Sunday, January 26, 2014

Obamacare Enrollment Misinformation

Obamacare Enrollment Misinformation

by Stephen Lendman

Mark Twain popularized what Disraeli allegedly said: "There are three kinds of lies: lies, damn lies and statistics."

A good rule of thumb suggests disbelieving official government reports. Misinformation infests them. It's hard separating facts from fiction. It's best to disregard them altogether.

Agendas alone matter. Reality is twisted to fit policy. It's standard practice. In December, a White House PR campaign went all-out to sell Obamacare.

Multi-millions of taxpayer dollars were spent. Lies substituted for truth. Facts don't matter. Government claims are duplicitous.

On January 10, Obama twittered: "Six million Americans have gotten coverage thanks to health reform. Have you?"

Official government figures say around four million. Hard evidence suggests many fewer. Data is so incomplete and inaccurate it's hard knowing anything for sure. 

A January 16 Washington Post report explained," saying:

"The 6 million figure comes from combining a figure of 2.1 million for people selecting a plan via state and federal exchanges, through December, and 3.9 million for Medicaid, through November." 

"Thus the claim that '6 million Americans have already signed up for coverage thanks to health reform.' "

It's deceptive. It says nothing about how the Affordable Care Act (ACA) affects Medicaid enrollment.

ACA expanded it to individuals with incomes up to 138% of the federal $15,850 poverty level. The Supreme Court let states decide whether or not to participate.

So far 25 plus the District of Columbia chose to do so. Four others are considering it.

ACA initially pays 100% of the cost. Later it drops to 90%. The current formula splits costs around evenly between states and Washington.

In 2014, the Congressional Budget Office (CBO) estimates about a nine million Medicaid enrollment increase.

Washington claims 3.9 million enrollees are people on Medicaid because of ACA provisions. 

According to Assistant to the President and Deputy Senior Advisor for Communications and Strategy David Simas:

"When we break down the numbers a little bit more, this includes more than 2.1 million people who've enrolled in private plans through the federal and state-based marketplaces since October 1st and 3.9 million Americans who learned that they're eligible for coverage through Medicaid and the Children's Health Insurance Program, also known as CHIP, in October and November."

Administrator for the Centers for Medicare & Medicaid Services (CMS) Marilyn Tavenner claims ACA is working as intended.

"Nationwide enrollment for health care coverage surged in December," she said.

"Additionally, 3.9 million Americans learned they're eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP) in October and November." 

"These numbers include new eligibility determinations and some Medicaid and CHIP renewals."

According to WaPo, "(t)he word 'some' should be a tip-off. Here's what the number actually includes:

  • ''Medicaid and CHIP eligibility determinations made directly through state Medicaid and CHIP offices in every state.

  • Medicaid and CHIP eligibility determinations made directly through state-based marketplaces (where the state is running their own marketplace).

  • New eligibility determinations as well as renewals - i.e., people previously enrolled in Medicaid who are deemed eligible for another year."

Something is missing, added WaPo:

  • "Any of the Medicaid or CHIP eligibility determinations made through healthcare.gov. (Through November, that figure was nearly 270,000 (not) 750,000."

"Note: this column was briefly posted with the (wrong) figure for the December report but the numbers have now been corrected."

Theoretically the Medicaid eligible November and December universe combined 3.9 million and 270,000. 

CMS acknowledges some duplication. Maybe more than some. The actual number is unknown or unreported.

Reported numbers don't explain how many additional Medicaid enrollees ACA made possible. No one knows.

CMS claims accurate information will be available in April. It'll be when states bill Washington for their Q I refunds. According to WaPo:

"Determining how many people came out of the 'woodwork' - the previously eligible who suddenly focused on health care options and thus joined Medicaid - will take even more analysis."

It's false to claim ACA enrollees "are in any way equivalent to the 3.9 to 4.2 million" Medicaid eligible individuals.

December Medicaid enrollment numbers are due out. They'll be as deceptive as the 3.9 million figure. They're false unless proved otherwise.

On January 18, Forbes headlined "Coverage Expansion Fails: Less Than One-Third of Obamacare Exchange Enrollees Were Previously Uninsured," saying:

"(N)ew data suggests that Obamacare" fell short of its goal. "Instead of expanding coverage to those without it, Obamacare is" is mostly enrolling individuals with coverage.

"Surveys from insurers and other industry players indicate that" from 65 - 89% of enrollees were previously insured.

A McKinsey & Co. report says "only 11 percent of consumers who bought new coverage under the law were previously uninsured."

Over half of non-enrollees cited affordability. Another 30% indicated "technical challenges in buying the plans."

HealthMarkets is a Texas-based insurance holding company. It conducted its own survey. It found only 35% of enrollees were previously uninsured.

A Priority Health insurer survey found only one-fourth of enrollees without previous coverage.

Michigan health insurers expected about 400,000 sign-ups by yearend. They got less than 76,000. Most hadn't paid their first premium.

A Minnesota-based insurer doesn't know "if we're growing the number of people" seeking coverage. "We're just adding complexity," it believes. According to Forbes:

"If we assume that around one-third of exchange enrollees were previously uninsured, and that 90 percent of those who have 'selected a marketplace plan' will eventually enroll in coverage, the Obamacare exchanges have thus far only expanded coverage to 660,000 people, far less than the 7 million projected by the Congressional Budget Office."

A separate analysis contradicts administration enrollment claims. "Sean Trende of RealClearPolitics (estimates) that only 5 - 7.5% of (new) enrollees were due to Obamacare."

He examined new Medicaid enrollments in states expanding their rolls under Obamacare. He compared them to others that haven't.

Of about 1.7 million people in November "determined eligible for Medicaid and CHIP by state agencies" under Obamacare, 55% were in states not expanding Medicaid coverage.

In other words, most new enrollees were previously Medicaid eligible.

Trende learned people are enrolling and leaving Medicaid all the time. Aside from normal enrollment trends, "we have an actual estimate for Medicaid enrollment due directly to the ACA's expansion of Medicaid (by) 190,000," said Trende.

CBO projects about 14 million previously uninsured Americans will gain ACA coverage.

About 10 weeks remain in this year's enrollment period. "(W)e're looking at a coverage expansion of less than one million," said Forbes.

"(A)s many as 100 million previously insured Americans will (pay) higher premiums…under Obamacare." 

Many face stiff increases. ACA beneficiaries may be way outnumbered by millions more harmed. It remains to be seen how disappointed Americans react.

On January 9, the Augusta Chronicle headlined "Most uninsured Americans haven't tried to sign up for health care plan."

Nearly 70% haven't visited Healthcare.gov or state web sites to do it. Most cite affordability.

Over 80% don't know they face a March 31 deadline. Many don't know they need to sign up. They're unaware of penalties for not doing it.

On January 18, The Hill headlined "Document: ObamaCare contractor faces mid-March deadline or disaster." 

CGI Federal was hired to fix back-end Healthcare.gov problems. In mid-December, it wasn't found up to the task.

Accenture replaced it. Limited time remains to complete the task. According to a government document: 

"If this functionality is not complete by mid-March 2014, the government could make erroneous payments to providers and insurers."

At risk is "financial harm to the government." Healthcare providers could be jeopardized.

"Additionally, without a Financial Management platform that accounts for enrollments and associated program costs that integrates with the existing CMS Accounting platform, the entire healthcare reform program is jeopardized."

Failure to meet the mid-March deadline may cause "inaccurate issuance of payments to health plans which could seriously put them at financial risk; potentially leading to their default and disrupting continued services and coverage to consumers."

Back-end problems extend beyond federal subsidy payments. The entire program is vulnerable to "inaccurate forecasting" of risk mitigation programs in place.

One issue among many is compensating insurers enrolling higher than expected numbers of sick consumers with costly illnesses.

This and other problems "potentially (put) the entire health insurance industry at risk," said The Hill.

By mid-March, Accenture must complete building a financial management platform. It must be able to track eligibility and enrollment transactions.

It must account for insurer subsidy payments. It must "provide stable and predictable financial accounting and outlook for the entire program."

It must be integrated with existing CMS and IRS systems. It's an enormous task to complete accurately in a short time. 

It involves making sure 500 million lines of Healthcare.gov's code works. Imagine the complexity. Imagine the time constraints. Imagine possible failure.

Many unresolved problems remain. It's unclear how, when or if they'll be fixed. On January 20, Wall Street Journal editors headlined "The Young and the Obamacare-less," saying:

Evidence disputes ACA defenders. They claim huge numbers of enrollees. They way exaggerate reality.

"Lifting the veil of secrecy last week, the feds revealed that 2.2 million people nationwide had selected a plan through December."

"Traffic increased sevenfold over October and November." It's way short of expectations. It fails "by Obama's own standard."

"About one of six Americans under age 65 lack insurance in the official statistics. So where are they?" They haven't sought coverage. Why not?

Signing up young and healthy enrollees is crucial for ObamaCare's success. So far, "merely 24%...are between ages 18 and 34."

At least 40% is critical mass. Current enrollment "skews heavily to people 55 - 64 years old, at 33%."

"Insurance policies plunge into a 'death spiral' when premiums don't cover the cost of claims..." Rates surge to compensate. Current enrollees unable to afford them drop out.

Washington, Ohio, Texas, Indiana and four other states face this problem now. Humana expects ACA's risk pool to be "more adverse than previously expected."

"Expect managed-care (companies) to start making writedowns on their ObamaCare business," said Journal editors.

Will things improve or worsen ahead? Nearly four months of ACA experience suggest greater trouble than already.

Obamacare is unaffordable for millions. It makes underinsurance the new normal.

Sticker shock awaits millions. They're responsible for paying 40% of out-of-pocket costs. Doing so is on top of expensive premiums.

Millions will remain uninsured. Nothing controls spiraling costs. Obamacare has many disturbing surprises. 

Eventually consumers will know they've been scammed. Corporate profits are prioritized over healthcare. 

When it's most needed, it'll be unaffordable for millions. How they'll react remains to be seen.

America is the only developed nation without some form of universal coverage. Obamacare makes a dysfunctional system worse. 

It appears worse than already imagined. Before end of 2014, we'll know more.

Stephen Lendman lives in Chicago. He can be reached at lendmanstephen@sbcglobal.net. 

His new book is titled "Banker Occupation: Waging Financial War on Humanity."

http://www.claritypress.com/LendmanII.html

Visit his blog site at sjlendman.blogspot.com. 

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