a back seat as HHS struggled to repair the HealthCare.gov user experience.
Although insurers are getting paid through a workaround system, it only captures consumers who get a tax subsidy to help pay for their coverage—so it’s not a comprehensive accounting of every enrollee.
A full count of actual enrollment will be available when that system is finished, the White House has said.
(When, exactly?) No doubt that will be before the mid-terms. Anyhow, here’s the punch list for the back end, as of mid-February:*
The to-do list still includes:
- Problems with the government sending enrollment transactions to the carriers––the 834s––that are still having error rates much too high for high volume processing.
- The inability of the government to do an automated enrollment reconciliation with the carriers––to be able to sort out who really is covered and who is not––because that system still hasn’t been built.[That’s not a bug. It’s a feature.]
- The inability of the government to pay carriers because that system hasn’t been built––carriers are sending estimated bills to the feds.
- The inability of the government to add and delete people from the system for things like a newborn or a divorce because that system hasn’t been built yet.
- The inability of the government to handle appeals when people think their eligibility or subsidy calculation is wrong because that system hasn’t been built yet. [That’s not a bug. It’s a feature.]
- The inability of the government to cancel people off of Healthcare.gov because they never built that functionality. As a result, I expect they will be reporting bloated enrollment numbers for some time. [That’s a bug. It’s a feature.]
At least two carriers have told me that because the government can’t cancel people off the system, it the person shows up next month they can’t reenroll on Healthcare.gov because the government can’t get the old enrollment off the system.
Finally, at some point in the near future, because of all of the administrations screw-ups in the enrollment process, we’re going to be asking the question: How many people think they’re covered under ObamaCare, but really aren’t? Those are the people who will show up in the emergency rooms, and then get stuck with a humongous bill. Yes, it can happen:
‘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.’
She told MailOnline that 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.
[C]omputer glitches in the ‘back end’ of healthcare.gov, enrollment records for as many as one-third of new insurance customers were corrupted or otherwise contain errors.
And the beauty part? Mary can’t even appeal a denial, because that part of the system isn’t built yet.
Of course, that’s an anecdote. And it is an anecdote because the administration, whether by accident or design, built a system that can’t produce anything other than anecdotes, that can’t even answer basic questions:
- How much has ObamaCare reduced the number of uninsured? (We don’t and can’t know.)
- How many people has ObamaCare enrolled? (We don’t and can’t know.)
- How many people think they’re covered under ObamaCare, but really aren’t? (We don’t and can’t know.)
Dear Lord. All that money, all that talent…
Readers, this is like one of those New Yorker four-parters about soybeans, I know. Or the story where the author and his subject go out into the swamps to find a bird — Maybe a snipe? — and don’t. I’m sorry.
Ya know, with single payer — simple, rugged, proven single payer — we’d have a lot easier time honing in on a reasonable enrollment number. “Everybody in, nobody out” means just that. Just saying.
ADDENDUM On another ObamaCare note, the Federal website debacle still boggles my mind. By all accounts, Obama — our chief executive, you may remember — performed no oversight on the technical infrastructure prior to launch. Stephen Brill, Time:
No one in the White House meetings leading up to the launch had any idea whether the technology worked. Early on, Lambrew, highly regarded as a health care policy expert and advocate for medical care for the poor, kept Park off the invitation list for the planning meetings, according to two people who worked on the White House staff prior to the launch. (The White House declined to make Lambrew available for an interview.) The only explanation Park offers for his exclusion is that “The CTO helps set government technology policy but does not get involved in specific programs. The agencies do that.” The other attendees were also policy people, pollsters or communications specialists focused largely on the marketing and political challenges of enrolling Americans.
McDonough, as chief of staff, was supposed to be tending to everything associated with the rollout, including the technology. But he and Lambrew simply accepted the assurances from the CMS staff that everything was a go. Two friends and former colleagues of McDonough’s say they spoke to him 36 hours prior to the launch, and in both conversations he assured them that everything was working. “When we turn it on tomorrow morning,” he told one friend, “we’re gonna knock your socks off.”
McDonough says that in meetings with the President prior to the launch, Obama always would end each session “by saying, ‘I want to remind the team that this only works if the technology works.'” The problem, of course, was that The President may have had the right instinct when he repeatedly reminded his team about the technology. But in the end he was as aloof from the people and facts he needed to avoid this catastrophe as he was from the people who ended up fixing it.
This still boggles my mind. A famously tech-savvy administration botches the rollout of the President’s signature domestic initiative because neither the President nor anybody in his circle pays attention to the tech. How does that happen? Is it in any way normal? This is a pointy-haired boss type of thing! But Brill doesn’t say.
One can only wonder if the administration is paying attention to the technical infrastructure required for, oh, I don’t know, invading other countries, or whether it’s policy, polls, and public relations there, too. I realize this is kind of two, two, two posts in one, but this question has been nagging at me, and I wanted to get it out there.
NOTE * It’s interesting and depressing that, as Brill describes, the White House got a tiger team to fix the front end, where people apply for insurance. But the back end, where the insurance is actually made available to
citizens consumers, and paid for, isn’t getting any such attention. Public relations again…
Great work! I don’t know how you do this; keeping up with the Affordable Extortion Act is a full time job for Sisyphus. If I were uninsured I would stay that way to age 65. Actually, I did stay that way to age 65, which may be the reason I am now 71. Health care is about working to stay healthy. Eat right, exercise, avoid drugs (particularly FDA approved ones), doctors and hospitals. Learn to do your own medical research. I have learned more about my conditions from reading published studies than the doctors billing Medicare on my account seem to know. Well, they are good at billing Medicare, and that’s something. One thing I do believe in is surgery. Find the best guy after making sure you need it. Surgeons are different from doctors. They have a skill.
This whole health care subject is so f*&#ed up the only thing that seems to help is making jokes about it. Sorry.
This still boggles my mind. A famously tech-savvy administration…..but this question has been nagging at me…..
You’re right–it is the million dollar question. And maybe the answer is the simplest and most obvious one–they’re NOT masters of technology and they never were.
Why do we even believe that in the first place? Because the technological “savvy” of the Obama campaign was used to explain the unexpected, mysteriously meteoric rise of an obscure politician to the presidency. And a black man at that!
It MUST have been “technology,” what else could it have been? Judging from the past five years, certainly NOT suitability for the office or qualifications or competence.
If you think about it, the current perception of technology as solver of all problems and producer of all benefits is a perfect way to explain many things, including “unusual” election results. No need anymore to resort to such crude devices as SCOTUS, manipulated Diebold voting machines or voter suppression. People don’t really know HOW technology works, but they are absolutely CERTAIN that it does. It’s perfect.
And the Obamacare website? Well, either it was designed by the truly tech-savvy to deliberately confuse, delay and undermine “government-run” “healthcare,” or the “tech-savviness” just ain’t true.
Whatever it is, Hillary Clinton stands to inherit it.
I don’t really think so. The Clintons got thrashed by a newbie, and by 2016 she’ll really be too old. There will be a surprise. In any case, it will be the Republicans’ turn to run the country into the ground.
“How much has ObamaCare reduced the number of uninsured?”
The propagandists will always have an answer to that question with the usual Obot bleating, derailments and stall tactics.
Shouldn’t the question be how much are the insurers/rent collectors extorting from working people? We don’t need to be robbed, we need health care.
I’m not quite clear on why you thought this administration was technologically savvy. I never saw any evidence of that nor, for that matter, evidence against it. Policy types in Washington are, from my experience, utterly ignorant of tech matters–they know how to use electronic devices and that’s it.
As I’ve said many times, the problem of technology in the USG is that they have no central technology agency–instead they farm out work to politically connected and largely corrupt contractors whose expertise is largely confined to the exotic world of writing and bidding on contracts.
Because the campaign tech team really was good.
The extreme contrast between the campaign and the administration is one of the features of life under Obama. There was an article complaining that they were completely different sets of people (why not go with success?), but even that doesn’t quite explain the different.
I do think that Obama is like Reagan or Bush II in that he’s purely a front man, a greeter, with shadowy figures running him behind the scenes.
The “frontman” tag is just right. It only produces good results if the behind the scenes folks are good, the current crop is not. I think think those of Bush were better than current but still poor, Reagan’s seemed to be better than Obama’s or Bush’s.
Again, evidence? They were good at raising money, but that isn’t a particularly tech-heavy process. As for the rest, I just don’t see the claim of being tech-savvy being particularly pertinent. They ran a great campaign both elections, and they definitely outclassed Clinton in the primaries in 2008 by fully appreciating the difference between a primary and caucus, and understanding how to game the latter.
Oh, no, they were WIDELY discussed as being extremely savvy in their use of tech in organizing and campaigning.
Note the sources, all hard core tech sites, not amenable to spin. The third piece reports on infighting and a botched project, but also makes clear the campaign was heavily tech reliant.
Feeling better? Good to see you appearing again.
I simply assert your comment about about the lack of spin isn’t really supported either- remember, a lot of hard core technology sites were lauding the brilliance of the coming ACA exchanges right up to the October launch- they certainly aren’t immune to spinning. I think if Obama’s campaign had used the technology of 2000, he would have won both elections by almost exactly the same amount. I think a lot of people, including yourself, are using the evidence of Obama’s win as evidence of being technologically competent.
No, we’re basing this on descriptions of what the Obama campaigns claimed to do, the track record of the protagonists in other fields subsequent to the work on the campaign, the contrast to the Romney campaign #FAIL with Orca, word from insiders, and in my case, a smattering of technical knowledge in the field. So, no, we aren’t.
‘Readers, this is like one of those New Yorker four-parters about soybeans, I know. Or the story where the author and his subject go out into the swamps to find a bird — Maybe a snipe? — and don’t. I’m sorry.’
Other than that, though, it has all the elements of a great tragic novel: bizarre plot twists; eccentric, lifelike characters; and an ever-present, inchoate sense of looming catastrophe.
The troof is stranger than fiction, that’s for sure. (And who is this ‘Lambrew’ character — Lambert’s insider alter ego in the White House?)
OMG, “The questions are worded differently on the online and paper applications, but in both cases, they just ask the customers whether they need health coverage.” What a loaded question! Are they looking for essay answers here? Mark Twain would have written a book answering.
“When we turn it on tomorrow morning,” he told one friend, “we’re gonna knock your socks off.” This is ambiguous. Is anybody in this administration able to give a straight answer?
“Everybody in, everybody out” — sounds like the current Obamacare to me.
Hi Lambert, is that correct, or is it snark that I didn’t get? Either way, more coffee!
Thanks, I will correct! Mere haste. What’s snark?
Since you are relying on anecdotes here is one for you. I have health insurance for the first time in 20 years due to ObamaCare.
That’s nice but meaningless unless you tell us the terms, particularly your deductible and the quality of your network (access to doctors, particularly specialists and hospitals). We have always said that some people will wind up better off but most will not (outside of Medicaid expansion) because the policies are mainly overprice insurance that does not cover much. This is a feature, not a bug, and we predicted that was what would result when the ACA was passed.
If the insurance is costly enough, you are better of being self-insured. For instance, one person I know in upstate New York, early 50s with a wife and one child, would have to pay premiums of $18,000 a year for his family and still have deductibles of over $3000 for each family member. He’s paying the penalty rather than have the policy. And this is an MD who had heart surgery in the last year (luckily when he was on a much cheaper plan).
It is not meaningless to me thank you.
I have been self-insured, whatever that means, since about 1993. Until now. Being self insured is great as long as you don’t get sick.
My Obamacare insurance plan is the Anthem Silver DirectAccess-cdne from Anthem BlueCross BlueShield. This is in Connecticut. The medical deductible is $2,400 with $5000 out of pocket limit. Many things seem to be covered at least in part before the deductible is met. Maybe you can look it up or contact me if you want to know all the details.
With the subsidy from Obamacare, I pay less than $100 a month for this. I certainly have no less access to care than I had previously.
So what is your purpose in railing against Obamacare? I don’t think anyone thinks it is perfect. I would bet that at least 75% of your readers would rather have a Medicare for all system and I would too. So why do you keep trashing something that is an obvious improvement for many people ? Why not acknowledge Obamacare’s benefits while also trying to improve on it? Do you think that if it fails we are going to be able to get something better? Cause I don’t.
The reason for actively opposing, or at least criticizing, Obamacare is that at this point, it stands between us and real health care reform. In particular, it fastens the vampire squid’s tentacles even more tightly around health care, putting the insurance companies in complete control and REQUIRING people to buy their defective product. That’s morally and politically offensive.
Could we get something better if it fails? That’s somewhat irrelevant; it will fail, if it does, of its own defects, not NC’s criticism. In any case, the answer to your question depends on the politics of that moment. But I’m afraid that, as with the bailout of the zombie banks, it will perpetuate our dysfunctional health insurance system for another 20 years – as the failure of Hillarycare, back with Bill was President, did.
I’m glad you benefit. Many don’t – at best, it’s predicted to leave 30 million people in the lurch.
I’m happy for you!* Why don’t you want everyone to be equally happy? Why don’t Obots?
* But watch out for narrow networks, narrow formularies, balance billing, and high co-pays and deductibles.
Adding, did you read the post, or it the word “anecdote” trigger something in your backbrain? The entire country is working from anecdotes because the supposedly tech-savvy administration fucked up the data-gathering so badly. See especially how they fucked up the user survery — accidentally, of course, if you assume good faith.
Thanks Lambert, I am happy for me too. And I DO want everybody to be equally happy. Or even more happy than I am having health care insurance for the first time in twenty years. I’m also happy that you give me credit for having a “backbrain”.
Look, nobody needs health insurance- they only need health care when they need it right? Obamacare gives more people access to that health care. That’s my backbrain formulation. And I read the entire post.
RE: Enrollment numbers:
Conclusion: The Democrats (and Barry) couldn’t run a lemonade stand on a scorching hot day, while Republicans could only sell bitter, repulsive lemonade that nobody wants!
It will be a great day when the taxpayers will be able to spend their own money how they want, and if he wants to fund another boondoggle, Uncle Sam will have to hold a bake sale.
“Public relations again…”
This is the big thing Obama learned from Ronnie Reagan (whom he admires, remember?): get the PR right and the rest doesn’t matter – or more precisely, you can get away with anything.
Mere competence has been an issue with Obama from the start, though for the most part, you had to wonder whether it was really just not caring. For instance, he was amazingly slow to fill in the lower-level nominations. Ordinarily, this is a very high priority, because it’s how you reward your people. But they left Bush people in place for a LONG time. Was that because they approved of the way Bush ran the government?
And there were widespread complaints from liberals about his failure to communicate in office, even though he (or somebody) ran such a superb campaign. There just wasn’t any leadership there – on that level, he was a piss-poor president from the start. He’s lucky the major parties have that little arrangement about taking turns in the presidency, two full terms at a time. The result was the Romney campaign.
The Obamacare rollout has been the first clear test of his competence, because presumably he’s committed to the success of this right-wing program with his name on it.
Doggie propaganda. Makes me feel warm and fuzzy all over. Where do I sign up?
This is gonna get worse before it gets better. I doubt it is reverse genius. No politician plans for a total defeat just to teach the other side what all the pitfalls are… so they need to just do single payer and forget it. But this is what is really happening. A material reality is being proven. Altho’ it’s anybody’s guess just who “the other side” is.
My estimate is that the uninsured number might be 3-4 million less than it was last year, and most of that decline is going to come from the Medicaid expansion.
As for the numbers in the exchanges, I don’t think you will ever get a solid number out of this administration. At the end of this month, they will tell you 5 million signed up, and they will stick to that number no matter what evidence is uncovered. As for the coming problems for people who can’t buy on the exchanges because they have stagnant, duplicate enrollments, or the people who thought they were covered but aren’t, or the people who drop their policies and get big bills from the IRS for subsidy clawbacks, or the people who ended up having to drop insurance because they couldn’t afford the new policies- well, you already see the meme that is going to be used- a meme that suddenly popped up in over dozen places on almost the same day a week or two ago- “Those people are lying or they don’t exist.” That meme had to have come from the Obama Administration directly through their back channels to sympathetic media.
It is so evil, to cause suffering, and then to lie and claim that the suffering isn’t happening at all. Because you know that a convenient number of people, will believe the convenient lie.
And that is what the Obama administration is doing, and much of the press going along with.
It is sick, and evil.
‘My estimate is that the uninsured number might be 3-4 million less than it was last year, and most of that decline is going to come from the Medicaid expansion.’
Probably so. Medicaid is a welfare benefit given to those deemed incapable of paying any premium for health coverage.
But for coverage on which premiums are paid (whether privately or through exchanges), has there been any net increase in the number of insured?
As Lambert says, we can’t know. But my guess is that even with the enticement of subsidized silver plans, the total privately-insured population likely is close to unchanged. Which is an absurdly poor result, considering the enormous cost of subsidies and marketing.
I think probably 75-80% of the people signed up on the exchanges had insurance last year- the ratio might even be higher.
Expect a huge uptick in the numbers covered by Obamacare effective April 1st. That is when SNAP recipients will be officially enrolled into the program – at least in the state of Michigan. I couldn’t find any recent numbers, but as of 2012, there were 1.8 million SNAP recipients in Michigan – or 19% of the populace. Based on the lack of improvement in economic activity in the state, my guess is that the number of recipients has likely increased since 2012. While I realize not all Michigan recipients are uninsured, the likelihood that they are is probably high given they are poor enough to qualify for SNAP benefits in the first place.
This guy tries to keep track:
In answer to your LAST question: “One can only wonder if the administration is paying attention to the technical infrastructure required for, oh, I don’t know, invading other countries, or whether it’s policy, polls, and public relations there, too. I realize this is kind of two, two, two posts in one, but this question has been nagging at me, and I wanted to get it out there.”
Yes, of course the same level of care is going into the foreign policy as the domestic. That’s why we are currently up the creek without a paddle or a canoe.
Unfortunately, I don’t expect anything better out of Hillary. Changing the head will not change the body or the program. Hillary has no useful experience at this sort of thing: her career in the Senate was pointless, her SoS tenure fruitless. She’d be nowhere without Bill.
No point arguing about personalities. We need a Hadrian, whether male or female, given the systemic issues we face, and we’ve got squabblers with a toddler-level sense of responsibility to public purpose. All of them. And having a non-toddler at the helm is necessary but not sufficient.
Well, no numbers of uninsureds can be down in California:
After going through the CoveredCA application with a very low income (before December 23), an algorithm returns the result saying to apply for Medi-Cal on the applicant’s nearest county site. After making the Medi-Cal application, uploading proofs, etc., one’s application is then “pending,” with case number and case worker assigned.
When going to see the case worker, one is told “your application is complete but there will be no MediCal for you until after the (state and county?) systems are merged.” There is no authority at the local level to give any kind of temporary number.
Only if you turn up as a John Doe incognito in a local county hospital will you get a Medi-Cal number.
All the rest who were told that applying by Dec 23 for Jan 1 coverage in California were told a big lie. If you are low income in CA and in an accident, be sure not to go anywhere other than the County hospital, or you will be billed by other hospitals, even state university hospitals.