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.
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…