Health Care

In Shocking Development, Health Insurance Companies Still Suck

The Affordable Care Act was designed to solve the big problem of health security—namely that nobody in America had it—and find a way to get coverage for the 50 million Americans who were uninsured. It also attempted to address lots of other problems, and this week it's a good time to remind ourselves that many of its provisions came about because, to put it bluntly, health-insurance companies are despicable scum who will literally kill people (more on this below) if it makes them more money. I bring this up because now, people in the news media are learning about a scam insurance companies are trying to pull on some of their customers, and are not only not portraying it as such, but are simply taking the insurance companies' word and blaming the whole thing on the Obama administration. I realize that part about "despicable scum" is a little intemperate, and without question there are employees of the insurers who are good people. But as a whole, outside of the tobacco companies or gun...

Things that Are Still True about Health Care

It isn't quite as bad as this, but there are still problems. (Flickr/Doug Kline)
It's been a pretty intense month on the health-care front, what with the beginning of open enrollment for the new exchanges giving rise to lots of disingenuous fulminating from Republicans, not to mention a whole lot of crappy journalism. Any time a story dominates the news for a couple of weeks, there's a temptation to believe that what's happening now will change everything. So I thought it might be a good idea to take a step back and remind ourselves about some things that are still true about the Affordable Care Act and still true about health care in America. Over the long term, the problems with Healthcare.gov won't have much of an effect on the success or failure of the law. Yes, it has been a huge screw-up, with both the administration and the contractors sharing responsibility. Yes, it has caused a lot of people trying to sign up for new insurance a lot of hassle. But it's the thing everybody's focused on now in part because it's the only thing happening with the law, until...

Oklahoma's Abortion Battle Goes National

AP Images/Peter Morrison
(AP Photo/J. David Ake) O n Tuesday, the Oklahoma Supreme Court handed down a ruling that will help determine how the U.S. Supreme Court handles its next big abortion case. But Cline v. Oklahoma Coalition for Reproductive Justice hasn’t been scheduled for oral arguments just yet. The law in question, which deals with abortion-inducing drugs, was messily written, leaving room for considerable doubt about whether the state of Oklahoma intended to require doctors to follow a particular set of dosage requirements (the state attorney’s argument)—or ban the use of the drugs for abortion entirely (the Oklahoma Coalition for Reproductive Justice’s argument). When it accepted the case, the U.S. Supreme Court sent it back to the Oklahoma court for clarification about the law’s original aim. After several months of deliberation, the Oklahoma justices decided that the law effectively bans all medication-induced abortions by prohibiting the use of one crucial drug. Now, the U.S. Supreme Court will...

Time to Investigate Those Insurance Company Letters

As a follow-up to this post , I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market. People all over the country are getting these letters, which say "We're cancelling your current policy because of the new health-care law. Here's another policy you can get for much more money." Reporters are doing stories about these people and their terrifying letters without bothering to check what other insurance options are available to them. There's something fishy going on here, not just from the reporters, but from the insurance companies. It's time somebody did a detailed investigation of these letters to find out just what they're telling their customers. Because they could have told them, "As a result of the new health-care law, your plan, StrawberryCare, has now been changed to include more benefits. The premium is going up, just as your premium has gone up every year since forever...

Another Phony Obamacare Victim Story

NBC News' Obamacare victim, who it turns out is not actually a victim.
In the last couple of decades, a particular technique of news-story construction has become so common that I'm sure you barely notice it as something distinctive. It's the use of a device sometimes referred to as the "exemplar," in which a policy issue is explained through the profile of one individual, whose tale usually begins and ends the story. It's ubiquitous on television news, but print reporters do it all the time as well. As the Affordable Care Act approaches full implementation, we're seeing a lot of exemplar stories, and I've been noticing one particular type: the story of the person who seems to be getting screwed. If it were true that most Americans were indeed being made worse off by the law, that would be a good thing; we'd learn their stories and get a sense of the human cost of the law. The trouble is that in the real world, there are many more people being helped by the law than hurt by it, and even those who claim to be hurt by it aren't being hurt at all. To see...

The Biggest Design Flaw in Healthcare.gov

The pathway to disaster.
In my column today , I argue that the Healthcare.gov disaster has its roots in the government-contracting system, where big projects that go past deadline and over budget is standard operating procedure. There is one particular design flaw, however, that I didn't get a chance to discuss there but is worth noting. My guess is that it wasn't given all that much thought, or at the very least, somebody had what sounded like a good reason at the time to do it the way they did. But the result was that the administration needlessly multiplied the headaches it would have with the rollout and made everyone's experience significantly worse, and it didn't have to be that way. Before I tell you what it is (the suspense is killing you, I know), let's stipulate that Healthcare.gov did indeed present an extremely complex challenge, much more so than just creating an ordinary website. That's because it isn't a closed loop, but rather needs to communicate in real time with a bunch of outside systems,...

Healthcare.gov 2: The Contractors' Search for More Money

AP Photo/John Amis, File
AP Photo/HHS E veryone agrees that the rollout of Healthcare.gov has been something between a fiasco and a disaster. One of the mysteries is how a famously tech-savvy administration, headed by a president whose campaigns broke new ground in using digital technology to accomplish their goals, could have presided over this kind of screw-up. The answer is nearly as complicated as the website itself, but as the administration has said, the problems are not insurmountable and the site will be fixed (hopefully sooner rather than later). The next important question is what we can learn from this episode. There are vital lessons to be absorbed about how our government functions—not the Obama administration in particular per se. Instead, we got a good peek at what happens when private companies adept at squeezing billions from the taxpayers are hired to build something big. There's plenty of blame to spread around, from the White House to the Department of Health and Human Services to the...

Mission Affordabled: Why Obama’s Website Problems Aren’t “His Iraq”

AP Photo/J. Scott Applewhite
AP Photo/Jacquelyn Martin, File Y es, the Affordable Care Act website rollout has been a fiasco. And, as always happens when political catastrophe strikes, the wave of bad analogies has rushed in its wake. One in particular is gaining ground: Healthcare.gov is for Barack Obama’s presidency what the invasion of Iraq was to George W. Bush’s administration, complete with outraged liberal reactions to it . Here’s the funny thing: it’s a bad analogy, which could turn out to be accurate … but probably won’t. To start with, the fact that people died in Iraq, as opposed to the inconvenience involved in a malfunctioning website, doesn’t make it a bad analogy. The analogy has to do with presidential decisions; it’s about process, not outcomes, and there’s nothing at all wrong with that. No, what makes it a bad analogy is that Iraq War was misconceived from the start, and the actual events of the war, to a large extent, made obvious what some saw from the beginning. With the exchanges, on the...

Terrible Republican Idea Exposed as Even More Terrible

Flickr/adwriter
Yesterday, the Congressional Budget Office came out with a report assessing the budgetary impact of something many conservatives have supported, raising the Medicare eligibility age from 65 to 67. What they found was that the change would save far less money than had previously been assumed: only $19 billion over the next decade. The main reason is that many of the people no longer eligible for Medicare would be eligible for either Medicaid or insurance subsidies through the health exchanges, so the net effect on the federal budget would be small. But more important than that, this is an opportunity to remind ourselves that when government is doing something worthwhile, doing less of it isn't a good idea even if it saved a lot of money. And if cutting back only saves a modest amount of money, it's a really bad idea. You know what else would save a lot of money? Eliminating the United States Navy. But I'm guessing that most conservatives think having a navy is a good thing. Medicare is...

Kasich Goes Rogue on Medicaid

AP Images/Tony Dejak
AP Images/Tony Dejak W hen news broke Monday that Ohio would be the 25 th state to expand Medicaid, there were plenty of cheers on the left. After months of negotiations with lawmakers that repeatedly broke down, Republican Governor John Kasich, who has made the expansion a centerpiece of his agenda, decided to take a new tack. With the legislature out of session, Kasich, through his Medicaid director, requested a waiver from the federal government to expand the existing Medicaid program without the assembly’s approval. It was an unusual move. He got permission to spend the money from a small body, called the Controlling Board, composed of three lawmakers from the House and Senate, respectively, as well as a governor appointee. The board normally moves money between programs to adjust for shifts in spending throughout the year. This time, it approved $2.5 billion in federal funds to open up health care for nearly 300,000 Ohioans. Kasich has been one of the leading Republican voices...

No, Healthcare.gov's Problems Will Not Offer the GOP Political Deliverance

Some of the healthcare.gov contractors testifying today.
Today marks the beginning of what will surely be a series of hearings in Congress at which members will fulminate and shake their fists at various people who had responsibility for creating Healthcare.gov. It's quite something to see some congressman who's still struggling to figure out how to work the Blackberry his staff gave him asking questions about beta testing and error logs and a bunch of other stuff he doesn't begin to understand. But maybe the weirdest thing is the feeling one gets from the GOP over the last few days, which can be summarized as, "We got 'em now!" They seem to believe that the website problems are going to provide the deliverance they've been waiting for after the political disaster of the government shutdown. Here's a little prediction: Feigned Republican outrage over the ACA web site is going to be just as effective in reversing the GOP's current fortunes as feigned Republican outrage over Benghazi was in undoing Barack Obama's re-election bid. Nevertheless...

The Key to the Broffordable Care Act's Success

Flickr/CNDOZ
W hen Barack Obama made the decision to design a universal health care program based on the private insurance market, he faced one key problem. If you require insurance companies to accept anyone regardless of pre-existing conditions—as everyone wanted—you face the threat of "adverse selection," in which only those who are sick (and therefore expensive) get insurance. Just as the system of car insurance needs those who go long periods without having an accident to pay premiums so there's enough money to fix the cars of those who do have accidents, the health-insurance system needs the currently healthy to keep paying to support the currently sick. The answer was the individual mandate, which pulls people into the system and expands the risk pool. And especially critical to expanding that risk pool is getting as many young, healthy people as possible to get insured. So it may have been inevitable that young people would become targets for both the law's advocates and its opponents. A...

Popping the Pill's Bubble

AP Images/THE JONES INSTITUTE
A s the Affordable Care Act creaks into gear—and the Obama administration sends its armies of tech elves into the back end of the Healthcare.gov website to deal with the glitches—newly insured women can, for the first time, begin to start thinking about what kind of birth control they want , rather than what they can afford. Under Obamacare, all forms of female contraception will be offered without a co-pay to insured women as part of a larger package of preventive-care services. The logic behind the “contraception mandate” is so simple it’s hard to believe insurers didn’t come up with it themselves. If women can choose a form of birth control that works for them, without worrying about the cost, they’ll be less likely to get pregnant, saving insurance companies thousands of dollars in sonograms and prenatal vitamins. Obamacare has the potential to end the birth control pill’s dominance over the contraceptive market. More than 8 in 10 women will use a contraceptive pill at least once...

Before Long, We'll Forget about the Problems with Healthcare.gov

I'll confess that I was pretty surprised about the difficulties Healthcare.gov has been having. After all, despite all the complexities of creating this system, it wasn't exactly hard to foresee that the workability of the exchange website would be a very big deal. So you'd think that once a day or so for the last six months, the President would be calling the Secretary of Health and Human Services and saying, "This is going to go smooth as silk, right? Don't let me down, Kathleen." And she'd light a fire under everybody reporting to her to make damn well sure it did, so they wouldn't have to scramble like mad to fix a hundred problems once it had already launched. While the different things the site has to do certainly present technical challenges, they're hardly insurmountable. Now, you might just put it down to the fact that the whole thing was outsourced to private corporations, and we all know you can't trust the private sector to do anything without screwing it up (ha!). But...

Blurred Lines at the Border

AP Images/Matt Rourke
AP Images/Matt Rourke L ast year, during the height of the “religious freedom” fracas over the Affordable Care Act’s (ACA) contraception-coverage requirement, three Catholic laywomen made the church’s case to an audience at the Catholic Information Center (CIC) in downtown Washington, D.C. Housed in an unassuming bookstore on K Street and operated by the controversial Opus Dei order , the CIC claims to cater to the spiritual needs of Washington’s political elites with daily mass as well as lectures and panels featuring prominent conservative pundits and activists. The “Women for Freedom” panel aimed to teach lay Catholics to “convince rather than antagonize” the public about the church’s stances on divisive issues, and, in the words of one panelist, “share and show love.” “Our goal,” said Kim Daniels, then the head of the organization Catholic Voices and now the spokesperson for the president of the United States Conference of Catholic Bishops (USCCB), “is to make the church’s case in...

Pages