ObamaCare's Black Box
Why the exchanges are worse than even the critics imagined.
Updated Oct. 17, 2013 8:59 p.m. ET
This isn't some coding error, or even the Health and Human Service Department's usual incompetence. The failures that have all but disabled ObamaCare are the result of deliberate political choices, which HHS and the White House are compounding with secrecy and stonewalling.
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The health industry and low-level Administration officials warned that the exchanges were badly off schedule and not stress-tested despite three years to prepare and more than a half-billion dollars in funding. HHS Secretary Kathleen Sebelius and her planners swore they'd be ready while impugning critics and even withholding documents from the HHS inspector general for a routine performance audit this summer.Yet the launch has been worse even than critics predicted. The rare users who weren't locked out experienced crashes, delays and error messages. Mrs. Sebelius initially claimed this was merely servers crashing under unexpectedly high demand. She called it "a great problem to have."
Health and Human Services Secretary Kathleen Sebelius
Associated Press
Then instead of rolling out the program in stages or delaying it as HHS has so many other parts of the law, the department simply dumped a bad product on the public to meet a self-created deadline.
Other failures have the same political character. Consumers must set up a complex account with sensitive personal information like Social Security numbers before they are allowed to browse health plans. The government wants to show consumers only their net out-of-pocket premiums minus subsidies, not the true underlying cost of insurance. That's because those all-in quotes are so much higher than what's available on the individual market.
HHS continues to claim that the exchanges are all about competition—they're even trying to rebrand them as "marketplaces." But real marketplaces are transparent and let consumers know what they get for what price. ObamaCare's exchanges are intended to obscure price and service options.
HHS still refuses to disclose how much taxpayers shelled out for this exchange lemon. The money came from several ObamaCare, general HHS and Medicare accounts and flowed to more than 50 outside vendors, with several no-bid contracts awarded outside the normal procurement process.
Mrs. Sebelius also refuses to reveal basic data about ObamaCare enrollment even as she brags about the millions of people who have supposedly visited Healthcare.gov. Information that would allow outsiders to evaluate the exchanges includes how many people have applied and qualified for coverage so far, what types of health plans they're selecting and what their health risks are.
Mrs. Sebelius claims she doesn't know the answers and that the government will pull such information together in November. Given the farce so far, it makes sense that the CEO of ObamaCare can't or isn't monitoring its day-to-day operations. But this claim is almost certainly false.
The states running their own exchanges report enrollment more regularly, which ranges from the low thousands in big states like California to a single person so far in Delaware. Literally, one. And the HHS-run exchanges are designed to make daily reports, seven days a week.
These reports are known in industry jargon as 834 transactions and they may represent the most serious ObamaCare breakdown. Insurers and the exchanges are supposed to swap electronic files every 24 hours that track the policies consumers select and their subsidies and check their lists against each other. The problem is that the exchanges rarely generate accurate 834s.
Our sources in the insurance industry explain that the 834s so far are often corrupted or in the wrong syntax, and therefore unusable unless processed by hand. In other cases the exchanges spit out multiple 834s enrolling and unenrolling the same user and don't come with time stamps that would allow the insurer to identify the most recent version.
The upshot is that the exchanges, the insurers and the consumers will often have different records on file. These mismatches are an architectural flaw that could persist for years. The administrative-bureaucratic tangle will only become more complex as more people enroll, providers start billing insurers, patients show up in doctors offices thinking they have coverage they don't, and the IRS starts fining Americans for not having insurance.
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Before the rollout, Mr. Obama and Mrs. Sebelius likened the exchanges to a new Apple product and asked for forbearance as problems were fixed. But Apple doesn't ship products that don't work and then force everyone to buy them, and a private business executive who supervised a fiasco like this would already have been fired.The crowd in charge of the country that includes Silicon Valley ought to be ashamed that they can't produce a serviceable website in 2013. A useful act of contrition would be to resign, or, failing that, to beg Congress for a year delay to clean up their wreckage.
I want to comment to your post on the wounded Ranger, but I fear you won’t see it since it is back from Monday. So I am commenting here at your latest post. I am very hopeful you will use what I did to help our soldiers.
ReplyDeleteYour courage doing this website astonishes me. You aren’t blogging about cupcakes, leaf identification, 1895 unused patents, or other safe things to blog about. You are directly challenging powerful people and interests who don’t want their current circumstances disrupted. And you do it in His name and from what I see, by His lead.
I did not read much here while rushing to find a way to contact you last night, but I did find your heartbreaking January 31, 2013 entry questioning why you devote so much effort to this website. Please know your work here, and your clear devotion to Him, gives me great hope you will help me. I have been turned away by so many who fear provoking those who want our soldiers to lose. I see no fear here from you, only devotion to His will. Please help me help them. I pray 24-7 (when awake) and know I will be shunned, hated, ignored, mocked, etc. for doing anything which advances His will. How I hope you will welcome my work for the soldiers, and if He leads you to do so, help me complete it. I cannot get heard.
So I will put my request at the October 14, 2013 Wounded Ranger “Salute Seen Around the World” post and hope you kindly, if He leads you to do so, direct me how I can send you what I hope you can get seen for the sake of our soldiers.
One of the other things I stumbled upon while still trying to find an email address to you, was your December 31, 2012 prayer. Thank you for calling Him Father. Thank you for using the name of Jesus and His blood repeatedly in your prayer. And thank you for praying that Satan be bound. I echo what you pray. I don’t see other people doing those things. Thank you for honoring Him with how you pray. And thank you for raising what angers Him. He must treasure your prayers to Him, if that is illustrative of how you honor Him when you do.
Anyway, I will post this using Live Journal which I joined less than two hours ago. I know there is a way to communicate there if you use it, but I have no idea how that is done. If you permit, I assume that is a simple way for me to put my work in your hands, if you kindly will consider it and if He leads you to do so.
After being battered and battered to give up serving Him, and in particular, to drop letting Him intervene for our soldiers if my task is His, your strong faith is so encouraging … that is why I am typing more than the mere few sentences I intended. It is an honor to write to one willing to serve Him courageously with the world able to watch.
I pray on posting this comment … if I serve Him, I need to add your Wounded Ranger post is how I found you. I searched for websites which wrote about the saluting Ranger. So far none of them have responded. Likely none will.
Now this is cleared to post. I will go work on my request which I will add as a comment to your October 14, 2013 Wounded Ranger “Salute Seen Around the World” post.
But first I must comment to whatever is the latest entry you have where I am installing this as a comment. I owe you that, or your readers will be displeased. So reading the post I am at, I offer these comments to it …