President Obama Fails To Explain Tech Glitches And Solutions In ACA Speech

Monday at 11:30am EST, President Obama spoke in the Rose Garden about the recent troubles with health insurance exchange enrollment and websites. With a team of young people standing behind him and Janice Baker at his side, the first person in the state of Delaware to successfully enroll in the exchange, President Obama said he was speaking to every American wanting to get affordable health insurance. He claimed that in the last three weeks, despite the horrific technological problems with the websites, that “half a million consumers across the country have submitted application through federal and state marketplaces.” He further touted that the “federal site alone has been visited 20,000,000 times” in the last three weeks. Unfortunately for those American’s who are really interested in signing up on the exchange sites, he glossed over the depth and breadth of the current troubles, giving a speech that sounded more like a State of the Union address with small-business examples and reading letters written to the White House.

President Obama also alleged that no one wants to see the exchange sites improve more than the federal government, noting that, “the website has been to slow, and people have been getting stuck during the process.” He also said that it is the mission of the administration to make them “more better,” with visible cringing from the audience, but claimed failures were due to response rates. He said the public response was “overwhelming, which has aggravated the underlying problems.”

However, he failed to go any further to explain what those other underlying problems were or when specifically they will be fixed. He did say that while HHS and contractors such as CGI Federal are working out the “kinks,” American’s should be patient. He claimed that “if the product is good, [American people] are willing to be patient,” suggesting that there will not be a delay for the individual mandate.

Nevertheless, he followed this by assuring the public that unlike Black Friday sales, the insurance plans will not run out like purchasing a new PlayStation – adding to the list of items the administration has compared exchange sites to, including iPhones and travel websites.

Despite his promises of improvements and putting the “best and brightest” on the job, CNN and other sites have insisted that the inherent technological and platform problems with Healthcare.gov will not be resolved anytime soon. This begs the question, that if the federal government is now searching for the best and brightest to correct the estimated 5,000-5,000,000+ lines of coding that need to be fixed on the federal site alone, who was working on the original platforms?

As he continued his speech, the President reminded the American public that although the websites for enrollment are not as, “quick, consistent or efficient as we want,” that the exchange sites are far more than “just a website.” He noted that many pieces of the Affordable Care Act (ACA) are already in place and being utilized by millions of Americans. He addressed pre-existing conditions, youth under the age of 26 and several other provisions that are already being rolled out by federal law, and the successes they have seen there.

He noted more examples of ACA triumph in Oregon, where he maintained that the exchange, “has cut the number of uninsured people by 10% in three week,” which is about “56,000 more Americans” with health insurance coverage.

During the speech, President Obama also tried to clarify the exchanges or marketplaces by describing them to the public as becoming part of a “big group plan… that bargains on your behalf for the best deal in health care.” He said that by doing so, insurance companies have created new products and options that strengthen market forces, leading to better deals.

He went on to say that without a doubt, “prices have come down,” further claiming that “when you add the next tax credits (those not yet implemented)… then the prices come down even further.”

The President rounded out his talk by noting the Republican party’s opposition to the ACA and how willing they were to “shut down the global economy” to fight against the ACA. A move, he claimed, that shows just how unwilling Republicans are to negotiate on legislation intended to, “free families from the pervasive fear that one illness one injury will cost you everything.”

While that may be the goal of the Affordable Care Act, the underlying technological and coding problems may prove to make that impossible.

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Dropping Employer-Sponsored Insurance Could Benefit Health Care System

Special thanks to Emily Egan for her thoughtful contributions, writing and ideas for this post. 

In 2010 President Obama told the American public that if they liked their health care coverage, they would be able to keep it. And, despite his signature health reform law, the Affordable Care Act (ACA), intending to expand the country’s employer-based health insurance system, many now estimate that the law will, in fact, do just the opposite. It is projected that a consequence of the coverage provisions implemented in 2014 will be for many companies to drop health care coverage for their employees.

To date, the majority of research studies, modeling estimates and employer surveys have predicted some level of employer insurance drop. While this is usually framed as a negative consequence of the law, moving away from our employer system may actually have positive implications for the health care system and individuals.

As a result of an expanded individual market, Americans participating in the health care system might see benefits in three specific areas: cost, transparency and portability.

The benefits would not manifest through Americans losing employer sponsored coverage, but in gaining new coverage from a choice of plans in a more robust individual market.

The individual market for health care insurance is historically underdeveloped compared to the employer-sponsored market due to high costs, individual underwriting, and the ability of insurers to deny applicants based on pre-existing conditions. This system began as a result of wage caps during World War II, and then expanded when preferential tax treatment for employer plans was codified into law. The dominance of employer-sponsored insurance (ESI) was solidified in an era of single income households where the breadwinner rarely changed jobs.

However, the individual market will soon experience substantial changes as a result of the ACA, and could become much more attractive to individuals as their choices increase. Further, knowing that employees will be able to find decent coverage elsewhere could become an incentive for employers to dump ESI.

In terms of improving cost, it is possible that when individuals have more consumer choice with regard to plans (rather than a single plan or a choice of several tied to one employer); most would be likely to choose lower-priced plans that require higher deductibles and out-of-pocket spending. This price sensitivity would not only reduce the aggregate amount spent on insurance, but may work to reduce unnecessary utilization of medical services and more price sensitivity when it comes to choosing providers, medications, and treatment plans. Which could, in turn, lead to an additional improvement: transparency.

Anyone who has attempted to navigate through the health care system can attest to the lack of transparency from providers and health systems. Most individuals do not ever see pricing information, as they are largely shielded from health care costs via their insurance providers. However, if individuals begin paying for treatment out of pocket up to a certain deductible, the demand for transparent and bundled prices should increase, and providers would be forced to respond or risk seeing patients walk away. We’ve already seen the popularity of retail clinics among those who are uninsured and use of high-deductible health plans by many Americans, in part, because of the clear pricing structure.

The third potential positive implication of significant ESI drop could be felt through an increase in the demand for portability of plans. Labor markets of 2013 look very different from those of the post- World War II era. Job transitions occur much more frequently, and with ACA implementation, health insurance providers are likely to alter their network of physicians. For patients with complex or chronic conditions, switching networks and losing access to a trusted physician as a result of a job transition, a job loss, or early retirement, can have harmful health consequences. However, with individual insurance coverage, loyalty to providers exists outside of ESI. Americans could soon have more flexibility to keep their coverage by not using ESI.

While it would certainly be preferable for major shifts in health care to be the result of thoughtful and well-researched strategy, there are potential unintended positive results of new ACA policies that align incentives such that it no longer makes sense for employers to purchase expensive insurance plans on behalf of employees.

Consequentially, the transition is unlikely to be a smooth one in the coming years, but the benefits of changes in individual market insurance coverage could outweigh the unavoidable growing pains of the changing market.

If a cycle of positive individual market results increases, more and more people could move to the individual market, by choice or force.  Only time will tell.

 

America, “We’ve Lost a Pod”: What Romney and Obama Didn’t Say…

While polls immediately following Wednesday’s Presidential debate in Denver suggested that Mitt Romney came out of the contest way ahead of Barack Obama, the real winners were clearly America’s fact-checkers and policy wonks. Sure, Romney may see a bump in his poll numbers after his performance, but it’s the detail-oriented folks—some might say experts—that really get to delve into the content as they aim to correct and rationalize the multitude of competing arguments and “data”. By contrast, the evening’s losers were: Michelle Obama, who spent her 20^th wedding anniversary watching the debacle; everyone on Twitter disinterested by politics; and moderator, Jim Lehrer, who “lost a Pod” due to poor facilitation. That’s right. After a full 90-minutes of debate, Lehrer was unable to keep the candidates’ comments concise enough and we missed out on what might have been the most exciting part of the debate: an open back-and-forth between Obama and Romney.

Nevertheless, health care comprised a large portion of the debate with both candidates touching on everything from the origins of ObamaCare—a label for the Affordable Care Act that Romney apologized to Obama for using, but one which Obama said he actually welcomed—to insurance premiums and a discussion of the Medicare Independent Payment Advisory Board, or IPAB. Still, given all the misinformation put forth by both Romney and Obama during the second Pod, it appeared by the end that neither had actually read the Affordable Care Act and that both needed new accountants.

But perhaps we should give the candidates the benefit of the doubt. Maybe, just maybe several important and highly anticipated topics were not simply forgotten or purposefully overlooked by the candidates, but were rather innocent victims of the last, lost Pod. Had the last Pod not become a casualty of debate, we might have heard about the following:

The Supreme Court Decision on the Affordable Care Act. Given the numerous amicus briefs, intense public emotions and extensive media coverage surrounding the President’s signature bill, it was shocking that neither President Obama nor Romney touched on the case. With the next four years offering an enormous opportunity to dramatically alter the landscape of the Court, and the highly partisan spin taking place during the debate, it was surprising that we didn’t hear either candidate discuss the case. Obama could have pointed to the ruling to give more credibility to health reform, while Romney could have capitalized on the close 5-4 decision arguably rewritten by Chief Justice Roberts to make the claim that ObamaCare— particularly the unpopular individual mandate—isn’t the best way to implement reform. We could have heard that, but we didn’t.

Then there was the diabolical 47 percent. Seriously. This was a softball lobbed right down the middle for President Obama. It hung there in the air in front of him for a full 90 minutes, untouched, while he took swings at several other topics and missed. Obviously, this gaffe isn’t one that Romney would be expected to draw attention to himself, but why on earth didn’t Obama go after the low-hanging fruit? Was he worried that he’d come off as too attacking? Perhaps. But the President never brought it up, and he should have. You can bet that Romney was ready with a prepared response on the topic. Too bad we never got to see him use it.

Reproductive rights. This past year has seen monumental coverage of reproductive rights as the Affordable Care Act and state legislatures have gone head-to-head over funding. Planned Parenthood and Susan G. Komen Foundation have clashed over support, Plan B became a battleground for HHS and the FDA, and politicians have made one gaffe after another (think “putting an aspirin between your knees for birth control” and “legitimate rape” for starters). Yet, once again, President Obama didn’t bring up a topic where he enjoys a lot of popular support for his position on the issues. Romney and the GOP have been behind most of the chaos and it would have been very easy for Obama to associate Romney with Todd Akin and the lack of women’s rights many women associate with the GOP. This was certainly a missed opportunity for Obama as women will undoubtedly be the deciders of this election.

A humanizing glimpse of Mitt Romney. It’s well known that Romney’s wife, Ann, has Multiple Sclerosis.It’s also been pointed out repeatedly that the Romney campaign has shied away from discussing the disease and its impact on their family. However, in last night’s debate, Governor Romney spent a lot of time and effort to come across as compassionate and in touch with the average American. In fact, he essentially led off his comments talking about health care and the economy, telling personal narratives about the impact of our broken system and the Great Recession on Americans. He focused on others, but he never focused on himself. Although I’m sure many would advise him to stay away from any topics that associate him with money, disease and his personal experience would have endeared him to so many. In a recent interview Ann said her husband’s response to the disease had been, “He said to me, ‘I don’t care how sick you are. I don’t care if you’re in a wheelchair. I don’t care if I never eat another dinner in my life. I can eat cereal and toast and be just fine. As long as we’re together, everything will be OK.’” That paints the picture of a man who actually cares about others, which is an image Romney desperately needs to convey to undecided voters. Perhaps he was just waiting to be accused of his comments about the 47% before unleashing this most personal secret weapon. Alas, America, we lost a pod, and the world may never know.