Photo Credit: Andrew Harrer/BloombergBy Megan McArdle.
There are two key signs that the administration of President Barack Obama is having trouble coping with the events of the last month.
The first is what it hasn’t done: attacked insurance companies. For the past four years, insurers have been a punching bag of the administration and the Democratic Party. Whenever insurers did something the administration didn’t like as a result of the new health-care law, Democrats punched back, hard, with complaints about greedy insurers who were blaming the White House for their own failures.
Not this time. Left-leaning columnists and policy wonks have been suggesting that the cancellation letters were part of an insurance company scam to enroll their customers in expensive policies, but the administration itself has been remarkably oblique. It needs the insurers, especially with the exchanges in so much trouble. Their cooperation is essential to avoiding another round of nasty premium shocks next year.
It reminds me of a late-Soviet joke: A man stands in line all day for bread, only to have the baker come out and say there is none. He loses it, and begins ranting about the government. Eventually, a man in a trench coat puts a hand on his shoulder.
“Be careful, comrade. You know, in the old days, it would have been …” and he mimes a gun pointed at the head.
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Beyond HealthCare.gov, Obamacare’s other challenges
By Jon Kingsdale.
Jon Kingsdale, who oversaw the Massachusetts health insurance exchange from 2006 to 2010, is a managing director of the Wakely Consulting Group. Wakely has provided actuarial and other technical assistance for the Obama administration’s Affordable Care Act.
“The Affordable Care Act is not just a Web site. It’s much more,” President Obama said last month. This focus beyond short-term technical problems is meant to bolster the faith of those, like me, who support the Affordable Care Act. However, it will succeed only if the administration does much more than fix the Web site.
As HealthCare.gov — the main door to insurance shopping for 13 million of the 17 million uninsured who are eligible for subsidies — gets patched up in the coming weeks, the government must also prepare the world’s largest insurance store to meet two equally daunting challenges.
The first is to get enrollment, billing and premium collections working smoothly. In 2006, when we launched the Massachusetts Health Connector, which became the prototype for insurance exchanges under the ACA, my team encountered start-up problems. Tracking billing and collections was a much bigger challenge than getting our Web site to work.
Here’s why: Enrollees are not covered until their first month’s premium is received. In the individual insurance market, premium billing and collection is difficult to track. Folks frequently pay late or in weekly installments, or send too little or even too much. And when they stop paying, they often do not notify the insurer; the company must determine whether it is an intentional termination, an oversight, or a lost or late payment. Unlike most of today’s 15 million direct enrollees, who pay premiums on their own, an estimated 27 percent of those who will be eligible for tax credits under the ACA do not have checking accounts. So they must use cash, money orders or prepaid debit cards to pay their share of monthly premiums.
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